NYC 9/11 Public Portal Document
~,,;~, . NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
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~ °'` • ~ - Asbestos Control Program
59-17 Junction Boulevard, 8~" Floor. Corona, NY 11368-5107 7 ~0~
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•~ ASBESTOS PROJECT NOTIFICATION
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ACCEPTED
ITTEN
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(ASBESTOS INSPECTION REPORT) . •
(Sea fee schedule)
~ilien 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 I65 WILLIAM 5 -I Q E ET Borough MAN Zip 1003 S
AKA 3. Block 4. Lot
5. Type of Facility 6. Name of Building
11. BUILDING OWNER
7. Name 169 EyMA0 &ssoetATES % }Act ResM1c r 4 SoNs, INc • 8. Contact Person PEtem ResMco 4
9. Tel.# (242) 421-1300 Fax# (2l2)1rse-x949
10. Address d o EAsS 59'nt 5T9Qr_-T City ,Iw Yoax State P1 Zip 10022
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name SEN.SAMIN KUQZAAN §t SoN 00.31 OL fie. 13. Contact Person LoutE IANM tCO
14. Federal Employer ID. # PII - 15. Tei. #. (t8) 531- 2900 Fax # ( tt8) 2O9-18
16. Address 1248 RALPtt AJ►ENUE. City 8P)0'LYN State N4 Zip 11230
V. THIRD PARTY AIR MONITOR
17. Name WARREN 4 PRMz.eit ENrc.INeeps 18. Contact Person M10AREL NokAN
19. Federal Employer ID. # _._._._._._PII -20. Tel. # (212) 922-eeoTT .Fax # c212) 922-0630
21. Address x216 EAST 45n Sr'erMT City NFW YoeK State NY Zip 10O1T
22. Sample Analysis Laboratory, 23. NYS DOH ELAP #
Vt. PROJECT INFORMATION
24_ Starting date for this portion of work 10 { 40 102. Projected completion date II 110102
Asbestos work schedule ® Monday ® Tuesday © Wednesday ® Thursday IE Friday ® Saturday Sunday
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Shift from: Soo ® am 0 pm to 8 '° ❑ am ® pm wk
If other, Tt
specify
Access to /nspet~t the premises must be provided derning the work schedule indketed!n this Item.
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25. Total amount of asbestos-containing material to be abated during this work
Square Feet, and/or Linear Feet nt,,,
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ACP 7
212001
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NYC-WTC 000110813
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