NYC 9/11 Public Portal Document P.02
Fax:718-595-3525* * Dec 12 2002 11:46
DEP COMB. OFFICE P.02/03
ftOMlMlSTRATIUE OPERATIONS
dec-12-2002 U:39
'I “' *
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
AsBestoE Control Program
JS-tr Junciwh Beulaverd. 0* Oteor. Corona. N* n3€6-S107
ONLY DSP BullSinj □SBl'or TRu nb
FOR OFFid.n USE tWLt
YYPEiWftn^N Sm. -dX asbestos PROJECT NOTIFICATION
POfiUS l^iLLVe f/^BESTOS INSPECTION REPORT)
ACC&»rEO 1____ ___________
(San ha KhadulO
When sufimtBiriB this form at (he NTC Ospurtmeni of GuildnB*- die orlBlna' fMm □no three O] copies wih original
signatures ere required. SubmlBel at ths NVC06P naquires one copy of ihe fonn with onglnel ugnatures. This
form must be submifisd to the NYC DEP net less than one wees in advance ef the tiah of ehatcmwit acfivlUes.
i, FACIUTY
? Aridr«ms 1 qty H9» Park Bomuoh Manhattan Zip 1P0Q7
aka City Hall 3. Block ___ 4 Lot _1
5 Type of Facility Mayor Offices 6, Name oJ Building City Hall
11. BUILQIMG OWNER
7 Name City of New York. OCAS 8. Contact Person Vazquez
9. Tei. a (212)669-7245 Pa«# (312)669-2897
10 Address 1 Centre Streot, 16 th Floor-North. Qjty Manhattan State NX__ Zip 20007
in. GENERAL CONTRACTOR
11. Name Tei. a
IV. asbestos ABATEMENT CONTRACTOR
1? Name & S Abatement. Inc. 13. Contact Person Chris Berkusanin
14, Federal Employer ID » 133g43248 IS. Tel, a (973)345-^685 Fat a (9^3) 345-9338
16. Address Resengren Ave. Citv Totowa. Slate Zip 07512
V. THIRO PARTY AIR MONITOR
17 Namn Consultants IB. Contact Person PWWMcIt^
19. Federal Employer IO. # 1130SB253 20. Tel. a (718)729-1597 FMd (718) 728-1122_____
21. Address 35-40 36 th Street. State Zip -LU®.®
22 Sample Analysis Laboratonr Consultants 23. NV5 OOM ELAP a 1'1273
VI, PROJECT INFORMATION
24. Starting dale for this portion of work Projaoled completion date
Asdasioe work schedule Cl Monday D Tuesday Cl Wednesday D Thursday 0 Friday 0 Saturday B Sunday
Shift from; Q am CI pm ta Q ant D pm
If Other,
specif P^*’ Hall schBflulB.
Access Io InsBort me firvmSses must bs lim i»afk MIcatsa in this Item
25. Total amount of asbesios'cantaining material to be abated during mis work
*50 Square Feet, and/or 1®. Linear Feet
NYC-WTC_OOO 149432
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