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.,PAJ SOUTHERN ALLEGHANIES- VALLEYVIEW DR., PA.
27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings)
a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ 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)
❑ Ftdl Containment ❑ Giovebag ❑ Tent ❑ DEP Variance Application
30. LOCATIONS OF ABATEMENT
DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING
Floor(s) OF FLOOR CONTAINING ACM PERFORMED
(e.g. . east wing, room S. d~Pipe l
( ceiling, plenum ~~ NF (e.8. rurndng cebAe. instating &e sprint
______
boiler room. lobby. etc) s.
boilers
ROOF MAIN & SETBACKS ASPHALT ROOF 1,920 ITEM #1
ROOF FACADE 1,500 ITEM #7
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 beeEos Contractor Print Name of Appilca (If other Sian Owner)
Signab+re nature nature
i't l a7 LO Il— 6 - y L // — G — 6 z_.
Date Date
32. 1 understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance
the asbestos abatement activities In accordance with the Asbestos Control Program Rules. I have contracted the third party airof
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.
NAG EP
Print Name of Owner Signature Dim
A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.
I Any modification of Information provided on this form must be reported Immediately in writing directly to the NYC DEP ACP.
of the Asbestos Control Program Rules may not be lawfully avoided or lessened
2/2001
NYC-WTC 000128504
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