NYC 9/11 Public Portal Document
SEP-19-2002 05:39 PM MUNICIPAL EXPEDITING INC 2125875702 P.04
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NYC DNPARTME ENVi*ON NTAWT PROT ION !.
Aabests Control
5e-17 Junoftn llo.Ao d, 8" Floor. Coon 3 NY 113084107 w wog an e
r ewrurrBAr ~~ i NOT AN ASBESTOS PROJECT I cPewrs
Pores MLL 00~s •• ? ,
eE ACI:lOPrura
When aamm* $ loss farm at the NYC Ospm U*l d eue*ps, ttrs aiginei ram and three (3) oopiss vh aelpintl
2. FacOly Adeirsss 18 Malden Lane gb h Mardvuttbn 10038 .
AKA 18 Jahn S(reet 3. Bbok 8ff• 4. Lot ?
8. BuIlding Owrwr Rekle Cormpraintt_ Tel. # (212} 964-3180
8. Addmes JS Medan Lane ga,m NY 10038
7. Coated Perron. Masco l'18ltar 8. TeL #(272) 864-3180
S. Oeeaipvon of the Lathe Scope d work
10. EeL Start Dab IN Aes aeon as p.niø sppeavod Eat. Dan 4odon Data &312_ dais
the Lathe Scope of work
11.1. RId P. Muow have acrAu red an esba lm + on 0 In soomdwm wish
nw.a
Secdorre 1-10 and 127 of the NYC DEP Aabsatos Control Prvgresn flutes And declare theist esld tautly address, the
0..prams to be demogstred!s free ofany asbestos comadr dap nm10 4 (ACM).
ob. premise to be damalahed eontak+s 10 square feet or less or 20 queer feet or lose of ACM.
QI a. nuowlalve swfaoee debuo tn(s) atfiated by the wok are fr ee of ACM.
d eumutegMe wtaoss of etrtad ero(s) arttaoeed by tae vwerk commkr 10 square feet or tee. ar 26 purser feet or less of ACIbI
Q e. rtwmdly non. rtebie ACM sleep be dlebabedtremoved. Spedry amount square test
Q L ACM *1 not be dletated drxb+p the scope of worts. Speedy amount of ACM prse t square feet liner feat
Alt AOW in "fly'. ar e• cr erem CO,. trc*di.•
yT
13. Attalyeoei Laboratory Me sake amp, .5
14. ELAP e 1a. Dete(s} 8srmpIae Anstyzed
18. I hereby provided herein b Irw and complate,
87601 5/101D2 911 826.2727
uOawe. fees aw" w~er.r
Any aadIlodon or do *at trrtarrrestlsa proNded an fete form must be reposed 111nwoaiety in
G1lt is The tefpAareeries dtivs Aseatoa Cvn6oi Pro6rsen Rules may not be I NYC J
s use the psrlbrtnenos d wok Si Onaemeneat or piaoemeer to
'rn p~Mapwdengasdl,p New v*%w*
NYC-WTC 000102083
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