Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

1L' h un NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 81" Floor, Corona, NY 11368-5107 B uilding Dept. or TRu loq 0 FOR OFFICIAL USE ONLY PEWRITTEN ASBESTOS PROJECT NOTIFICATION FORMS WILL BE ACCEPTED ":"-~S:!?°'~'•r. (ASBESTOS INSPECTION REPORT) 1. G ee 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.

1. FACILITY

2.'Address~4 NASSAU 5 -rgEET Borough b(AN Zip (00313

AKA t29 fI ct STREET / 40 Arbk STt2Ec~ 3. Block 91 4. Lot 13

5. Type of Facility 6. Name of Building II. BUILDING OWNER

7. Name 2~l_i Tl ol~t FO Q TME ItO ME LESS '8. Contact Person MA Q I A U ir,- .A OLIV E (2 AS

9. Tel. # (21Z) 96.1- S900 Fax# (212) 96e -1303

10. Address 89 C11AM8I 2S STtLEE.T City JQ Yo21c State Oq Zip 10007

III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name . M 11a ICu¢ZSAN 4 Sort Coe'T OL 13. Contact Person LOUIE I f*Nu1CO 14. Federal Employer ID. # P_I.!_._._._._._ 15. Tel. # ~C ta) 531-2900 Fax # CTIS 209 - 1808 16. Address 124 t3 R^tom H A'QE-MUE City Qe00KW~t State N9 Zip _II " 36 V. THIRD PARTY AIR MONITOR

17. Name WAR-Q-EU 4 NZM t2 I NeE25 18. Contact Person J ICI&AEL %1O&,

19. Federal Employer ID. #j .!.!L. J 20. Tel. # C212) 922-ooTT Fax# C212) 922-0630

21. Address _ZS EAST 45 TN ST2E 6T City NEt'. YoLK State N'? _Zip (001t 22. Sample Analysis Laboratory. 23. NYS DOH ELAP # VI. PROJECT INFORMATION 24_ Starting date for this portion of work O$ 118 102 Projected completion date . 99118 L2_

Asbestos work schedule ® Monday ® Tuesday ® Wednesday ® Thursday ® Friday ® S Shift from: 1 I am ❑ pm to 8 ❑ am ® pm If other, 1 4. ~ specify *ECEIVED I Access to inspect the premises must be provided during the work schedule indicated in this item AUs 20 2002. 25. Total amount of asbestos-containing material to be abated during this work

12546 Square Feet, and/or d Linear Feet ~ / ACP 7 212001 dip !ut!tU Of MIRM1M~f. RfY , A;BL„Os CENT pROCRJJI U2

NYC-WTC 000111366