Emergency asbestos abatement notification form, undated

NYC 9/11 Public Portal Document u'... ru PAta 04. ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler A.T.C. Inc. NYS DEC Permit # IA-371 Tet.# 1631) 9245050 Disposal Site(s) Meadowfilll Landfill, Route #2 Box 68, Bridgeport, WV 26330 ---Y

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement C) ❑ Sprinkler Replacement d) ❑ RenovatIon/Alterarion e) ❑ Fireproofing Replacement f) El Other (Describe) ACM Abatement 28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair © Clean up 29. ABATEMENT PROCEDURE (Check *al appropriate boxes) ❑ Full Containment 0 Glovebag 21 Tent ❑ DEP Variance Application 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM Floor(s) OF FLOOR DESCRIPTION OF WORK BEING CONTAINING ACM PERFORMED (e.g. entire, east wrap, rooms, (e g. Pipe liming, oeuu g. plenum SQUARE UNEAR bolter room, st bnks. dodo FEET FE_ (e g• funning ofdte.:Oth g b bra s, einkra" b;. teoawn and o,Vam eft Bsmt. Elevator Shaft Walls And Windows 300 Clean up 1 Elevator Shaft Walls And Windows 35 Clean up 2 Elevator Walls And Windows 35 Clean up 3 Elevator Shaft Walls 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. Fri. 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 familiiar with Federal,

Donohoe Environmental, Inc. D.S.A. Services, Inc. Anthony Frassettr Print Name of Air Monifor Pint Nn e9ClOr Print No ail thin Ownary

Signature .'.. .. ,g re

Dme ate

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 activlties In accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parses 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. Print Name d Owner Signalwa Date A STAMPED COPY OF THIS FORM iNCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

[- Any modification of inforrriaticn provjded on this foram must be reportedimmediately in writing directly to the NYC DEP ACE. 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, 2/2001

NYC-WTC 000129022