Invoice for facade cleanup, 200 Church Street and Duane Street

NYC 9/11 Public Portal Document

prr 004 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION (.:3 CO Asbestos Control Program smction Boulevard, &' Floor, Corona, NY 11368-5107 Building Dept or TRU No FOR OFFICUIL USE ONLY ' IFC P(TEW ASBESTOS PROJECT NOTIFICATION WILL BE ~~+°na~iNruiaon°coy' (ASBESTOS INSPECTION REPORT) EPTED ~`'~•^fit je+l~M, 1.

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 NYCOEP 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 L -1 N _ I T Borough N Zip e~.►~t AKA —) ~ 1 & S f _ 3. Block y — 4. Lot _

5. Type of Facility_____ ----- 6. Name of Building — II. BUILDING OWNER

7. Name 2 D Cj&C_±_1 C I AT £S 1 LC8. Contact Person r ------

9. Tel. # -------------- Fax # ---

10. Address City -- U — \ ---- State _-N Zip L O 0 O _

111. GENERAL CONTRACTOR

11. Name-------- ---------- Tel. # -------_________

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name -/- ~ ~U __ ---`---` 13. Contact Person PII —._._.~ 14. Federal Employer ID. #; . W Tel. a # ------ 2@ -3 ! --- — Fax # _--__--------_ 16. Address ol&v 1_v --------City _2/ /3 — _ State Zip

V. THIRD PARTY AIR MONITOR pp , r 17. Name _b Oj_ ~Fe~T? S rh C 18. Contact Person

19. Federal Employer ID. # _ ---------- 20. Tel. # _QJ=~aa-~~ — Fax # I_~~a=~~

21. Address S'sr' ---- City _d ——_ State L~Y Zip _

22. Sample Analysis Laborato S`(~M!l <<-h A6 C -P-'A~`rf~S ~ c 23. NYS DOH ELAP # _ L f 4 VI. PROJECT INFORMATION 24.. Starting date for this portion of work L . Projected completion date ~P

Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Satu -da_❑`Sunday

Shift from: --`_ ❑ am ❑ pm to ---- ❑ am ❑ pm

If other, specify Orcfl"iEo 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

d-I~L✓ ou — Square Feet, and/or _—_ Linear Feet r / ACP 7 212001 0 Grad PFCuR1tf rrn~

NYC-WTC 000126451