Permit application cover sheet, 92 Fulton Street, Oct 2002

NYC 9/11 Public Portal Document

ASBE 6,U1SPECTION REPORT (continued)

26. Asbestos Hauler I S N4 NYS DEC Peimit # IBS -462 Tel.# CT(8) 522- 2263

Disposal Site(s) 5Lu pe Box 399 ScsstsyA Pa 1T2S4 t r 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) • • s• a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair 19 Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ! 6~O -~~ S-- '2- ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT ROOF M~TEtZtAt... ' P OF MEMB2AME DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing. room N. (e.g. Pipe tagging, ceiling, plenum SQUARE UNEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby. etc) ducts. storage tanks. decking, etc.) FEET FEET removing and replacing balers, etc.)

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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.

WAQ'aE-N 4 TAtr Z EOG { N EE12S 3. V-UELZ tA 4 Sots CC{.:TU A- Print Name of Air Monito Print Na f Asbestos Print Name of Applicant (If other than Owner)

nature Signature Signature

> —25'—CZ pe> _zS—c"L Date Date Date

32. 1 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 who is completely independent of all parties involved in the ashes os project. I hereby declare that I have authorized the filing of this notification for the work specified herein. wo-DEP 09 -2S -O2. Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. ACP7 212001

NYC-WTC 000127547