Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document , / v NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program / '` ~ IBttr 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 3uilding Dept. or TRU No I>rr FOR OFFICIAL USE ONLY tea. rRMSW ITTEN ASBESTOS PROJECT NOTIFICATION a! 'yuFNru INSPECTION REPORT) t'. K -~i&MS WILL BE (ASBESTOS • ,%?' ;/ ACCEPTED www.nrc.lov(aer fee

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

I. FACILITY d 1—,SPAN S -I MC-E-r Borough SAN --- Zip --10038 ---_ 2. Address 3. Block Nt8 ---__ 4. Lot - I Sot AKA

5. Type of Facility___ Mlxt=o ' . -------- 6. Name of Building

II. BUILDING OWNER

7. Name 8. Contact Person

9. Tel. # Fax #

10. Address City State _____ Zip

Ill. GENERAL CONTRACTOR

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

V. ASBESTOS ABATEMENT CONTRACTOR I -_13. Contact Person _~outE IaNN 1 co --__— 12. Name C3elalanAlu kuRZ156! ' Soa _CA17TROL --

14. Federal Employer ID. # L. _. _. _. _. _PII _.. _ 15. Tel. # _sii9~53i_29oo___ —__ Fax #

16. Address I24 8 Qslr_P K Av iEW v C ----- City BR.ao►c y L__ State Nom__ Zip ..J11_...

V. THIRD PARTY AIR MONITOR

17. Name __----- _18. Contact Person _ M Wow---

PII 20. Tel. # C2~2~~ 22- c oT t__ — Fax # jZ 2_)_ .ia. o63d____ 19. Federal Employer ID. #1

21. Address 22 8 si___45T11 STr -et" City U'~__--______—_ State _ N~_ Zip _J_2 ! ...

22. Sample Analysis Laboratory. 23. NYS DOH ELAP #

VI. PROJECT INFORMATION ++ O_i (2 2 24.. Starting date for this portion of work _ 09 10T (b? Projected completion date _ yC

Asbestos work schedule I Monday I Tuesday I Wednesday ® Thursday Q Friday ® Saturd?y . day

Shift from:

If other, [Z am 0 pm to ❑ am ® pm /7 specify ------------------------ ------------- RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. SEP 6 2002 25. Total amount of asbestos-containing material ot be abated during this work ort~~ ,1 —_ 1-64S9 Square Feet, and/or _______2__ Linear Feet ACP 2/200 g',PEiU OF ErnilotIVSS'll _NEa,A(:Q1 % ENcCSCEMENT ;jaf: SAS CAN.P..OL

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NYC-WTC 000111352