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NY State Dept of Labor Asbestos Notification Form, Oct 2001

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Initial asbestos notification form submitted to the New York State Department of Labor for a project at 133 Fulton Street.

NYC-WTC_000127813–000127818

Folder label: “BINDER - PHASE 1 DECONTAMINATION PLAN

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NYC 9/11 Public Portal Document

ASBESTCS PROJECT NOTRCATON STATE OF NEW YORK DEPARTMENT OF LABOR Division of Safety & Health Asbestos Control Bureau y 12. Room 157 :ate Campus Albany, NY 12240

A. TYPE OF NOTIFICATION ('Jreck naafi, rote nPPC o/ tmri/Ieaiiot helot'.

❑✓ Initial ..... ................... Complete all sections and submit 10 calendar days prior to starting date.

E ('ancelled Amended , Submit amended notification with all completed and attended itenils) circled. sections

fl Emergency ................ Complete Section G and attach copy n) initial notification or complete all sections. You must first call the Program Manager's office of the Asbestos Control Bureau at 518-457-1255 for prior approval of emergence status, then complete and retrirn this form including: Date ( 1 / ) Time (_...__ 1 Emr reencv Status Granted Authorized by: (From Asbestos Control Bureau)

[B. CONTRACTOR INFORMATION Prot itic ,til in/ormatwe reyt« is 'd below.

I IHN _I Asbestos 1 ii.. No. P11 3, contractor Name and Address 4. Mailing Address (ifdiffrciat) Ha7ardnt ts Flirninatinn Cc)rp ms_ Sa 195H Central Avenue Farmingdale, New York 11735

> Duly Authorized Representative 6 Will Suh-Contractoi(s) be used ' o Yes fllrcs, cnntplete line.t helutr) Name Donald Gold Name

lltle Vice President Asbestos Lie. No m -

ri I Phone NO ( 631) 752-2898 Name Asbestos Lie. No. LII - 7. Patrty for Whom Work is Being Performed: Name The Cooper Group, Inc. Address 666 Fifth Avenue, New York, NY 10103

C. PROIF CT SITE INFORMATION l-'rmde all itfnrttittion rrelueeted be /nty for' i/ic 1' 1'1ing<eile ru trhir h rho v be.etus proieca rill (re e'otc'h1Cted.

8. Protect Location: County New York Name of htuldinca

Room or other specific location Entire Basement, 1St and 2nd floors, roof and B-2 facade Street address 133 Greenwich Street aka 25-29 Thames Street City, town or village New York, New York 10006 9. Building Information Current use Commercial 13uildin !, age _

Prior Use Commercial Building size - sq. ft.

10. Builditig Representative/Site Contact: Name Chanan Rozenbaum I hone No. ( 21)2 2084614 SH-483 (10-03)

NYC-WTC 000127813

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NYC-WTC_000127813Source: NYC Law Department, mirrored locally

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