Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

) (G `pµ~„*, f, ry NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION '3 C` Asbestos Control Program 59-17 Junction Boulevard. 8e Floor. Corona. NY 11368-5107 3uilding Oept. or TRU No ONLY D ~I■rp d~ ASBESTOS PROJECT NOTIFICATION FOR OFFICIAL USE ONLY

7YPEWATEN FORM BE fNN O (ASBESTOS INSPECTION REPORT) 1. ACC ._erc.ter/a<r. fee

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

NI ACILITY

83 MA ~ OEN f_At.1E Borough MAW —zip _- 10038 2. Address _

AKA 3. Block ___2.!____ 4. Lot 3 --

5. Type of — 6. Name of Building

II. BUILDING OWNER

7. Name MAIDEN L.M4 € -- ' 8. Contact Person

9. Tel. # ± 47 f --__Fax#

10. Address _L`I2J AMELL~s~ —F~—`Z City ---_ State i4.4. Zip °G

III. GENERAL CONTRACTOR

11. Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name B~NlAMEN kE)rL28AN Soo CoNv1z.oE_ — INc _,_13. Contact Person _ L004E1pNN

Fax # o9tot3 ——_ 14. Federal Employer ID. #j. . . .!.!! _.. ...L__ 15. Tel. # City — B~OKE_YN —~ State N_ Zip _11236 16. Address —_12A16 RALPr1—AJE NYE -_-----

V. THIRD PARTY AIR MONITOR

17. Name W494-04_I_PAu2 EN6,NNr=r=2S __---- _18. Contact Person _~i1%WACL- 00EA13

PII _._._._._._._.~___ 20. Tel. # (21?) 9?2-oo7T 924- O. 3o — Fax # (2E2) 19. Federal Employer ID. #_._,_ --- 45_M S — City — NEw yo¢E- _ State _NQ_ Zip _ 10o Et 21. Address Zs 6 FAST FL—

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

VI. PROJECT INFORMATION 24_ Starting date for this portion ofwork O S - 2T- OZ _ Projected completion date

Asbestos work schedule ® Monday I Tuesday IN Wednesday I Thursday I Friday ® Saturday_® Sunday

Shift from: _O ©am ❑ pm to _ ❑ am ®pm . 1d `:

If other, t ' specify ~------------- - ------- ------ - ~E~yED Access to inspect the premises must be provided during the work schedule indicated in this item. nq

BURfAU~E1`M `.' 25. Total amount of asbestos-containing material to be abated during this work r, a,wcuu +oS~

(312 — Square Feet, and/or —_Q— Linear Feet ~"~ /

212001

8 WAU~jopf~ENVipp .~A9ES105 CON~~ PROyX14

NYC-WTC 000111368