Asbestos project notification form, DEP Box 39

NYC 9/11 Public Portal Document

L;o c` ,2 7 p,Ci)r o[rrgf NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION

D Asbestos Control Program 59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107 #!k103*7&oJw Buildi Dept. or TR No ONLY b FOR OFFICIAL USE ONLY TYPEWRITTEN ~~°~MrHr~ii~n°cct' ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED 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 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 _W —___--- - - .j_____...._ Borough _L Zip _l OP L___

AKA —___---- ----_ __ 3. Block 4. Lot -

5. Type of Facility--------------------- 6. Name of Building II. BUILDING OWNER

7. Name __ _CAL01=- — _— _ B. Contact Person P11

9. Tel. # _-------------- Fax #

10. Address -_ PII__ .-._— City_ CMV- L' __ State _N' Zip1 __ III. GENERAL CONTRACTOR

11. N Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ (h~i —~ -- -----------------------------_13. Contact Person

14. Federal Employer ID. # 1 I I ._._._. . ._. .j15. Tel. # J 16 _7(_3v0 _ Fax #

16. Address ~ q l'~ L'_ — ___--- City J / ~ State A) Zip _LL22_- V. THIRD PARTY AIR MONITOR

17. Name V -2 ~T(Zc D_ C 18. Contact Person 19. Federal Employer ID. # PII v 20. Tel. # ~(=~aa =00 Fax 21. Address_ Zip - — ~ ~ `-~—~~~~ 1~~~ —/I-- City State

22. Sample Analysis Laboratory__ / EI`~(( ~L G- ~~ -'«S 23. NYS DOH ELAP-# _.1t f d _____

VI. PROJECT INFORMATION 24.. Starting date for this portion of work Z~J---t~1 t O ~~ Projected completion date

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

Shift from: __ __ ❑ am ❑ pm to _N _ ❑ am ❑ pm

If other, specify ---------- REl lVEO Access to inspect the premises must be provided during the work schedule indicated in this item. II( 2 2002 i's: 0 'EP/8ANHM 25. Total amount of asbestos-containing material to be abated during this work O PROGRAM~ Square Feet, and/or Linear Feet TRUG 2 6T ACP IeP 212001 B•I+EA+r ~r Ea tP1-1: Z!:1;,L

t..o- lJ3 ir1y7ACt o1T rrn~

NYC-WTC 000111104