NYC 9/11 Public Portal Document
NYC OIPAWTM __ Mj AL MdIiC'TION
59.17 .hnolion Bou tetd. a PIOM. NY tt3i61U7
r,iri DP ASBESTOS PROJECT NOTIFICA1
III - (A~ESTOS INSPQCflON REPORT) 1.
`rww.ete.1 tsar.
ACCEPTED
of Bum• the'original form and three (3) copies *0 odghrel
When submitting this form at the NYC Department requires one copy of the form with odgkW signatures. This
signatures are required. Submittal at the NYCDEP
than one week In advance of the start of abatement activities.
form must be submitted to the NYC DEP not less
I. FACILITY
Borough MN __— ZIP 1ao38
2. Address 164 w ILLfam -SYQg. •r --
3. Block 9 —_ 4. Lot 2_
AKA --- -----
4 .E- __ 6. Name of Building —.~.---
5. Type of FacilitY--M L x Eo
---
U. BUILDING OWNER
re 8. Contact Person _---------
7. Name SAL V A T C f2 c i'c
El . . . .~ Fax # --- ------------ -------
=_
PII Nr City J_._._._._._._._._P11._._._._._._._._.
10. —_._._._._._._._._._._._._._._._._._.: —
III. GENERAL CONTRACTOR
Tel. #
11. Name __—____----------------- — -
CONTRACTOR
IV. ASBESTOS ABATEMENT
13. Contact Person _~~ aLa - ---__—
Sc.~—CAN due
---------
12. Name ~~AµL~ kygz~9~i
PII 15. Tel. # t z rt f~) 3 r - g 9 eo_-- Fax #
14. Federal Employer 10. # b__._._._._._._._._._._._._._._._•.--- -
►+j__ Zip _n 2 3E _
S:t City -_ -Y N -_---•-- State
16. Address i 24Is A QV
------------- --
V. THIRD PARTY AIR MONITOR
~ ----------_18. Contact Person ~~►rAs~ _cN ----
c _ __tokN__~u — -
17. Name —aja►
-----
2 max:C t — Fax # 30---
20. Tel. # _--_71 9?--=
19. Federal Employer I0. # 1
City --. fo
`=---------- State _ ZiP - t rc . ____
Zz f Cpl ; ci ~t
---------------
21. Address
--------- 23 NYS OC~I =LA? x
22. Sample Analysts Laborato ----"-"'-
VI. PROJECT INFORMATION ;
_____________ __ Projected completicn dare _ =% ~' ---
24.. Starting date for ih:s portion of work
=rt;a; Saturday 12 Sunday
© Wednesday~ 0 Thursday
Asbestos work schedule ©htcnday ~ Tuesday
ck. 10
© am ❑ pm to _ _— Dams pm ?1 • 1/
Shift from: _ '__
4
$ iry ----------------------------------------- RECEIVEO
If other. ___
this item. '
~Ac~cess inspect t ~p rer*S~esmusr~prmavtd~eddudng
be the work schedule indicated in _ AUG 0 5 2007
material to be abated during this work ::
25. Total amount of asbestos-containing C
rvJ
C
2230 _ Square Feet. andlor _.^__.—.- Linear Feet ! Ac.
i .
NYC-WTC 000110917
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