Asbestos abatement permit application, 100 Church St, Jun 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler ATC NYSDECPermit# 1A-371 Te.# (631 )924-5050

Disposal Sites) Southern Alleghenies Disposal Svc. Road 3 Box 310 Vallevview 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) 0 Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration . Containg Dust e) ❑ Fireproofing Replacement f) El Other (Describe) Asbestos

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) II Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application / / V/00' 30 LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. ordre. ast'Mng. room 0. (e.g. Pip. lagging. cMlt0. PMnmt SQUARE ' L*IEAR (a.9. nswWtg be spawners. body room eke tr+ka deck etc FEET a odies, sic.) 5a}}sna, to r 42,00 Cleaning of ACM 7th Entire r 12,00 Cleaning of ACM 8th n rN•11• f} ' tits 10th S.W. Corner or Cleaning of ACM Wailsna'Con 0 11th S.W. Corner a sna'Con?en 2,000 Cleaning of ACM 12th S.W. Corner a in , Fl or 6,000 Cleaning of ACM 14th S.E. Corner a± sna'Con Bents 2,000 S C ntra Side QR j nj'CoA?8fits 1,000 Cleaning of ACM 16th Cleaning of ACM ii 20th S.W. & E. Side WaIIsna Con~o ent 7.506 Mezz. S.W. Corner Ce in , F1 or 4,000 Cleaning of ACM

Federal. 31. 1 hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with State and NYC laws and regulations applicable to asbestos related work. 192 Branc7t Interior 192 Branch Interior AMA v Gi 'P we _ Pnnl sme pø tf otter than Pnnt of Air P t Nam of Aabss Contractor 1 ~

!I dI Z1 t 2 Date Oat ate

for the performance of 32. 1 understand that as the owner of a building where asbestos abatement activity occurs, I am responsible the third party air with the Asbestos Control Program Rules. I have contracted the asbestos abatement activities in accordance have authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I of filing this notification for the worlcSspecified herein Mtv S t~v P ZA Print Name of Owner ~~IF J— 1~/t* Signature ,i' o i Date

AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE directly to the NYC OEP ACP.. Any modification of information provided on this form must be reported immediately in writing lawfully avoided or lessened The requirements of the Asbestos Control Program Rules may not be fashion. ACP7 through the performance of work in incremental or piecemeal vtoot

NYC-WTC 000126864