Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION J CITY Of/A,4 Asbestos Coe tegLPrpgram 59-17 Junction Boulevard. 8'h Floor, Corona. NY 1136&5107 JL'# 'k Building 1 t0. f D...P ccdd ASBESTOS PROJECT NOTIFICATION Dept.WTRU FOR OFFICIAL USE ONLY PEWRITTEN MMrtinuinoR FORMS WILL BE ACCEPTED (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.

I. FACILITY

2. Address _34 fu3TON S•Teec-'T----- N--- __ Borough — kN --- Zip _ (OOSB

AKA J29_FutSOn1 Sil2EEI —/— AO 5 ,M4Ee:T --- 3. Block _ I. . 4. Lot t3_ -

5. Type of Facility___---__--------__--- 6. Name of Building --- N —_----~~~—~

II. BUILDING OWNER

7. Name C o ME —_ -- _ 8. Contact Person MAR1 A 11 aL q oLIV il R AS _

9. Tel. # (212)9CA-S2c22 _Fax# C21z)96A=t3o3 ---

IOG27 _ 10. Address _B9 _ C4 AM B4E(LS— 5 MEE----- City . State ±.L. Zip

III. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name IC~¢z6L~N SRti 001 -1 i'OL- —_13.ContactPerson l-ou%EIAN►J~CO ----

14. Federal Employer ID. # PII 15. Tel. # 1_2900 --~ Fax #«~S~ 2c9- ISOS —_

16. Address _ H AvcN~`t __--__--- City —.DSS v `I _--_ State N,̀r Zip _ t c 2 3G —_

V. THIRD PARTY AIR MONITOR

17. Name Li?RPRE►J_ _!AAZt= - ItN6i aeE25 __—__——_18. Contact Person --- 22-0630 _-- 19. Federal Employer ID. # P11 20. Tel. # ~7~2) 92_~_oot'( -- Fax # _

21. Address 2~ EAST 4S TR S'n.~ ET _ City New {{0 _~—___ State iLi _ Zip .J921.!_...___

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

VI. PROJECT INFORMATION

24.. Starting date for this portion of work _ 0$ I i s 102 Projected completion date

Asbestos work schedule ® Monday ® Tuesday ® Wednesday ® Thursday ® Friday ® Saturday ®.Sunday

® am ❑ pm am ® pm 9 10 Shift from: _$f— to ...._ 1 0

If other, specify ---------------------------------------------- I. ECEIVED .J, Access to inspect the premises must be provided during the work schedule indicated in this item. AUG L20 :I~f2. lJ Fr

25. Total amount of asbestos-containing this work

Square Feet, and/or::;:::::z: ~~ t

9C?rAJ rr EI"'..........I

IFI12

NYC-WTC 000111370