Asbestos project notification form, 200 West Thames

NYC 9/11 Public Portal Document

N C DEPARTMENT OF ENVIRONMENTAL PROTECTION r ^` =- ~+"~~ti Asbestos Control Pro rare $~ 59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 L -- Building Dept. or TRu No ONLY ^ 'I LG ~D,fc~`'o" FOR OFFICIAL USE ONLY TYPEWRi4ily ' ~q'MrNru ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1 $800 4 CEI?TEO "' °'' ' (See fee schedule) ----

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 NYCOEP 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

2. Address 200 West Thames Street __—________—__—__—_____-- Borough Manhattan ____ Zip - 10006---------

AKA None __--_ — ---- 3. Block 1 6 _ _ 4. Lot ___--

5. Type of Facility Residential 6. Name of Building None ------------------ 1I. BUILDING OWNER

7. Name Les Jacobowitz c/o Liberty Court Condominium__—____-- 8. Contact Person Les or Dianna Jacobowitz

9. Tel. # (212) 891-9517 Fax #

10. Address 200 West Thames Street City New York —_--_--_-- State NY Zip 0006

III. GENERAL CONTRACTOR

11. Name_ None --------------------------- - Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR PAL Environmental Safety Corp. .-----------------------13. Contact Person Michael Chain 12. Name -------------,--------------.------ - ----------------- -- 14. Federal Employer ID. #_._._._._._._. 15. Tel. # L7 II 18) 349_0900------ _--- Fax # 718)_349_2800

16. Address 43-09 Vernon Boulevard------------------- City LIC-----------______ State NY __ Zip _11101

V. THIRD PARTY AIR MONITOR

17. Name ATC Associates,. Inc.._._._._._._._._._._.__._. 18. Contact Person Ben Sellami

19. Federal Employer ID. #w P11 __ ____ 20. Tel. # ------------------Fax 828 # (~12)353 3599

21. Address 104 East 25th Street--------------------- City -------------------State NY___ Zip _ 10010

22. Sample Analysis Laboratory—ATC---------------------- _—____ 23. NYS DOH ELAP # 1879 _____•

VI. PROJECT INFORMATION

24. Starting date for this portion of work _12/12/01 Projected completion date 12/12/0

Asbestos work schedule ❑ Monday ❑ Tuesday ❑✓ Wednesday ❑ Thursday ❑ Friday ❑ Saturday' ❑ Sunday

Shift from: 8:00--- ❑✓ am ❑ pm to 5_00--- ❑ am 0 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

------___ 00 Square Feet, and/or 0 Linear Feet

ACP 7 2/2001

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NYC-WTC 000110084