7/28/2019 2134 Market St

1/11

_____

2700.FMAQ0021 Rev. 11/2007

~ ' ! . ~ ~ ABATEMENT AND D E M O U n O N / R ~ ~ 6 \ i A ' f I ~ I : i N g i t ~ 1 ~ ~ f r O N FORM J ~ . b /For Official U S ~ onr, . Date Received 1.. u; " L ! : I Date Received') 13 A"tltST05 co lTOL Uf11TPostmark Date: (Jl Project 10#: ____- :-__ -;:-::;:--__ Permit#: _ _ _ _ - ' 9 ~ . . ; ; . . . ~ _ = _ Other #: ____ -:--_______ Inspector: __ .... ~ - ' L ' - - ___':....o/......,'RNOTICE: This is not a valid asbestos abatement notification for the purposes of he Asbestos Occupations Accreditation and Certification Act unlessindividuals and contractors have met the certification requirements as set forth In the Asbestos Occupations Accreditation and Certification Act. Act of1990. PL 805. No. 194 (63 P.S. Sections 2101-2112).REFER TO THE ATTACHED INSTRUCTIONS FOR INFORMATION AND REQUIREMENTS.I1. TYPE OF NOTIFICATION (check one): ~ I n i t i a l o Annual Notification

.Revision (high light here, and changes) o Phase of Annual Notificationo Postponement o CancellationDate of Initial Notification or, if previously revised, date of last revision:2. PROJECT LOCATION (check one):o Allegheny County o City of Philadelphia o Other Location in PA (specify county):3. For Allegheny County and City of Philadelphia projects only:

A. Does this project require a permit? 0 Yes 0 No (If Yes is checked, a permit application must be submitted along with thnotification and approved prior to the start of the project.)B. For City of Philadelphia projects requiring a permit:

Asbestos project inspector: Certification #: Company name: Address: City: State: Zip: Phone:

4. WILL ALTERNATIVE METHODS TO ANY OF THE APPLICABLE REGULATIONS BE USED? DYes ONo(If Yes Is checked, approval must be obtained prior to the start of the project. Please contact the appropriate DEP regionoffice or local government agency (see reverse of Instruction Sheet for contact list).5. TYPE OF OPERATION (check one): o Abatement prior to Demolition

cg] Demolition o Ordered Demolition o Renovation o Emergency Renovation6. FACILITY DESCRIPTION: Job No.: 139-13 (see instructions)

Facility Name: COMMERCIAL B!JILQING Street/Rural Address: 2134 MARKET ST City: P!:IILA State: EtL-... Zip Code: 191Q3 Present use: COLLAPSED B ! J I L D I N ~ Prior use: OCQUPIEQ COMMERCIAL Will the facility be occupied during the abatement activity? 0 Yes cg] No Facility size in square feet: 125 SF # of floors: 2 Age in years: +/-60YR

7. ABATEMENT CONTRACTOR:Company name:Allegheny County or City of Philadelphia License # (if applicable):Street/Rural/POB Address:City: State: Zip:

Contact: Telephone No. (between 8:00 & 4:30):

- 1

7/28/2019 2134 Market St

2/11

7/28/2019 2134 Market St

3/11

2700-FM-AQ0021 111200714. OPERATION SCHEDULE(S) (as applicable)

A. Asbestos abatement: Start Date: Completion Date:Daily hours of operation: OamOpm to OamOpmDays of week (check) OMo OTu OW e OTh OFr OSa OSu

B. Demolition: Start Date: 6/28/2013 Completion Date: 12/31/2013Daily hours of operation: 7:00 t8l am 0 pm to 4:00 o amt8l pmDays of week (check) t8l Mo t8l Tu t8lWe t8l Th t8l Fr OSa OSu

C. Renovation: Start Date: Completion Date:Daily hours of operation: OamOpm to OamOpmDays of week (check) OMo OT u OWe OTh OFr OSa OSu

COMMENTS: L & I HAS TOLD GEPPERT BROS. THIS COLLAPSED BUILDING IS PRIORITY AND TO START AS SOON AS POSSIBLE

15. DESCRIPTION OF PLANNED DEMOLITION OR RENOVATION WORK:COMPLETE DEMOLITION OF COLLAPSED COMMERCIAL BUILDING

16. DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO REMOVE ACM AND TO PREVENEMISSIONS OF ASBESTOS AT THE DEMOLITION. AND RENOVATION SITE:

17. WASTE TRANSPORTER(S)A. Transporter#1 name:

Street/Rural Address: City: State: Zip: Contact: Telephone:

