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Document / 6 pages

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 E. FEE SCHEDULE Refer to item 17 to calculate your required fees. This fee is non-refundable. Check one box for linear feet and one box for square feet. 18. Fee Schedule: a) Linear feet 0-259 260 - 429 430 - 824 825 - 1649 1650 or more (SO) ($100) ($200) ($500) ($1000) b) Square feet 0 - 159 (S0) 160- 259 ($100) 260-499 ($200) 500- 999 ($500) 1000 or more .......... ($1000) 19. Total Fee Due for Project$_1000.00 (add 18a and 18b) F. REMARKS Use this area to provide additional information. Asbestos Abatement shall be performed utilizing NYC DEP Sub-Chapter G Regulations and site specific variance. All waste shall be double bagged for disposal purposes. Waste Disposal Site: Meadowfill Landfill, Route 2, Box 68, Bridgeport, WV. BFI Imperial Landfill- PO Box 47, Route 980 & Boggs Rd., Imperial PA Cumberland County Landfill - 620 Newville Rd, Newburgh, PA 17242 Waste Hauler/Transporter: DJM, Inc. 109-113 Jacobus Ave., Kearny, NJ 07032 G. SIGNATURE I certify that the information specified on this notification is true and accurate and that the project will be conducted in compliance with the requirements of Code Rule 56. June 9th, 2005 Date Signature of the Contractor or Duly Authorized Representative Print Name of the Contractor or Duly Authorized Representative See next page for submission instructions and notification information. NYC-WTC_000127815

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NYC-WTC_000127815Source: NYC Law Department, mirrored locally

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