Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

,o33Ui I C~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 81° Floor. Corona, NY 11368-5107 — cb /a k Building Oept. or T o FOR OFFICIAL USE ONLY

* ITTEN f Nruii~o~° ASBESTOS PROJECT NOTIFICATION L. MS WILL BE __,._ (ASBESTOS INSPECTION REPORT) 1. Nvweyc.$ev/dp , ACCEPTED ( Ie)

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 __I14_ 06 FeerON S-r2. r Borough Zip

AKA 3. Block 4. Lot

5. Type of Facility_ 6. Name of Building

II. BUILDING OWNER

7. Name Crp A2 S UT _ 8. Contact Person _

9. Tel. # C21?) TS2 —r63___ Fax # —_--

10. Address _=o V~ ss EA? _STRa T _ City __ _~ State _L'L_ Zip

III. GENERAL CONTRACTOR Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR KuRZB~w i SOM ~DtN-i120L- ANC 13. Contact Person _ Lout` 1pNN1 CO 12. Name 'BEaSA M 1Q1

14. Federal Employer ID. # _---- —___~ 15. Tel. # CI18)_ 531-2900___ Fax #

16. Address j24e f?L-'P1t City d~OK~-YN __ N State JL. Zip X1236

V. THIRD PARTY AIR MONITOR

__18. Contact Person 1i(%cW AeL- NOLA►J __ 17. Name )APQ I ~fAN zts eOG raft- (W-* N

19. Federal Employer ID. # 20. Tel. # 922 -oo7T__ Fax # _ C2r2) 92Z- 0630 _

21. Address 226 671e r 4 -STit ST ET ____ City _J?-------- State _~L_ Zip _ 10OIT

22. Sample Analysis Laboratory.________— ------ 23. NYS DOH ELAP # _____-

VI. PROJECT INFORMATION , 24 Starting date for this portion of work "T! U?? _ Projected completion date 7/zaz~ Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday ❑ Sunday

Shift from: __ ❑ am ❑ pm to ____ ❑ am ❑ pm

If other, specify Access to inspect the premises must be provided during the work schedule indicated in this item. I- 25. Total amount of asbestos-containing material to be abated during this work r 13 32.1' Square Feet, and/or __ a Linear Feet i7 ACP 7 212001

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NYC-WTC 000111295