Asbestos project notification form, 100 Church Street

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) ~(~~~ p 26. Asbestos Hauler ~0~~ NYS DEC Permit rO t Tel. /ego > "272 3& / ) Disposal Sites) O( e& ~'I •e 5 ( (7 ' !"- f (E 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) 0 Boiler Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement f) ❑ 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 0 Glovebag ❑ Tent ❑ DEP Variance Application

30 LOCATIONS OF ARATFu iT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g snGre. eau wing. room /, (s.g Pps 1a99irg, cs~a+p. pienvn SOUARE LNEAR (s.g nrrrnrng able. ulstanmg Ire apinklers, boner room lobby. .tc) t kxts. q tanks. d.d . etc.) FEET FEET and repiadnQ bodtsrs. tc) pp t~ 0 (.,O 5 a o3 ry -Q-4 i L CD X91 N ete,q 3fo e+te.. i c4s S IrJ~1~o

31. t 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.

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32. I Understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor.wtir is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the i tfbis notificati or the wort( specified herein. C O -3 a 7-- Pr.P4a I sign.an ate

STAt ED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE

The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throuqh the performance of work In incremental or plecemeal fashion. ^CPI 2= 1

NYC-WTC 000126768