Asbestos Demolition Notification Form, Oct 2001

NYC 9/11 Public Portal Document

NOTIFICATION OF DEMOLITION AND RENOVATION (continued) X. DESCRIPTION OF PLANNED DEMOLITION OR RENOVATION WORK, AND METHOD(S) TO BE USED: All work to be done in accordance with the applicable New York State Industrial Code Rule 56, NYC-DEP Sub-Chapter G utilizing a site specific variance. XI. DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO PREVENT EMISSIONS OF ASBESTOS AT THE DEMOLITION AND RENOVATION SITE: A HEPA Vacuum shall be kept on site at all times. WASTE TRANSPORTER #1 DJM Address: 109-113 Jacobus Avenue City: Kearny State: NJ ZIP: 07032 Contact: Vito Pesce Telephone 201-997-8870 XIII. WASTE DISPOSAL SITE Meadowfill Landfill Corp. Address: RL 2 Box 68 Dawson Drive City: Bridgeport State: WVA ZIP: 26330 Contact: John McGarvey Telephone: 304-842-2784 XIII. WASTE DISPOSAL SITE Cumberland County Landfill Address: 620 Newvllle Road City: Newburgh State: PA ZIP: 17242 Contact: Telephone: XIII. WASTE DISPOSAL SITE Address: City: State: Contact: Telephone: XIV. IF DEMOLITION IS ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY BELOW Name: Title: Authority: Date if Order (MM/DD/YY): Date Ordered to Begin (MM/DD/YY) XV. FOR EMERGENCY RENOVATIONS Date and Hour of Emergency (MM/DD/YY): Description of the Sudden, Unexpected Event: Explanation of How the Event caused Unsafe Conditions or Serious Disruption of Industrial Operation: XVI. DESCRIPTION OF PROCEDURE TO FOLLOWED IN THE EVENT THAT UNEXPECTED ASBESTOS IS FOUND OR PREVIOUSLY NON-FRIABLE ASBESTOS BECOMES CRUMBLED. PULVERIZED. OR REDUCED TO POWDER: WORK WILL BE STOPPED IMMEDIATELY, NEW ENGINEERING CONTROL AND CLEAN-UP AS PER ICR-56 WILL BE IMPLEMENTED IMMEDIATELY, NEW ABATEMENT METHOD WILL BE EVALUATED TO ADDRESS NEW SITUATION PROPERLY. XVII. I CERTIFY THAT AN INDMDUAL TRAINED IN THE PROVISIONS OF THE REGULATION (40CR PART 81 SUBPART M) WILL BE ON-SITE DURING THE DEMOLITION OR RENOVATION AND EVIDENCE THAT THE REQUIRED TRAINING HAS BEEN ACCOMPLISHED BY THIS PERSON WILL BE AVAILABLE FOR INSPECTION DURING NORMAL BUSINESS HOURS. (Required 1 year after promulgation).

Signature of Owner /Operator Date XVIII. I CERTIFY THAT THE ABOVE MENTIONED INFORMATION IS CORRECT.

Signature of Owner /Operator Date ----------------------------

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NYC-WTC 000127823