Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

6426206039 ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler Tristate Transfer/ ATC NYS DEC Permit# 2A456/1A371 Tei# (718) 617-0771

Disposal Site(s) BFI Imperial Landfill-Imperial,PA; Meadowfill Landfill-Bridgeport,WV 27. This asbestos abatement is part of a (Item a through e requires filing of this form with the NYC Department of Buildings)

-)□ Demolition b) □ Boiler Replacement c)n Sprinkler Replacement d) Q Renovation/Alteration

e) □ Fireproofing Replacement f) 0 Other (Describe) ACM Removal

28. TYPE OF ABATEMENT (Check all appropriate boxes)

□ Removal □ Enclosure n Encapsulation □ Repair Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes)

0 Full Containment □ Glovebag □ Tent □ DEPVarfeince Application

30.LOCATIONS OF ABATEMENT SECTION OF FLOOR AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) CONTAINING ACM SQUARE LINEAR PERFORMED <e.g. entire, east wing, room #. (a.8. Pipe lagging, celling, plenum (e.g. ronnhrg cable, installing fire sprinklers, boiler room, lobby, eto.) rliicte, storage tents, declilng, etc.) FEET FEET remwlng ami replacing boilers, ate.)

A,7-18 N w/#24 elv.shaft Debris from WTC 155,250 Clean-up

5/6 MER Debris from WTC 250 Clean-up 4 Cafeteria Debris from WTC 240 Clean-up 3 NW Comer Debris from WTC 2,575 Clean-up

2 NW Comer Debris from WTC 4,600 Clean-up

1 NW Comer Debris from WTC 100 Clean-up B-bevel Vaults Debris from WTC 9,500 Clean-up #24 Elv Cab Debris from WTC 100 Clean-up

Additional pages attached □ 31.1 hereby declare that the information povided 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.

Ambient Group, Inc. Pal Environmen S^Rty Ambient Group, Inc. _ PrintXamo of Air Monitor of

Signature (nature Signature

3/13/03 3/13/03 3/13/03 Date Date

32.1 urtderstand 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 in the asbestos project. I hereby deebre that I have authprfeed the filing of this notification for the work specified herein.

Jones Lange LeSalle a/a/f Deutsch 3/13/03 Print Nams of Owner \ Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS 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 PEP ACP. | The requirements of the Asbestos Control Program Rules may not be lawfully avoided dr tessaned through the performance of work in incremental or piecemeal fashion.

NYC-WTC_000154678