Asbestos project notification form, 30 West Broadway, Aug 2002

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. e°i Floor. Corona, NY 11368-5107 ONLY \+.DsP ASBESTOS PROJECT NOTIFICATION "° y~b~K►aoR`` BE (ASBESTOS INSPECTION REPORT) C. 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.

1. FACILITY

2. Address C), li PDP_0 f W1 ( Borough N . I Zip t O ID O

AKA - -'-i- 7 çf Q..&-.-n)tCL WC 3. Block 4. Lot

5. Type of Facility—__— 6. Name of Building II. BUILDING OWNER

7. Name Cu r' _.. C ' 8. Contact Person ('t.. oVIL t .

9. Tel. #'ltLq-iO - Fax #

10. Address _g 5 ' g~ ` S L_ City -- = I State YZip 00

III. GENERAL CONTRACTOR

11. Name --- Tel. # — —

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name E'ie ~C%~-' ~I _ —__—_-13. Contact Person

14. Federal Employer ID. # P11 _._._._._._._._._._. Tel # c) ' 3400 Fax # -----5LT 7~~ ✓dSS - 16. Address oc~ t> ~— — City J / 1 ~ ' _ State /V Zip IL? 3

V. THiRD PARTY AIRMONITOR ~j A 17. Name Vt Q ZE2 /~(~i r 'T ~S rC 18. Contact Person ~i4 (- 1 ` 0 •

19. Federal Employer ID. # ---_— 20. Tel. # a (~=I$ - 00 Fax # .a V P - OI✓ 3o 21. Address 2~ ijLS (r --E7 City L 7 C? State _Zip oO / 22. Sample Analysis Laboratory— S-1 (((L ~~ ~ ~ '(ES ar c 23. NYS DOH ELAP #_(I S

VI. PROJECT INFORMATION - 24_Starting date for this portion of works 0 a _ Projected completion date ...2i° o3

Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday 0 Saturda Li Si

Shift from: _ ❑ am ❑ pm to 0 am ❑ pm

If other. specify —

Access to inspect the premises must be provided during the work schedule indicated in this item.

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

1.I . DSquare Feet, and/or Linear Feet ACP 212OC 'O:AY;ITETo~~'i "SC 0.tF..t 4:d T C'.t:RCi rpm

NYC-WTC 000109850