11 JOHN STREET

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I- NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59.17 Junction Boulevard, 8°i Flea', Corona, NY 11368-5107 aR I USE 0* N ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) (See tee Whhedul 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. 0#J 1. FACILITY

2. Address 11 JOUtJ ST2EET Borough MN Zip _ 1OO38 AKA 3. Block 'r 4. Lot IS 5. Type ofFacility COMMER.O tAt. 6. Name of Building II. BUILDING OWNER

7. Name CO LLEG t e.Y E C"U CC..t Coep, 8. Contact Person 9. Tel.# 1212) 233-1%.O Fax #

10. Address ..AS SOIAN S•rtzmET City jcrri State XL.. Zip 1OO3 8 III. GENERAL CONTRACTOR

11. Na Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name E3t_i.UAMIN KV¢Z. A$ 4 Sow C1JT1.Ot_ (NC. 13. Contact Person LoulE IPt.NhCo 14. Federal Employer ID. # _._._ PII._._._._._._._.~_ 15. Tel. # C7 t8) S3I- 2200 _ Fax #...(3j8) 209 - 1808______ 16. Address 124Q RA4-PI1_ AV~IUE ' City B¢oQ '4 IJ State NY Zip it 236 V. THIRD PARTY AIR MONITOR

17. Name A¢o,Fra 4 paa2re_ ~h1610, zE95 1PC- 18. Contact Person M1CNIkrt__ }Je1~!.N 19. Federal Employer ID. # PII_._._._._._._._.L 20. Tel. # 1212) 922 - ooT-r Fax # C212) 92z - ob 3O 21. Address _??8 EAST 45 ru 5 - e i- _ City _ New Yowc State NY.!_ Zip ...L°° T -- 22. Sample Analysis Laboratory _ 23. NYS DOH ELAP # VI. PROJECT INFORMATION Ct 24- Starting date for this portion of work _ Z Projected completion date

Asbestos work schedule ® Monday ® Tuesday ® Wednesday A Thursday ® =riday ® Saturday ® Surday

— Shift from: [S am ❑ pm to S ea ❑ am ® pm

If other, specify ' RECEIVED I Access to inspect the premises must be provided during the work schedule indicated in this item. I 1~ AUG G' 8 2Q 25. Total amount of asbestos-containing material to be abated during this work

. 8 300 Square Feet, and/or 0 Linear Feet

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NYC-WTC 000094123