Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

WTc NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59.17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 D:P Building Oepll or TRIJ No FOR OFFICIAL USE ONLY WRITTEN Iy%►e "ru iien cn ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED • . r c •ta<r 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 TS tA A t D1=N t_ M4 —_--__ Borough —M p-N — Zip __l003

AKA - 3. Block ---_ 4. Lot

5. Type of Facility_— CoPAMc-¢ca4.<_ 6. Name of Building --- _____-

II. BUILDING OWNER

7. Name ------------------- 8. Contact Person ___ _

9. Tel. # ------------- Fax #

10. Address City ------------ State Zip --------

III. GENERAL CONTRACTOR

11. Name_-- __ -------__ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name REWAA N_ (Cu "e' A13 4 S opt Co t,1rft t_ —INC --_13. Contact Person _ Loutar (AaNiCo

14. Federal Employer ID. # PII_ _ _ _ _ ___ 15. Tel. # C118) 53i — 2900 -- Fax # t l l a) 2o9=t 80g — ___

16. Address __ 1248 P-At_Ptt AvoroE -- City 2 __ State u Y — Zip

V. THIRD PARTY AIR MONITOR

17. Name _ W 0-94-E 3 Pga zEe EtJG IN S ----_18. Contact Person _ Mt~A,FL—NOL ---

19. Federal Employer ID. # PII 20. Tel. # t 2._o9_r7-- Fax If

21. Address _ 2 $ Ep6T ASM ST¢EET ----- City __ VQM yc — _ State _ L'L. Zip _ 1001T

22. Sample Analysis Laboratory__--__ __—__ ----- 23. NYS DOH ELAP # —_—__--_

i •'' VI. PROJECT INFORMATION 24. Starting date for this portion of work 2!.J.!2_ Projected completion date

Asbestos work schedule Monday I Tuesday I Wednesday ® Thursday IZ Friday ® Saturday I Sunday Shift from: ~ ® am ❑ pm to 8 ❑ am ®pm C3 ` IQ

If other, 4. specify pr r ------------------ RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. A U6 '

CG ~i -P.safl4." 2002 25. Total amount of asbestos-containing material to be abated during this work St.E~~ &TORAh' =CG TUG _ €2.2._ Square Feet, and/or C Linear Feet S ACP 7 2/2001

NYC-WTC 000111358