17 JOHN STREET Block: 79 Lot: 10 BIN: 1001216

NYC 9/11 Public Portal Document

S~ ~'~ ~, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION b Asbestos Control Program Ar 59,-17 Junction Boulevard. Vi Floor. Corona, NY 11368-5107 BuUding Dept or TRU No ONLY :.P FOR OFFKCAL USE Or&r+ ASBESTOS PROJECT NOTIFICATION - (ASBESTOS INSPECTION REPORT) 1. A ....Yc.~•l~e . scneouie)

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 . •

L FACILITY

2. Address I 1 11~ ~- - T Borough Zip OE

AKA 3. Block 4. Lot

5. Type of Faclity 6. Name of Building II. BUILDING OWNER

7. Name i &! C LL C- • • 8. Contact Person _ i tU bs L c- Lt3

S.Tet.# Fax# 1~ ti 6 D3 10. Address _t 3Wt l e wig- I City State ' Zip

III. GENERAL CONTRACTOR

11. Name Tel. #_____________________

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name -F ' Fell Y2t7c,( 13. Contact Person 7 ' G'&/4

14. Federal Employer I0. # Pi I Tel. # p - 7ç/ ^'3°O 0 Fax # Jt'p ?d 3 S

16. Address J )l b it & 'AE JL' City 09 -A)I State /J ( Zip t 1?!3

.', T:i:RD F JtTY AIJ MONITOR pp ~j rI 17. Name Q A T A7'(2-EtZ. -fNG t W S l PC 18. Contact Person P ltd - (OI^Pcr4-

19. Federal Employer ID. # 20. Tel. # . a (r2 ' ~aa - DOS Fax # 2147 — a -O(7 D

21. Address a d g 'VIESf H-J i Ef city I -G-io T'7=~1~. State Zip 00

22. Sample Analysis Laboratory ~cf TftL k,3~ xa~c>r£St try 23. NYS DOH E.AP # t t gO - VI. PROJECT INFORMATION 24_Starting date for this portion of work fl y — Projected completion date > b 02,. _J_ Asbestos work schedule ❑ Monday D Tuesday D Wednesday ❑ Thursday ❑ Friday 0 Saturday ❑ Sunday

Shift from L3 am 0 pm to ❑am❑pm

If other, specify

Access to inspect the prardses must be provided during the work schedule indicated in this kern.

25. Total amount of asbestos-containing material to be abated during this work o_ Square Feet, and/or linear Feet \. ACP 7 m StF ' :.' tf:'F.JJ IAit

NYC-WTC 000094295