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Asbestos project notification form, DEP Box 39

Machine-extracted title · confidence 90%

Standard DEP form notifying authorities of an asbestos inspection project at a specific facility.

NYC-WTC_000111090–000111108

Folder label: “Zone I Originals

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Scanned page image, NYC-WTC_000111096
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NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION

109 i~~ 0b"'Ar Asbestos Control Program 59.17 Junction Boulevard. 8°' Floor, Corona. NY 11368-5107 L1t7M1 iO L euadng oeoc or TRU No FOR OFFICW. USE ONLY TYB ASBESTOS PROJECT NOTIFICATION LL BE (ASBESTOS INSPECTION REPORT) 1. , QQPTED foe

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 OEP not less than one week in advance of the start of abatement activities.

I. FACILITY c1 ~O 2. Address 9' W k-2 V 2Til2 ET Borough Zip _L

AKA 3. Block 13 7 4. Lot

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

7. Name1U G~ 1v W A~ LL -.0 ' 8. Contact Person 11 A-N4 M A'I 1-+ `G~~ "it 9. Tel. # I ~ - ~-(1 ax # Id`h~ 9 .----------------------------------------- .-.-.-.-. . 10. Address .-...-.-.-.-.-.-.-.-.-...-.-.-.-.-.-.-P.....-.-.-.-.-.-.-.-...-.-.-.-.-.-.-.-.-....— City " StateN' Zip . ,O pp3

III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name e1L Tvo`-' ~O 13. Contact Person ___SL____

14. Federal Employer ID. # j Pu1 ,15. Tel. # 516 - 2 j -340 0 Fax ~W- 3dV S

16. Address _City ) /! _ _ State Zip IL?

V. THIRD PARTY AIR MONITOR

17. Name (/22 2 &lZr CP 18. Contact Person V41tci4*j (oC kr-I. 19. Federal Employer ID. # _____ 20. Tel. # a(3 - as - OOJ Z Fax # 2.1a — ~a 21. Address ~2 LL 1 City _ b7=~ State Zip 0O / 22. Sample Analysis Laboratory_ SC (~((1=(L L'473' 7(`#'(ES ctc 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.Starting date for this portion of work 7-- D Projected completion date _J_ J_ Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday 0 Thursday 0 Friday ❑ Saturday 0 Sunday

Shift from: ❑ am 0 pm to 0 am ❑ pm MEE 19 If other, specify _ _

Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work -3

8 tPS° Square Feet. and/or Linear Feet e ZI I~ ACP CJR~A7 ~' J. t! 212001 iP ;

IFII

NYC-WTC 000111096

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NYC-WTC_000111096Source: NYC Law Department, mirrored locally

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