NYC 9111 Public Portal Document
'I NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 Building Dept. or TRU
FOR OFFICIAL USE ONLY
ON, !.
qDvRIrTEN ASBESTOS PROJECT NOTIFICATION
FORMS WILL PE; (ASBESTOS INSPECTION REPORT) 1. $1200
ACCEPT yt _guv/dep .;
(See fee schedule)
~When bmitt' at the NYC Department of Buildings, the original form and three (3) copies witp otiyi
wired. Submittiil at the NYCDEP requires one copy of the form with original signatur
st be submitted to the NYiiDEP not less than one week in advance of the start of abatement acti iet1
I. FACILITY
2. Address 110 Church Street Borough Manhattan____ Zip 10007
AKA 3. Block 1 26 4. Lot 2
5. Type of Facility Vacant Commercial Bldg________ 6. Name of Building
II. BUILDING OWNER
7. Name Lions Head 110 Development LLC c/o Worldwide Holdin In(8. Contact Person Michael Riegler _____
9. Tel. # (212) 948-6200 ____ Fax # -
10. Address JIO East 58th Street City New York __,____ State .N.Y._ Zip 10155___
III. GENERAL CONTRACTOR
11 Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Pinnacle Environmental Corp ._ __13. Contact Person Robert Ryan__ ^
14. Federal Employer ID. ;~ ___._._._. P11 - _ 15. Tel. # (718) 397-9292 ` Fax # -__(718)397-1472
16. Address 64-54 Maurice Avenue City Maspeth State NY__ Zip 11378 ___
V. THIRD PARTY AIR MONITOR
17. Name Contact Person George Russell
19. Federal Employer ID. # - P11 --- 20. Tel. # (732) 249-3005 _ Fax # (732) 249-3384
21. Address PO Box 872 City Sommerville _____ State NJ __ Zip 08876_--
22. Sample Analysis Laboratory EM&CA __ 23. NYS DOH ELAP # jjQ.5$=01
VI. PROJECT INFORMATION -
24. Starting date for this portion of work _ 11/27/01 Projected completion date . 1/31/UL _
Asbestos work schedule El Monday El Tuesday El Wednesday El Thurgday [D Friday ❑ Saturday ❑ Sunday
Shift from: 7.00 Sam ❑pm to 5.30 _ Dam wpm
If other,
specify j REC~D
Access to inspect the premises must be provided during the work schedule indicated in this item. NOV 2 A 2001
25. Total amount of asbestos-containing material to be abated during this work . ~ ti
=ARAAM~
$>. /
622,702 Square Feet, and/or 0 Linear Feet 6
ACP 7
2/2001
I
rJ
NYC-WTC 000098640
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