114 FULTON STREET 1001209, 78/7501

NYC 9/11 Public Portal Document

ASBESTOS INSPEfTION REPORT (continued)

26. Asbestos Hauler _ % ESt i tJ Y NYS DEC Permit # NJ - 4 6 2 Tel.# (-t t $) 522-223 •.

Disposal Sde(s) 13LUE PA D61< LANDFILL PO BOX S99 5Co't•5OAt,+e. ?A 17254

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) 0 Boiler Replacement c) ❑ Sprinkler Replacement • d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ 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

30. LOCATIONS OF ABATEMENT T IP0 ?P- N .t.oZ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION O WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room At, (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 replacmg toilers. etc NOQrI.4 FACAV FACADE ( it -TON STQE-.T) 4410

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

WAWe-13 4 'AIJZ.~R Nfstnie>ctr5 BENIPMI ,. yue-ZBA13 i So►3 C,3 riot Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

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Signature i• • Signature Signature

~o• 26- t?z- Date Date Date

32. I 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 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. •~ ~Ep ©6~g~ ~02 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. ACe.... 212001

NYC-WTC 000128815