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Document / 6 pages

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 9111 Public Portal Document

D. PROJECT DETAILS I rut ih ail tn/Ormat ion re4/ta ti d below rel(awt ; Ii) cpe't'ilit .1 a/ ,11/05/05 rrnlot'Ol.

Project Dates. Starting date Completion date

Ifamendcd: Starting date Completion date

Is this a phased project: E] No Ej Yes U/ ins. li.vt ,scope, locutinu, anti rtartins Baru/ completunr <lules /iu cat li pitu.x' in Sc( F, Rentcu'ks)

12. Do You :Anticipate Doing: El Night work CE Weekend work E✓ Shift work ' tails in Section F.)

13. Dollar Amount of Contract Between Parties Named in Item 3 and Item 7 $

14. 1f work is being conducted under a variance, check appropriate box and supply variance number.

fl Applicable Variance No. ® Individual Variance Petition No.

I a. :Asbestos 1)isseml nation Prevention Methods (its" .1'ccom) F. Remurn's. and ,111Uc/1 additional sheets it tu''csvarl')

a) Type of equipment & ventilation ,vstenis used

Equipment: Manufacturer: Model Number: Quantities: HEPA Vacuums N/A N/A 2 Portable Decon Unit N/A N/A 1 Respirators Various N/A Negative Air Unit Various N/A 1

Airtek Environmental Corp. b) Name of air monitoring firm Asbestos Lie. No, 9 9 — 0 5 8 9

c) Laboratory performing the analysis 11040 / 10879 Name Airtek / ATC Associates ELAP Registration. No.

16. Type of Asbestos Work (check all that up/i)

Pipe related Q✓ Rooting.; flashing Caulking/mastic [ Clean-up 0 Vessel covering Siding 0 V:11 Sprayed -on insulation ❑ Demolition - i,"site survey was previously submitted, provide Reference No. t WTC Dust, window caulking and coping stone caulking Other (specify}

17. Type and Amount of Asbestos-Containing Material Involved

Friable linear feet 57 Friable square feet 17,651 Non-friable linear feet + Non-friable square feet + 671 Total linear feet _ Total square feet = 18,322

NYC-WTC 000127817

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NYC-WTC_000127817Source: NYC Law Department, mirrored locally

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