Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

OD W7-~ ' °`'a;,r, o~ w NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program /1~LfS3y~tNo D o rp 59-17 Junction Boulevard. 8" Floor, Corona, NY 11368-5107

ASBESTOS PROJECT NOTIFICATION 8uida9 Dept. or TRU Nor FOR OFFICu1l USE O►av

(ASBESTOS INSPECTION REPORT) 1. lee $u educe)

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.

L FACILITY 2. Address t - (05 IA.) j Q)(LO M Pr I Borough Zip UO

AKA 3. Block 4. Lot

5. Type of Facility 6. Name of Building It. BUILDING OWNER 7. Name I/~ -e.n ~oC1 LLC- • 8. Contact Person 1 rtA-'- k, 9. Tel. 7 o&S~ Fax #~i )) 7 #~ 10. Address 37 S, ilk- 'tl-i2,s•~-A-- City N ' 1 State N ~]1 Zip 10, Ill. GENERAL CONTRACTOR 11. Name Tel. fl

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name y L3€'e 13.ContactPerson 7 - tom 14. Federal Employer ID. # _._ _._.WP . 5. Tet. # _$1 - ~~ Fax f! --n4 - // 7'' -3° 0 16. Address O/ ~ City_State /J ¶( Zip J (7

V. THIRD PARTY AIR MONITOR

17. Name t' f A T r4Z.ErL - ice_°3 S, fC IG 18. Contact Person %___4fVcE7_f ,( 0LAr4. 19. Federal Employer ID. a 20. Tel. # a f3 - 9aa - 00~ Fax # 2!3 21. Address, g lKI IF.l S'( E City 9 -m -r i -K State Zip 00 / 22. Sample Analysis Laboratory SCf&4-rtl'!L _ 23. NYS DOH ELAP # (f VI. PROJECT INFORMATION 24.Starting date for this portion of work 2 'a Z Projected completion date

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

Shift from: ❑ am ❑ pm to D am ❑ pm If other. specify Access to inspect the premises must be provided during the work schedule indicated in this Rem.

25. Total amount of asbestos-containing material to be abated during this work I 05IV Square Feet, and/or Linear Feet AP 7 22001 4t.'~,i tt!•Y r K^::vA•1t:4 U,,'

NYC-WTC 000111304