Asbestos project notification form, 100 Church Street

NYC 9/11 Public Portal Document

—' r , 7 ~ ` on. avy, !w NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program T1Pa /75711/14 TYPEWRITTEN D ur 59-17 Junction Boulevard. 8' Floor. Corona, NY 11368-5107

ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU No FOR OFFICUL USE ONLY

FORMS WILL BE r'- (ASBESTOS INSPECTION REPORT) 1. t✓ ACCEPTED •!!' 1! t. be etheduls)

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 d 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 l? • 2. Address I 7l 0 ~ 0 2 C-N 1 tE 1 Borough N 1 lap __f O dO

'JA _4 4 _ -At- I - ~-/ 3. Block a- 4. Lot D

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

7. Name _I C ~{-t t e--C " L~L & 7A -2 `r4-BTCotad Person Ov -,Y' ~-2 e~

S. Tel. tt1?-t 91 t' o f 1k Fax

10. Address 3 . 1 T'E'S L City _State _ZapZip (

Ill. GENERAL CONTRACTOR

11. Name Tel. Zk

IV. ASBESTOS ABATEMENT CONTRACTOR

• 12. Name -#~ L e!L G7 _ _f 13. Contact Person 7 C-.as1 ) 14. Federal Employer ID. a'2 .H._._._._._._. ? 15. Tel. # 616 - 7V -300 O Fax# 5f _?, ' 3'85

16. Address 201) O , 4ve City ____________State Zip 1 -?

V. THIRD PARTY Al MONITOR ~j A~ ff 17. Name Q kr42E . J6'• l~-' S PC 18. Contact Person Alt (..(O L. Ar4 .

19. Federal Employer ID. #_____________ 20. Tel. if (3 - 99P - 001Z Fax a .2Ja

21. Address a B AS I_1{ S'f E ( City /Y' 7(7 State j Zip -

22. Sample Analysis Laboratory Sc(f1`(1 lL / t^ CJs ~ r~sj ~~ 23. NYS DOH ELAP # ! f S

VI. PROJECT INFORMATION 24. Starting date for this portion of work 10 a Projected completion date if .&f b).-- 1 Asbestos work schedule D Monday ❑ Tuesday ❑ Wednesday 0 Thursday 0 Friday 0 Saturday,;

Shift from: ❑am❑pm to fl am❑pm

If other, specify

Access to inspect the premises must be provided during the work schedule indicated in Us kem.

25. Total amount of asbestos.containing material to be abated during this work

WA.l 2L Square Feet, and/or Linear Feet ACP 7 r»~~ Ot 2 OOt

1 * r ':S v wlR;t IF:-r;,q K,.r

NYC-WTC 000126767