Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document 1 l/ / , l 'Q„~,ittr oc~air NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control !Bm 59-17 Junction Boulevard. 8'" Floor, Corona, tJY 11368-5107 Building Oept. or TRU No FOR OFFICIAL USE ONLY y N ~Opwcaruii~o~° ASBESTOS PROJECT NOTIFICATION ILL BE (ASBESTOS INSPECTION REPORT) 1. PTED (See fee sched )

copies with original When submitting this form at the NYC Department of Buildings, the original form and three (3) signatures. This signatures are required. Submittal at the NYCDEP requires one copy of the form with original abatement activities. form must be submitted to the NYC DEP not less than one week in advance of the start of

I. FACILITY Borough _ I A►. --- Zip__ %0038 2. Address 2 It _ AQL__S'' eE'~ % ----- Block — 6 9 -- 4. Lot 5 _ AKA -------------------------------3.

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

II. BUILDING OWNER

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

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

--- City ---------__— State ____ Zip 10. Address ----------

III. GENERAL CONTRACTOR Name____--------------------------------------- Tel. # 11.

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name IN 141 Cz Bi,N Q So--- ---- INC • — _13. Contact Person — ------. .. ------- Chttti~_S3i - 29CO _ Fax # _C7c~~ 2C`~_ 18C>i __—_ 14. Federal Employer ID. # ..._._._._._.PII_._._._._._. 15. Tel. #

124 __C A~ t,~ V u~ -- City %Q ±1___.... State u~' _ Zip J2____ —_ 16. Address

V. THIRD PARTY AIR MONITOR

17. Name —WAME_ 4 —?AazEe ENS I ts —__—__- 18. Contact Person _I~I~ups __--

19. Federal Employer ID. # _- -----P11 } 20. Tel. # C2,z) 922=22L?____ Fax # J !_2:_22____

c~T - AS114 ST¢E'ET --- City ~ ` , c ex_--- _ State EL... Zip _ I CO t( 21. Address ?? 23. NYS DOH ELAP # 22. Sample Analysis Laboratory • VI. PROJECT INFORMATION 24. Starting date for this portion of work _°`3 io oZ _ Projected completion date

Asbestos work schedule ® Monday ® Tuesday 0 Wednesday ® Thursday ® Friday 0 Saturday day

Shift from: -g"' ® am ❑ pm to __Q_ ❑ am ® pm

If other, specify

Access to inspect the premises must be provided during the work schedule indicated in this item. SEP I' s 25. Total amount of asbestos-containing material to be abated during this work 102. ~ Square Feet, and/or _Q_ Linear Feet ACP 2120(

NYC-WTC 000111362