Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

asbestos INSPECTION REPORT (continued)

26, Asbestos Hauler Jimmy Byrne - JBT / lESI NYS DEC Permit # 1A-375/NJ-462 veL# (718) SIZ-OTffc . Disposal Site(s) Greenridge Redamation - Scottdale, PA/IESG - Biueridge, PA

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) n Demolition b) O Boiler Replacement c) n Sprinkler Replacement d) D Renovation/Alleration^ e) n Fireproofing Replacement f) 0 Other (Describe) ACM Removal

28. TYPE OF ABATEMENT (Check all appropriate boxes) 10347067 3 □Removal □ Enclosure n Encapsulation n Repair 0 Cleanup ■lilliilio DEPT. OF BLDGS. 29. ABATEMENT PROCEDURE (Check all appropriate boxes) □ Full Containment Q Glovebag □ Tent 0 DEP Variance Application

30, LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #. (e.g. Pipe lagging, coifing, plenum SQUARE LINEAR (a.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts, storage tanks, decking, etc.) FEET FEET removing and replacing boilers, etc.)

8-24 Entire - North Debris from WTC 102.000 Clean-Up

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

Ambient Group, Inc. PAL Environmental Safety Com. Ambient Group, Inc.^ I’tor Print Name of Asbestos Print Name of ^^iplicant (I /thw in Owner)

9 >S/gnalurB Signature Sign&tafe

A Date

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 activities in accordance with the Aslfestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties involvealn the asbesto^rojcjit. irojcjt. I here hereby declare that I have authorized the filing of this notification for the work specified herein. I Ij /I) Cushman & Wakefield a/a/f Deutsche Bank Print Name Of Owner * Signature \-

A STAMPEO COPY OF THIS.FORM INCLUDING AMENPMENTS MUST BE AVAIl^BLE AT THE WORK SITE.

I Any modification of information provided on this form must be reported immediately in writing directly to the NYC PEP AGP. 1 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. ACPZ 2/2001

MAY 28 2003 17=15 2129444618 PfiGE.03

NYC-WTC_000154676