Asbestos abatement invoice, 198 Broadway, Aug 2002

NYC 9/11 Public Portal Document

copies with original When submitting this form at the NYC Department of Buildings, the original form and three (3) original signatures. This signatures are required. Submittal at the NYCDEP requires one copy of the form with of abatement activities form must be submitted to the NYC DEP not less than one week in advance of the start

I. FACILITY _ Zip 2. Address 19 lR o D W A`r®---.v._.—.~_.._--- ____. Borough

_ ®—_—_ 3. Block ?'9 —~ 4. Lot I E3 AKA ___~-- ®_ —

5. Type of Facility t°a S C+---------- 6. Name of Building —

II. BUILDING OWNER

7. Name -CCwt uecu_—®_ —~__— -- 8. Contact Person --

9. Tel. # (212) 233-196Ci Fax # _ _...._.---.___....~.—_.._--

City 1J `(o --. --- - State _ZiP 10. Address _45 ,Ou At ! 5'

Ill. GENERAL CONTRACTOR --.__—._ —®_ ---__ - G,- ,- ---__--_ 11. Name_ ®

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name i3 A lh1 W' e *' 4 SO tt l2a JT L 13 Contact Person LUlE LA iLCO —®

C1tE3)5 1t 29 _____— Fax # (Zt ) 2 9 I O 14. Federal Employer ID. # PI'._._._._._._._._. 15. Tel. #

16. Address _1 2 A 8 1 N QV ~4E _ ~_n-- City __- - N _— _ State Nj — Zip _ 11256

V. THIRD PARTY AIR MONITOR

17- Name W PAN ENF ►►s e~J!~ ®_ _ __18. Contact Person cc*ZT — Fax 19. Federal Employer ID # 1 P.I ._._._._._._._._. 20 Tel. # At2t2> 922-

E7Asv__4S rN_SL r -- --.,-. City ® ®®______ State N Zip 100`T_ 21. Address

_ ____-- ----_____— 23, NYS DOH ELAP # 22. Sample Analysis Laborato _

VI. PROJECT INFORMATION / Projected completion dale 24 . Starting date ,eor this port i on of worK -_-~--~C _

Wednesday Thursday Friday Saturday Sunday Asbestos work schedule Monday Tuesday

6 T: c g ca ~` Jn am ❑ pm tc __._—__ am ~ pm Shift from: - ___ ~

If other, _ ____—~ _ — __ jam specify _— ~______ ---- /

work schedule indicated in this item. ✓Cj c'✓ Access to inspect the premises must be provided during the /

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

NYC-WTC 000123195