Asbestos project notification form, 100 Church Street area, undated

NYC 9/11 Public Portal Document NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ' p 4 Asbestos Control Program D R r 59-17 Junction Boulevard. a Floor. Corona. NY 113MSI07 • Bolding DeKlar No TYPEWRITTEN :' ASBESTOS PROJECT NOTIFICATION FOROFFICALUSEOW:v

FORMS WILL BE _ _ "="'1O (ASBESTOS INSPECTION REPORT) ACCEPTED ~—• :L•,L:r:•t. 1.

Ven submitting this form at the NYC Department of Buildings, the original form and three (3) copies with P '. 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.

Ic CILITY n 2. Address O t l µ U C.f} S 12i I- ( Borough Zp O Od AKA 3. Block 4. Lot 5. Type of Facility 6. Name of Building II. BUILDING OWNER

7. Name 10_CL Hu CL-H; Z fc 2 (?E A4* *t Contact Person _ ' . ____r ) 9. Tel. # Fax. 10. Address r.J l > ` State Zip 11I. GENERAL CONTRACTOR

11. Name Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 'E' 4 13. Contact Person ~~) (o ~1_— ' /g 14. Federal Employer ID. #- PIE -I 5. T .# $ 16 - 751 - 3 °0 O Fax# 51 16. Address es rty J 177v/ State Zip I!? _ V. THIRD PARTY AI t MONITOR

17. Name ) P. kr(Z E . it ,bS Pc 18. Contact Person IM11tr fL (tr ot- A-r`I - 19. Federal Employer ID. #_____________ 20. l.# of 3 - 9a2- OO~' Fax # L -qua -OE, D 21. Address,, € T r`'J< ~I'UEE7_ // City 1Y" _'7 State !47'Zip 00 22. Sample Analysis Laboratory C(f 1 (' - /' 23. NYS DOH ELAP # d VI. PROJECT INFORMATION r 24_ Starting date for this portion of work 'O t O~ Projected completion date _I rc:) Asbestos work schedule D Monday D Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday 0 Sunday

Shirt from_ D am D pm to ❑ am D pm If other, ll it specify ti T

Access to btSPect ttte Prarrtises oust be provided during the wor*schedule indicated in this kern. RECEIVED ' OCT 15 25. Total amount of asbestos-containing material to be abated during this work ratr~ Square Feet, and/or Linear Feet `` mur ` o~ ACP 7 tt! ri E ic w, 2=1 :i Ltrryrry y

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NYC-WTC 000126547