Permit Application for 114 Liberty Street, July 2003

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) Assoc_ NYS DEC Permit # 1 _ -------- Tel.# l 8} 617_0661 ---_- 26. Asbestos Hauler Tri State Transfer Boggs Road, PO Box 47, Imperial, PA 15126---------------------------- Disposal Site(s) BFI Imperial Landfill, 11 with NYC Department of Buildings) 27. This asbestos abatement is part of a (Item a through e requires filing of this form b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration a) 0 Demolition ACM em 1 _9±Y------- e) 0 Fireproofing Replacement f) 21 Other (Describe)

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

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

30. LUGA I IUN5 Ur AtIAI CMCM I DESCRIBE SECTION AFFECTED SURFACES I AMOUNT OF ACM DESCRIPTION OF WORK BEING CONTAINING ACM PERFORMED Floor(s) OF FLOOR SQUARE UNEAR (e.g. running cable, installing fire sprinklers, (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum FEET ducts, storage tanks, decking, etc) FEET removing and replacing boilers, etc.) boiler room, lobby, etc)

Bsmt Boiler Room Pipe Lagging 80 ACM Rem, Tent/Glovebag

Bsmt Oil Tank Room Ceiling Block 144 ACM Rem/Tent Containment

Bsmt Water Meter Room Pipe Lagging 16 ACM Rem, Tent/Glovebag

Bsmt Water Heater/Storage Pipe Lagging 6 ACM Rem, Tent/Glovebag

1st Pizza Restaurant Spray-On/Plaster 824 ACM Rem/Full Cont. w/variance

1st Miam Restaurant Pipe Lagging 64 ACM Rem/Tent Cont. w/variance

2nd Bathroom Pipe Lagging 10 ACM Rem, Tent/Glovebag

3rd Apt./Hallway Pipe Lagging 128 ACM Rem, Tent/Glovebag

9th West Hall Pipe Lagging 24 ACM Rem, Tent/Glovebag

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

Hillmann Environmental Co. Inc. AC rating, c. racting, rin am of Air r e of stos Contractor f! nat! th

Signature

7/29/03 7/29/03 7 z ,8 Date Date Date

for the performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible with the Asbestos Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance authorized the monitor who is completely independent of all parties involve 'n the asbestos project. I hereby declare that I have filing of this notification for the work specified herein. n Liberty, LLC GLj Z'~ vo 3 euidl 'SA ate Print Name of Owner Signature SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK DEP ACP. Any modification of information provided on this form must be reported immediately in writing directly to the NYC 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 srzoot

NYC-WTC 000155035