NYC 9/11 Public Portal Document
PAGE OF
ASBESTOS INSP ION REPORT
PREMISE NQ STREET INSPECTION DATE
-t-o3
FLOOR ZIP BORO CODE BLOCK LOT SQUAD M BADGE M
INSPECTOR, BLDG TYPE BASIS OF INSPECT. PHOTOS TAKEN YES l@
t
SAMPLE NO. }u
CONTRACTORS NAME
ADDRESS CITY SAMPLE NO.
STATE ZIP PHONE SAMPLE NO.
LABORATORY NAME OWNERS NAME
ADDRESS CITY ADDRESS CITY
STATE ZIP PHONE STATE ZIP PHONE
TIME OF INSPECTION FROM: I2. oam m TO.y O am m
CONTACT PERSON: M 4 . I ç S Nc
Inspection disclosed that the following Requirements. Specifications,
and Procedures were complied with.
• D Section 8150- Notifications, Reports, Plans, and Fees
Lam' Section 8170- Air Sampling, monitoring, and Analysis
£7 Section 8180- Worker Protection
£7 Section 8190- Materials and Equipment
£7 Section 8211- Work Place Preparation
• Q Section 8212- Worker Decontamination Enclosure System
£7 Section 8213- Waste Decontamination Enclosure System
Q Section 8221- Engineering Controls Q Section 8222- Entry/Exit
• £7 Section 8223- Equipment, Waste Decontamination & Removal
£7 Section 8224- Maintainance of Decontamination System & Barriers
d Section 8231- ACM Disturbance, Handling & Removal
d Section 8232- Encapsulation Q Section 8233- Enclosure
JT7 Section 8234- Glovebag ,Q Section 8235- Tent
Q Section 8241- Preliminary Clean Up
£' _Section 8242- Final Clean Up
£7 Project ongoing, expected completion date ..,/.../....
Q Project completed on or about .../.../....All surfaces,including abated
• surfaces are free of visible ACM debris and Encapsulated
£7 Project not started All ACM intact. Expected start date.../.../. ..
£7 No Access. Premise £7 Locked, No response to bell or knocks £7 Abandoned
Inspection based on complaint,no ACM being disturbed or present.
/Q Variance Inspection -Approved/Disapproved. Section(s).........................
£7 Follow Up Necessary
Contact person at the site -Jt t' £
Additional Comments
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NOV M INFRACTIONS RESULT CODE
NOV !' - SUPERVISORS INITIALS
I I ( I I
BORO 1 MANHATTAN 2 = BRONX 3 = BROOKLYN 4 - QUEENS 5 =RICHMOND
BLDG TYPE A > 6 Stories 8 < 6 Stories C Single Family
D School E Hospital F Public Owned Properly
RESULT CODES 1 = Violation Issued 2 = No iolations Issued 3 = No Access
4 = Project not Started (No NOV) 5 = Protect Completed (No NOVI A 30190
NYC-WTC 000126914
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