Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor, Corona, NY 11368-5107 Building Dept. or TRU No FOR OFFICIAL USE ONLY TYPEWRITTEN • . ASBESTOS PROJECT NOTIFICATION FORMS WILL BE nio~Mrarw i on~c (ASBESTOS INSPECTION REPORT) 1. C k ACCEPTED (S4e 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

2. Address _—$r NASSAU SrraEET __ Borough ___M±____ Zip -- 10038

AKA 3. Block _t.?___ 4. Lot _J----

5. Type of Facility_----~— 6. Name of Building —

II. BUILDING OWNER tREtuAY R-e A LT L LC Div t o K OCPREt N 7. Name C/Q !< t'L coM PANiEs t1G _----; 8. Contact Person _---

(212Z74T-ic+B- -_ 9. Tel. # _1212)'344-21So ——Fax# State _ ± _ Zip 10022.61(5 10. Address _ 5T5 LEY4M6kTON AJEtA_.'E ---_ City-- MY-

III. GENERAL CONTRACTOR

11. Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR KOQ'LBAW 4 Son1 Cs sT2OL I NCB 13. Contact Person LOc l>` I Pt t CO 12. Name 604 A 1N

14. Federal Employer ID. # PII_._._._._._. -- 15. Tel. # C3tt) s 3i - -zS)C0 —__ Fax #

16. Address __ 12 Av j City __ QR!LC V- ± ---_ State v— Zip _

V. THIRD PARTY AIR MONITOR

Pr~NZBR Contact Person 140LAO---- 17. Name WAR QEN ~ ! ac-> tzs__---_18.

—_ 20. Tel. # X212) 22-0o zT — Fax # (.2t2) 922_0630— _ 19. Federal Employer ID. # ___- _

21. Address _ 2-7S Fst.sr 4Sr►t S're- T City !u ~y _~--_ State 1~__ Zip _100 IT —_

22. Sample Analysis Laboratory___,_... ........... — ------ 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24. Starting date for this portion of work C00 I I _O_ Projected completion date

Asbestos work schedule © Monday ® Tuesday I Wednesday © Thursday ® Friday ® Saturday, I Sunday

eo 00 / r'My Shift from: _ 8 am ❑ pm to 8 — ❑ am pm 1

specify --- ----------- 'r; , E ----- 1VED Access to inspect the premises must be provided during the work schedule indicated in this item. )f UEp

25. Total amount of asbestos-containing material to be abated during this work t7~ Square Feet, and/or 0 Linear Feet ACP 7 4tP ,,,.rat 212001 4itl'tPR~ z.. iRl1~

NYC-WTC 000111346