114 FULTON STREET 1001209, 78/7501

NYC 9/11 Public Portal Document

% ~'v • NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program , ?' 59-17 Junction Boulevard. So Ftoor. Carona. NY 11388.5107 O2 « D A FOR OFMAL USE ONLY

h.,, KITTEN eri~ar"` ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1 2) ACCEPTED •" " ..- sa't'yr, feeschedule)

When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This form must be submitted to the NYC DEP not less than one week In advance of the start of abatement activities.

1. FACILITY

2. Address Ito -116 FULTOt4 ST Borough MN Zip AKA --- —_ 3. Block 4. Lot

5. Type of Facility 6. Name of Building

II. BUILDING OWNER

7. Name _CEO M ANA6 E M NT • 8. Contact Person

9. Tel. # (2 12' 132 -T653 Fax#

10. Address _ 20 V ESE S; e ET N City W tW Yo 2.k- State_j±L Zip

Ill. GENERAL CONTRACTOR

11. Name_ ________

IV. ASBESTOS ABATEMENT CONTRACTOR

12, Name L_.,. q SoN—COktT(10L._--_13. Contact Person LayiE~ALaNICtZ—

14. Federal Employer ID. # t PII — 15. Tel. # _C itg) 531J1229_____ Fax # _Z 129-

16. Address __1248 _ RALPt(— AdENUE ---- -- City __ 21[0 N —_ N State NY— Zip S 1236

V. THIRD PARTY AIR MONITOR

17. Name WA20EISJ_ 'PA0Z Et3(z,1N 2S NC _—_18. Contact Person M ICU Amt NOL_ m

19. Federal Employer ID. # _._._ Pil 20. Tel. # (212)922 -oo T — Fax # (22) 22O °

21. Address ~2$ EAST 45 Tlt SsTee>` r City __—_~J~ —__ State ~1 ~ _ Zip i0O tT —_

22. Sample Analysis Laboratory --~ 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work - 06123 _ b _Z Projected completion date 0 G 12 2

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday 0 Saturday Sunday cn } Shift from: am ❑ pm to 8 ❑ am Of pm ti ~ If other, lt specify ---__-- j, ~NfD a: Access to inspect the premises must be provided during the work schedule indicated in ttus item. J'N 2 ZUp2 csT~1N TR~RANHI,~ 25. Total amount of asbestos-containing material to be abated during this work ,. ' — 4410 Square Feet, and/or Linear Feet 2

6 2Ai220C

NYC-WTC 000128814