Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document Xy fcW iflfARTMEN^SlFEN^dJiiiSlS’ PROTECTION , 103470673 Asbestos Control Program 59-17 Junction Boulevard, 8*’’ Floor, Corona, NY 1l36a-;i1O7 DEPT. OF BLDGS.

d) mt ASBESTOS PROJECT NOTIFICATION I (ASBESTOS INSPECTION REPORT) 1. 3See fee schedule) -------------------------------------------- —------------------- ----------------------- ---------------------- cO <^hen txnCting this form at the NYC Department of Buildings, the original form and three (3) copies with original /are required. Submittal at the NYCDEP requires one copy of the fonn with original signatures. This be submitted to the NYC DEP not less than one week in advance of the start of abatement activities .

cwBS 2. Address ‘>30 Liberty Street Borough Manhattan Zip 10006

AKA 3. Block 84 4. Lot _1

5. Type of Facility Commercial 6. Name of Building

IL BUILDING OWNER

7. Name Cushman & Wakefield a/a/f Deutsche Bank B. Contact Person Mahno Prodan

gTa,.# (212) 618-3902 Fax# (212) 618-2208

10. Address Wall Street city NewJ^rk State NY ZIP 10005

ill. GENERAL CONTRACTOR 11. Name Tishman Construction 7ei. # (212) 399-3600

IV, ASBESTOS ABATEMENT CONTRACTOR 12. Name Environmental Safety Corp. 13. Contact Person Mast

14. Federal Employer ID. Pll 15. Tel. #11181349-0900 Pax# (718)349-2800

16. Address 43-09 Vernon Boulevard City Long Island City Slate NY a„ 11101

V. THIRD PARTY AIR MONITOR

1'7, Name Ambient Group, Inc. 18. Contact Person ^Q^n Leitner

19. Federal EmpIdyer'iO'. ----------- Pll 20. Tel.# (212)944-1615 Pax#-(212) 944-4618

21. Address 85 West 39th Street City New York „State NY Zip JOOIS

22. Sample Analysis Laboratory Ambient Group, Inc. 23. NYS DOH ELAP #11Z^

VL PROJECT INFORMATION 24. Starting date for this portion of work ^^24/02 Projected completion data 7/31/02

Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday 0 Sunday

Shift from; 8 0 am Q pm to 0 am 0 pm

If other, specify RtEENtH Access fa Inspect the premises must be provided during the work schedule indicated in this item. APR 1 6 W

25. Total amount of asbestos-containing materia] to be .abated during this work A 102, Square Feet and/or 8 Linear Feet

A( 2fi

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