Asbestos project notification form, 30 West Broadway, Aug 2002

NYC 9/11 Public Portal Document L'—'v.tom f NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 6°i Floor, Corona. NY 11368-5107 ONLY . Dmap . ASBESTOS PROJECT NOTIFICATION BE br~i►aoR° (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 ®_~-E& t 6p-O , W F ( Borough N ' I Zip 1OO 07 AKA )3 ~--' 7fQ-» bJ lCL ~s_ 3. Block 4. Lot

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

7. Name C L tJ C 8. Contact Person r f to l_E) VAX y t . 9. Tel. # 17 - L Q— . Fax # r 10. Address _g 5' S City --JI- State --YZip 00

Ill. GENERAL CONTRACTOR

11. Name _— Tel. # — —

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name — —_-13. Contact Person

14. Federal Employer 10. # ._._._._. P11 _._._._._._._._._. Tel1. # J —1 - 70 - ' 3400 Fax # ----- St ;W1 3d~s

16. Address O V ~ — City _______ State Zip IL? 3

V. THiRD PARTY AIR MONITOR

17. Name R krl 2E2 ~S + r~jC 18. Contact Person A ~ii4 (- I'` Ot

19. Federal Employer ID. # ---_— 20. Tel. # a (>= a - OO Fax # -2Ja _ -O '3

21. Address 2~ L 4L ( r— E 7 City State (`(` _ Zip 0O / 22. Sample Analysis Laboratory— S'C(~c(1 ( -~ _ _± (E5i c 23. NYS DOH ELAP # ,'f g - c)

VI. PROJECT INFORMATION - l 24 Starting date for this portion of work( `( () a1 - Projected completion date 1 3° 03

Asbestos work schedule 0 Monday 0 Tuesday d Wednesday ❑ Thursday 0 Friday ❑ Saturda Sunday

Shift from: _ 0 am 0 pm to 0 am ❑ pm '`.

If other, specify ____—

Access to inspect the premises must be provided during the work schedule indicated in this item. f~11'll ^20~t. 25. Total amount of asbestos-containing material to be abated during this work

~I 3 DSquare Feet, and/or Linear Feet 1' ACP `~• • 2!!0C ~. k6y°=.A'I :Ir E :7 :! : cM1 i'iF..•73:r.'Cow Cdc:ra5 C'.t:RCi P6•^~a;,al rpm ~

NYC-WTC 000109850