Asbestos Project Notification form, Oct 2001

NYC 9111 Public Portal Document

I .~ t I ~~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION W "10t""~r,, Asbestos Control Program , 59-17 Jtmctlort Boulevard. 801Floor, Corona, NY 11368-5107 Build r TRU P4 FOR OFFICIAL USE MY O ASBESTOS PROJECT NOTIFICATION E C111__ (ASBESTOS INSPECTION REPORT) 1. A (gee xheduk)

original form witho~93 copies with on inal When submitting this form at the NYC Department of Buildings, the the form I signatures. This the NYCDEP requires one copy , , signatures are required. Submittal at than one week in advance of the start of abatement activities. less form must be submitted to the NYC DEP not

I. FACILITY Borough ManattanZip h 11201 Street' 2. Address 125 Cedar 3. Block 52 4. Lot 21 AKA Residential 6. Name of Building 5. Type of Facility II. BUILDING OWNER Joe Messino 8. Contact Person 7. Name 120 Liberty L L.0 - Fax# 9. Tel.# _._._._._._._._._._._._._._.. I I l Ci~, F 1 ush i nq State NY Zip 11374 10. Address ' .. - - -----------------------------------------------------.-. _---

Ill. GENERAL CONTRACTOR Tel. # 11. Name CONTRACTOR IV. ASBESTOS ABATEMENT Peter Grande Control inc. 13. Contact Person 12. Name F 1' ber 516-781-3085 PII 15. 516-781-3000 Fax# 14. Federal Employer 10. # NY Zp 1 1 793 Wantagh State 3 010 Burns Avenue city 16. Address

V. THIRD PARTY AIR MONITOR Fred Burkhardt A.T.C. Associates 18. Contact Person 17. Name 212-353-8280 212-353-8306 PII Fax 19. Federal Employer ID. # — 20. TeI. # New York State NY Zip 10010 104 East 25th Street City 21. Address 10879 •T•C Associates 23. NYS DOH ELAP # 22. Sample Analysis Laboratory_A

VI. PROJECT INFORMATION Projected completion date l0 24. Starting date for this portion of work _ Friday I Saturdal Asbestos work schedule 13 Monday ® Tuesday 0 Wednesday 13 Thursday

Shift from: I am 0 pm to. // Oam©pm

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

abated during this work 25. Total amount of asbestos-containing material to be _0 Linear Feet 00 Square Feet, and/or 8 : ACP 7

C

NYC-WTC 000111316