NYC 9/11 Public Portal Document
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NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard. B"' Floor, Corona, NY 11368-5107 Building Dept. or TRU No
FOR OFFICIAL USE ONLY
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ASBESTOS PROJECT NOTIFICATION (-
FORM BE (ASBESTOS INSPECTION REPORT) I,
A tee
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.
ACILITY
83 MA t OIEN t_AM' E Borough FAA'3 Zip 10038
2. Address
3. Block 19 4. Lot 3
AKA
5. Type of Facility GO1na1ESCIA L 6. Name of Building
11. BUILDING OWNER
7. Name MP tC-t LkAJ E P SSo o ' 8. Contact Person
Fax #
~u) '-f fl tt.tc. State Zip i 003 _
10. Address fl40_ c cc At. EeL% 'A;S IZS I` Z City
Ill. GENERAL CONTRACTOR
11. Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name tdSAMiM kUR.2.BAt 4 Soo CCI$M1 OL- INC . 13. Contact Person t.ouWE I11N131C0
14. Federal Employer ID. # P11 N 15. Tel #. (l&) 5'31-2900 Fax # cTtd) 209- t$b8 _
_._._.,
AJtr NUE City ~ito0Kt.Y N State N Zip 11236
16. Address — 1248. RALPMI
V. THIRD PARTY AIR MONITOR
17. Name WRtur!N j Parr. . Eu61aEE:Rs 18. Contact Person M1c.1tAEL 140LAN
19. Federal Employer ID. # ._._._._._._._._._P_11 _._._._._._._._ _ 20. Tel. # (212) 922— oo7T Fax # (212) 922— 0430
21. Address X 22 6 EAST 46Ti1 $TR T City NEU3 _le '- State t Zip 10011
22. Sample Analysis Laboratory. 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
09-2T-02
24.Starting date for this portion of work 08_2T_02. Projected completion date
Asbestos work schedule ® Monday I Tuesday IN Wednesday ® Thursday ® Friday ® Saturday. ® Sunda
Shift from: 80O Z am 0 pm to ❑ am ® pm
If other,
specify ~1VEDn
Access to inspect the premises must be provided during the work schedule indicated in this item.
] - pU6 2'' 900Z
25. Total amount of asbestos-containing material to be abated during this work ~'ak
11312 Square Feet, and/or _0 Linear Feet
ACP 7
212001
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NYC-WTC 000102399
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