NYC 9/11 Public Portal Document
PROTECTION
NYC DEPARTMENT OF ENVIRONMENTAL
Asbestos Control Program 0
39-17 Junction Boulevard. 8" Floor, Corona. NY 11368-5101 sr TRU PM
Use ONLY
TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE "
N4- (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED " "-r'!' • • .
the original form and three (3) ooplaa'Mfh original
When submitting this corm at the NYC Deportment of Buildings, of the fonts with olglnal signatures. This
signatures are required. Submittal at the NYCDEP requires one copy
advance of the Start of abstament settvtiies .
form must be submitted to the NYC QEP not lea than one week in
I. FACILITY
`
--~E C g ~— 1 Borough _ —._ Zip
2. Address _ __ ----
_
-----__._ ._ -----------
—_ 3, Block ` 6 —..- 4. Lot r
AKA_-
KA -------- ------- --
5. Type of Facility 8. Name of Building ,_— —_-- —
it.. BUILDING OWNER
7. Name 6 Contact Person ..~--- -----
9. Tel. # 1 S? )- tJ max --------
10. Address _lid --- -- S --_— City _ — - - State -.--
III. GENERAL CONTRACTOR
Tel. #-----------
11,
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name (~ --
I---------------------__._ -340 13. Contact Person
14. Federal employer ID. i t
PII -15. Tel. # orb_- ~E~_ O
---- Fax # ~S~I35 -
~'~ /1
16. Address
/~
old_ 1Jy_-- -- City
_ Ci, r~"-'4~--- State IV zip ~.LZ -
V. THIRD PARTY AI MONITOR , r
17. Name 2.?G i~ Ec_,._ 16. Contact Person
19. Federal Employer ID. #
-
_____--_-— __ 20. Tel. # ?
as _a
— o __ Fax # _213 - _ bi
r --
,n
-
~~f-r
City -CLAW ----- State L= _ zip _
21. Addressg rte- --
0 oX(E 23. NYS DOH ELAP
22. Sample Analysis Laboratary__ _~. ( '"~
V1. PROJECT INFORMATION 0 Z
I _QZ Projected completion date —
24.. Starting date (or this portion of work
Asbestos .vcrk schedule 0 Monday 0 Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday
2 3 ~
Shift from. ❑ am ❑ pm to __ ❑ am Q pm
It other,
specih' —_------- ---------- —
;;' Rt 0 \
Access to inspect the Arei'rii.t mutt be provided during the
work schedule Indicated in this item. JUN 28
2002 a>
during this work
25. Total amount of asbestos.containing material to be abated M
TRUE V
Square Feet, and/or __ __— Linear Feet
ACP7
Fi 212001
e,n AU or EMnx1wN
a l~irrryLr►;t;w-
V-30BY U7rA "j
Inn
NYC-WTC 000111190
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