Chemical analysis summary for 114 Liberty Street, 2003

NYC 9/11 Public Portal Document

* ASBESTOS INSPECTION REPORT (conttnued) 26. Asbestos Hauler Tri State Transfer Assoc. NYS DEC Permit # Tai # (718)617-0681

Disposal Site{s) BFI Imperial Landfill. 11 Boggs Road, PO Box 47, Imperial, PA 15126

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

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal Enclosure□ O Encapsulation Q Repair D Clean up

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, celling, plenum SQUARE LINEAR. (e.g. ninnlng cable, installing fire sprinklers, boiler room, lobby, etc) duds, storanetanks, decking, etc.) FEET FEET removing and replacing boilers, etc.)

3td Apartment VAT 3,000 ACM Removal With Variance

4th Entire VAT 5, 550 ACM Removal With Variance

5th Entire VAT 5,000 ACM Removal With Variance

6th Entire VAT 5,000 ACM Removal With Variance 7th Entire VAT 5, ACM Removal With Variance

8th Entire VAT 5,000 ACM Removal With Variance 9th Entire VAT 5,000 ACM Removal With Variance

10th Entire VAT 5,000 ACM Removal With Variance 11th Entire VAT 5,000 ACM Removal With Variance

31. I 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 relaj^ work.

Ambient Group, Inc. ETS itrai Inc. ETS ictii Inc. Prin] of, than Owner)

signature Signature

’18/03 9/18/03 Date Date

32. I understand that as the owner of a building where asbestos abatement acfivity 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 inysived in the a^stos project I hereby declare that I have authorized the filing of this notification for the work specified herein. Liberty, LLC Mr. David E. Stanke

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 DEP AGP. | 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. ACP7 20001

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