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Asbestos Project Notification Form Submission

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Form submission instructions for an asbestos inspection report required by the NYC Department of Environmental Protection.

NYC-WTC_000108268–000108269

Folder label: “120 LIBERTY STREET; 1001040, 52/21

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NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor, Corona, NY 113685107 TXat 9~tOO&No Building Dept. or TRU No ~.. ONLY DA/P FOR OFFICIAL USE ONLY 1YPEWRI7TEN . ASBESTOS PROJECT NOTIFICATION e FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED w.+v. oia. 1. c _ (See schedule)

l~ir'J When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This form must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.

I. FACILITY ' I 2. Address 125 Cedar Street Borough Manhattan Zip 11201 AKA 3. Block 52 . 4. Lot 21 5. Type ofFacility residential 6. Name of Building II. BUILDING OWNER 7. Name .120 Liberty LLC 8. Contact Person Mr. Joe Messino 9. Tel. # (718) 830-0131 Fax # 10. Address 97-77 Queens Blvd City Flushing State NY Zip 11374 III. GENERAL CONTRACTOR 11. Name n/a Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Fiber Control Inc. 13. Contact Person Mr. Anthony Costa 14. Federal Employer ID. # L !.LJ 15. Tel. # (516) 781-3000 Fax # (516) 781-3085

16. Address 3010 Bums Avenue City Wantagh state NY Zip 11793 V. THIRD PARTY AIR MONITOR

17. Name A.T.C. Associates 18. Contact Pelson Mr. Fred Burkhardt 19. Federal Employer ID. # j PI I _ 20. Tel. # (212) 353-8280 Fax # (212) 353-8306 21. Address 104 East 25th Street City New York state NY Zip 10010 22. Sample Analysis Laboratory A.T.C. Associates 23. NYS DOH ELAP # 10879

24. Starling date for this portion of work 10/5/02 Projected completion date 10/7/02

Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday ❑ Saturday Sun n0ay

Shift from: Dam ❑pm to Dam ❑pm

If other, specify Access to inspect the premises must be provided doing the work schedule indicated in this Item.

25. Total amount of asbestos-containing material to be abated during this work

- 2,346 Square Feet, and/or 0 Linear Feet

l .' ACP7 212001

NYC-WTC 000108268

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NYC-WTC_000108268Source: NYC Law Department, mirrored locally

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