NYC 9/11 Public Portal Document
t
Gj t-' NYC DEPARTMENT OF ENVIRONMENTAL PROTEi;TION
Asbestos Control Program
ONLY D... a r 59-17 Junction Boulevard, 8' Floor. Coma. NY 11368-5107
ASBESTOS PROJECT NOTIFICATION
Building Dept or TRU No
FOR OFFICW. USE ONLY
(ASBESTOS INSPECTION REPORT) 1.
tee sdledule)
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 51 M WYro~-1/ -&C _.~ Borough I Zip
AKA 3. Block 4. Lot
5. Type of Facility 6. Name of Building
U. BUILDING OWNER
7. Name M Wrr O .-c rr ___£ U -C-S. Contact Person PP -t ( At f (Cn1~
9. Tel. # I b—)_1 " Og~t) Fax #\ )
10. Address 2>7 5 1ppL k. Pr' 4-r -'-L- City IS • Staten t I Zip I' S~
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name f L3ei_ G.-) , (
._._._._...__.,
13. Contact Person 7 .) y( '&/,4
L
14. Federal Employer ID. # PI I 5. Tel. # 5 16 - 7 5 ( - 3 00 C Fax!! 51 ?d 3 5
/Q
16. Address 30l b it )y1?f4YS city ll))t____/ _ StateIOY' Zip l l ? ~i ?
V. THIRD PARTY AIR MONITOR
17. Name PSI AT( ZEQ. -44 'S Pc 18. Contact Person 1t L t`to(^A .4
19. Federal Emmplloyer ID. # 20. Tel. # P(P - 9as - 0 0j Z Fax # 2!a - 22; - 06 3 O
21. Address. g f I i< City _ Zip (00
State t-(
(
22. Sample Analysis Laboratory ! C!Ite[1 (- 1,klg t_____23. NYS DOH ELAP # (f '
VI. PROJECT INFORMATION
24.Starting date for this portion of work r~ Projected completion date t0 1 )OL
Asbestos work schedule D Monday D Tuesday ❑ Wednesday D Thursday ❑ Friday 0 Saturday 0 Sunday
Shift from: ❑ am D pm to D am D pm
If other.
specify
Access to inspect the penises must be provided during the work schedule indicated in this kem.
25. Total amount of asbestos-containing material to be abated during this work
o Square Feet, and/or Linear Feet
►cP 7
etp 212001
Jf.•YirV•.
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NYC-WTC 000099579
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