Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

v~ l I ILi G'y DE►,ur NYC DEP MENT OF ENVIRONMENTAL PROTECTION ,I ~` h~ Asbestos Control Program 59-17 Junction Boulevard, 6th Floor, Corona, NY 11368-5107 1g3 Building Dept. or TRU No FOR OFFICIAL USE ONLY 'b'I~ycHrgiiiva°i~ ASBESTOS PROJECT NOTIFICATION L. i

. !~ ~ TED BE :.ww nYc.fer <p (ASBESTOSINSPECTION REPORT) 1, (See

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 205 PEA2I_ Sr T__.___ ._ Borough — AW -- Zip _J _ ___

AKA --------------------________3. Block b8 -- 4. Lot - '750% --

5. Type of Facility_----_ r-- ...,.,,._-- 6. Name of Building

II. BUILDING OWNER

7. Name --------------- 8. Contact Person

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

10. Address City State ____ Zip

Ill. GENERAL CONTRACTOR

11. Name------------------- --------------------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 3E',LaArA1►3 kuQ213Am 4 Sc,0 CzwrCGL 1NC v-- ~13. Contact Person _Lcute _ (ANN 14. Federal Employer ID. #._._._._._._._PII 15. Tel. # 3! 53 - 2900_-- Fax # Ise) 202 - 1160 _

16. Address _ 124 $ ' At..P►) ~1dG r,:.1E --- City —_ State N Zip a 236

V. THIRD PARTY AIR MONITOR

17. Name WAt'R_EN PAN _~ ENGi plFrt%S _ --_18. Contact Person _ N11CalAE~-1:1t,~AN —

19. Federal Employer ID. # j PII ___ 20. Tel. # C212)~22- cOY r -- Fax # _CZi2) 922- 40630 —_

21. Address ------ Oty N Ycctt _ State _Zip iobr7 ---

22. Sample Analysis Laboratory----~— ------------23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24. Starting date for this portion of work _ e9i! 0 I o 2 _ Projected completion date

Asbestos work schedule 13 Monday IZI Tuesday © Wednesday 10 Thursday D Friday 0 Saturday ® Sunday Shift from: 8 __—_— ® am 0 pm to 8 ❑ am pm l0 If other, specify ------------------------ -------------- Fr{1►FD Access to inspect the premises must be provided during the work schedule indicated in this item. SEp ' 25. Total amount of asbestos-containing material to be abated during this work

Square Feet, and/or _ 0 Linear Feet S t 4" / ACP7 2/200'

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NYC-WTC 000111364