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Asbestos Project Notification form, Oct 2001

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NYC DEP Asbestos Project Notification form for an inspection report submission.

NYC-WTC_000111453–000111499

Folder label: “Zone III Originals

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NYC 9/11 Public Portal Document

uWRL NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 80' Floor. Corona, NY 11368-5107 X14'3 8u"Ing Dept. or TRU N a FOR OFFICW. USE ONL ASBESTOS PROJECT NOTIFICATION 1r - FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED (S fee Schedule

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 50 Broadway Borouga4anhattan Zip10004

AKA _ 3. Block 22 _4. Lot 24

5. Type of Facility________________________________ 6. Name of Building II. BUILDING OWNER Colliers ABI 7. Name 50 Broadway Realty Corp. c/o 8. Contact Person

9. Tel. # 212-758-0800 Fax# 10. Address City State Zip

111. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan

14. Federal Employer ID. # PII L. 15. Tel. # 71 8-961-41 00 Fax # 71 8-961-41 03 16. Address 14-20 129th Street CityCollege Point StateNY Zip 11356

V. THIRD PARTY AIR MONITOR

17. Name Warren & Panzer Engineers, P.C. _18. Contact Person Michael Nolan

19. Federal Employer ID. # 20. Tel. # 212-922-0077 Fax# 212-922-0630

21.Address_228 East 45th Street city New York State NY Zip 10017

22. Sample Analysis Laboratory Warren & Panzer Engineers 23. NYS DOH ELAP # 1 1 251 VI. PROJECT INFORMATION —/ 24. Starting date for this portion of work / Z? t1 Projected completion date Z7 (J Z

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday 0 Saturday ❑ Sunday

Shift from: _❑am ❑pm to Dam ❑pm 1 I 1r ~ If other, specify [hC,f~L Access to inspect the premises must be provided during the work schedule indicated in this item. ,~, JUL 2 6 2u~2 DEP/BAfltit.' 25. Total amount of asbestos-containing material to be abated during this work SgESTOS/l.c 51 770 PaoGaHt: Square Feet, and/or Linear Feet \\...s,>.>. TRUG f ACP 7

NYC-WTC 000111461

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NYC-WTC_000111461Source: NYC Law Department, mirrored locally

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