Chemical analysis summary for 114 Liberty Street, 2003

NYC 9/11 Public Portal Document

a ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler Tri State Transfer Assoc. NYS DEC Permit # 1A-375 _ Tel.# (718) 617-0661 15126 Disposal Site(s) BFI Imperial Landfill, 11 Boggs Road, PO Box 47, Imperial, PA

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) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑✓ Other (Describe) ACM Removal Only `~~- ____

28. TYPE OF ABATEMENT (Check all appropriate boxes) El Removal 0 Enclosure 0 Encapsulation ❑ Repair 0 Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ Tent ❑ DEP Variance Application

an I OCATIONS 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, ceiling, plenum SQUARE LINEAR . (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) dtxts, sto a tanks, deridn eta) FEET FEET removing and replacing boilers, etc.)

3rd Apartment VAT 3,000 ACM Removal With Variance

4th Entire VAT 5,000 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 5,000 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 relapd work.

Ambient Group, Inc. ETS tract Inc. ETS ntracti nc. erne o r r a nfraoior Prin a an Owner) s zpo~ ign Yu Signature Signature

1/18/'03 9/18/03 ate Date 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 Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties in Ived in as stos r ject. I hereby declare that I have authorized the filing of this notification for the work specified herein. Liberty, LLC Mr. David E. Stanke )f'.._/t) 'S t' L ! i y!Oe~`of er Sign re D `T 1~ ( A WNzPED PY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

Any modification of Information provided on this form must be reported immediately in wilting 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. ACP7 28001

NYC-WTC 000154946