Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION estos Control Program 59-17 Junction Boulevprd. 8"' Floor, Corona, NY 11368-5107 Building Dept. or TRU No A FOR OFFICIAL USE ONLY ONI" T' tL r,uiean°C ASBESTOS PROJECT NOTIFICATION L_ (ASBESTOS INSPECTION REPORT) I. - -w.nyc.rar(d.P. fee ~y. 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 NYCOEP 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 44 JON N 5 reeEr -----_~ Borough __ MN Zip _ 10038 2. Address 3. Block 6 _ 4. Lot 90 AKA ------------------------- --

5. Type of Facility__, cµt 0.4 6. Name of Building

II. BUILDING OWNER - J. M c G,0^40 7. Name cLa JO1NN STeFE-r UN"TED Mr<-cuootsr CMuRCA _ 8. Contact Person

9. Tel. # _ (L 12 ~ 269- aO f 4 —__ Fax # _------------

10. Address ----- City — Nt _Y ca —__—_ State --my _ Zip

Ill. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR 3&A, ku~ zaP SaN Cco ,— ZOI. IN--• 13. Contact Person LcutE IAl1NIC0 12. Name ------ --------------------------- 14. Federal Employer ID. # ._._._._._._._PII -J...___ 15. Tel. # tut3) 53t_- 29oU_--- Fax # _!1236--_ 16. Address ► 24t3 awrt _A_v_rcNUE__ — _ --____-- City S ±t'±___.. . State NL._ Zip

V. THIRD PARTY AIR MONITOR

17. Name ~,aRf2QP.. - - Lee. cifac i w Bees __ ___— _18. Contact Person ----- I____ ___ 20. Tel. # t 2+'s) 922 - or,T 7 Fax # 2t 2) 922 ^ 06 30 19. Federal Employer ID. # = 21. Address T 45ru S-r1Q:4'r ----- __ City ~~u_forz~_-__--_ State _►~ti' _ Zip _ iCOtT _

22. Sample Analysis Laboratory 23. NYS DOH ELAP #

VI. PROJECT INFORMATION t2 24.. Starting date for this portion of work _ c `-''~ 1 o?___ Projected completion date __►o (i 02 __

Asbestos work schedule ® Monday I Tuesday ® Wednesday © Thursday © Friday ® Saturda' s Shift from: 8 ® am 0 pm to 8 __ 0 am ®pm

If other, specify 7 ~', V G~ Access to inspect the premises must be provided during the work schedule indicated in this item. J( !fl %.?

y bJWA a t'K

25. Total amount of asbestos-containing material to be abated during this work 0 Linear Feet S Square Feet, and/or b ACP 7 2/2001 o4pr*i1 of ! P

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NYC-WTC 000111348