41 JOHN STREET 1075701, 78/7502

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Janction Boulevard, 8"' Floor, Corona, NY 11368-5107 r4 dcjNa_ Building Dept. or TRU No FOR OFFICIAL USE ONLY

( 4W YPEWRITTEN ~'AONMNruvaon°`~o ASBESTOS PROJECT NOTIFICATION ~is y'FORMS WILL BE _ (ASBESTOS INSPECTION REPORT) e'4 <• ACCEPTED •i'•s1°!'°r.• (See fee

copies with original When submitting this form at the NYC Department of Buildings, the original form and three (3) requires one copy of the form with original signatures. This signatures are required. Submittal at the NYCDEP abatement activities . form must be submitted to the NYC DEP not less than one week in advance of the start of

1. FACILITY

4l —~oN N S_r ce'l- ----- —__ Borough _NAN --- Zip _ 10038 — 2. Address 3. Block —TS ---__ 4. Lot _ Z So2---

5. Type of Facility___ MtxeD _USE---- ___ --- 6. Name of Building

II. BUILDING OWNER

7. Name ------------------ 8. Contact Person

9. Tel. _-- _---__ Fax #

City State _____ Zip 10. Address _ _______ ,---__—_

Ill. GENERAL CONTRACTOR

11. Name Tel. #

iV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ UAMI" VorMSA►J C 4 Sbr3 C2 lac. --- _13. Contact Person _LootE—IpN~11cA--____— !-.-.-.-.-.-.-1-1-1-1-1-1-1-.-...-" 53t=?22___-- Fax # ~at )_? —_____ 14. Federal Employer ID. # = ~,__-P~~--________ 15. Tel. # si tg1

16. Address 2 _J4 P-A(nP K —Av liE U F _------ City — 8t2r~o►c u i N ---_ State NY__ Zip _ 1 I? _ —_

V. THIRD PARTY AIR MONITOR

17. Name tL`Ae =2J_~__~A►~_,—EciaFFtz S --_18.ContactPerson_ MI +k FJOt.A+ ---- ---------- ------- ------- -------, Fax # 19. Federal Employer ID. # i L__ 20. Tel. # C2L 22 .2.2!3__

__451?t._- s -ct=ter City ---~~------ ___—_ State _± _ Zip OO1T____ 21. Address __Z? a — ---- ------

22. Sample Analysis Laboratory——_—__—__—_— _-- 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work C9 c T (b 2 Projected completion date

Saturday_®Sunday . Asbestos work schedule ® Monday ® Tuesday ED Wednesday ® Thursday Q Friday ®

Shift from: __ ®am ❑ pm to ❑ am ®pm row If other, specify ---------------------------------------- RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. StP 6 0 2 WORGUU or orlR N4I. 25. Total amount of asbestos-containing material to be abated during this work ,ç , I —_ 1-6489 Square Feet, and/or _-0 Linear Feet ACP 2!200 9cr BL'AEAJ OF E%•!IR01IMF TAL eSaEO ~C0'i . ENFORCEMENE df 5:o$ C f P.GL FFCf;RAtl

NYC-WTC 000092897