Asbestos Project Notification Form

NYC 9/11 Public Portal Document

FOR OFFICIAL USE ONLY C,n nerd NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION roo Asbestos Control Program Variance # r _£ 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 Fee Paid TYPEWRITTEN ~~ ~o°a Asbestos Variance Application Notification # FORMS WILL BE ""TA1PµO~ ACCEPTED wwwnv .gov(;eu

I. FACILITY Application must be Address 21-23 Thames Street Borough Manhattan Zip 10006 made at least 2 weeks prior to the II. APPLICANT start of work.

Name Airtek Environmental Corp. Tel # (212) 768-0516

Address 39 West 38th Street City New York State NY Zip 10018

Capacity: ❑ Contractor IZI Consultant ❑ Owner 0 Other Contact Person Benn Lewis

Ill. SPECIFY ALL NYC DEP OR NYS DOL (ICR56) ASBESTOS RULE PROVISIONS FROM WHICH A VARIANCE IS REQUESTED 1.41 (.) 1 (d) 1 a1Q) 1-81(m) 1 Q2(a) 1-83(a~ 83(h)2 1-a1 1-102(b) 1-112(d) 1-112(e) 1-125(l) -"^tln~ c s~ v7r t ~~ •+~c ~~ c n c , , ~ + ~ n c

SPECIFY FLOORS AND/OR AREAS WHERE WORK INVOLVING THIS VARIANCE IS TO OCCUR Rasemont 1st 7nri 9rr1 doh cth & Roof

REASONS FOR REQUEST AND DESCRIPTION FOR PROPOSED ACTION (Attachment(s) shall be submitted In TRIPLICATE)

Explain why the procedures required by Title 15, Chapter 1 of the Rules of the City of New York (RCNY) and/or Part 56 of Title 12 of New York Codes, Rules and Regulations (Subparts 56-4 through 56-17) cannot be used. (Attach Additional Sheets)

i State the alternative procedures that will be employed to satisfy each requirement as modified. (Attach Additional Sheets)

Provide color coded drawings identifying work area(s) and location of decontamination enclosure system(s).

IV. FEE SCHEDULE 18,322 57 linear feet = Total Amount of ACM 18,379 feet Amount of ACM affected by this variance: square feet +

If total amount of ACM If total amount of ACM is less than 5000 feet: Is 5000 feet or more: Seven day notification period waiver $300 $400 See Section 1-03(e) First sub-section (per category) $400 $600 of the NYCDEP Each additional sub-section (per category) $200 $300 Asbestos Rules for Maximum fee $1200 $1800 category definitions.

Enter applicable fee based on schedule above Total Fees

V. I hereby declare that the information provided herein and in any and all accompanying attachments is true and complete to the best of my knowledge. I understand that failure to comply with conditions set forth by the Department in an approval of the application shall render this variance null and void.

Greenwich Street Project, LLC. Airtek Environmental Corp. Print Name of Owner Print Name of Applicant (If not owner)

Signature of Owner Date Signature of Applicant Date Work involving a variance may not commence prior to the receipt of the Departments approval of the application. Any • violation of the terms of any variance issued pursuant to Title 15, Chapter 1 of the RCNY Section 1-03 is considered a violation of the lettered subdivision modified by the variance. ACP9 212001

NYC-WTC 000127794