NYC 9/11 Public Portal Document
STATE OF NEW YORK - DEPARTMENT OF LABOR EMERGENCY NOTIFICATION REQUESTED
FA
DIVISION OF SAFETY AND HEALTH
ASBESTOS CONTROL BUREAU a. Date of Request b. Time of Da)
State Office Campus
Building 12- Room 454 c. Name of Person Granting Request
AMENDED NOTIFICATION Albany, N.Y. 12240
❑ Postponed O Cancelled
New Start Date WITHIN TWO WORKING DAYS OF THE
c New End Date EMERGENCY APPROVAL, you must submit
Submitted By ASBESTOS PROJECT NOTIFICATION duplicate copies of this form witn the
appropriate fee to the Asbestos Contro
eier to Information Sheet or Bureau at the address shown.
Rule 56 for Time Deadlines
NAME AND ADDRESS OF CONTRACTOR 2. FEDERAL__ EMPLOYER
_._._._._._._IDENTIFICATION
_ NO. 3. ASBESTOS LICENSE NO
_._._._._. . . . . .
DEGMOR, INC. P11 Pit
, (if different than listed in ITEM 1
51 1 Canal Street - 3rd Floor
Jew York, NY 10013 5. NAME AND ADDRESS OF PARTY FOR WHOM THE PROJECT IS BEING PERFORMED
LANDLEASE REAL ESTATE 1
787 7th Avenue - New York, NY 10019
a NAME AND TITLE OF DULY AUTHORIZED REPRESENTATIVE b. TELEPHONE NO
Morris Napolitano (212) 431-0696
PROJECT INFORMATION
PROVIDE ALL INFORMATION REQUESTED FOR THE BUILDING/SITE AT WHICH THE ASBESTOS PROJECT WILL BE CONDUCTED.
ADDRESS (INCLUDE NAME OF BUILDING.ROOM NO., CITY, TOWN, VILLAGE) 8. NAME OF BUILDING OWNER
14 Wall Street - New York, NY 10005 LANDLEASE REAL ESTATE
9 COUNTY 10. CURRENT USE OF BUILDING 11. AGE OF BUILDING 12. TOTAL CONTRACT AMOUNT
Manhattan Commercial 80 TBD
3 PROJECT DATE(S) - List 14. TYPE OF ASBESTOS WORK (CHECK 15. WILL WORK ON THE PROJECT BE CONDUCTED UNDER A VARIANCE 7 if
pnaseo project dates in ALL WHICH APPLY) yes, specify the type of variance:
REMARKS (Item 28) $j}CAPPLICABLE VARIANCE - NO.: AV- 11 9
❑ Pipe Related
a ACTUAL STARTING DATE ❑ Sprayed on Insulation O INDIVIDUAL VARIANCE . PETITION NO.:
i Roofing/Flashing
8 - 1 0-0 1 ❑ Vessel Covering
❑ Siding 16. WILL SUBCONTRACTORS BE USED ON THE PROJECT? ❑ NO ❑ YES
PP.OIECTED ENDING DATE ❑ VAT
❑ Demolition If yes, please list name and federal employer identification number of eac'
❑ Other (Specify) subcontractor in REMARKS (Item 28) on reverse of form
7-10-02
' 7 ASBESTOS PROCEDURE(S) TO BE USED 18. TYPE OF ASBESTOS 19. AMOUNT OF ASBESTOS INVOLVED - CHECK ALL APPLICABLE BOX(ES)
(CHECK ALL WHICH APPLY) MATERIAL LINEAR FEET SQUARE FEET
❑ Less than 260 ❑ Less than 160
, XREMOVAL ❑ DEMOLITION (Specify) (Specify)
❑ ($100) 260-429 ❑ ($100) 160.259
j ENCLOSURE O DISTURBANCE O FRIABLE ❑ ($200) 430-824 ❑ ($200) 260-499
ENCAPSULATION ❑ HANDLING ❑ ($500) 825.1649 ❑ ($500) 500.999
OTHER(Specify) ❑ ($1000) 1650OR MORE } ($1000) 1000 OR MORE
)E3 NON-FRIABLE 10, 0 0 0
(Specify) (Specify)
20 METHODS TO BE USED AT PROJECT SITE TO PREVENT ASBESTOS DISSEMINATION (INCLUDING TYPE OF EQUIPMENT AND VENTILATION SYSTEMS USED)
POLY SHEETING, WATER RESISTANT DUCT TAPE & WOOD WILL BE USED FOR THE SET UP OF THE
.NCLOS(JRES & DECONTAMINATION FACILITIES. DECONTAMINATION FACILITIES SHALL BE
QUIPPED WITH SHOWERS AND WATER FILTRATION DEVICES. AIR FILTRATION DEVICES SHALL
BE USED TO FILTER CONTAMINATED WATER. AMENDED WATER SHAT,T, RE rTSF1) TO WET ACM
1 I verify that the information specified on this notification is true and accurate and thatthe project will be conducted in compliagce with the rea;yrements
of Code Rule 56
YUL l,' J (REP) 7-31-01
a Signature of the Con tractor or Duly Authorized Representative b. Date
PREPARE THIS APPLICATION IN TRIPLICATE AND SUBMIT:
• An original and one copy (with an ink signature on both copies) to the New York State Department of Labor. Division of Safety and Healtr Asoes..'s
Control Bureau, State Office Campus, Building 12-Room 454, Albany, NY 12240; retain one copy for your records.
• A certified check or money order, made payable to the Commissioner of Labor, for the fee due based on the project size as shown n item ' 9
This notification must be submitted at least 10 days prior to the starting date of the asbestos project.
NYC-WTC 000094955
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