NYC 9/11 Public Portal Document
ENVIRONMENTAL PROTECTION
I , , NYC DEPARTMENT OF
/~` ov~h ~ Asbestos Control Program
411 NY 11368-5107
d—Zi%g—"tJ
59-r +ebbn Boulevard. 80 Floor. Corona. Building Dept. or TRU No
FOR OFFMIA USE ONLY
ASBESTOS PROJECT NOTIFICATION
E (ASBESTOS INSPECTION REPORT) 1.
FO ..... a.ee.~aeo
(See schedule)
Department of Buildings, the original form and three (3) copies with original
When submitting this form at the NYC NYCDEP requires one copy of the form with original signatures. This
signatures are required. Submittal at the start of abatement actMties .
not less than one week in advance of the
form must be submitted to the NYC DEP
I. FACILITY
Borough ManhattanZip 11201
2. Address 125 Cedar
3. Block 52 4. Lot 21
AKA
Residential 6. Name of Building
5. Type of Facility
II. BUILDING OWNER Joe Me s s i no
8. Contact Person
7. Name 120 Liberty L.L.C.
718-830-0 131 Fax#
9.Tel.#
97-77 Queens Blvd. City Flushing State NY Zip 11374
10. Address
Ill. GENERAL CONTRACTOR
Tel. #
11. Name
CONTRACTOR
IV. ASBESTOS ABATEMENT Peter Grande
Inc. 13. Contact Person
12. Name Fiber Control
Pill 15. Tel. # 51 6-781
-3000 Fax# 51 6-781 -3085
14. Federal Employer ID. # ----- --------------
NY Zp 11793
Wantagh State
16. Address
301 0 Burns Avenue City
V. THIRD PARTY AIR MONITOR Burkhardt
18.ContactPerson Fred
A.T.C. Associates
17. Name 212-353-8306
------------ 212-353-8280 Fax
PII 20. Tel #
19. Federal Employer ID. #
New Yor k State NY Zip 10010
04 East 25th Street City
21. Address 1
Associates 23. NYS DOH ELAP # 1 0 8 7 9
22. Sample Analysis Laboratory T•C
VI. PROJECT INFORMATION
/ Z _ Projected completion date fb 7 /ate
24. Starting date for this portion of work
Wednesday ® Thursday [ Friday I Saturday- . Sunday
Asbestos work schedule Y ® Tuesday ®
13 Monday ~-~
oa ~
Shift from: ® am 0 pm to
If other, \`
specify
the work schedule indicated in this item.
Access to inspect the premises must be provided during
25. Total amount of asbestos-containing material to be abated during
this work
C)? 1
~i
—9• _0 Linear Feet
ood Square Feet, and/or ACP 7
22001
NYC-WTC 000107429
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