Document header, 144 Chambers Street, 2002

NYC 9/11 Public Portal Document UCr c.t..D f cxX • L1L—, of - 14JJ Jun dti ltjtj

ASBESTOS INSPECTION REPORT (continued) 28. Asbestos Hauler C-© 0 NYS DEC Permit G TO Tel. .

Dtsposa sites) _ o 2 ( S iq'r f`( 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) ❑ RenovatiorlAiteration a) ❑ Fireprootmg Replacement t) 0 Other (Describe) 28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair ❑ clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM bECRlPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g antke. teat wing, ream 0, (e.g Fiat legging cea+g• p +m SQUARE LINEAR (e.g. ruMbfg cable installing fire sprinklers. twig ranks. deckl I5? ' FEET rem end reedna loo'

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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.

Pmt kor Name/As Contractor Print of Ap t (If other Ihan Owner)

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a~-sd3 -ate , ~c~ _ ate t 32. I understand that as the owner of a building where asbestos abatement activity occurs, lam responsible for the performance of the asbestos abatement aolivides In accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties Involved In the asbestos proJed. I hereby declare that I have authorized the fling this nopcation for the work specified herein.

PMt Named owner si4n++a+ro °

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. My modlfoa etiiYormtion provided onthiVorrn mut be reported Imrned4tely In wtlthg directlyto the NYC DEP ACP The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throuOh the earformance of work In incremental or piecemeal fashion. thp m At

NYC-WTC 000127279