NYC 9/11 Public Portal Document
ASBESTOS INSPECTION REPORT (continued)
26. Asbestos Hauler ASBESTOS TRANS. CO. NYS DEC Permit # 1A-371 Tel.# (631) 924-5050
Disposal Site(s) IMPERIAL- P.O. 47, 11 BOGGS RD.,PA. / SOUTHERN ALLEGHANIES- VALLEYVIEW DR., PA.
27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings)
a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement .d) 0 Renovation/Alteration
e) ❑ Fireproofing Replacement t) ❑ Other (Describe)
28. TYPE OF ABATEMENT (Check all appropriate boxes)
❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up
29. ABATEMENT PROCEDURE (Check all appropriate boxes)
❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application
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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 LINEAR (e.g. running cable, Installing fire sprinklers,
boiler room, lobby, etc) ducts storage tanks, decking, etc) FEET FEET removing and repladno boilers etc)
ROOF MAIN ROOF ASPHALT ROOF,DUNNAG 2,320 ITEM #1
FACADE WINDOWS, LEDGES 5,900 ITEM #8
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.
WARREN & PANZER ENG., P.C. TRIO ASBESTOS REMOVAL STEVEN PARMIGIANI
Print Name of Air Monitor Print Name of Asbestos Contractor Print Name ofApplicant (If other than Owner)
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Signature Signature Signature
1d/L-S/ C7L- O ~.3 -O . to -D.2 --O2
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 bestos Co trot Program Rules. I have contracted the third party air
monitor who is completely independent of all parties invo a in at~~Tect. I hereby declare that I have authorized the
filing of his notification for the work specified herein. /1
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. Acv?
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NYC-WTC 000128400
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