NYC 9/11 Public Portal Document
~) T/~ , ,~,, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
1+~ i. -r*4,0 Asbestos Control Program &!V1&A0b
~ 59-17 Junction Boulevard. 8 f=loor, Corona, NY 11368-5107
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ASBESTOS PROJECT NOTIFICATION
Suil~Iq orTIW No
FOR OFFICUL USE ONLY
(ASBESTOS INSPECTION REPORT) 1.
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,ter 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.
1. FACILITY
2. Address 161 WILLIAM SIQ4EWr Borough _IA,' Zip _10036
AKA 3. Block J2 4. Lot 5
5. Type of Facility COMM>r.QC.& i-. 6. Name of Building
11. BUILDING OWNER
7. Name J Act- R_N ICX- 4 Sass t i& . * 8. Contact Person "&-P^"^ G^Ss•. a
9. Tel.# (2I242.1-$3O Fax# C242) Z5*- 25►4113
10. Address Ito t s 'flf bsw r City Na=w TOO.$L — State Ny Zip O02
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name A&M1t_ kurazeA$ # SON Cro 5T-01 INC __13. Contact Person Mewls_% t_o
14. Federal Employer ID. #`- - 15. Tel. #. e- ItA_ Sal •2.900 Fax # _C-tAtk) 209.. I eM
16. Address!248 C* AUEMUE City c0itU4 N State _W Zip 11234
V. THIRD PARTY AIR MONITOR
17. Name WMRE 4PAN2eg _ 1 its a INC. 18. Contact Person _~CM~L• OWN _
20. Tel. # C2t2L922 -o T Fax # (4 ) 022-045120
21. Address _ s" CAST 4STIt S-to City t I A Yews State_ Zip % O tZ
22. Sample Analysis Laboratory, 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24,Starting date for this portion of work Ic t0R toe Projected completion date 1©1 3%102
Asbestos work schedule ® Monday ® Tuesday 0 Wednesday ® Thursday ® Friday ® Saturday 0 Sunday
Shift from: t ® am 0 pm to 840 0 am 19 pm
If other, `~
specify _M
1 4
Access to inspect the premises must be provided during the work schedule indicated in this item.
;~ ~EIVED
25. Total amount of asbestos-containing material to be abated during this work t /
106 2 3 Square Feet, and/or o Linear Feet
,.~ 212001
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NYC-WTC 000110825
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