NYC 9/11 Public Portal Document
AS ESTOS INSPECTION REPORT (continued)
28. Asbestos Hauler DJM Company, NYS DEC PemYt# NJ344 Tel.# 973-344-6447
DisposalSite(s) Greenridge Reclamation Landfill
27. This asbestos abatement Is part of a (Item a through e requires filing of this form with NYC Department of Bulklings)
a) 0 Demolition b) ❑ Boiler Replacement c) 0
Sprinkler Replacement ,d) ❑ RenovattonAteration
e) El goofing Replacement (I D Other(Describe) WTC Attack Directive
28. TYPE OF ABATEMENT (Check all appropriate bootee)
❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Clean up
29. ABATEMENT PROCEDURE (Check all appropriate boxes)
❑ Full Containment ❑ Glo mbag ❑ Tent C]DEP Variance Application tI Other — WTC Directive
30_ LOCATIONS OF ABATEMENT ••~
DESCRIBE SECTION AFFECTED SURFACES AMOUNT' OF ACM DESCRIPTION OF WORK BEING
Poor(s) OF FLOOR CONTAINING ACM PERFORMED
(e.g entire, east wing, mom #, (e g Pipe tsgghig.ceiling, Plenum ~T RE LNEM (e9. cep. file > .
boiler etc tarots eta S
2 Dust CleanuD
1st Erttixe.. All
3rd Entire
31. 1 hereby declare that the information provided herein is true and complete to the best of my knowledge. I am farniliar with Federal.
State and NYC laws and regulations applicable to asbestos related work.
Hillmann Environmental AEi2, LLC AEi2, LLC
print Name of Air rt x*r print Name nt MbestceC raoi her then
Signature Signature
3 N4-
Signature
/2-d3-. e-7f
Oats
j 2 3 Gf flats
1L-/ 1i
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 Asbesjp,ControI m Rules. I have contracted the third party air
monitor who is completely independent of all parties involva ilIe asbest p ect. I hereby declare that 1 have auth91z0d the
filing of this notification for the work specified herein.
/
Essa Batch - 2- J /
Hint Name of Owner
A STAMPED COPY OF TWS FORM INCLUDING AM MENTS MUST BE AVAILABLE AT THE WORK SITE.
I Any modification of information provided on this form must berepqrted immediate!y in writing direct!y to the NYC DEP ACP.
The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened
through the performance of in incremental or piecemeal fashion. „
moos
NYC-WTC 000128595
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