Permit application cover sheet, 92 Fulton Street, Oct 2002

NYC 9/11 Public Portal Document

n -f l ~~ ,;~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION J, t T .~ . V l~~ ~, Asbestos Control Program 59-17 Junctiori Soulevard. 8"' Floor. Comm. NY 11368- . ! ! Build"g Oea• TR No FOR OFFICI& USE ONLY G.

ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1, .rs:pe~t?.r,' (See schedule)

with original When submitting this form at the NYC Department of Buildings, the original form and three (3) copies ~f requires one SPY of the form with original signatures. This signatures are required. Submittal at the NYCDEP equi abatement activities. _ \ JCS form must be submitted to the NYC DEP not less than one week In advance of the start of ((fi~rr 1'` 1. FACILITY E Borough MAI — Zip t Oo2 B 2. Address — F h.Xo a s Te>= V 3. Block 'rt 4. Lot 22 AKA

5. Type of Facility MWED USE 6. Name of Building —

II. BUILDING OWNER -

7. Name _ 8. Contact Person

9. Tel.# ___ _ Fax # } City _—__— — State Zip 10. Address — N

Ill. GENERAL CONTRACTOR r __ Tel. # __

IV. ASBESTOS ABATEMENT CONTRACTOR Sorb COtaz-t2.Ol t$ - 13. Contact Person lcc)+L- I RNtitCo -- 12. Name _ctJAtuttni—KuR2i3AtN __PII___ 15. Tel # Cit sx~ 53i- 2~C?C`_ Fax # _____ 14 Federal Employer ID. #_ Ave E City f' 'u~`) State . y Zip I ?) ___ 16. Address t2.d8 l2-AL4;9

V. THIRD PARTY AIR MONITOR

17. Name to Aez 4 ?Amz 12etiG Eu5 _ _18. Contact Person t'ktCiAAE'- Wot.At4 ) 922-C>:,3C' _ PII 19. Federal Employer ID. #_._._._._._._._._._._._._._._._._._._. 20. Tel.# (7+2) 922-c:cz7 -- Fax# ('2t.2

EASY 4S U- S -rrz a`T City _J,.1E YG State i~4 _ Zip _ tT 21. Address _2!

22. Sample Analysis Laboratory— 23. NYS DOH ELAP #

• VI. PROJECT INFORMATION 24_ Starting date for this portion of work t S (2 (t c 2 Projected completion date tC t2 Y

Asbestos work schedule ® Monday © Tuesday ® Wednesday ® Thursday © Friday © Saturday ® Sunday

Shift from: _ ® am ❑ pm to S ❑ am ® pm

If other, • Specify __ --- `E E VED Access to inspect the premises must be provided during the work schedule indicated in this item. SEP 26

25. Total amount of asbestos-containing material to be abated during this work r _ h o8 T T_ Square Feet, and/or _ Linear Feet ACP g 21200 .. R1:PiS'li'rcy~ y

G,:di°T:5 ;CM2a~ r tl

NYC-WTC 000127546