Asbestos project notification form, [date]

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION

I. Asbestos Control Program 59-17 Junction Boulevard, 8S' Floor, Corona, NY 11368-5107 3y3th Building Dept. or TRU No FOR OFFICIAL USE ONLY ti WRITTEN ~t oy,~aiA.x?'' ASBESTOS PROJECT NOTIFICATION ORMS WILL BE (ASBESTOS INSPECTION REPORT) 1. _E ACCEPTED :•; .o•;:a~,''d'< te—r c.d (See fee Sschad le)

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 66 PEARL STREET Borough Manhattan Zip 10004

AKA 3. Block 7------------4. Lot _ 7501

5. Type of Facility_RESIDENTIAL 6. Name of Building 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

III. GENERAL CONTRACTOR

11. Name --~_—_ Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name JBH ENVIRONMENTAL, INC. JAMES BOOTH ---13. Contact Person ----- ----------------- ---- -- — ----- ----- 14. Federal En`lployer ID. P 11 15. Tel. # (516) 741-1777 Fax (516) —.. 741-5807 -- --- ----- -- — - — 16. Address 194 ATLANTIC AVENUE------------- City GARDEN CITY PARK-- State NY __ 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 # (914) 346-0045 ---_---

21. Address 2269 SAWMILL RIVER ROAD City ELMSFORD _—_—_ State _NI___ Zip 10523 __-

22. Sample Analysis Laboratory EMSL ANALYTICAL —_ 23. NYS DOH ELAP# 11469

VI. PROJECT INFORMATION 24. Starting date for this portion of work Projected completion date

Asbestos work schedule 0 Monday El Tuesday El Wednesday 0 Thursday ❑✓ Friday 0 ❑ Sunday

Shift from: 800__ O am ❑ pm to 5:00 ❑ am El pm

If other, specify ----------- — - ------------------ --------- rf RECEIiVED Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work RARla 1 650 Square Feet, and/or _—_-_0 Linear Feet r ACP7 '~,% 212001

NYC-WTC 000115470