Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

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cariiinyp,.,~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8ei Floor, Corona, NY 11368-5107 Buifding Dept, or TRU No TYPEWRITTEN FOR OFFIcfAf, USE ONLY FORMS WILL BE °^ ?u? W ASBESTOS PROJECT NOTIFICATION ACCEPTED (ASBESTOS INSPECTION REPORT) 1. (See fee schedule) When submitting this form at the NYC Department of Buildings, the original signatures are required. Submittal at the NYCDEP requires one copy of the form and three (3) copies with original form must be submitted to the NYC DEP not less than one week in form with original signatures. This advance of the start of abatement activities, I. FACILITY

2. Address 150 Franklin Street Borough Manhattan Zip10 013 AKA WTC Indoor Dust .C1epring Pro ram 3. Block 4. Lot 5. Type of FacilityResidential Apartments 6. Name of Building II. BUILDING OWNER

7. Name Emily Sorkin 8. Contact Person _ Emily Sorkin 9. Tel, # 212-941-7858 Fax# 10. Address 150 Franklin Str, Apt, 2N city NY State Zip10013 Ill. GENERAL CONTRACTOR

11. Name Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR 12. Name Trio Asbestos Removal Corp. 13. Contact Person his Horan 14. Federal Employer ID.hf. P!1_______ 15.Tei.# 718-961-4100 Fax#718-961-4103 16. Address 14-20 129th Street city College Point State)~X__ Zip JJ35j V. THIRD 'ARTY AIR MONITOR

17. Name ATC Associates Inc. _._._._._._._._._._. . _18. Contact Person Fred Burkhardt 19. Federal Employer ID. # _ P11 ._._._._._._._ 20. Tei. # 212-353-8280 Fax# 212-353-8306 21. Address 104 East 25th Street c;~ NY State L Zip 10 010 22. Sample Analysis Laboratory EMSL 23. NYS DOH FLAP #11506 VI. PROJECT INFORMATION 24. Starting date for this portion of work JL 2 2 / 03 Projected completion date _1L2 2 / 03 Asbestos work schedule ❑ Monday ❑ Tuesday ® Wednesday ❑ Th ursday 0 Friday ❑ Saturday Sunday Shift from: 8 ®am ❑pm to 4 4 Dam ®pm If other, specify

Access to inspecf the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work Square Feet, and/or Linear Feet

'ACP 7 212001

NYC-WTC 000129016