Asbestos project notification form, Oct 2002

NYC 9/11 Public Portal Document

`~ ry ~ ~ y~ WiY OfvAgfyENi NYC DEPARTMENTF ENVIRONMENTAL PROTECTION s,r•~ os Control Program 59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107 I(o.t Building Dept. or TRU FOR OFFICIAL USE ONLY

/ \ TEN ~ns+i"raio+pn°ccA ASBESTOS PROJECT NOTIFICATION S WILL BE ~~ (ASBESTOS INSPECTION REPORT) 1. CEPTED www.nVc.ter/aep (See the schedule) ,Q 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.

I. FACILITY

2. Address _ 12 _309N STP-E.ET — _Borough MAN Zip tOO58 AKA —____--- . 3. Block 4. Lot

6. Name of Building ButL..DiN~; 5. Type of Facility. LA(.'( t_o USE P.tJDE2SON

II. BUILDING OWNER

7. Name TRAfsS woP-L.D ECIcsf 1 ES—~ -- - _ 8. Contact Person D F- LR_ESTC 2

9. Tel. # !! .4(4 - L___ Fax# _---

10. Address 2 ~ ea►EST t`'Tt{ S-r t Et_T — City State _ Zip _1 00jj—___

III. GENERAL CONTRACTOR

11. Name- -- --------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name SEN.SA-MIN kuezPA.N A ~oav CoNT¢cL — lac 13. Contact Person

14. Federal Employer ID. P11 ___ 15. Tel. # o__-- Fax# C-ti+a) 2b9-teo8 _. _

A .1 -- __— City 9±___ State u4 —Zip l t2 3 —_ 16. Address t2d u

V. THIRD PARTY AIR MONITOR

17. Name ~uP2¢EN ~ NLEaz—EuG~ORE s 18. Contact Person _Mtct•tAE(- NCL►N ` _ 20. Tel. # -SJ. 9 za oc=r7 __— Fax #_j 22-o ° - 19. Federal Employer ID. #

21. Address _2 2 t3 EasT ASIM Sr 'T — City NEwYor --- - State _ Zip tOOtT

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

~-.'• VI. PROJECT INFORMATION 2 8 (o z _ 24. Starting date for this portion of work - c I'. Projected completion date

Asbestos work schedule ® Monday ® Tuesday © Wednesday I Thursday © Friday I Saturday- .und

Shift from: © am 0 pm to ~~ 0 am ® pm

If other, r' >~ specify --- ~_N------- ------- ,~ CtPZ 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 3250 Square Feet, and/or Linear Feet ACP 7 2/2001

P, CSSC',r,°.~

SPit 2

NYC-WTC 000094145