Asbestos project notification form, 100 Church Street

NYC 9/11 Public Portal Document

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' "a3BESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler ATC NYS DEC Permit # 1A-371 Tel.# (631 ) 9 2 4 5 0 5 0

DisposalSite(s) Southern Alleghenies Disposal Svc.—Road 3 Box 310 Valleyview Hollsopple, PA 15935 27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration Asbestos Containg Dust a) 0 Fireproofing Replacement I) El Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation ❑ Repair ® Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ® Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application / 4///1I

an r nr•_ATtnNs OF ARATFI&FNT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e_g. entire. eat room #. (e.g. Pipe lagging. cling. p +m (e•g• nav*q inatsang~ boler ro mom, etc ducts tanks, del* etc F0( FEET and twigs Nc ~1a}}sna, r 42,00 Cleaning of ACM 7th Entire o°n .S ' E' ~njai}ina, In r 12,00 Cleaning of ACM 8th ~~inerN 10th S.W. Corner Cleaning of ACM ~a}}ina'CFloonfs 3.000 11th S.W. Corner a}}sn a'Contents 2,000 Cleaning of ACM 12th S.W. Corner a in , _Floor 6,000 Cleanin of ACM

14th S.E. Corner a} sna`Contents 2,000 Cleanin of ACM 16th S.0 ntra Side Wa} . 'Con ts 1,000 Cleaning of ACM

20th S.W. & E. Side Fla}}sn_ Con~en>t 7,50 CleaningofACM Mezz. S.W. Corner Ce' in , Floor 4,000 Cleaning of ACM

31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with Federal. State and NYC laws and regulations applicable to asbestos related work. 192 Bran Interior 192 Br nch Interior /vt I FN(' q/1P ING s Print Nama or Air nit P ft Nsm of Aabest Contractor Pnnt ame ptit~n If other than

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performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the monitor who is filing of this notification for the work specified herein

Pnnt Name of Owner signature Oate J SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK

An modification of information rovided on this form must be re rted immediate) in writin direct) to the NYC DEP ACP. avoided or lessened The requirements of the Asbestos Control Program Rules may not be lawfully through the erformance of work in incremental or iecemeal fashion. ACPY 1Root

NYC-WTC 000126758