NYC 9/11 Public Portal Document
/CJ
1 ! ~.
"•
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Cdntrol Program
ti 59-17 Junction Boulevard, as' Floor, Corona, NY 11368-5107 ~ s1 M/
Building Dept or TRU No
FOR OFFICIAL USE ONLY
ASBESTOS PROJECT NOTIFICATION
_www:eYL.aevldap .
(ASBESTOS INSPECTION REPORT) 1.
TED
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 2 S tvi e,i +DE N LA E. Borough `MAta Zip 10038
AKA 3. Block b5 ___ 4. Lot 4
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name CEDAR MA►. AGEM'E.'IT _ '8. Contact Person RtOAARA kBEU.
9.Tel.# (2.12)'732-T653 Fax#
10. Address — yESS 9 STia_ r — City t' YoR - State _ tiq Zip t003
111. GENERAL CONTRACTOR
11. Name_ ____N ___ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Bc .Mt -OP7-BA4 4 Sots CCaTtzcx.. i NC_ 13. Contact Person Lot. tf t4 tCO
-------------------------- ------- ,
14. Federal Employer ID. #;w _ ._._._. P 15. Tel. # .S 2920
LL22 0 Fax # C'Ct8) 2O9- 11308 —_
16. Address 12413 "LPP Ave+-'G _ City State J`? Zip tt236
V. THIRD PARTY AIR MONITOR
17. Name tR1 Ro.P" PANzvz. E— 1 aE+= P-S ____18. Contact Person.., Mt tP€L CIJD3
19. Federal Employer ID. # _ 20. Tel. # -('212) 922-' OoT ( _ Fax # C, t2) 9'Z2- c
21. Address _ a21, gAsi 4S7it Snz City N " / 0l?- State I9' Zip JOFZ
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work O I t6 (o Z Projected completion date JoJ1J 02
Asbestos work schedule ® Monday ® Tuesday 13 Wednesday I I Thursday ® Friday © Saturday IZI• Sunday
Shift from: ® am 0 pm to 8<° 0 am ® pm
ç
If other, ;%
specify
1 ECEIVED tat•
I Access to inspect the premises must be provided during the work schedule indicated in this item.
1 SEP 17 2OY2
25. Total amount of asbestos-containing material to be abated during this work ~
a wa +irron a t ,
t08OS Square Feet, and/or '' Linear Feet
ACP 7
2/2001
NYC-WTC 000102172
OCR can misread numbers and units. Confirm readings against the page image before using them.