NYC-WTC_000129388

NYC 9/11 Public Portal Document

CVA 1. Client 2. Project Name PROJECT MQNIIOFJ LPG 4. oject #: 5. Work Area(s): Part 1

3j P o Ayid~~,s: ~~ 4a. Task

C7 6. Contractor: 7. Contractor's Foreman: 8. ATC Representative: 9. Date: ______________

f?.-ic Type of Project: Full-Containment Tent-Containment Glovebagging Other

Size of Project: Large (> 160 sq. ft., 260 lin. ft. of ACM) Small (< 160 sq. ft.. 260 lin. ft.)

Phase of Abatement: Pre-abatement Sampling Prep Removal Cleaning Encapsulation Waste Load-out Finals

FULL-CONTAINMENT ABATEMENT

Work Area Location (floor, room, section):

Preparation of Work Area: Yes (Indicate prep work performed in 1 - 10) _ N/A (If already completed) 1. Construction of Decon: Yes No 2. Ceiling Poly: Yes No 3. Critical Barriers (CBs): _ Yes No 4. Wall Poly: Yes No 5. Removal to establish CBs Yes No 6. Floor Poly: Yes No 7. Negative air: Yes No 8. Pre-cleaning: Yes No 9. Prep work completed: Yes No 10. Temporary Power: Yes No 11. Other Yes No 12. Prep-Inspection Passes: Yes No (Explain why)

Removal: — Yes (Complete 1 - 5) N/A

• 1. Type of ACM: Pipe Insulation Boiler Insulation _ Duct Insulation Transite Boards Fireproofing Floor Tile Ceiling Tile Other:

2. Negative air pressure ≥ 0.02 in. of water: __ Yes -- No 3. Amended water used during removal: Yes No 4. Critical barriers intact for shift's duration: Yes No 5. Proper Decon procedures followed: Yes No

Cleaning: — Yes (Complete I - 6) N/A 1. 1st Stage 2nd Stage 3rd Stage 2. 12/12-hour waiting period after 1st cleaning: 3. Removal of 1st poly layer after 1st cleaning: Yes — No 4. 4/12-hour waiting period after 2nd cleaning: Yes No 5. Removal of 2nd poly layer after 2nd cleaning: Yes - No 6. 1/12-hour waiting period after 3rd cleaning: Yes No

TENT-CONTAINMENT ABATEMENT

Work Area Location (floor, room, section):

Preparation of Work Area: Yes (Indicate prep work performed in 1 - 6) _ N/A (If already completed)

1. Construction of Tent: Yes No 2. Pre-cleaning: Yes No 3. Construction of Decon: Yes No 4. Negative Air: Yes No N/A 5. Prep work completed: Yes No 6. Pref-inspection passes: Yes No

Removal: 1. Type of ACM: Pipe Insulation Duct Insulation Fireproofing Ceiling Tile Boiler Insulation Transite Boards Floor Tile Other: 2. Method or Removal: Gross removal within tent Glovebag removal within tent (check 3 through 8) (It Glovebag Removal Check 3 through 8) 3. Glovebags smoke-tested: Yes No 4. Glovebags attached to smooth surface: Yes No 5. Amended water used: Yes No 6. Removal included cleaning and encapsulation: Yes No 7. Open/damaged ends of insul. sealed: Yes No 8. Glovebags vacuumed, double-bagged: Yes No

Continued on Back Form NY-8 1/01

NYC-WTC 000129432