NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
,;o84 £0 rc" rye, Asbestos Cohtrol Program
59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 mil= V~
DAP ASBESTOS PROJECT NOTIFICATION
Building Dept. or No
FOR OFFICIAL USE ONLY
#BE (ASBESTOS INSPECTION REPORT)
ww.nyc. E o.I da~
%~IC aEPTED
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.
I. FACILITY
2. Address I —M ST 2- ____Borough _ 1~1 (_— Zip _ C O b D ^—~1 _
AKA t.~" ~ 1 ___--- . 3. Block 4. Lot
5. Type of Facility___--_----- ------6. Name of Building -- ----
ii. BUILDING OWNER
7. Name ~tJ~—s i~t L11N 3 C c> -P 8. Contact Person --_ --,-
9. Tel. # P-1;L='Q=~- Fax # _---r—~--
10. Address a~A~ L ( S 1
—t
—__ city —__—},~_ IIr_—______ State I11Zip f-
Iii. GENERAL CONTRACTOR
11. Name __---------_ Tel. # _-----__—
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name j3e ( P ~__ -- _ - --- --- _13. Contact Person _ f L/ _
C
14. Federal E p .
mployer ID. # ~._._._._._._._._._._._. P11 _._._._._._._.;15. Tel.I # J / ~v6 O
_---__-- Fax # Jri ~
_——__----__—_
16. Address Dv1 LJ 1 ~_--__--- City / /7 --_ State Zip i(22 _
V. THIRD PARTY AIR MONITOR
7 Z p f~jC
17. Name ~ _ 18. Contact Person ~ L
19. Federal Employer ID. # J_____ P I~ .., e ,. ` 20. Tel. # Q t3. ± - ao _ Fax #
21. Address L. --- City _> _--_ State t- ,.̀ _ Zip
22. Sample Analysis Laboratory i l ( tL h a ~-A ~~~='~£ S tt — 23. NYS DOH ELAP # __—
VI. PROJECT INFORMATION
24.. Starting date for this portion of work Projected completion date __ __~__
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday 0 Sunday
Shift from: ❑ am ❑ pm to 0 am ❑ pm ~~ z
If other,
specify _-----_
Access to inspect the premises must be provided during the work schedule indicated in this item.
0 2 2001
25. Total amount of asbestos-containing material to be abated during this work ~2ESTO A.
RUGAM
Square Feet, and/or— Linear Feet •~
~~„i 2+ (, ACP7
2/2001
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4Eb::+I.7JL~J 31:B.^,'J7,+~17TAt
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NYC-WTC 000100135
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