B. Transporter #2 name:Street/Rural Address: City: State: Zip: Contact: Telephone:

-3

7/28/2019 2134 Market St

4/11

2700-FMAQ0021 11/200718. WASTE DISPOSAL SITE(S): (any asbestos containing material)

A. Landfill name: DEP permit #:StreeURurai Address:City: State: Zip:Contact: Telephone:

B. Landfill name: DEP permit #:StreeURural Address:City: State: Zip:Contact: Telephone:

19. AIR MONITORING FIRM(S)A. Company name/individual:

StreeURural Address:City: State: Zip:Contact: Telephone:

B. Final clearance firm: (if different than 19A)StreeURural Address:City: State: Zip:Contact: Telephone:Final clearance firm was hired by (check one) D Contractor DOwnerD Other Explain

20. AIR SAMPLE F/RM(S) (City of Philadelphia projects only)A. PCM company name/individual: Certification #:

StreeURural Address:City:Contact:

State:Telephone:

Zip:

B. TEM company name: Certification #:StreeURural Address:City: State: Zip:,Contact: Telephone:

21. FOR EMERGENCY RENOVATIONS:Date of emergency (mm/dd/yy): Hour of emergency: Dam DpmDescription of the sudden. unexpected event:

Explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden aa consequence of complying with the 10 working day notification requirement:

-4

7/28/2019 2134 Market St

5/11

2700.FMAQOO21 11/2007

22. FOR ORDERED DEMOLITIONS (attach copy of order):Government agency that ordered:Name of individual who ordered: Title:Date of order (mm/dd/yy): __________ _ Date ordered to begin (mm/dd/yy):

23. DESCRIPTION OF PROCEDURES TO BE FOLLOWED IN THE EVENT THAT UNEXPECTED ASBESTOS IS FOUND ORPREVIOUSLY NONFRIABLE ASBESTOS MATERIAL BECOMES CRUMBLED. PULVERIZED. OR REDUCED TO POWDER:Stop work immediately and contact the Owner.

24. PENNSYLVANIA CERTIFICATIONSILICENSES:Project designer: Certification #: ___ . , -__ _Contractor (Individual): Certification #: ______ _Supervisor: Certification #: ______ _Contractor (Firm) Certification #: ______ _

25.

26.

* * * * * SIGN BOTH STATEMENTS * * * * *I HEREBY CERTIFY THAT AN INDIVIDUAL TRAINED IN THE PROVISIONS OF 40 CFR PART 61 SUBPART M (if applicableWILL BE ONSITE DURING THE DEMOLITION OR RENOVATION AND EVIDENCE THAT THE REQUIRED TRAINING HASBEEN ACCOMPLISHED BY THIS PERSON WILL BE AVAILABLE FOR INSPECTION DURING ALL WORKING HOURS, ANDI CERTIFY THAT ALL WORK WILL BE DONE IN ACCORDANCE WITH ALL APPLICABLE FEDERAL, STATE AND LOCALAGENCY RULES AND REGlILATIONS.h/JL4- b / ~ 7 1 r 3(Original Signature of Owner/Operator) / (Date)Printed Name of Owner/Operator: .:..W""'IL""'L....A...M.....""G'-'A""-SS=-_______ Title: ADMINISTRATORI HEREBY CERTIFY THAT THE FOREGOING STATEMENTS AND THE INFORMATION CONTAINED IN THIS NOTIFICATIONFORM ARE TRUE. THIS CERTIFICATION IS MADE SUBJECT TO THE PENALTIES SET FORTH IN 18 PA C.S. 490RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES.

(Orig narSignature of Owner/Operator) '(Date)Printed Name of Owner/Operator: . : . . W ' - " I L " " L : ! L I A . . ! I . M ~ G " - ' A " " " S S________ Title: ADMINISTRATOR

-5

7/28/2019 2134 Market St

6/11

l>3te Rcceiv

7/28/2019 2134 Market St

7/11

.June 14,2113

COD't\JA'OORP. B . I , A D J L P m ~ P . A , . t m " . 1 f11ODW'MAID!T~ ~ .. .... '

DtllrsmORMADAM:Beaclvised't.at . . . .ttoPMladtlp& .coa.1$eedA.8OSA, e D e ~ . t o fUee_lhnull . .'. .. '.. . . ... f l ~ ~ ! t I I t . f l o l a i _ s . n d _ _ i t k m s , ~e J i s t . ~ ~ e . l t ( W ~ _ t l . ~ P ~ ~ ~ ~ . .p ~ m d p r e s e n t h u J l ~

to the hedhtafetymulwelfartot'tIle pabk ".... ThevWatWDsmust e ~ e e W. .mediatefy. . '.

