NYC 9/11 Public Portal Document
,36h 1 NYC DEPARTMENT OF ENVIROttMENTAL PROTECTION
. Asbestos Control Program
59-17 Junction Boulevard, 8" Floor. Corona, NY 11368-5107 f^-(2# rto
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D...P.
r. Building Dept. or TRU 4o
FOR OFFICIAL USE ONLY
PEWRITTEN ASBESTOS PROJECT NOTIFICATION
G lf
er~i'w"
FORMS WILL BE
ACCEPTED _'R• ere.9a:r der_ (ASBESTOS INSPECTION REPORT) 1.
ee 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 NYCOEP 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 . 4 NA s$ A U Borough UM Zip
AKA i29 Fix7oN St- ET / .40 Awtm 5T¢EET 3. Block -9 1 4. Lot 13
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name 9~L%T10M F01Z - Me Ito ME LESS • ' 8. Contact Person MAtLt 4 u~c q 0Ll l E 12 A5
9. Tel. # (212) 964 _S900 Fax# (2t2) 96A - 1303
10. Address Cat AMBERS STR.EVET City t' V yo2K State _I' Zip 1000T
III. GENERAL CONTRACTOR
11. Name_, Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name B€ -LM 1N Vol?z8AN 5 SoM Co*TIZoL 13. Contact Person LoutE• IANutCO
14. Federal Employer ID t P11 - 15. Tel. # ?C 15) 531- 2 900 Fax # CTtS) 209 1808
16. Address _? 4 8 RgLP H A\JL-NUE v _ City _~eo0tr. W 14 State ±L Zip 112 3G
V. THIRD PARTY AIR MONITOR
17. Name Gt)I Eta S ?A AZEIZ It N61 aeEM- 18. Contact Person ~ii JCAtAtZ 11.l0uatJ _
19. Federal Employer ID. a PII _ 20. Tel. # C2t2) ej22_o0-rT Fax# (2I2.' 22030
21. Address a AAsT 4STR STSeT City Yaex State _IJq _ Zip 100 11'
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION t
24.. Starting date for this portion of work 08 118 (0 2 Projected completion date 1 (02
Asbestos work schedule ® Monday ® Tuesday 10 Wednesday ® Thursday ® Friday ® Saturday.1m.,
Shift from: 8 ®am ❑ pm to 8 ❑ am ®pm
If other,
specify
ECEIVED ,
Access to inspect the premises must be provided during the work schedule indicated in this item
Aug 20 200Z.
25. Total amount of asbestos-containing material to be abated during this work
12546 Square Feet, and/or b Linear Feet
ACP 7
: 2/2001
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NYC-WTC 000099015
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