Asbestos project notification form, [date]

NYC 9/11 Public Portal Document

2 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8s' Floor, Corona, NY 11368-5107 lewo 5o3 - Building Dept or TRU No FOROFFICIAL USE ONLY WRITTEN ' ---nb.! ASBESTOS PROJECT NOTIFICATION \.,,VYORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED (See fee sch Ie) 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.

1. FACILITY

2. Address 66 PEARL STREET Borough Manhattan Zip -10004-- AKA 3. Block 7 4. Lot 7501

5. Type of Facility RESIDENTIAL _ — _— —_—__ 6. Name of Building e II. BUILDING OWNER

7. Name ORB MANAGEMENT 8. Contact Person WYN CHAMBERLIN 9. Tel. # (212) 246-1330 Fax #

10. Address 41 HUDSON STREET City MANHATTAN State NY--- Zip 10014 111. GENERAL CONTRACTOR

11 Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name -JBH E VIRONMENTAL, INC. JAMES BOOTH ---13. Contact Person --- ---- N ----------- ------ ---------- — ------- — - - r PII 741-5807 (516)-_----~---.-•_-- 14. Federal EtYlployer IL._._._ _ 1 )----- 56 15. Tel. # .~_-- 741-1!!__.___ — Fax # —._.. 16. Address 1 94 ATLANTIC AVENUE----- ---_—_ City GARDEN CITY PARK- __ State N1__ Zip - 11040

V. THIRD PARTY AIR MONITOR

17. Name COLE CONSULTANTS - ---- ----------18. JOHN ANOFIRO Contact Person ---------------__--•

19. Federal Employer ID. # --------_-----_ 20. Tel. # (914) 345-6000--_—_ . Fax # 2269 SAWMILL RIVER ROAD ------- _ — _ City ELMSFORD _— ---- 21. Address --------------_—_-- State NY Zip 10523 -~

22. Sample Analysis Laboratory EMSL ANALYTICAL _-- - - --- -__--__ _ 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24. Starting date for this portion of work 3 / 11 / 0 3 _— Projected completion date 4 / 11 / 0 3 __

Asbestos work schedule 0 Monday El Tuesday El Wednesday 0 Thursday 0 Friday ❑ Saturday ❑ Sunday Shift from: 8:00-__ 0 am ❑ pm to 5 00_-- ❑ am 0 pm If other, specify

I Access to inspect the premises must be provided during the work schedule indicated in this item. I

25. Total amount of asbestos-containing material to be abated during this work — — 650 Square Feet, and/or _—_—_—_P Linear Feet

ACP 7 2/2001

NYC-WTC 000115468