Asbestos project notification form, Zone I Originals

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8'" Floor, Corona. NY 11368-5107 •- Building Dept. or TRU No A D ONLY IED FOR OFFICIAL USE ONLY

TYPEWRITTEN f'~R° rNr~~ °+ ASBESTOS PROJECT NOTIFICATION FORMS WILL 8E - (ASBESTOS INSPECTION REPORT) 1 ACCEPTED - (See tee schedule)

When submitting this form at the NYC Department of Buildings, the original form and thrra ral nnnien .uilh nrininnl signatures are required. Submittal at the NYCDEP requires one copy of form must be submitted to the NYC OEP not less than one week in advanc

I. FACILITY

2. Address

AKA ---- ----- ------- ----- — 5. Type of Facility------- II. BUILDING OWNER -------- -------6. Name of Build L'o/ô /► 7. Name El ~~ ^ 3~ 9. Tel. # Va l a~ / ~5--J

_42 ax# _----------_ ~-!~ %Lam__

?ci\ fl lo?L 10. Address ~C7 ~ 4 PA [_ [ S~ City ---N

III. GENERAL CONTRACTOR

11. N

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ eIL ._I_._._ ._._._._._. / --__-- __13.

14. Federal Employer ID. # II_ — _ 15. Tel. # c1«- 2 L:

16. Address oL2 1 -------City J /!

V. THIRD PARTY AIR MONITOR

17. Name

19. Federal Employer ID. # P II _ 20. Tel. # a ~~=~~a -

21. Address g1 _L__I --- City

22. Sample Analysis

VI. PROJECT INFORMATION 24.. Starting date for this portion of work _ : Projected car

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Tllul uoy — . ..--- - -

Shift from: __—_— 0 am 0 pm to 0 am 0 pm

If other, specify ----------- --- Access to inspect the premises must be provided during the work schedule indicafed in this item.

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

0 0 Square Feet. and/or _—_-- Linear Feet 7 Dl

Pef.CR,aI rrn ~

NYC-WTC 000111197