NYC 9/11 Public Portal Document
AENTTOF ENVIRONMENTAL PROTECTION
Asbestos Control Program
Boulevard, 8a' Floor. Corona, NY 11368-5107 Building Dept. arTRU No
NYC FOR OFFICIAL USE ONLY
LY
TfrPEwRITh ESTOS PROJECT NOTIFICATION (_
RMS WI (ASBESTOS INSPECTION REPORT)
CEPTE fee sd-duls)
LCtl When submitting this fom at the NYC Department of Buildings, the original form and three (3) copies with original
rewired.- ubmittal. at the NYCDEP requires one copy of the form with original signatures. This
form must be su the NY( DEP not less than one week In advance of the start of abatement ac vities .
1. FACILITY
2. Address 65 Nassau Street Borough Manhattan Zip 10001
AKA N/A 3. Block 65 4. Lot 1
5. Type of Facility Apartments 6. Name of Building ±LA
11. BUILDING OWNER
7. Name 65 Nassau Owners Corp. 8. Contact Person Scott Jaffe
9. Tel. # (718) 596-1616 Fax# (718) 834-9850
10. Address 65 Nassau Street City NY State NY ZIp 11101
III. GENERAL CONTRACTOR
11. Name N/A Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Black Rock Construction Co. 13. Contact Person Tony Brown
15. Tel. # (718) 297-8361 Fax # (718) 746-3023
14. Federal Employer ID. #_
16. Address 88-15 168th Street # 6C City Jamaica state NY Zip 11432
V. THIRD PARTY AIR MONITOR
17. Name Central Environmental Inc. 18. Contact Person Aiim Yerima
19. Federal Employer ID. # _ _ _ _ _ _ _ _PII _ _—_ - ` 20. Tel. # (718) 293-8727 Fax# (718) 996-4430
21. Address 91 McClellan Street City Bronx state NY Zip 10452
22. Sample Analysis Laboratory Taylor Environmental 23. NYS DOH ELAP # 11480
VI. PROJECT INFORMATION
24. Starting date for this portion of work 12/5/01 Projected completion date 4/5/02
Asbestos work schedule El Monday El Tuesday El Wednesday El Thursday ❑✓ Friday ❑ Saturday ❑ Sunday
Shift from: 9:00 _Elam ❑pm to 5:30 Dam ©pm
If other, ! ~ r ~`` n C
specify Must call (718)746-8054 for access to building ... ~7' ~~~ J V
Access to inspect the premises must be provided during the work schedule indicated in this item. nT(
n c F.
I.-
25. Total amount of asbestos-containing material to be abated during this work .
4 5O Square Feet, and/or 0 Linear Feet \ 'N. TAU "\
., vzoo,
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NYC-WTC 000098006
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