Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 1, M~ a Asbestos Control Program 59-17 Junction Boulevard, 8"' Floor, Corona. NY 11368-5107 ILi UJO Building Dept. or TRU No ~~ FOR OFFICIAL USE ONLY (J - 1 • Hruiiion~ ASBESTOS PROJECT NOTIFICATION BE (ASBESTOS INSPECTION REPORT) fee

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.

1. FACILITY

2. Address _2112 __ PEA L S Te_ ET- -- Borough 1AA►s -- Zip _- 10038 —_

3. Block Q__ . 4. Lot 2LO AKA ------------ --------- 5. Type of Facility_—__- i t4 E E -- —__--- 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 .N ku2?B_ L 5614 Q0L:-2,Ct- Ac - - -13. Contact Person _Lcu,g—~ AN►;~Cc---__— - P 15. Tel. if ~~! ) 53i_ 29CO _—__ Fax #_ J. 2c9= tt3o8 14. Federal Employer ID. #

16. Address __t 2 4 E5 _ RA t_P►•i A J cN C E --- City 8(ZC Cttiw N —`—_ State N~ — Zip

V. THIRD PARTY AIR MONITOR

ARaE►J 'PAp ENGINeeQs —_18. Contact Person _µ1GNAEL ~a-AA 17. Name PII 922-cc>l7 1s—2 22 Fax #_L2— 19. Federal Employer ID. # _.-____.____ .-•-____ 20. Tel. # (212 ) _---------_— 0630 —' ------

21. Address _? Fpsi _ 45 REt=r ----City —~lEu+ {og:c__--_ State NY Zip _ too~'C__—_

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

VI. PROJECT INFORMATION 24. Starting date for this portion of work o9 f_I 0 2 Projected completion date

Asbestos work schedule ® Monday ® Tuesday 0 Wednesday © Thursday 13 Friday 13 Saturday ® Sunday

Shift from: —8! L am ❑ pm to t3 ❑ am 0 pm

If other, specify ------------------------------- 1'.

Access to inspect the premises must be provided during the work schedule indicated in this item. i1 ocr0 (!U

25. Total amount of asbestos-containing material to be abated during this work __ Square Feet, and/or _-- o — Linear Feet ACP 7 2/200'

NYC-WTC 000111360