NYC 9/11 Public Portal Document
r ~S ma,~pr~ h,4 NYC DEPARTMENT OF ENVIR6NMENTAL PROTECTION
Asbestos Control Program
ONLY DAP
59-17 Junction Boulevard, 8a Floor. Corona. NY 11368-5107 io9ogH ,
Building bept or TR No
FOR OFFICIAL USE o v
TY
BE "ru~~ ASBESTOS PROJECT NOTIFICATION
~'.~:ievtiep (ASBESTOS INSPECTION REPORT)
p
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
form must be submitted to the NYC DEP not less than one week In advance of the start oforiginal signatures. This
abatement activities.
I. FACILITY
2. Address _O 1 0 F ( Borough N Zip _ _ 0 0
AKA 2' E_ -'fl Q-7 b ) tCk 3. Block 4. Lot
5. Type of Facility 6. Name of Building
11. BUILDING OWNER
7. Name ~~ 1~ l '8. Contact Person ►
9. Tel.# ~~P11 ;ax#
----------- ----
10. Address g > ga S { City — J~' State 0
III. GENERAL CONTRACTOR
11. Name
Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name ellp !,CO(
__13. Contact Person
~~
14. Federal Employer ID. # P11_ _ ..-._ 3c0 Fax #
W115. Tel. # ~ ~ - 7~I 1lr4t 3~
16. Address 0 l v ~n ie City—___-- _______State
State /V Zip 11Z~
V. THiRD PARTY AIR MONITOR
j'J~►?~
1
17. Name kr[ZE2 -N&'4ta7fc1 Pc 18. Contact Person i L (`tflL
19. Federal Employer ID. # 20. Tel. # 0« 1- 00j Z Fax # te t,22 -O6 30
21. Address I1 67(
'1E67 City _ l`i - 7 State Zip Lc( .
22. Sample Analysis Laboratory ! Ie_
C f '! (Ft'L Ai5c _9A Th '(~S ~ c 23. NYS DOH ELAP # rf L g -O
VI. PROJECT INFORMATION
24.. Starting date for this portion of work 'i/o a Projected completion date 71: o~
Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday 0 Thursday 0 Friday ❑ Saturda ❑ Sunday
Shift from: ❑ am ❑ pm to ❑ am ❑ pm
If other. :
specify _ s ~► :t,.,.
Access to inspect the premises must be provided during the work
schedule indicatedin this item. fI . •
l 2.O(
MM .
25. Total amount of asbestos-containing material to be abated during this work
uare Feet, and/or Linear Feet 1 i
'-1 I (Poo ~,
212001
NYC-WTC 000109770
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