NYC 9/11 Public Portal Document
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tq NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
4 Asbestos Control Program
59-17 Junction Boulevard. 8ei Floor. Corona, NY 11388-5107 l5331.1 1~
ONLY .D;sr R. Sul dag Dept. or TRU No
FOR OFFICYIL USE ONLY
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1.
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 espy of the form with original signatures. This
form must be submitted to the NYC DEP not lass than one week in advance of the start of abatement activities.
L FACILITY
f_ t c
2. Address (P . [N P &RL I'\ s T R 1' Borough I~ Zip
AKA 3. Block 4. Lot
5. Type of Facility 6. Name of Building
IL BUILDING OWNER
7. Name cc'L
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t-LC' 8. Contact Person _ .ra-T. [~
i t~C-~ XCI V4
9. Tel. # 1 ~g~ Fax #n
10. Address 3'7c dt(_ _ City ' State Zip O ) ]—
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name V,13E 1L . -Cb ( 13. Contact Person /~➢'~~ (~
14. Federal Employer ID. [ P111 i15.Tel.# $Id -7c -30000 Fax #_ 5r —? '-3c8s
pp /
16. Address b no ,EA)S /TVa City k, th state ,/ Zip _1123
V. THIRD PARTY AI MONITOR
17. Name kit ZE 2 G r ) 18. Contact Person IM11t
pe EL
19. Federal Employer ID. # _ 20. Tel.# ' (a~- 9942-OO • Fax it 2Je3 — P-06-30
21. Address € ►cl
r (c6 ( City i - )- T A, State Zip 00 r
22. Sample Analysis Laboratory. SClfT(1 — L A6 o ( S 1t a 23. NYS DOH FLAP # (f C .
VI. PROJECT INFORMATION
24. Starting date for this portion of work
Asbestos work schedule
1 I U')— Projected completion date
❑Monday bTuesday ❑Wednesday ❑Thursday El Friday ❑ Saturday Sunday
Shift from: ❑ am 0 pm to D am ❑ pm
If other.
specify
Access to brspect the prermses must be provided during the work schedule indicated >n this item.
25. Total amount of asbestos-containing material to be abated during this work
I 5 Square Feet, and/or Linear Feet
*E.':s L:1Ci
CL::JJ
1Rn ~
NYC-WTC 000100467
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