Asbestos project amendment form, DEP Box 39

NYC 9/11 Public Portal Document

~, l ~~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ~ 02 ~ 1/7 W ( ' d` ~~ Asbestos Control Program "`" 59-17 Junction Boulevard, 8" Floor. Corona, NY 11388-5107 Building Dept. Cr TRU M ONLY FOR OFFICIAL USE ONLY TVPE N ASBESTOS PROJECT NOTIFICATION. f0 BE "-="1O (ASBESTOS INSPECTION REPORT) 1 L IE (See sdwdule)

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. 4 1. FACILITY _ 2. Address 150 15L CWAM 5 l 1 Borough N 1 - Zip________

AKA 3. Block 13 *71 4. Lot 7S"I

5. Type of Facility. 6. Name of Building 11. BUILDING OWNER

7. Name 15e - i - CWct- vi'a~a$ S\ Crc a M I m WW £M. Contact Person t ►A u 9. Tel.# Fax# 1 10. Address l — &~~ 1 Atl.e ST City ~^ N State Zip R I

111. GENERAL CONTRACTOR

11. Name Tel. # _

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name llJ' e1L p 13. Contact Person _7 Y 7/ t~8 14. Federal Employer ID. # P" 15. Tel. # cJ X340 o Fax # 5I'P— l f' J S

16. Address 301 ~ e City J ~ State Zip _?

V. THIRD PARTY AIR MONITOR

17. Name 4 E Ci r 3 Pc 18. Contact Person nii4{*EL i t O L-

19. Federal Employer ID. # 20. Tel. # 1 )_0Oj9L Fax # 2.149 c2a -0 6-3 0

21. Address 2~g k1 (~~F City I4 ~C/=~1~ State Zip Oo

22. Sample Analysis laboratory SC fotf wic— 1. ___ crc 23. NYS DOH ELAP # (I ~Sd

VI. PROJECT INFORMATION ~1 24_ Starting date for this portion of work ` Projected completion date

Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturday 0 Sunday

Shift from: ❑ am 0 pm to 0 am ❑ pm

If other, specify _ `'~ t][ a 1 Access to inspect the promises must be provided during the work schedule indicated in this Item. 2002 N G~P;(3ANHM ,. 25. Total amount of asbestos-containing material to be abated during this work 3~S10S;LEI.- ~ 'PROGRAM Square Feet. and/or Linear Feet ACP7 e°a s212001 4 a;~u a. '. s C`f IFr- a„~,I r^E3IrAT

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NYC-WTC 000111074