Emergency asbestos abatement notification form, undated

NYC 9/11 Public Portal Document IIYt., ru PA3 84. INSPECTION REPORT (continued) 26. Asbestos Hauler A.T.C. Ino, NYS DEC Permit # - IA371 Tel.# 631) 8245050 Disposal Sites) Meadowfilt Landffill, Route #2 Box 68, Bridgeport, WV 26330 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) Cl Demolition b) ❑ Boiler Replacement C) 0 Sprinkler Replacement d) ❑ Renovation/Aiteratton e) ❑ Fireproofing Replacement f) El Other (Describe) ACM Abatement 28. TYPE OF ABATEMENT (Check alt appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair © Clean up 29. ABATEMENT PROCEDURE (Check *a# appropriate boxes) ❑ Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application 30. LOCATIONS OF AMATFMr-ld r DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM Floor(s) OF FLOOR DESCRIPTION OF WORK BEING CONTAINING ACM PERFORMED (e.g. entlre. east wing, room u, baler room. (e.g. Pipe leggug. Dewing. Plenum st Ianke dads' to SQUARE FEET (JNEAR FED (e g• running and root tin and bstibboNam ila n, etc.) . gtG Bacot. Elevator Shaft Walls And Windows 300 Clean up I Elevator Shaft Walls And Windows 35 Clean up 2 Elevator Walls And Windows 35 Clean up 3 Elevator Shaft Waits And Windows 35 Clean up 4 Elevator Shaft Walls And Windows 35 Clean up 5 Elevator Shaft Walls And Windows 35 Clean up 6 Elevator Shaft Walls And Windows 35 Clean up 7 Elevator Shaft Walls And Windows 35 Clean up Roof Entire Floor And Parapet 5,000 Clean up Bldg. Fit. Entire Sidewalk, Stairs And Windo 2,955 Clean..up

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

Donohoe Environmental, Inc. D.S.A. Services, Inc. Anthony Frassettr Print Na(he orNr Monitor Print N.1 tractor Print Na ether thin Owner)

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Dare -- I 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 Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all pares involved in the asbestos project. thereby declare that I have authorized the filing of this notification for the work specified herein. 150 Franklin Owners Corp. PrintName of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

(- Anv modification of information pmvjded on this forth must be reportedimmediately in writing directl 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 fashi0 AM 2/2001

NYC-WTC 000129022