Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

7624206030 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8th Floor, Flushing, NY 11373-5108 Building Dept, or TRC No ONLY TYPEWRITTEN /DSP’ ASBESTOS PROJECT NOTIFICATION For OFFICIAL CSE ONLY

FORMS WILL BE W- _ -I ACCEPTED (ASBESTOS INSPECTION RB>ORr) itww,n/t.gov,'<Jt«r ' ra 0 W When submitting this form at the NYC Department of Buildings, th© ofiginal form and three (3) copi^ wrth wiginlr ■ signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This form $1200 must be submitted to the NYC OS’ not less than one weak in advance of the start of abatement activities. (See fee schedule) I. FACILITY

2. Address 130 Liberty Street Borough Manhattan ziplOOOS Premise# Prefix street Name

AKA 3.Block 4. Lot

5. Typo of Facility Commercial 6. Name of Building

11. BUILDING OWNS?

7. Name Jones Lange LaSalle a/a/f Deutsche Bank B.Contact Parson Marino Prodan

9 Tai # (212) 618-3902 Fax# 618-2208

10.Address K Wall Street NYC 04-0704 Qjjy New York stated Tin

IB. GENERAL CONTRACTOR

.. Tishman Interiors Tel.# (212) 708-6759 11. Name _________________________ IV. ASBESTOS ABATEMENT CONTRACTOR

.. PAL Environmental Safety Corp. 13. Contact Person Doughy - ------------------- - i_____ — 12. Name _____________________________ 14, Federal Employer D. < PH 15. Tel.# (718) 349-0900 Fax# (718) 349-2800

16.Address 43-09 Vernon Blvd. City Long Island City Sterte NY Zip 11101 V. TURD PARTY AIR MOMTOR

17 Mama Group, Inc. 18. Contact Person Drago

19. Federal Bnployer D. # PH 20. Tel.# (212) 944-4615 Fax# (212) 944-4618

21.Address 55 West 39th Street City New York State NY Zip 10018

22. Sample Analysis Laboratory RJ Lee Group, Inc./Ambient Group, Inc .23, NYS DOH ELAP # 10884/11732 VL PROJECT INFORMATION

24. Starting date for this portion of work 3/31/03 Projected completion date 34^/04

Asbestos work schedule; 0 Monday 0 Tuesday Q Wednesday Q Thursday 0 Friday 0 Sat^urday—.^.Sunday Shift From: 8 0am n pm to 12 0 am □ pm If other, specify

Access to Inspect 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

172,615 Square Foot,and/or ® Linear Feet < ACP7 12/20/02

NYC-VVTC_000154677