15 JOHN STREET 1001217, 79/14

NYC 9/11 Public Portal Document

t oul L , NYC DEPT MIT OF IPPIItIWL P VEC11ON

59-17 Junction 8oui vaid.If Ftoor. Carona, MY 11368-5107

ASBESTOS PROJECT NOTIFICATION L_ (ASBESTOS INSPECTION REPORT) Z. ACCEPTED • »..•erg =o.r<r, tee

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 3e, I. FACILITY "r ------_.-----__ Borough N AN--- Zip 2. Address _-15

AKA -------------- 3. Block _L9__.......__ 4. Lot - 111 — - 5. Type of Facility___---__------ 6. Name of Building

II. BUILDING OWNER

7. Name _______ --------. • 1 8. Contact Person

9. Tel. # —_ —__-------__ Fax #

__-----__—_ City State _____ Zip 10. Address ___

Ill. GENERAL CONTRACTOR Tel. # ---__--_ -- 11. Name--------------------

IV. ASBESTOS ABATEMENT CONTRACTOR — rL—x—. ~- L"►~'' C L --------13. ANN!c=—____— 12. Name ~c1~Li AM_i k~'a Lei ►' Contact Person _ Lc ~_~ . --------------------------------- 14. Federal Employer ID. #` PII __ 15. Tel. # __c 53i _z9ca _-- Fax#

16. Address 1248 —R1itr^li_11vr~ - 7 r=------------- City -- e.~_c_C~t~Y ►~----- State .'T__ Zip ..J! ___

V. THIRD PARTY AIR MONITOR —_---------_ 18. Contact Person ---- 17. Name k:A ~N_ _~~~ Zap- E-JL4I NeEes PII 20. Tel # _ L LL Y7__ _ Fax # 12i2>_ 9'~2-c•63G —___ 19. Federal Employer ID # 2 S Ql5 _ 4Se----------- -- City —WE1__ krzil -------- State N~_ Zip i cci __—_ 21. Address

22. Sample Analysis Labcrato _—__— —_ _ 23. NYS DOH ELAP - _____—_____

VI. PROJECT INFORMATION 24. Starting date for this pc cr of pork _ s Z P o;ec:ed complet:c^ dare __ )JP Saturday ❑ 5Jr'day Asbestos work schedule ❑ Mcr.day ❑ Tuesday ❑ Wedresday ❑ Thursday ❑ Friday ❑

Shift from: F<~ am ❑ pm to __ __ ❑ am ZI pm

If other, specify - ------------------------------------ ,/?:S)/ r~ r tCEIVfg Access to inspect the premises must be provided during the work schedule indicated in this item. —; AU,, n 2 L 25. Total amount of asbestos-containing material to be abated during this work —ZrCGC __ Square Feet, and/or ____2..._ Linear Feet -7 22 i a at~•, •r 4 •w 4 : = 4ii•.t

NYC-WTC 000094200