Asbestos survey report form, Oct 2001

NYC 9/11 Public Portal Document

DEPARTMEf T OF CITYWIDE ADMINISTRATIVE SERVICES r. OFFICE OF THE GENERAL COUNSEL » MUNICIPAL BUILDING, 16th Floor NEW YORK, N.Y. 10007 (212) 669-8400 Fax: (212)669-8558

WK E-Mail: [email protected]

WILLIAM J. DIAMOND PHILIP DAMASHEK Commissioner General Counsel/ Deputy Commissioner For Legal Services

Joint Asbestos Survey Report

Agency;

Address;

Project #: _____________ Floors: 5’ s Reviewed by: Date: O

Renovation; Yes No AHERA: Yes No

Asbestos Found: Yes No O&M Recommended: Yes No

Material Type/ Approximate Sample #/ Location Amount/ Condition % Asbestos Recommended Action

Miscellaneous Material Material is in good condition at Floor tiles-/z" x /^' floor Not estimated/ 1.5-20% asbestos the present time. Implement an tiles, vari ous colors good condition Operations and Maintenance throughout 2"^ 3*^, 4“’ program designed to prevent and 5 floors. damage or disturbance to asbestos containing materials (ACM). Continue O&M program until all ACM is removed.

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