NYC 9/11 Public Portal Document
/aO NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos ConqLroram
59-17 Junction Boulevard, 8°i Flo , NY 11368-5107
DAP: ASBESTOS PROJECT NOTIFICATION
eufiding Dept. orTRU No
FOR OFFICIAL USE ONLY
rur
.:n ~ ~ Wiu BE (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED . !!!!''!t.
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
A
2. Address S M , Ll f . 14 { S T Borough Zip t 130 z~
AKA 3. Block l 33 4. Lot a_
6. Type of Facility 6. Name of Building
11. BUILDING OWNER
7. Name C- f 1_T% EM. 8. Contact Person
9. Tel. # Fax #
10. Address S City N ' _ _ ___ State t Zip IO O p
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name e!` l 13. Contact Person --08111f
_ 7~13p0O
_
Fax # I (~
1
~~0.5
14. Federal Employer ID. # L._._._._._._._._._._._
PI ; 15. Tel. # l
S
16. Address o~ e City ar State Zip 1( 2
V. THIRD PARTY AIR MONITOR
17. Name____ _ ~ Z2E G r )?S ~
h
r jC 18. Contact Person 1M11tC~f L ('-(°L cr4 .
19. Federal Employer ID. # 20. Tel. # a(2__- D0 Fax # 213 0 0
21. Address 2P $ ' 'fS,l 4L& ~ ( E ( City f` -&w 7Ct~ State _ Zip 00 r
)
22. Sample Analysis Laboratory ~~ (, (F~L h4i3 t 7 23. NYS DOH ELAP # (I' _f C
VI. PROJECT INFORMATION ,
24_ Starting date for this portion of work $_)S ~L. Projected completion date
9)_1_
Asbestos work schedule D Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturda r Sunday
Shift from: D am 0 pm to ❑ am ❑ pm
If other,
specify Rte~1vC@
Access to inspect the premises must be provided during the work schedule indicated in this Item. AUG 0 L 2002
25. Total amount of asbestos-containing material to be abated during this work
J1JD sC Square Feet, and/or Linear Feet
s
c' ACP7
2r2f1o1
.'aC .rF.•V
t+6z:'OS IVN:RbI 4 A1
tFcccaa
1Ru~
NYC-WTC 000100143
OCR can misread numbers and units. Confirm readings against the page image before using them.