NYC 9/11 Public Portal Document
SEP-30 02 08:,14 FROM:NYS DOL ACB NYC 2123526902 TO:7185953T44 PAGE:06
STATE OF NEWYORK- DE►ART 3ENT OF IA90R EMERGENCY.NOTIFICATION NEOUESTEO
01VISiON Of $AFETY AND HEALTH
r A$RSSTOS CONTROL etJA11J ~- S. Call of RagI aft b. Titsla ofDay
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a. O Paspenea O Gno
cP A1bariY, N.Y. 1224* • :'
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4 2O8
. Fisher
dr. N.w$tut 04N - —
t: NowI(nd Daa
d. Submhted By ASBESTOS PROJECT NOY AtTLCN
auto
1. NAME AND ADDRESS QF CONTRACTOR 7, FEDERAL EMPLOYER 10ENTiRCATION NO. 1. ASBESTOS LICENSE NQ
02-0356
JVN Restoration Inc.
47 Foster Road 4. MAILING AOORBSE. (If dHltrent than Iitt.d in ITEM I)
Staten Island, N.Y. 10309
LL. NAME AND ADDRESS 0? PARTY FOR WHOM THE PROJECT IS IIING PERFORMED
Fire Dept. of N.Y. Engine Co.10/Ladder Co.10
6. a. NAME AND TITLE Of DULY AUTHORIZED REPRESENTATIVE b. TELEPMONG NO.
John Tardy, Project Manager (718)605-6256
PROJECT INFORMATION
P40VIDEALL WFORMAT?ONRfOUF.STEOVOR THE eUrLDJNGfltTJrATW#fICrf THEA$USTOSPROJECT WN2 if CONOUCTtb.
7. ADDRESS (INCLUDE NAME OF BUILDING.ROOM NO., CITY. TOWN. VILLAGE) $. NAME OF BUILDING OWNER
124 Liberty Street City of New York
0. COUNTY to. CURRENT USE OF BUILDING 11. AGE OF BUILDING t 2. ro TAL CONTRACT AMOUNT
Manhatten Commercial 50+ TBD
11. PROJECT DATE(S) - Litt 14. TYPE OF ASBESTOS WORK (CHECK i 9. WILL WORK ON THE PROJECT BE CO U FO UNDER A VARANCE? . If
phased project d.tes In AML NMJCHAPPLY) yet. specify the type of variance;
REMARKS (it1A110 Ct APPLICABLE VA14ANGE - NO.: JJ £. 12 tl
0 Plea Related O INDMPUAL VARIANCE - PETITIOIN NO.:
a. ACTUAL STARTING DATE Cl Sprayed on tlltedation
9/24/02 II Roeftn FISMIF0
O Mass( covee(sp
O $4034 16. Witt WSCONTI 04CTORS BE ed5W ON THE PROJECT) 20 NO C YES
b. PROJECTED [ RDiNG DATE N VAT
O Oarnoltlon U yab.pleuolist name and federal employer Identification numberof each
10/01/02 p Other (4podfy/ subcontractor ii RiBMRKS (item 25) on raverlle of fetM,
xargtir-
1 i. ASBESTOS PROCEbURI(S) YOU USED is. TYPE OF ASBESTOS i9. AMOUNT OF ASBESTOS INVOLVED - CHECKALL APPLICABLE AOX(ES)
PCNECKALL P KHAPPLP7 MATERIAL UNEAR 1
G Lest an ©tats than l 0
REMOVAL O DEMOLITION r—
a FRIABLE V O($100) 260.429 O (11100) 16075'
N ENCLOSURE O DISTURBANCE C (1200) 430444 a (12001 260499
ENCAPSULATION pl NANOLING ) I BSQ OR MORE Cl ($5
D OTMI R (Specify) C ($M01 (S i fom SIWO Oa
M NON'fit1ABL.E
20, METHODS TO BE USED AT PROJECT SITE TO PREVENTASBE$TOS DISSEMINATION (INCLUDING TYPE OF IQVIPMENY AND VENTILATION S fSTEM/S USED)
HEPA-filtered negative air filtration units. Wet methods, HEPA-filtered
vacuums, decontamination facility with showers.
21. I verify that the 6nformatlg/tghdfijd'4n this notNicatlon is true ad accurate and that the project will ne tondueed In compilance with INS IQGUIramant
John Tardy 9/23/02
a. pn taro tJreCo+ s arBarr► orlsedhlepretSMs Project Manager 6. 1e
PREPS APPUCATION IN!RIPUCATE AN 5U8MIT:
Asbestos
o An Grp nal andane copy (with an Ink denature on both eoples) to the New York State Department of Labor, Division of Safety and health.
Control Bureau, State OfAca Campus. Building 12-Raven 157, Albany, NY 12240; relit+ one copy for your records.
e A check or money order, made Cambslonerof Labor, for the 1te due based on the project ii;, as shown to Item 19
able to the m
Thh noWkatAsn must be = at Juaf f0 days pflor to thisatar1Jnp date of oa asbesaarpvoje~t
....•, 'I*'
NYC-WTC 000097275
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