NYC 9/11 Public Portal Document
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TYPEWRITTEN S `=:~oiri► 1
FORMS WILL BE ` 1. $ 00 0 (L—
ACCEPTED ••• •" ~•• "~ (5M fee schedule)
and ewes (3) copies with aghrel
When submitting this f one copy o(9hs form with odginal signatures. This
signatures are required. advance of the start of abatement activities.
form must be submitted to the NYC DEP not less than one week in
1. FACILITY
100 Church Street Borough Manhattan Zip 1 nnn7
2. Address
3. Block 1.2 5 4. Lot 20
AKA
6. Name of Building
5. Type of FacIlity
1I. BUILDING OWNER
LLC. Zar Realty 8. Contact Persorua ll i ni Shah
7. Name 90 Church,
Fax )465—Rcc4
9.Tel.# (212)971-0111
384 Fifth Avenue City New York State NY 711) 1 nn1 R
10. Address
Ill. GENERAL CONTRACTOR
Tel. #
11
IV. ASBESTOS ABATEMENT CONTRACTOR
Branch Interior Services. Inc _ 13. Contact Person Chris Sal i ani
12. Name 192
15.Tel.# (631 )563-7300 Fax# ( 631 )563-7~R9
14. Federal Employer ID.i---
Drive City Holbrook State NY Zip1174l
16.Address 101-2 Colin
V. THIRD PARTY AIR MONITOR
18. Contact Person Peter Shork
Ambient Air
17. Name
19. Federal Employer ID. #
PII =- 20. Tel # (212) 944-461 5 Fax # (631) 563-7389
Street City New York State NY Zip
21.Address 55 West 39th
Ambient Air 23. NYS DOH EtAP # 1 0865
22. Sample Analysis Laboratory
VI. PROJECT INFORMATION
11/1 4/01 projected
i completion date 1 2 / 07 / 01
24. Starting date for this portion of work
Monday ® uesday ( Wednesday Thursday 0 Friday 3~~~atf
Asbestos work schedule h
Shift from: 8 :00 $a am ❑ pm to 8.0 ❑ am ®
0 pm
RECVEO
If other.
snAdti NOV 3 0 2001
Access to inspect the premises must be provided during the work schedule indicated in this item. = ,,
RUG
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
?12001
NYC-WTC 000126772
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