Asbestos project notification form, 100 Church Street

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler ATC NYSDECPenMt# 1A-371 Tel.# (631 )924-5050

Disposal Site(s) Southern Alleghenies Disposal Svc. Road 3 Box 310 Val levview 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 e) ❑ Fireproofing Replacement I) ® Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation 0 Repair ❑ Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ® Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application /L// b/ en I ne•ATW%I C nC £DAT ICtur DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.9. ondw coat % tg. room S. (L9.Pip. lagging. cain0. pistun (e.9 rtnnitq cable. itst ng fin spdnl tws, bolter room eta .k and spisdng boilers. s ) fei}in , to r 42,00 Cleaning of ACM 7th Entire a s N.E. ~a} }Sna, to r 12,00 Cleaning of ACM 8th ~S b n r 10th S.W. Corner il Cleaning of ACM WaIIsn~'Con on s 3.000 11th S.W. Corner WaIIsna'Con ent 2,000 Cleaning of ACM 12th S.W. Corner e' in , F1 or 6,000 Cleaning of ACM 14th S.E. Corner sna'Con~eni:s 2,000 a Cleaning of ACM 16th ± . ngrCEA28Fits 1,000 S C ntra Side Cleaning of ACM i1 20th S.W. & E. Side Con?oor, 7,50 Mezz. S.W. Corner Ce' in , F1 or 4,000 Cleaning of ACM

familiar with Federal. 31. t hereby declare that the information provided herein is true and complete to the best of my knowledge. I am State and NYC laws and regulations applicable to asbestos related work.

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

Signature Date hint Name of owner j WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE directly to the NYC DEP ACP. Any modification of information provided on this form must be reported immediately in writing or lessened requirements of the Asbestos Control Program Rules may not be lawfully avoided through the performance of work in incremental or piecemeal fashion. ~t

NYC-WTC 000126773