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Asbestos Project Notification Form, DEP Box 39

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NYC DEP form for notifying the department of an asbestos inspection project at a facility.

NYC-WTC_000111225–000111226

Folder label: “Zone III Copies

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NYC 9/11 Public Portal Document

44

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 Asbestos Control Program 59-17 Junction Boulevard. 8o Floor. Corona. NY 11368-5107 ONLY ~ opFF LUSE EO ON.YY (c DArP) TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION FORMS WILL BE t- - (ASBESTOS INSPECTION REPORT) ACCEPTED ! www.e,c.p♦ 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 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 26 Wall Street BorougtP anhattan Zip 10005 2. Address

AKA 3. Block 4 3 4. Lot 6

5. Type of Facility 6. Name of Building II. BUILDING OWNER (Ve SlPl 7.Name United States Dept. of Interior 8.ContactPerson

9. Tel. # 212-825-6990 Fax# * 10. Address City State Zip

I11. GENERAL CONTRACTOR

11. Name- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR 12.NameTrio Asbestos Removal Corp. ___-13.ContactPerson Chris Horan

14. Federal Employer ID. # P11 -15. Tel. #718-961 -41 00 Fax#71 8-961-41 03 16.Address 14_20 129th Street CityCollege Point State NY Zip 11 356

V. THIRD PARTY AIR MONITOR Warren & Panzer Engineers, P.C. Michael Nolan 17. Name 18. Contact Person

19. Federal Employer ID. # 20. Tel. #21 2-922-0077 Fax# 212-922-0630

21. Address 228 East 45th Street City New York StateNY Zip 10017

22. Sample Analysis Laboratory Warren & Panzer Engineers, P. 23. NYS DOH ELAP #1 1 2 51

V1. PROJECT INFORMATION 24. Starting date for this portion of work /7/ Projected completion date

Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday ❑ Thursday 0 Friday 0 Saturday 0 Sunday

Shift from: —__❑am ❑pm to Dam ❑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 53,91 0 . Square Feet, and/or Linear Feet '7 31

NYC-WTC 000111225

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NYC-WTC_000111225Source: NYC Law Department, mirrored locally

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