NYC 9/11 Public Portal Document
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NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8"' Floor. Corona. NY 11368-5107
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ONLY ,. ®~1I — ) 1 FOR OFF . USE ONLY
TYPEWRITTEN ~<o.,_ 4/ ASBESTOS PROJECT NOTIFICATION
FORMS WILL B " O -- (ASBESTOS INSPECTION REPORT)
1.4ee~te~e
When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original
signatures are required. Submittal at (he 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
53 Nassau Street
2.Address Borough Manhattarizip 10005
AKA 3. Block 64 4. Lot 5
5. Type of Facility__ 6. Name of Building _
II. BUILDING OWNER
7. Name Century Realty, Inc.
8. Contact Person
9. Tel. # 212-267-7778 Fax #
10. Address - City State Zip
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan
14. Federal Employer ID. # 15. Tel.# 7188-961-4100 Fax# 718-961-4103
16.Address 14_20 129th Street CityCollege Point State NY Zip 11 356
V. THIRD PARTY AIR MONITOR
17. Name Warren & Panzer Engineers, P.C. _18_ Contact Person Michael Nolan
19. Federal Employer ID. # 20. Tel. # 21 2-922-0077 Fax 212-922-0630
228 East 45th Street Ciry New York
21.Address State NY Zip 10017
22. Sample Analysis Laboratory Warren & Panzer Engineers 23. NYS DOH ELAP # 11251
VI. PROJECT INFORMATION
24. Starting date for this portion of work 7 3 oy • Z
Projected completion date
7J8
Asbestos work schedule Monday <t!I Tuesday n WednesdayZThursday riday ' Saturday (Sunday
Shift from: am ❑pm to Dam
If other.
specify
of 4
Access to inspect the premises must be provided during the work schedule indicated in this item.
RECENED
I
0 JUL 05 2002
25. Total amount of asbestos-containing material to be abated during this work 0EP/BANi ,
- SRESTDS/LEA r'
R
1,200 fi1GM
Square Feet. and/or Linear Feet
2
4 fZtiZ) 9. ~7 ACP 7
V2001
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NYC-WTC 000111473
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