Asbestos project notification form, DEP Box 39

NYC 9/11 Public Portal Document

Ofl~gr NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION D/ J ? &)/l Asbestos Control Program L 59-17 Junction Boulevard, 8th Floor. Corona, NY 11368-5107 Building Dept. or U No ONLY FOR OFFICIAL USEONLv .ar ASBESTOS PROJECT NOTIFICATION I (ASBESTOS INSPECTION REPORT) 1, (S ee 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 NYCOEP 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 .

FACILITY r7 O 'D 2. Address _ C'1 £L_ 1-EJ. — Borough _ -- Zip - l

AKA 3. Block ____ 4. Lot

5. Type of Facility___---__--------__--- 6. Name of Building

II. BUILDING OWNER

7. Name ~ —S L L_C 8. Contact Person

9. Tel. # Fax #

10. Address L _ _— A L_ City — —_____ State N _~ zip

III. GENERAL CONTRACTOR

11. Name_--____ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ~I~ ( U ---------- _13. Contact Person

14. Federal Employer ID. # P11 - 15. Tel. # ~ 1_____— ± q9 —__—____-- Fax #

16. Address __301v_g~C~ ✓`~_--__--- City —___ — i ~_-- _ State /v Zip _LLZ _

V. THIRD PARTY AIR MONITOR

17. Name _y_ 2 _ PC 18. Contact Person

19. Federal Employer ID. tk P11 ; 20. Tel. # J = CEO — Fax # ZI ;~~0_~!s✓?L~__

21. Address n L S _f ri --- City >~~`~t __--_ State N Zip 100 (_

22. Sample Analysis Laboratory—_ -1 if 23. NYS DOH ELAP # _ _ _

VI. PROJECT INFORMATION '7 24.. Starting date for this portion of work __ __ Projected completion date __ Zz!_ ____2- Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday .~ Shift from: ❑ am ❑ pm to _--__ 0 am ❑ pm

If other, r specify - ---------------- -------------------------- R "~ Access to inspect the premises must be provided during the work schedule indicated in this item. — J Ul 0 2 2002 (" DEP/BANHM 25. Total amount of asbestos containing material to be abated during this work O `^SES RAMA: of rFUG _.LL. __ Square Feet, and/or ______ Linear Feet 6 V ACP 7 8 ••P6f,~N,'vd::2Clr.u'T T4•• Irn

NYC-WTC 000111100