Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

Ea~&Tl NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8" Floor, Corona. NY 11368-5107 /~ j ~Q' C/k~vv t1f, Building Dept. or TRU No FOR OFFICIAL USE ONLY ONLY i TYPEW fh'*o ASBESTOS PROJECT NOTIFICATION FOR """L - E .wa nvc{er/aer. ~~~~~ (ASBESTOS INSPECTION REPORT) 1 AC (S ee schedul )

copies with original When submitting this form at the NYC Department of Buildings, the original form and three (3) 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 iS _ C)VTCL—S5? -- 2CrGT —__ Borough __±L_ M — Zip

AKA ----------------- 3. Block _TB__ 4. Lot _2.!2.4___

5. Type of Facility...------------- 6. Name of Building ' r II. BUILDING OWNER

7. Name 8. Contact Person '..P2' `- ' -

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

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

Ill. GENERAL CONTRACTOR

11. Name---------------------------------------- Tel. #

• IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name wAMc1J__JeUl!715Au ~ 5011 Co&.;TRc~L G Nc__13. Contact Person 1QUIE__lA N NICo ---

11 )_~31= 2 22____ Fax # _i 8) 2 a 9 - t Eio8 ___ 14. Federal Employer ID. # _._._._._._._._P __ 15. Tel. #

ADEN( __--- ~— City — BRooKcy L___ State uL. Zip J! 2 36_. _ 16. Address J24_ _—RA+_PN

V. THIRD PARTY AIR MONITOR

17. Name W AQRLE N_ -P A N_ ZC- P- __CuG I u C 5 ----- _18. Contact Person 922-c;2I — Fax#_L21Z1 922- a6.3o—_ 19. Federal Employer ID. # ______._._._. ` —_ 20. Tel # C?t?) P~~

City NEW YGa-~--_ State _~`'t _ Zip _ J oolT —_ 21. Address _ 728 —EA LATH;___ NYS DOH ELAP # 22. Sample Analysis Laboratory------------------------23.

VI. PROJECT INFORMATION 24, Starting date for this portion of work _ L O oL _ Projected completion date

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

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

If other, CCE~CO specify _----- ---- ------ ---------------- -- ~ r• RU,C L (t

Access to inspect the premises must be provided during the work schedule indicated in this item. C ' 2002 ~G j V ;•EP 25. Total amount of asbestos-containing material to be abated during this work ! p '`,~R:•: . RUG $8!__ ~ Square Feet, and/or____ Linear Feet

. ...;,,.opt• ..~.

NYC-WTC 000111299