Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos ftauleAsbestos r NYS DEC Permit # 1 A— 3 71 TEL.# .~ 1-924— 5 n R n Disposai site(sgLmpperial POB 47. 11 PA, Southern Alleghenies, Boacrs Rr~ Valleyview Dr nge • 27. This asbestos abatement is part of a ~ W ~il3, Rte`2, Box 68, Bridgeport WVA (item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) 91 Other (Describe) SCOpe B Work WTC Indoor Dust Cleaing 28. TYPE OF ABATEMENT (Check ail appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate. boxes) ❑ Full Containment ❑ Olovebag El Tent 0 DEP Variance Application 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES Floor(s) OF FLOOR AMOUNT OF ACM DESC I ION OF WORK BEING (e.g. entire, east wing, room s<, CONTAINING ACM (e.g. tripe lagging. cewing. plenum SQUARE UNEAR PERFORMED boiler room, t , etc ducts, store tanks, dedcin ,etc (e.g. running cable, installing fire sprinklers, FEET FEET removi and re boilers. etc 2nd Apartment 2N indows 120 Scope B Cleaning

31. 1 hereby declare that the information provided herein is true and complete to the best of my knowledge. State and NYC laws and regulations applicable to I am familiar with Federal, asbestos related work.

ATC Associates I11c t Name of Air Trio Asbe$tos..,uembu tt jkfJt/// PdM — ca K er than Owner) '.7 1 ~I rr4Lt Signature Signature

/Izi/ 32. cc. the work specified have authorized the Emily Sorkin ,—„. Print Name of Owner 1 Zt a3 Signature D e A STAMPED COPY OF THIS FORM INCLUDING AMEND ENTS MUST BE AVAILABLE AT THE WORK SITE. Any modification of information provided on this form must be reported immediateli itjnq directly to the NYC DEP ACP. the Asbestos Control Program Rules may not h the performance of work in incremental or of or ACP7 2/2001

NYC-WTC 000129017