204 BROADWAY 1001222, 79/21

NYC 9/11 Public Portal Document

/ v Oo h, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION \ Wn Asbestos Control dram C 59-17 Junction Boulevard, 8"' Floor,~t:or .s .• 11368-5107 E--s it Qt~P; • Building orTRU No FOR 0"10&usEop&y IASBESTOS PROJECT NOTIFICATION WJLL BE .,.. rura vao (ASBESTOS INSPECTION REPORT) •I, s~~ftW EPFED www.nyt.Eerl~rr, (See feeSCwU

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 20A BRGAOUA¼ Borough Mats Zip 2. Address AKA 3. Block — 4. Lot

5. Type of Facility C. 4E2C4 At 6. Name of Building

II. BUILDING OWNER Nac~ 7. Name COtMt.E61ATE Citt;t2C 4 8. Contact Person _MD_?t iv

9. Tel. # (212) 233-196O Fax# N cR~ —__-__ State _Y _ Zip tG S ___ 10. Address _ d5 ..i0PI4ScetrE= ____ — City

III. GENERAL CONTRACTOR

11. Name---__---- --------- Tel. # .—__.__M

IV. ASBESTOS ABATEMENT CONTRACTOR

12, Name t3Eta~N+tJ i~tifMZ3AN $ S"4 Cco t. I s+ .-- _13. Contact Person _Lc'~'te— lflN""« ~_— —At 14. Federal Employer ID. # _ .-~- 15. Tel. # tYts) X31_ 2yCc~-- Fax # _c tits) 2G9-160$ -- State NY__ Zip _1123 — 16. Address (2AS F_R,-P►t A~iCtll:re ---- City o ±L___

V. THIRD PARTY AIR MONITOR

17. Name _tztAR_ was PR(JZt's.R v + ►>`C r~s ___.--18. Contact Person M IC9AC-LiJ__AN --

_ w 20. Tel. # t2 t 2 j g22-M f L__ Fax # 3 ti z )922 ' 3y 19. Federal Employer ID. #.~ _N .-.-. PII 21. Address _22t3 EAF't Q5tip S T__.____ City L t ___- State _Nti _ zip- I QOi? --

22. Sample Analysis Laboratory, 23. NYS DOH ELAP #

VI. PROJECT1fTORMATION Get-o1-O2 Projected completion date _ o-4? ~ z9._- 24.. Starting date for this portion of work

Asbestos work schedule 91 Monday ® Tuesday 91 Wednesday 0 Thursday I Friday 0 Saturday 0 Sunday

Shift from: _ E~L ® am 0 pm to EF ❑ am ® pm / ) ii!r7), l/ If other, specify __ --------- - -------------- — R£cEiVEO Access to inspect the premises must be provided during the work schedule indicated in this item. AUG 0 7 2002 3A,NKI 25. Total amount of asbestos-containing material to be abated during this work 12 33O Square Feet, and/or Linear Feet AC

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NYC-WTC 000123275