NYC 9/11 Public Portal Document
1
PROTEi
a(d^DapL<IBUNa
FOR OFFICJALU^ ONLY
. ONC V^ATIO,
1. $1 2nn An
ACCEPTED • (isMfeasehwiula)
When submitting this for ’QQh^^C p^rtmant otBullcHngsTil^ original form and three (3) copies with original
signatures are reffiiired. Submittal attho-NYCOEn rsqutres one copy of!^ form with original signatures. This
form must ba submitted to the NYC DEP not less than one week In advance^of the start of abatement activifies.
I. FACILITY
2. Address 100 Church Street Borough Manhattan Zip 1 nnn?
AKA 3.BIockJ 2^ 4. Lot 20
5. Type of Facility_________ ___________________ 6. Name of Building
II. BUILDING OWNER
7.Mama 90 Church^ LLC. Zar Realty 8. Contact PersorMa 1 Ini
9.Tel.# (212)971-0111 Fax# (21
10. Address ^84 Fifth Avenue atv New York State NY Zip lOnift
nt. GENERAL CONTRACTOR
11. Name, Tel.#
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name 192 Branch Interior Services. Inc. 13. Contact Person Chris Saliani
14. Federal Employer ID. # Pll 15.Tel.# (631 )563-730Q Fax# (631 )56.3-73flQ
16.Address '101-2 Colin Drive CityHolbrook State NY Zip11741
V. THIRD PARTY AIR MONITOR
17. Name Ambient Air 18. Contact Person Peter Shork
19. Federal Employer IO. # Pll 20.Tel.# (212) 944-4615 Fax# (631 )563-7389
21. Address 55 West 39th Street_____ City New York_________ State NY Zip
22. Sample Analysis Laboratory Ambient Air 23. NYS DOH ELAP# 10865
VI. PROJECT INFORMATION
24. Starting date for this portion of work 11/14/01 Projected completion date 1 2/07/01
Monday Q^uesday 0 WednesdayThursday 13 Friday^
Asbestos work schedule AOI
Shift from: ?J^0 d pm to Q * 00 d am 0 pm
If Other, Receweo
specify------------------------------- - ------------------------------------------------------- ---------- —-
NOV 3 0 2001
Access to Inspect the premises must be provided during the work schedule indicated in this item. r'
25. Total amount of asbestos-containing material to be abated during this work ^9
79^50 0 gqyg^Q pgg{, and/or 0 Linear Feet
ACP7
2«001
NYC-WTC_000154727
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