NYC 9/11 Public Portal Document
ENTAL PROTECT / ~~~
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Moir. , NY 11
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TYPEWRITTEN `. ' •~_ ..- 1 .CT OTIFICAT10
FORMS WILL BE =" ="' wp REPORT) 1. _$1,2110 _ LLO
ACCEPTED •• ••` ••• ••• (Si. f's •dNd~I.)
When submitting this fo t r i OaDldmentp ~~ngs a original form and tiiree (3) copies with original
we required. llt&at-the-NYCDE one copy dthe form with original signatures. This
form must be submitted to the NYC DEl' not less than one week in advance 0f the dad of abatement activltles .
I. FACILITY
100 Church Street Borough Manhattan Zipl nnn*7
2 Address
3. Block 12 5 4. Lot 20
AKA
6. Name of Building
5. Type of Fadlity
N. BUILDING OWNER
LLC. Zar Realty 8. Contact PerSortJ 1 i n i shah
7. Name 90 Church,
9.Tel.# (212)9710111 Fax# (212)41;S-RSg4
3 8 4 Fifth Avenue City New York State _NY Zip 1 n n 1 R
10. Address
Ill. GENERAL CONTRACTOR
Tel. #
11. Name
IV. ASBESTOS ABATEMENT CONTRACTOR
Services. Inc_ 13.ContadPerson Chris Saliani
12.Name 192 Branch Interior
15. Tet. # (6 31 ) 5 6 3 7 3 0 0 Fax # (i; q1 )S63-71l9
Colin Drive City Holbrook State NY Zip11741
16. Address 101-2
V. THIRD PARTY AIR MONITOR
18. Contact Person Peter Shork
17. Name Ambient Air
...... ......
.PIT
19. Federal Employer ID. fi` ------- ---- ------1 20. Tel. # ( 212) 944-4615 Fax# (631)563-7389 _
Street_ city New York State NY Zip
21. Address 55 West 39th
Ambient Air 23. NYS DOH ELAP # 10865
22. Sample Analysis Laboratory
Vt. PROJECT INFORMATION
12/07/01
1 1 /1 4 / 01 Projected completion date
24. Starting date for this portion of work
Asbestos work schedule 9 Monday MyTuesday ® Wednesdays Thursday [2 Friday )0
Shift from: 8 0 0 U am [] pm to 8 0 0 ❑ am ®pm
If other.
RECEVED
specify NOV 3 0 2001
item.
Access to inspect the premises must be provided during the work schedule indicated in this
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
vt001
NYC-WTC 000126863
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