Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

I'

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8S' Floor, Corona, NY 11368-5107 ONLY TYPEWRITTEN r.Dti• I, ASBESTOS PROJECT NOTIFICATION Bu ng Dept, or TRU No FOR OFFICVL USE ONLY

FORMS WILL BE _ (ASBESTOS INSPECTION REPORT) ACCEPTED i •••arcs.• ae• 1. (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 48 Beaver Street Borougt1anhattan Zip 10004

AKA 56 Beaver Street 29 7501 ..3. Block 4. Lot 5. Type of Facility 6. Name of Building II. BUILDING OWNER j Spr 7. Name Time Equities 8. Contact Person Z t .l t4 41 1 < 9.Tel.# 212-206-5694 Fax# 10. Address City State Zip III. GENERAL CONTRACTOR

11 Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan

14. Federal Employer ID. #L-.-.-.-.-.-.-..P. .- 15. Tel. #71 8-961 —41 00 Fax# 718-961-4103 16. Address_ 1 4-20 129th Street CityCollege Point State NY Zip 1 1 356

V. THIRD PARTY AIR MONITOR

17.Name Warren & Panzer Engineers, P.C. 18. Contact Person Michael Nolan 19. Federal Employer ID. # 20. Tel. # 2922-0077 Fax# 212-922-0630 21.Address228 East 45th Street New York _City State NY Zip 10017

22. Sample Analysis Laboratory Warren & Panzer Engineers 23. NYS DOH ELAP # 11251 V1. PROJECT INFORMATION 24. Starting date for this portion of work Projected completion date

Asbestos work schedule ❑ Monday 0 Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday Shift from: ______Dam []pm to Dam ❑pm

If other, specify

I 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,_250 - Square Feet, and/or _ Linear Feet 7 11

NYC-WTC 000111221