Asbestos project notification form, 100 Church Street area, undated

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION t2° / Asbestos Control Program 59-17 Ainx lion Boulevard. 8e Floor, Corwla. NY 11368-5107 7 PU /757144 8ua0mp Depf. or TRU No ONLY DAR FOR OFFICIAL USE ONLY TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1. 7,LI 1C, pe ACCEPTED —i!:i•a••~, (5u4 tee echsduls) 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 ,) O C , t U It nn_ C A Borough _M 1 p O t7 O —2D AKA 4 4' 1" a _ K. r 3. Block t - 4. Lot

5. Type of Facility 6. Name of Building 11. BUILDING OWNER

7. Name _I e"~ ~E'{-U.I-C1' LL "T - 2 Person Vw 9. let. ON ~e~-i l - 0% < < Fax #

10. Address ~ ~ ~ ~ u& ---City f" ' State F Zip 1ti)IV III. GENERAL CONTRACTOR

11. Name Tel. *

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 'e Co aJ, KO ( 13. Contact Person 7 _)/(1S/,9 14. Federal Employer ID. a _._._._. Ply t._ 15. Tet. * $ 1 _ _ 7V -3"0 0 Fax ll S! - 7,'-3'c85 pl 16. Address .,? P4 /7yt city KJ / State Zip 117

V. TIIIR-- PARTY All MONITOR

17. Name

19. Federal Employer ID. # Q$J e j Ait E2$I&4t 20. Tel.# 1 PC 2~a-9aa-e0 18. Contact Person h1t44itfL. (. OL#v 4 . Fax 21 _ -92a-0630 21. Address g ~r~ (c- t S'( F ( / City -~, 7'1=~1 9 _State_ Zip( 00

22. Sample Analysis Laboratory. SC -(f lL L A t _!~'I£$ 1 ct 23. NYS DOH ELAP # (I C.

VI. PROJECT INFORMATION 24.Starting date for this portion of work (0 a-- ~.Z-- Projected completion, date

Asbestos work schedule O Monday O Tuesday O Wednesday O Thursday O Friday O Saturday] Shift from O am 0 pm to ❑ am O pm

If other. specify Ac ess toInspect the promises must be provided during the work seheduk Jndxated in mis kern.

25. Total amount of asbestos-containing material to be abated during this work (p9, _f .. Square Feet. and/or Linear Feet ACP7 4!20(11

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NYC-WTC 000126544