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Asbestos project notification form, Zone I Originals

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NYC DEP Asbestos Project Notification form submitted for abatement activities in Zone I.

NYC-WTC_000111109–000111113

Folder label: “Zone I Originals

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Scanned page image, NYC-WTC_000111109
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NYC 9/11 Public Portal Document ——m St 07BWIO Ss ‘ . . WNYC DEPARTMENT OF ENVIRONMENTAL PROTECTION - “~, Asbestos Control Program D=Pp : 50-1? Junction Boutevard, 8" Floor, Corona, NY 11368-8107 Nae. Nw? ASBESTOS PROJECT NOTIFICATION balan ce (ASBESTOS INSPECTION REPORT) ACCEP SEE ARE ROTA ee, When submitting this form at Ine NYG Oepertment of Buildings, the original form end three (3) copies with original | signalures are required. Submittal at the NYCOEP requires one copy of the form with arginal signatures. This form must be submitted to the NYC OEP nat lees then one week in advance of the start of abatement activities . Guiding Capt. or TRIKNG FOR OFFICIAL USE ONLY 1. FACILITY . _— 2. Address LO CHamé<cRs STése/ Borough N ‘ Y Zip L8o va AKA 3, Block 4.lot 5. Type of Facility 6. Name of Building fl. BULLOING OWNER 7. Name Pil +” 8. Contact Person VidCisi 9. Tol. f Pll Fax # - — ~ 10. Address MIO CHAmee¢9 ST ciy__N): al State Nal Zp tooo} Ill. GENERAL CONTRACTOR . 11. Name Tels IV. ASBESTOS ABATEMENT CONTRACTOR 12. Name Fibel CorsT£o 13. Contadt Perin TROY Cos/# 14. Federal Employer ID. # Pil ‘18. Tel. # AY f 6 < 7g! 2300 0 Fax # ol é-? th “JoP S 16. Address 5. oO! Ave Aye City k) ROIS A State ) ¥ Zip MU2¢3 | V. THIRD PARTY AIR MONITOR , . 17. Name ___ VV re Rent 8 Piizen. Lucamenes, Po. Contact Person _MMiciteeL Noe rn! : 19. Federal Employer 10. # 20. Tel.# Hd - 49P-002F Fae HI -999 -0630 21. Address SI CERT Lge QT2LET city EW Tae, state zip [00( Z. 22. Sample Analysis Laboratory__S e(€NT(F (Ce b abs %aror 68, fers 23. NYS OOH ELAP #_11¢EO Vi. PROJECT INFORMATION . 24. Starting date for this partion of work —__{ 0) 2 Projected completion date U3 O72 - Asbestos work schedule [] Monday Q0 Tuesday O Wednesday 0 Thursday O Friday Q Saturday Oo Sunday Shift from: O am QO pm to : Q am O pm if other, specify _. Access (0 inspect the premises must be provided during the work schedule Indicated in this Kem. 25. Tota! amount of asbestos-containing material to be abated during this work LOEO_ Squere Feat, andior___ ss Linear Feet eureay eh pcedectn ba thes 2tvd Te: TT 2002 8e unc Scpl-T9f-ZTZ: xed €93 dad NYC-WTC_000111109

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NYC-WTC_000111109Source: NYC Law Department, mirrored locally

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