Invoice from contractor to DEP for environmental services

NYC 9/11 Public Portal Document

EMERVI , ~ NYC DEPARTMENT OF ENVIRONMErkrAL PROTECTION Asbestos Control Pr m 59-17 Junction Boulevard, 8th Floor, Coro ; NY 11368-5107 Building Dept or TRU No

1 TYPEWRITTEN fpm FORMS WILL BE rtc~Òa ASBESTOS PROJECT NOS;TIFICATION (ASBESTOS INSPECTION REPORT) I 1 FOR OFFICIAL USE ONLY

ACCEPTED *"* ^Y5•s.o+ta<r,

When submitting this form at the NYC Department of Buildings, the orl final 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 adv nce of the start of abatement activities.

1. FACILITY l

2. Address _9=1i A t DEN L.AN E ____ — Borough M_AW Zip 10038

AKA --- -- — 3. Block _ 65 4. Lot 10

5. Type of Facility___-- 6. Name of Bugiding ---~ 11. BUILDING OWNER

7. Name I I ' 8. Contact Person

9. Tel. # L._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._ # --~— — 10. Address _--- ---__—_~-- —~ City ~_ M ---~ State Zip

Ill. GENERAL CONTRACTOR

11. Name_-----__---___ ---__—__ Tel. # -------- IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name BEt1►AIAlm I~'.uiL'Zt3AW 4 +~ Cu' EL___13. Contact Person (1414►+Co

14. Federal Employer ID. # Ji-2492T95 _—___ 15. Tel. # C'tvB)531 _2900__ — Fax # C7t6> 2C9•- i808 —_____

16. Address 1248 _ RAL.FIt A4i- !. E —__--~~— City BO__ State __ Zip _1L _ V. THIRD PARTY AIR MONITOR

17. Name _ ±a 4 PAM' EN6.ta las ---_18. Contact Person Mc.a+a _NCtAt l

19. Federal Employer ID. # i3-34 (0 54_ —_ 20. Tel. # C2i2) 922- Qo77 -- Fax # _ (.2t2) 922-0G30

21. Address _2L3 EaS _45 rN S'7V T~ —Y— City Newyob• ---_ State ~+Y_Zip _Iccl l' _

22. Sample Analysis Laboratory______ ,,,________ 23. NYS DOH ELAP # _-- _____-

VI. PROJECT INFORMATION 24.. Startingdate for this portion of work 2 !_ ] ..?2 Projected completion date!c4

Asbestos work schedule ® Monday Z Tuesday ® Wednesday ® Thursday 0 Friday ® Saturday ® Sunday ,,ma ~cc ex: Shift from: _ t5 — aam 0 pm to 0 am 0 pm

If other, specify _-- ---_____--- — —____—____— ~F/LIED Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work 4O 000 Square Feet, and/or _0 Linear Feet ~ l ~ i~ ACP7 ~. 212001

NYC-WTC 000101851