Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 Building Dept. or TRU No FOR OFFICIAL USE ONLY EWRITTEN f , IM . .. Ri rHru!~ ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED w+:^rc.~evlear_ (See tee schedu )

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 __;L1! PEA ¢L__ SER - ~I — -----__ Borough MAN---- Zip _ i0038 --_

AKA —_ 3. Block 68 —__ 4. Lot _ 4 _- 5. Type of Facility__, 6. Name of Building

II. BUILDING OWNER

7. Name 8. Contact Person

9. Tel. # Fax #

10. Address _---- r ---__--__----- City State _____ Zip

III. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _6kwRut!t_' ~2BAu Sc N ~y L_ J_ -13. Contact Person _~cutE _IANu1co

14. Federal Employer ID. # _`.-.-.-.-.-.PII ___ 15. Tel. # _L-(t a) -_21.2.__ Fax #

16. Address _ 124E QA-L.P City 3acoK=v N __---_ State NY Zip ? 36 --_

V. THIRD PARTY AIR MONITOR

17. Name WAQa. _ 4 __PANzee ti I N~"~R5 __---- _18. Contact Person til t Ct3& —1~OLAn1 __— ----------- -------------------, 19. Federal Employer ID. # __~.y_ P11--+ ____ 20. Tel. # C2 ) 922=c_C?TT_ — Fax# C2t2) 922_060____ _

21. Address __2 2 cs __E A:sL 4S rN SY•R.EET ---- City __~~~?- del +___ _ State _L. _ Zip _ IOUIT __—_

22. Sample Analysis Laboratory 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24. Starting date for this portion of work _ CSI 1o I o 2 _ Projected completion date

Asbestos work schedule ® Monday I Tuesday I Wednesday 10 Thursday 0 Friday 121 Saturday ®Sunday

co ri Shift from: i am ❑ pm to $m ❑ am ® pm

If other, 1# \ specify -------------------------------- ------- EEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. SEP 6 .2002 h1P(AU(YU 25. Total amount of asbestos-containing material to be abated during this work \ ° i 14C:1T:0t1 j~ Ica y P(I — 9960 Square Feet, and/or____— 0 Linear Feet ACP' 2/200

NYC-WTC 000111350