NYC 9/11 Public Portal Document
7i!ENI~ - L PROTECT
W NYC grarfi
ona. NY 11368- 7 uNo
8ur~+Y
ONL
DP; OTI~ICATIO
Fono o~Y
TYPEWRITTEN --= l REPORT)
FORMS WILL BE 1 $( 7 nn nn
.yc I• un aw fee sdled ")
ACCEPTED
When submitting this original form and three (3) copies with original
signatures are requIred. L6bmIlt&-st-the-NYCDEP~req ilres one copy of.lha form with original sgnatuxes. This
advancs,of the start of abatement activities.
form must be subrtlitted to the NYC DEP not less than one week In
1. FACILITY
100 Church Street Borough Manhattan Zip 1110117
2. Address
.3. Block 1 25 4. Lot 20
AKA
6. Name of Building
5. Type of Facility
II. BUILDING OWNER
Church, LLC. Zar Realty 8. ContactPersOrtJ 1 i ni shah
7. Name 90
Fax# (212)46 -SSS4
9. Tel.# (212)971-0111
384 Fifth Avenue City New York State NY Zip 1001R
10. Address
111. GENERAL CONTRACTOR
Tel. #
11
IV. ASBESTOS ABATEMENT CONTRACTOR
192 Branch Interior Services Inc 13. Contact Person Chris Sal i ani
12. Name
P11 15. Tel. # (6 31 ) 5 6 3 7 3 0 0 Fax # f6 31 )563-73R9
14. Federal Employer 10. #_._._._._ _ _ _
Colin CityHolbrook State NY Zip11 741
16. Address 101-2 Drive
V. THIRD PARTY AIR MONITOR
18. Contact Person Peter Shark
17. Name Ambient Air
20. Tel. # (212) 944-461 5 Fax # s 6 31 )563-7389_
19. Federal Employer ID. # L._._. P11
Street City New York State NY Zip___
21. Address 55 West 39th
Ambient Air 23.NYS DOH ELAP# 10865
22. Sample Analysis Laboratory
VI. PROJECT INFORMATION
1 2 /07/ 01
1 1/ 1 4/ 01 Projected completion date
24. Starting date for this portion o••~~ftwork
~y Thursday I Friday U
Asbestos work schedule l:.:r Monday ®Xfuesday ® Wednesday
Shift from: 8 :00 a am ❑ pm to 8 ' 0 0 0 am ® pm
RECVE0
If other.
specify 71 NOV 3 0 2001
indicated in this item.
Access to inspect the premises must be provided during the work schedule
during this work
25. Total amount of asbestos-containing material to be abated
79 50 0 Square Feet. and/or _____0 Linear Feet
ACP 7
212001
NYC-WTC 000126757
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