Asbestos project notification form

NYC 9/11 Public Portal Document

cv NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8°t Floor, Corona, NY 11368-5107 4W01:22ao Building Dept 3 TRU No A/ FOR OFFICIAL USE ONLY \ ONLY TYPEWR i4 ASBESTOS PROJECT NOTIFICATION FOR ma1a vaØ<<6"~~ (ASBESTOS INSPECTION REPORT) 1. A& F&... (see 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.

1. FACILITY 2. Address 300 Rector Place - Apartment_._._P!._._._. Borough Manhattan Zip 10280

AKA 3. Block 16 4. Lot 7504

5. Type of Facility Residential Apartment Building 6. Name of Building Hudson View It. BUILDING OWNER

7. Name Akam Associates 8. Contact person Don Moskovic

9. Tel. # (212) 986-0001 Fax #

10. Address 8 West 38th Street 7th Floor City NY State NY Zip 10018

111. GENERAL CONTRACTOR

11. Name Termon Construction Inc. Tel. # (718) 694-0900

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Specialty Service Contracting Inc. 13. Contact Person John A. Tancredi

14. Federal Employer ID. #_._._._._._._._PII 15. Tel. # (201) 941-8292 Fax# (201) 941-6992

16. Address 845 Broad Ave City Ridgefield State NJ Zip 07657

V. THIRD PARTY AIR MONITOR

17. Name Athenica Environmental Services Inc. 18. Contact Person Theresa Vasquez

19. Federal Employer ID. #1_._._._ _ _ PII 20. Tel. # (718) 784-7490 Fax # (718) 784-4085

21. Address 45-09 Greenpoint Avenue City LIC State NY Zip _11104

22. Sample Analysis Laboratory EMSL 23. NYS DOH ELAP # 11506

VL PROJECT INFORMATION 24. Starting date for this portion of work 1/24103 Projected completion date 1/29/03

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

Shift from: 9:00 Elam ❑pm to 5:00 Dam ©pm

If other, specify Saturday if owner approves. Sampling Tuesday. Results Wednesday. Access to inspect the premises must be provided during the work schedule Indicated in this Item. t~ G c~ `O ~~t► ® i

25. Total amount of asbestos-containing material to be abated during this work v ~y 0 Square Feet, and/or 0 Linear Feet .1~ :++ ACP 7 . - zrzoo,

NYC-WTC 000116312