NYC 9111 Public Portal Document
7624206030 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8th Floor, Flushing, NY 11373-5108
Building Dept. or TRU No
For OFFICIAL USE ONLY
ONLY
TYPEWRITTEN rrr
•FORMS WILL BE '~t` .. ;a` % ASBESTOS PROJECT NOTIFICATION
ACCEPTED "'-+++tirlkir1`" (ASBESTOS INSPECTION REPORT)
Mien submitting this form at the NYC Department of Buildings, the original f orn and three (3) copies with original
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This form 1 $1200
nust be submitted to the NYC DEP not less than one week in advance of the start of abatement activities. (See fee schedule)
I. FACILITY
2. Address 23 Thames Street Borough Manhattan Zip 10006
Premise # Prefix Street Nmne
21 Thames Street 3.Biock 52 4. Lot 8
AKA
5. Type of Facility Commercial 6. Name of Building
II. BUILDING OWNER
7.Name Greenwich Street Project, LLC. 8.Contact Person Chanan Rozenbaum
9.Tel.# (347) 643-9960 Fax# (212) 208-4614
10103
10.Address 666 Fifth Avenue City New York State NY Zip
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
Hazardous Elimination Corp. 13. Contact Person Ernie Carranza
12 Name
14. Federal Employer D. #[ P11 15.Te1.# (631) 752-2898 Fax# (631) 752-2910
16. Address 195 H Central Avenue City Farmingdale State NY Zip 11735
V. THIRD PARTY AIR MONITOR
17 Name Airtek Environmental Corp. 18. Contact Person Benn Lewis
19. Federal EmployerID.# PII 20. Tel.# (212 ) 768-0516 Fax# (212 ) 768-0759
_._._._._._._._._._._._._._._._._ -
21.Address 39 West 38th Street City New York State NY Zip 10018
22. Sample Analysis Laboratory Airtek / ATC Associates 23. NYS DOH ELAP # 11040/10879
VI. PROJECT INFORMATION
24. Starting date for this portion of work Projected completion date
Asbestos work schedule: m Monday m Tuesday ® Wednesday m Thursday m Friday m Saturday ® Sunday
Shift From: ❑ am ❑ pm to ❑ am ❑ pm
If other,
specify
Access to inspect the premises must be provided during the work schedule indicated in this item.
• 25. Total amount of asbestos-containing material to be abated during this work
18, 322 Square Feet, andlor 57 Linear Feet
02
L J
NYC-WTC 000127792
OCR can misread numbers and units. Confirm readings against the page image before using them.