Document Cover Sheet, 94 Fulton Street, 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler is51 t4 y NYS DEC Permit # A51-462 Tel.# rots) 22-223

Disposal Sites) Bwt=RO Ge LAODFiu., Po Box 'x199 SINOMOAt E Pis i'f25.4

27. This asbestos abatement Is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) 0 Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF.WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire. east wing, room #. (e.g. Pipe lagging, ceiling. Plenum SQUARE UNEAR (e.g. running cable. Installing fire sprinklers, boiler room. lobby, etc) ducts, storage tanks. decking, etc.) FEI'_T ' FEET removing and replating boilers, etc.)

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31. 1 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.

WARe€u 4 ?AtliZ R E*3 71&.. w.+az4aw." 4 Soy► Cb ,L to Print Nama of Air Monitor Print Name of Contractor Print Name of Applicant (If otherthan Owner)

Signature Signature Signature

Fottt1o2 In~t-t IC>Z 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 asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein.

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. I The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throughtheperformanceof work In incremental or piecemealfashion. ACP7 uoo+

NYC-WTC 000127590