NYC 9/11 Public Portal Document
/ V V `' i +Qay, CITY OfP,~q, Nl NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
D 9'1,
Asbestos Control Program
At~l 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 ll Dept. or J t
M cor ASBESTOS PROJECT NOTIFICATION
Building
OFFICIAL USE ONLY
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RMS WILL BE (ASBESTOS INSPECTION REPORT)
ACCEPTED www.^Y<.;a+laer, fee schedule)
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. FACILITY
2. Address 9 6 1~2 1J ASSAU 5T!EE r -- ---___-- Borough —__MLA__-- Zip
3. Block __ re--__ 4. Lot 4!__—____
5. Type of Facility-_COM M EQ Ct~+ ----------6. Name of Building
II. BUILDING OWNER
7. Name 8. Contact Person
9. Tel. # l2►?) 696- 2500 --__ Fax # _(2►2) 696 - 03 33
10. Address _ ___ City State _____ Zip
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name BEN,AMIN QRZBAN 4 SON Wr-'rt20L_ 13. Contact Person LoWIE fANNi Co
14. Federal Employer ID. #.-.-.-.-.-.-.-..LL-.-.-.-.-.-.-. 15. Tel. # CZt~) _53i=2900 - __-- _Fax # (zts> 209 -LBCS
___
16. Address _12 RAIPJ__ qyE Nt~ —__—______-- City B¢GOK~Y ~►______—_ State N±._ Zip _J12 _ __
V. THIRD PARTY AIR MONITOR
17. Name Ul aee N ANZER e06 t A! EER5 I Nc ____--_18. Contact Person _~1 CNa EL __NDLA___—____
----- ---------------------------- _O6 _0 ______
19. Federal Employer ID. #1___--___PII__--_---- 20. Tel. # (212) 922_02I ___ Fax # C2t2) 922
21. Address ?28 EA57A5TN 5 TTZEET --__--__ City NEtJ_ Yc+Rb ---------State _L._ Zip _I 1__
22. Sample Analysis Laboratory___—__---__—_--__------_______- 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24.. Starting date for this portion of work _ 7I / -1p Z Projected completion date
Asbestos work schedule 1=1 Monday Tuesday (0 Wednesday tlst Thursday 0 Friday IEJ Saturday W► Sunday
Shift from: — _— am ❑ pm to ❑ am Id pm
if
If other,
specify -------------------------------- --------------- /' Rc,,,
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Access to inspect the premises must be provided during the work schedule indicated in this item.
]( JU1 '
5 2002
/EsBANHM
25. Total amount of asbestos-containing material to be abated during this work
2604. Square Feet, and/or __—o— Linear Feet
ACP 7
2/2001
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NYC-WTC 000098963
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