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Appendix F

The document is an application form for Asbestos Handler/Supervisor Certification from the New York City Department of Environmental Protection. It includes sections for project location, scope of work, building owner's information, number of workers supervised, project dates, and comments on the materials abated. The form requires the applicant's signature and notarization.

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Appendix F

The document is an application form for Asbestos Handler/Supervisor Certification from the New York City Department of Environmental Protection. It includes sections for project location, scope of work, building owner's information, number of workers supervised, project dates, and comments on the materials abated. The form requires the applicant's signature and notarization.

Uploaded by

xiomaraborrero989
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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New York City Department of Environmental Protection

Asbestos Control Program


59-17 Junction Boulevard, 8th Floor
Flushing, New York 11373
Application for Asbestos Handler/Supervisor Certification
Appendix F
Project Location Scope of Work Building Owner’s Number of Floors, Exact Dates Comments
(Full Address and Nature of Name and Workers Sq. ft. or Li. ft. of Project (List surfaces and types of
Supervised you were material abated e.g. boiler/TSI,
Locations) Responsibility Full Address deck/surfacing material,
responsible for Start/ Completion pipes/TSI, floor/VAT, etc.)

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Attach additional sheets, if necessary. Updated 12/2003
The foregoing is a statement of fact.

________________________________________________________
Applicant’s Signature Date

____________________________________________________
Signature and Seal of Notary Public or Commissioner of Deeds Expiration Date

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