Asbestos Project Notification Form, 111 [name]

NYC 9/11 Public Portal Document

O/ "J/ -' NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program V ~~~ 59-17 Junction Boulevard, 8" Floor. Corona, NY 11368-5107 ~ aw D d* ASBESTOS PROJECT NOTIFICATION NO T IFI C ATION Building pt or TRU FOR OFFICIAL USE ONLY

t R1 ~~'~MtNrK /Ili nc~ FORMS WILL BE (ASBESTOS INSPECTION REPORT) i• ter ACCEPTED "• "' "'"'^ ~ fee schedule)

copies with original When submitting this form at the NYC Department of Buildings, the original form and three (3) Submittal at the NYCDEP requires one copy of the form with original signatures. This signatures are required. of abatement activities. form must be submitted to the NYC DEP not less than one week in advance of the start

I. FACILITY

2. Address 114 - 116 F V L'T 0 tJ— 5_T 2E E T —N--- ,__ Borough — MN--- Zip _-- --_

Block 4. Lot - ______ AKA -------------------------------3. -----

5. Type of Facility___------_______ 6. Name of Building — _---- --__—

II. BUILDING OWNER

7. Name _ C SOAR M ANA6 E M N ----- 8. Contact Person ___------------

9. Tel. # _ C2 12)-f 32 -1653 -- Fax # - ------------

10. Address _ 2C+v ESc'~ .r__...__-----City ------------ STR e E ~► Yo R k State _ N~_Zip

Ill. GENERAL CONTRACTOR

11. Name_----------------------------------_ Tel. # __________

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ►-~~nt_—kuQzBAN_ SoN — COu_i'noL_ --- __13. Contact Person _ LouIE__~A~H1~~------

P11 ` -- 15. Tel # _ C t~8 ) 531 - 2900_-- 14. Federal Employer ID. # ---------------------------------- Fax it _(?!8~ 20~=1808 _____

16. Address I_24F _ RA~Ot(— AdENUE __---__-- City __6wokL-`~ N—__--_ State EL... Zip _ ( ►236 —_

V. THIRD PARTY AIR MONITOR

17. Name wARgtE11_ _ pA02ee ENe, rIacE1z------- 18. Contact Person ------- --------------------------- 19. Federal Employer ID. # J P11 .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-, i ___ 20. Tel. # L?t?) 922-oo-r __ T Fax #

21. Address 2?8 Ems i _ QS Tll—_STaEcT ---- City _ j4 ?---__--_ State _iiL... Zip _I21T_____

22. Sample Analysis Laboratory__--__---__-------------- 23. NYS DOH ELAP #

VI. PROJECT INFORMATION o 24.. Starting date for this portion of work _ OG?~ 3~ b 2 _ Projected completion date oG I ? 3 I 2

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturd Sunday 3 Shift from: _ e — ICt am ❑ pm to _ — ❑ am Ix pm

If other, specify -------- ---------------- --------- -- REED Access to inspect the premises must be provided during the work schedule indicated in this item. ev JUN 27 2002 -S 25. Total amount of asbestos-containing material to be abated during this work 0 SLE_ RTR~GAN, l2 —_ 4410_— Square Feet, and/or — Linear Feet 4> 4iji ACP an0C

NYC-WTC 000111273