Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

Ea~&Tl GtT O[I.yr'Mf NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8'" Floor, Corona. NY 11368-5107 Building Dept. or TRU No FOR OFFICIAL USE ONLY ONLY TYPEW '•+°4M~"raii~~°cd~ ASBESTOS PROJECT NOTIFICATION FOR L E (ASBESTOS INSPECTION REPORT) 1 ~ .w. nvc~er/aer. AC (S ee schedule)

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 1S - IJ VTC 1 —S~? 2 ciaT —__ Borough ! -- Zip 2. Address 3. Block 'T8 4. Lot _ - 7 SO4 AKA -----------------

5. Type of Facility...------------- 6. Name of Building ~M-- — --

II. BUILDING OWNER :~1 C~i

7. Name 8. Contact Person!____ . P1I —

9. Tel. # ----------- -- Fax #

---__—_ City State _____ Zip 10. Address _------

III. GENERAL CONTRACTOR

11. Name---------- ---------- Tel. # — • IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name wAMIN__KU¢?15Au 4 Sc* toiIJrRoL. (Nc__13. Contact Person 1QUIE__~A NNICo----

14. Federal Employer ID. # _._._._._._._._P I I _ _ _ _ _ _ _ 15. Tel. # )_ t-=2922____ 22___ Fax # A~EfJt __--- — City — BRooKt.y ---_ State u~__ Zip J! 2 36_____ 16. Address c 24 8 _—RA!-PN

V. THIRD PARTY AIR MONITOR

17. Name l>`S AQ9* N-__ '-PA N ZC- R COG r ►?G 5 ----- _18. Contact Person 922-v6 30 —_ 19. Federal Employer ID. # -__ _ _ _ _ PII _____ . 20. Tel. # (212 ) 922 -c;oT T — Fax # _t21Z1 NEW YGa-~ --_ City ---------- State ~`t _ Zip __L221T-- 21. Address _ ?~ i4____

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

VI. PROJECT INFORMATION 24, Starting date for this portion of work _ V L 4Qa _ Projected completion date

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

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

If other, J pC CO specify _--------------- ---------------- -- REM YL

Access to inspect the premises must be provided during the work schedule indicated in this item. C ' 20(12 G j V

25. Total amount of asbestos-containing material to be abated during this work ! p ?`,~R',• iRUG J4_ Square Feet, and/or _ Linear Feet

NYC-WTC 000111299