Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program L II ~► DAP 59-17 Junction Boulevard, 8°i Floor, Corona, NY 11368-5107

ASBESTOS PROJECT NOTIFICATION Building Dept. or TJ No FOR OFFICIAL USE 0fILY EWRITTEN ~c FORMS WILL BE` (ASBESTOS INSPECTION REPORT) ACCEPTED fee

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

I. FACILITY

2. Address _-12 5 FUL10 N smizgET Borough — — Zip

AKA —__-- —_ _ 3. Block 4. Lot

5. Type of Facility_---- 6. Name of Building _

II. BUILDING OWNER

Rt' — — • ' 8. Contact Person ~V Qr s 1Mov 7. Name a, €G ^*ti

9. Tel. # _C!i8) T2-' -_TZ~? Fax # _---

10. Address _!2's- VOLToA SI 'L_ _---- City --N` ------r State u`L _ Zip__ —_

Ill. GENERAL CONTRACTOR

11. Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 13MISo.~.uw1 Kt112.2.E'~P.W A 50 — L`oaYre_o~- 13. Contact Person _t~utE IANu 1 Co —__-

2og _ tpo8 _ 14. Federal Employer ID. # _--- ---_ 15. Tel. # t:,t8) 5 31- 2 .22 .._ Fax # C1tt3 )

16. Address J4 —~VEWOE __-- -- City — BRook4-'~ N —_ State JL. Zip _ (I?36

V. THIRD PARTY AIR MONITOR

17. Name ~'? ~ PAWZEi- eA1~rn ggeS INC --_18. Contact Person _Mlct>lAeL. 1Jo4.A►1J --- 20. Tel. # 'LL.._. Fax # 22 - 063o 19. Federal Employer ID. # -------------

21. Address 22 8 - EAST 4511/ S-rMee7 '--- City —W q ------ State N4 _ Zip _100LL _.

22. Sample Analysis Laboratory—__— ___—r ---------- 23. NYS DOH ELAP # - ------

VI. PROJECT INFORMATION 02 _ 24.-Starting date for this portion of work e6' 20' Projected completion date ~-

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday 0 Saturday 0 Sunday

Shift from: __—~ ❑ am ❑ pm to _--__ ❑ am pm

If other, specify -- ---------- ------- // Rip Access to inspect the premises must be provided during the work schedule indicated in this item. JUN 18 2002 N NM ^ 25. Total amount of asbestos-containing material to be abated during this work P3ESTOS ~ - TR RAMFA Square Feet, and/or —b Linear Feet 2 ACP 7 2/2001 9 ''RIU !t' ,~£1fE~rUefu ~`~ R~~ P~p~7Rp~

3-~ f

NYC-WTC 000111291