Asbestos project notification form, DEP, 2002

NYC 9/11 Public Portal Document ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler A.T.C. Inc. NYS DEC Permit# 1A-371 Tell (631) 9246050

Disposal Sites) Meadowfill Landfill, Route #2 Box 68, Bridgeport, WV 26330

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) ❑ RenovationAlteration e) ❑ Fireproofing Replacement t) ® Other (Describe) ACM Abatement

28. TYPE OF ABATEMENT (Check aft appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ® Tent ❑ DEP Variance Application 4n I W ATWAu4 rw ARATcucur

• DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. Pipe lagging, oaikng. plenum SQUA1 LINEAR ing cable. lns Iling 16e spd skiers. (e.g. running (e.g ankh, east wing, room S. duds oragotanks etc.) FEET FEET remlng mid repladTlg boilers etc) boiler roam etc

Bsmt. Elevator Shaft Wails 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 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. 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 knowledge. I am familiar with Federal, State and NYC laws and regulations applicable to asbestos related work.

Donohoe Environmental, Inc. D.S.A. Services, Inc. Anthony Frassettl Prtnt4 e Air lonitor Prrd 9 ontracfor Prird Na A n alfier t on owner)

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1//24 _____________ _____________ Date

32. 1understand 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 I e asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. 150 Franklin Owners Corp. Prod Name downer Dale

A STAMPED COPY OF THIS FORM INCLUDING AM ENTS MUST BE AVAILABLE AT THE WORK SITE.

I 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. ACK arloo+

NYC-WTC 000129035