NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
PAID1
Asbestos Control Program
ONLY
(rn& 59-17 Junction Boulevard, 8°i Floor, Corona, NY 11368-5107
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1. $1200
ACCEPTED -Y-`-. V.l ?.
(See fee schedule)
When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This
form must be submitted to the NYC DEP not less than one week In advance of the start of abatement activities.
1. FACILITY
2. Address 114 Liberty Street Borough Manhattan Zip 10006
AKA - -- ------ -------- 3. Block 52--------- 4. Lot 7502 —
5. Type of Facility ndominium/Commercial -_ - 6. Name of Building 114 Liberty Street------ _ - -------
1I. BUILDING OWNER
7. Name Liberty, LLC Go Epic, LLC _— 8. Contact Person Ms. Denise Sweeney
9. Tel. # (212) 633-6500 Fax# (212) 727-8969
10. Address 12 East 44th Street _ ---- City New York--,-----_-- State NY___ Zip 10017 —
III. GENERAL CONTRACTOR
11. Name N/A Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name ETS Contracting, Inc. _ __ _ ___13. Contact Person Mr. Robert Middleton
14. Federal Employer ID. #_._._._._._._._ 15. Tel. # (718) 706_6300_— —— (718) 706-1032
.: _ —_ Fax # --_
16. Address 160 Clay Street ---------------- City Brooklyn—___- _ ___— State .NY_ Zip _11222 ---
V. THIRD PARTY AIR MONITOR
17. Name Ambient __ __18. Contact Person Mr_Jack Springston
19. Federal Employer ID. #L--------P11 ____ 20. Tel. # (212) 944-4615 __-- Fax #
21. Address 55 West 39th Street _ City New York __—___--- State NY — Zip
22. Sample Analysis Laboratory a!er Group, Inc. -- — _ 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work 10/2/03 - --- Projected completion date
Asbestos work schedule 0 Monday 0✓ Tuesday El Wednesday 0 Thursday 0✓ Friday 0 Saturdg . Sunday
Shift from: 7:00 __ O am ❑ pm to 6_00 -- ❑ am 0 pm
If other,
specify
I Access to inspect the premises must be provided during the work schedule indicated in this item. I
25. Total amount of asbestos-containing material to be abated during this work
____ 43,000 Square Feet, and/or _______! Linear Feet
ACP 7
212001
NYC-WTC 000154945
OCR can misread numbers and units. Confirm readings against the page image before using them.