NYC 9/11 Public Portal Document
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NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8e Floor. Corona, NY 11368-5107
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1. (S fee schedule)
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 ..JL 3G Wit A m S-;VeeT Borough _ 1AA" __ Zip — 10038
AKA 3. Block 'TT , 4. Lot
5. Type of Facility MIX €0 ust 6. Name of Building
II. BUILDING OWNER
W(LL1 AM rr t1Lr3IJ (2EALr' LLC
Lt<- 8. Contact Person ( A.~c MtsFtAi-
7. Name eLnMa.re REALTY
9.Tel.# (212 ) 924- t520 Fax# c212 )924- 1509
10. Address 3 9 wES'r I411-( ST2EET City JEW Yo- State roY Zip toot
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name C3eN 1.'-MIN tcvez(3A l A Sot CoNTPCL INC __13. Contact Person L.00'E (R te _
14. Federal Employer PII_ 15. Tel. if (,1t;) S3t-2900 ^Fax# +tb~ 2c9-tt3OS __
16. Address 1249 ' = City C3eo0V---" State Ni Zip tt 2 36_~
V. THIRD PARTY AIR MONITOR
17. Name WAIN "a,.Nzee ENe-INEEP 18. Contact Person Mtct1AEl 0Wa
19. Federal Employer ID. # ._._._._. _._._._._.P.ii_._._._._._._._._
20. Tel. # (212) 922 - co07 T Fax# (21x) 922-03c
21. Address 228' Eks T 4 S"L1t STET City ~~"' Yom- _ State NY Zip %0011 T'
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work (t -I 8 ' 02 Projected completion date tt -30-0.2
Asbestos work schedule ❑ Monday ® Tuesday ® Wednesday ® Thursday ® Friday 0 Saturday® ,Sunday
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Shift from: T co ® am ❑ pm to ? ❑ am © pm
If other,
specify
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
9900 Square Feet, and/or _ 0 Linear Feet
ACP 7
2/2001
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P`pORAY
NYC-WTC 000110553
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