114 FULTON STREET 1001209, 78/7501

NYC 9/11 Public Portal Document

• ASBESTOS INSPEcj1ON REPORT (continued) 462 28. Asbestos Hauler t t , tai NYS DEC Permit # fas Tel.# 'J '

tat szt pG E LAMV- t t.L D P ( `3" ___i t ? Disposal Sit9(s)

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement • d) ❑ Renovation/Alteration

e) 0 Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation 0 Repair Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent 0 DEP Variance Application g an I 1 Artnuc fl C ARATl=Lt MT - 7i .1. O /O / f .o DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION O WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE UNEAR (e.g. running cable, Installing fire sprinklers. (e.g. entire east wing room #. (e.g. Pipe lagging. ceiling, plenum FEET boiler room. lobby. etc) ducts, storage tanks. decking. etc.) FEET ' removing and replacing boilers. etc 2 F3 CACE l € z5 (tA PES 750

Fs+CAM So~xit 13c. E 3430

R-cx Rco> S 34 T9 ft 'p -r 333

1' ,i3t>t~c ~t EAD O0 u M~TA~ wotZ' too sE aAG Q~+oF RooF Sutza=ACLU T3S ~C UM ITS 4000

Federal, 31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I amjamiliar with State and NYC laws and regulations applicable to asbestos related work. A 6 IAT

Yd 9 ~~~- ' -' / rl3F k- rzaa,vso Print Name of Air Monitor Print a of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

. 19- w2 d al Date le Date

performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the the third party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted have authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I filing of this notification for the work specified herein. _. 11 ,4102 Date Print Name of Owner gnatun

AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE writingdirectly to the NYC DEP ACP. I_Any modification of information rovided on this form must bereported immediately in writing the Control Program Rules may not be lawfully avoiaea or AC) .. 2a001

NYC-WTC 000128813