Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

/L" cm oary~r NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor, Corona, NY 11368-5107 3uilding Dept. or TRU No r ASBESTOS PROJECT NOTIFICATION l- FOR OFFICIAL USE ONLY ~"\ .EWRITTEN hoa Nrµ OnctP (1~ RMS WILL BE _ CCEPTED ~w ^.yS teIar, (ASBESTOS INSPECTION REPORT) 1, (See fee 4 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. activities. form must be submitted to the NYC DEP not less than one week in advance of the start of abatement

I. FACILITY

2. Address 2j 3 __PEAP-I_ . S .L T______------- Borough — -- Zip _—0038

AKA ------------------------------3. 3. Block _ 69 —__ 4. Lot -S ---

5. Type of Facility 6. Name of Building

II. BUILDING OWNER

7. Name - ---------------- • . 8. Contact Person

9. Tel. # ------------- Fax # City State Zip _--__-- 10. Address -----__--__--__— -

Ill. GENERAL CONTRACTOR —M Tel. # 11. Name_----__—__-----_

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name e~*1 ► 2ESA Sou ti"tR~_ NC —_13. Contact Person _

14. Federal Employer ID. #; P -I I ___ 15. Tel. # (T ZS 31_2 0 C.___ Fax # _ <TL~~ 2oq_Lf~OL3 __—_ State UY __ Zip _i1t 2 36 _ 16. Address !24 $ _RtPN AV ENJE —__------ City ~Q W------

V. THIRD PARTY AIR MONITOR NctAty --- 17. Name U31)2REN_4_~AN2E«_ ENG~u~EQS—_-----_18.ContactPerson_ MIquAt_t—

19. Federal Employer ID. # PII _ 20. Tel. # .!2 aJ22=o h_t Fax #

Estis~ ASTGt SrrRer1 r --- City __u -/ ---_ State ~L.. Zip _ 1001(__—_ 21. Address _ 2? 8

22. Sample Analysis Laboratory____—_—__—__--------------- 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 1 O9~ 101oz Eel101o2 24. Starting date for this ponion of work _ __---_ Projected completion date ——____—___

® Monday ® Tuesday ® Wednesday © Thursday © Friday iaturday ®' Sunday Asbestos work schedule

Shift from: _ d"J ® am ❑ pm to a"t ❑ am 0 pm

If other. specify ----------------------- ---------------- KICEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. SEP S 192002 ~, 25. Total amount of asbestos-containing material to be abated during this work •ti. Square Feet, and/or _---c Linear Feet ACP

NYC-WTC 000111354