Permit application for work at 143 Fulton Street, undated

NYC 9/11 Public Portal Document

ASBES74MOSSPECTION REPORT (continued) 26. Asbestos Hauler I,ESt, NY NYS DEC Permit# 13.1-462 Tel.# C'Tl8)522-2263

Disposal Sites) B(.E Iz.Io6e I NDFI LL PO Box 399 ScoTSPAtE. PA t-f254

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) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) j~ ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application +-r ., /9/ /( 1 ~~ { 3n LOCATIONS OF ARATFMFNT 12ca~F` {ut P [ Eft iA . : DOOF MWM GaA.~t. Q- 'TAR) -------------- -- ---- ---------- DESCRIBE S4CTION 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, FEET - FEET removing and replacing boilers. etc.) boiler room, lobby, etc) ducts, storage tanks, decking, etc.)

ROOF FLAT ixne.t-tot3 RooF -*U9,FAC4 Z t BZ h loot (2 OP Pt ou "OF StNt ccee RxcF -YC Uutts 4 #Ar. AL-. 2-000

f7ooF SU tte-AD L0Aus 900 FA_oe >~~apE Sutra -cz5 2.430 P.00F :VW v Lt.A i1 S 500

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.

ix3Af2RE*t f YAAZWZ rurtuta u5 'B. Kvti.2.gku $ SCa Co" eeL Print Name of Air Monitor Print Na of Asbestos Co Print Name of Applicant (If other than Owner)

Signature Signature Signature

o QL ~~3olt~2 ate 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 'asbestosabatement 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. . . µterm owl lag _ MPrint 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. ACP1 vao01

NYC-WTC 000128043