OtISHaWet,.Jr.,DirettOI' N ~ m t . d ~ ~ .

http:///reader/full/B.I,ADJLPm~P.A,.tmhttp:///reader/full/Beaclvised't.athttp:///reader/full/fl~~!tIIt.%E7%A6%AColai_s.ndhttp:///reader/full/HaWet,.Jrhttp:///reader/full/B.I,ADJLPm~P.A,.tmhttp:///reader/full/Beaclvised't.athttp:///reader/full/fl~~!tIIt.%E7%A6%AColai_s.ndhttp:///reader/full/HaWet,.Jr

7/28/2019 2134 Market St

8/11

d J ~ h a s " i " s , ~ i t h $ $ U b l ~ ~ ~ r ; t J r f ~ ~ , t i f t h l n t t ~ e meaningOf' the

J m ~ U ' i " ~ f l 9 f i r o U S S t r u c t t J r e s ,Y O ~ ~ I ' $ _ e I : > y t t d ...ed,to IMMEDtA1iet d e m o t l $ h o r r $ p a i r ~ , H f d ' p r a m J s e s a J $ ~ s a r y t o

e o r r e c t t t m ~ t m s ~ J P W ~l f y a f 1 d t t ~ l t m ~ r t y M H IW l M ~ e b f l ~

1 n _ ~ 1 t ychatQ_:Sbelng

n l t f " O l 1 C E I $ f l N A L . O n c e , t h e d t y h l & b e g U f i ~ t k > " , ( t w l l ' b e " ~ s m y , t o s e e u r e l ~ a l~ ' f o r y b u ' t Q ~ t h a t ' ~ I 1 .

.t f , ~ l y o u m y ~f:!QOf', J*date of ttliSitmce.19,' t i 6 ~ s a t y , f h a t ' i a l f $ u b m i t ~ ..ooJlyof

P u b l I c S e ~ v f _ 1 1 t lFA 9 ~ 0 2 " Witlin5b e d i ~ t othesf'PSBt

~ S e e A " S O ( 2 )lfyou ~ V $ m ' l ' i q ~ i ( m s regardfhgthfsnotice.,YQI..I'maycall'!heCQntl'fJctqafServif)S UnUm ~ 1 o .~ 2 5 a a

e o t o r ~ C e M t H 00ntraettmlSelvfeesUnftVJOLAl'lONS:

I m p o m m l ~ f f i o n f i l l l l ' l f G r m j t b n ' f o r l m m i n l n ~ D a . r o u s eondrtioM:ftyoo fail to cornpiyWith

7/28/2019 2134 Market St

9/11

~ ~ . ~ .~ . f l t ~ M t a , ~ I J s h O l . f ~ ~ ' i . ~ & ~ ~ . 9 r . a t ' * y p $ r t O f U f Y O U . m ~ o b t a l n a f lr ~ ~ . l ) e r m t t s .. n , ! d v ~ _ ~ . ~ ~ . $ l J e H . w O t k .

l . ~ : B u I l M * n Q . t ~ J I d ~ . ~ ~ J ) f & . b t l s ..tal,low"and . . . .t ;"t ~ ~ .$ ~ NOr O M P l . I ~~ f t o o r J c e i J i f 1 i ~ ! f ~ . A h i n ~ ~ l ! n d ~ . ~ l ; > f i l o w ~ f t t \ a ~ j ~ G t ~ ~ o t i ; 1 r e b_Ii ~ n t ~ ~ ~ ( ) f

7/28/2019 2134 Market St

10/11

a ' ~ t 1 f t ~ < * ~ a f ~ S a r t ~ p u h { ~ A ..S01.2)i:thFfoOfl ....... ..... five:

m N . ~ n l h l s ' f l C l l . t o f i l !

7/28/2019 2134 Market St

11/11

l . f ~ ~ ' ~ I l ~ ' 8 a ~ ~ ~ b b t' . i O ' ~ I ' J J ' , d i ~ . " . $ , . . ~ ... q . " " . m ~ , Q j . e ~. . . . NOTCOMPU .

~ ' @ r ~ I ~ . a ~ $ l l b l Y ~ ~ n . f n e Q f ~ . s u b j ( ~ i t r u o t t ; l r t l $. r e h . s , ~ e f ~ . b e e f