NYC 9/11 Public Portal Document
ASBESTOS PROJECT NOTIFICATION STA78 ov aewtroRtt
txveioa of Satay a Heath oeaARTteear OP LABOR
AsbeMs Coemd Bureau
B 12. Rome 187
saes Census
Aasn. MV 12260
•^ 0:•!5~' s'~ it .L '~ i ~..1.. •. .
• ilii`•li OF OT 1Ct TIVKW`• • i:f.'4 •;i in, ..
Ckeekosivene ypetf behna
Imtiel.. _ Complete all sections end submit 10 colander days pier to seining date.
Amended submit amended uotifleation with all sections completed end amended Item(s) circled.
Cato gilled . Coaprlete Section Cl and attach copy of imdel nottfleatiou or complete all sections.
Bmeiency_,__, — You must firer an the Prag~ram Mnnageras office of the Asbestos Control Borneo at 318437-1233
for prior approval of emergency status, ten complete and return this form Inoladlag:
Daze (_1 I_) Time (~..) Emer cnay Status Created
Authorized br. (Prom Asbestos Control Bureau)
Pr Wde al t,t*m odaaa neewasted belay.
---- --------------- --------- -------------,
1. FEN p11 2. Asbestos Lin. No. g g—
[oh J4 le
_._._._._._._._._._..
3. Conunator Name and Address 4. Mailing Address ((f )
I'Jg{a".rlro as t:iirrairictl, n ,g, amaa
195H Central Avenue
New York 11735
5. Duly Authorized Representative 6. } 1_Sy "4s" a3tal be
res !I! below)
Name Dataid Gold Name fi
Asbestos Lic.No.
Title Vice President W
phone No. ( 631) 752-2898 Name u,
Asbestos Lin. No. ®-
7. Pony for Whom Wotk is Being Pcrfonmed: Name The Cooper Group, Inc.
Address 666 Fifth Avenue, New York, NY 10103
F.c paoIFG.rn/LsJf4iZ O?4 r ',.°~i". 'f'`.P> !d ~ fN ~'d wl~:. :j gar
7°"iFf.•.-
P+ovldo allb vagrwwd belowfa' the btdidl#sfe at which the arbesmapvnie w llbe meduated
8. Project Location. County New York
Name of building
Room or other speciflo bmnd n Entire Basement. 1st and 2nd floors, roof and facade
Street 23 Thames Street
City. townorviflage
C1 New York, New York 10006
9. Building Bafocmation
Current use Commercial_ Building ego
Prior Use Commends) Building size sq. R
10. Building Representative/Site coanct Name Chanan Rozenbaum pm, No. ( 21)2 208-4614
SH.483 (1043)
NYC-WTC 000134163
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