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NY State Dept of Labor Asbestos Notification Form, Oct 2001

Machine-extracted title · confidence 95%

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

ASBESTOS PROJECT NOTIFICATION STATE OF NEW YORK

Division of Safety & Health DEPARTMENT OF LABOR Asbestos Control Bureau Building 12, Room 157 State Campus Albany, NY 12240

A. TYPE OF NOTIFICATION

t hechs onh.• one (;pt' of notification below.

Initial .......................... Complete all sections and submit 10 calendar days prior to starting date. Amended,,,,,,,,,,,,,,,,,, Submit amended notification with all sections completed and amended item(s) circled. Cancelled ............... Complete Section G and attach copy of initial notification or complete all sections. Emergency......,. You must first call the Program Manager's office of the Asbestos Control Bureau at 518-457-1255 for prior approval of emergency status, then complete and return this form including: Date ( / l } Time ( ) Emergency Status Granted Authorized by: (From Asbestos Control Bureau)

3 CO1RAC CONTRACTOR 1Nf ClR €ATt )N Provide all ini=n!nation requested below.

1. FEIN P1i 2. Asbestos Lic. No.

3. Contractor Name and Address 4. Mailing Address (if different) agar i~ Fliminntinn (^nrn ~ P 195H Central Avenue Farmingdale, New York 11735

5, Duly Authorized Representative 6. Will Su -Contractor(s) be used o ❑JYes (1fyes, complete lines below)

Name Donald Gold Name

Title Vice President Asbestos Lic. No. — Lillilil Phone No. ( 631) 752-2898 Name Asbestos Lic. No.LIII — LIIIIIII 7. Party for Whom Work is Being Performed: Name The Cooper Group, Inc. Address 666 Fifth Avenue, New York, NY 10103 C PRA-/lT ,I SiTE ARM FlON :.:n...,...

Provide all information requested be/ow/or the lruilclin</sit: at which the asbestos project will be conducted.

3. Project Location: County New York

Name of building Room or other specific location Entire aye ent, 1St n 2n floors roof and facade Street address 23 Thames Street City, town or village New York, New York 10006 9. Building Information Current use Commercial Building age Prior Use Commercial Building size _ sq. ft. 10. Building Representative/Site Contact: Name Chanan Rozenbaum Phone No. ( 21)2 14

SH-483 (10-03)

NYC-WTC 000127816

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NYC-WTC_000127816Source: NYC Law Department, mirrored locally

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