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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_000111195–000111199

Folder label: “Zone I Originals

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Scanned page image, NYC-WTC_000111195
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NYC 9/11 Public Portal Document « a E iy) ? 7 LUT. aon, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION oe - “ty Asbestos Controi Program == . 50-17 Junction Boulevard, 8" Floor. Corona, NY 11968-6107 wer TRUM ONLY a ia . USE OMY TYPEWRITTEN“ ® ASBESTOS PROJECT NOTIFICATION FORMS WiLL GE {ASBESTOS INSPECTION REPORT) ACCEPTED MEALS LEY LOE8 , When submitting thig form at the NYC Deparment of Buttdinge, the original form and three (3) copies with original | signatures are required. Submittal al the NYCOEP requires one copy of the form with original signatures. This form must be submitted to the NYC DEP not tese than one week in advance of the siart of abatement activities . 1. FACILITY 2. Address {Qu CHAM! 2S STCEOT Borough NJ + ~ Zp_[looo a AKA a.Block 37 4 vot ac} 5. Type of Facility 6. Name of Building {t. BUILOING OWNER 7. Name HERBERT Mestdomye _.: 8. Contact Person @. Te #24 92) 132-4 049g 10. Address |} Pacact eTtte 27 City No State N : ‘Vio {eetS Itt, GENERAL CONTRACTOR , 11. Name Tel. # IV. ASBESTOS AGATEMENT CONTRACTOR 12. Name Fibee CorSTKo[ 13. Contact Person Tory Cos/A 14. Federal Employer 10. #: Pll sto. # 516- 28/-3000 Fax# Sié- 2dL-F OSS 16. Address Solo Bvbus AY ¢ City k) AOTC G state A) ¥ Zip Ul? F V. THIRD PARTY AIR MONITOR 4 17. Name cert & Pins ZER. Euainenes, PCa Contact Person Micrel None! : 19. Federal Employer ID. # 20. Tel. # DD- 999-0027 raxn 2d 992 - 0630 21. Address 2QE EMT UCM Spacey city KEW Tree State ie zip [000 F. 22. Sample Analysis Labormtory__ S ee MTEC hapsrearacies, fore 2a.nYsooneape ((¥HO VI. PROJECT INFORMATION ; 24. Starting date for this portion of work 1 | \ 2 | (é) 2 Projected completion date _3| is]oz } Asbestos work echedule CJ Monday O Tuesday i) Wednesday | Thursday oO Friday D Saturday ] Sunday O am 0) om Shift from: oO am CJ pm to If other, spacify Access te inspect the premises must ba provided during the work schadulo indicated In thle em. 26. Total amount of asbestos-containing material to be abated during this work 3°77°0_ Square Feet. and/or. Linear Feet cay of tie ay ? viid Os: TT 2002 8e unc SEhI-19Z-ZTZ:xe4 G33 d3d NYC-WTC_000111195

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NYC-WTC_000111195Source: NYC Law Department, mirrored locally

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