Asbestos Project Notification Form

NYC 9/11 Public Portal Document

6426206039 ASBESTOS INSPECTION REPORT (continued) 1 26. Asbestos Hauler DJM Co. Inc. NYS DEC Permit # NJ-344 Tel.# (973) 4910006

• DisposalSite(s) Meadowfill Landfill, Bridgeport WV & Cumberland Landfill Shippberg, PA 27. This asbestos abatement Is part of a ( Item a through e requires filing of this form with the NYC Department of Buildings)

a) © Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration

e) ❑ Fireproofing Replacement f) 14 Other (Describe) Asbestos Abatement/WTC Dust Remediation

28. TYPE OF ABATEMENT (Check all appropriate boxes)

g] Removal ❑ Enclosure 0 Encapsulation ❑ Repair ❑ Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes)

❑✓ Full Containment 0 Glovebag 0 Tent m DEP Variance Application

30.LOCATIONS OF ABATEMENT SECTION OF FLOOR AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) 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.) FEET FEET removing and replacing boilers, etc.) Bsmt Entire WTC Dust 12,000 Sub-Chapter G

1 Entire WTC Dust 12,000 Sub-Chapter G

2 Entire WTC Dust 12,000 Sub-Chapter G

Roof Entire Flashing 35 Asbestos Abatement

Roof Bulkhead Tar 10 Asbestos Abatement

B-2, R Facade WTC Dust 6,378 WTC "Bldg Ext. Cleanup"

•

Additional pages attached ❑ 31. I hereby declare that the information povided 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.

Airtek Environmental Hazardous Elimination Airtek Environmental Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant

Signature Signature Signature

Date Date Date

32. I 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.

Greenwich Street Project, LLC. 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.

L I NYC-WTC 000127780