Asbestos control emergency notification request, Sep 2002

NYC 9/11 Public Portal Document

SEP-30 02 08:t4 FROM:NYS DOL ACB NYC 2123526902 TO: 7185953T44 PAGE :136 :tee RATE OP NIIW YQ X. DEPARTMENT OF 1ABOR EMERGEftCR.MOTW1CA11ON NEGUESTEO DNLSION Of SAFETY AND HEALTH AS6iSTOS CONTROL BURKA ~- a. Caa erf Regwn a Tints ofo"y SSa18 Offke Comp 9/23/02 21S0pm iuiWln 13- Room e -r `~'~ ~ J4bariy, N.Y. 12240 ~' ~. ..•. +~~ a. q nap"" a pne cP Sp r. Fisher

b. N.w$(art QaIa - - e. Nowand Date d. Submitted By ASBESTOS PROJECT lV ~UON 54 ii 1/ J QQO

1. NAME AND ADDRESS QF CONTRACTOR 2. FUia6RAL EMPLOYER IDE:NTIRCATION NO. E f,.~ASi.E$YQSILK NSE NO. JVN Restoration Inc. 47 Foster Road 4. MAILING ADORBSS. (H dWennt than lifted in ITEM I) Staten IsLand, N.Y. 10309 S- NAME AND A009115S 0f PARTY FOR WHOM THE PROJECT IS BEING PERFORMED Fire Dept. of N.Y. Engine Co.10/Ladder Co.10

ti. NAME AND TITU OP DULY AUTHORIZED RBP*ESENTATIVE b. TELSP1IONG NO. John Tardy, Project Manager (7181605-6256

PROJECT INFORMATION P40 VIDEALL WFOAMATION MOU'FSTEO FQR THE 8U7LDJNG/IITtA T Wlr1Cl TINE A$IIIISTOS PROJECT WELL if CONDUCTED. 7. ADDRESS (INCLUDE NAME OF BUILOING.ROOM NO, CITY. TOWN. VILLAGE) S. NAME OF BUILDING OWNER 124 Liberty Street City of New York

B. COUNTY IS. CURRENT USE 4F EUILDING 11. AGE OP BUILDING 12-TOTAL CONTRACT AMOUNT Manhatten Commercial 50+ TBD 12. PROJECT DATE(S)- LIst 14. TYPE OF ASBESTOS WORK (CHECX IS. WILL WORK ON THE PROJECT BE CONDUCTEO UNDER A VARIANCE? . it phased pr ect dotes In A4L W14K'HAP?LY) yet. sp•tily the type of variance; REMARKS (Itttn 20 IR APPUCMLE VARIANCE - No.: ,1 1 a £ 121 O Pipe RIIIeted O INDIVIDUAL VARIANCE. PETITION NO.: a. ACTUAL STARTING DATE Cl Sprayed on tnaldation 9/24/02 _IB Roofin Raehirt0 O Vestal Coveting D sidnq 16. WILL SUJBCONTRACTORS BE WED ON THE PROJECT? n NO C YES b. PROJECTED ENDING GATE 12 VAT Cl DSRIOIIUUon It Vol, please lbt name and federal employer IdSntifituian number of each 10/01/02 N Other (Sp•dfy) subcontractor in REMARKS (item 26) ar' reverse at faun, ~aAtir- 11. ASBESTOS PROCEDURE(S) TO EE USED 1$. TYPE Of ASeU$TOS I1. AMOUNT Or ASBESTOS INVOLVED - CHICK ALL APPLICABLE BOX(ES) (CFNECXALL W 1KHAMLY) MATERIAL LINEAR F _QdIs D LeO thdidlilO © Laisthint 0 REMOVAL a DEMOLITION ~' r O FRIABLE O 1001 2II0.429 O ($to0) 154.251 1D ENCLOSURE a DISTVRBANCE O (5200) 430`$14 Cl (12061 260499 BNCAPSuuT~N Oc wwot.Iiv<1 Cl ($300) 521.1149 Q $500) 500999 D OTIIE R (Speciy) CI ($1000) 1650 OR MORE ja S f OOpL 10)M OR y~ M JNON•fiUABLE 5355 X73

20, METHODS TO BE USED Al PROJECT SITE TO PREVENTASBESTOS DISSEMINATION (INCLUDING TYPE OF EQUIPMENY AND VENTILATION 1Y$TEb4S USED) HEPA-filtered negative air filtration units. Wet methods, HEPA-filtered vacuums, decontamination fat~ility with showers.

21. 1 verify that the lnformatl I R n Ihie notification is true a+d accware and that the project will be Cw ducted In compliance with the roaulronlent cRY John Tardy 9/23/02 a. gn lure tJ1e contra or aMtrrd tlepreaenta Project Manager 6.Dole

PREP T IS APPUCATI0N IN IPRIPUCATE ANO SUBMIT: Asbestos • An orprnal and one copy (with an Ink signature on both toplat) to the New York State Department of Labor, Division of Safety and Health. Control Bureau. State 0ffl,e Cuopas. Building 12-Acorn 157, Albany, NY 12240; Islatrr one copy for yoarr reewds. e A check or money order, made able to the mComisaiorter of Lebow, for the foe due based an the project sloe as shown in Item 19 Thu notflkatlart must be = a t Lao t f0 dart prior to theItardhp date of the asbetearp'ojeet ....•• , .ewe

NYC-WTC 000097275