NY State Dept of Labor Asbestos Notification Form, Oct 2001

NYC 9/11 Public Portal Document

1). PROJECT DETAILS

, hroe1 reque_rted be~lo~r is Latin ' ía ~+p < rlh s n/ isIs>~was removal.

11. /1 all t Dini man Starting date Completion date

If amended: Starting date Completion date

Is this a phased project: Q No Q Yes d/ i's, Iii r s s pe, location, and surrting turd comp/rn'ni 'alas jnr inch 1ihirse in Sh'cnion F !'midi ks)

12. Do You Anticipate Doing: ❑ Night work Weekend work ~✓ Shift work (Provide details in Section T")

13. Dollar Amount of Contract Between Parties Named in Item 3 and Item 7 $

14. 11'work is being conducted under a variance, check appropriate box and supply variance number. [~ ,•applicable Variance 's o. ❑ Tndividual Variance Petition No. Asbestos Dissemination Prevention sIcthods use .tic,cn(1u F, Reniar'ks, and allieIi adililiuna s/reek i/ net s n —r)

a) 'Type of equipment & ventilation systems used

Equipment: Manufacturer: Model Number: Quantities: HEPA Vacuums N/A N/A 2 Portable Decon Unit N/A N/A 1 Respirators Various N/A 8 Negative Air Unit Various N/A 1

Airtek Environmental Corp. Asbestos Lic. No. 9 b) Name of air monitoring firm

c) Laboratory performing the analysis

Name Airtek / ATC Associates EIsAP Registration No. 11040 / 10879

1h, Type of Asbestos Work (checkall dial apple')

[ Pipe related [✓ Roofing lashing Caulkingmastic ® Clean-up Vessel covering ® Siding (0 VAT Sprayed-on insulation [l, Demolition - if site survey was previously submitted, provide Reference No. Other tijleilha WTC Dust and Tar

I7. 1`spc and \mount of Asbestos-C&iniaining Material Involved

Friable linear feet Friable square feet 42,378

Non-friable linear feet + Non-friable square feet 45

Total linear feet Total square feet = 42,423

NYC-WTC 000127814