Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

a 6(, Cj NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor, Corona, NY 113685107 '""~ ✓ ✓ ' 7 FOR Op oevr. a TRU No ONLY D FoaoaFra~useorev ASBESTOS PROJECT NOTIFICATION I (ASBESTOS INSPECTION REPORT) 1. ~..:.~ t: r..~ • s.ql.e sofloduN) 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.

1. FACILITY

2. Address 51 M 1hYr S ._ — Borough 1 Zip AKA 3. Block 4. Lot 5. Type of Facility 6. Name of Building U. BUILDING OWNER

7. Name wr r i o..r r ' -SS_ LLc . Contact Person - l-A-t~ ('AA-a'c u l8 9. Tel. # L _ o&50 Fax U \ J ) rIS — 0$Sa-

10. Address 2 7 ~_ p 1' k.. -6- -~ City - - -t•S ' _ State' L± Zip III. GENERAL CONTRACTOR

11. Name Tel. #______________________ IV. ASBESTOS ABATEMENT CONTRACTOR /~ 12. Name 'elpl 13. Contact Penton 7 Cam 14. Federal Employer IO. # P I I _._._._ _ _ _ _ 15. Tel. # c~ 16 - 7 'i ' 3 00 O Fax # c 7( - / d 3.5 d ~ 16. Address 3d b it o /TY* City /I7v7 State IJ ( Zip 117 V. THIRD PARTY AIR MONITOR ~1 ll rr 17. Name _(_ kr(ZE2 Gl fC 18. Contact Person 19. Federal Employer ID. # 20. Tel. # a (P - 9aa - ODJ ?• Fax # 2/ 06:3 O 21. Address e -EAST S'( E 7( City 1 1R 2 lz. State Zip 00 r

22. Sample Analysis Laboratory S2/t9`[T/FlE. al. 0 r-A~W/BS/ Tcrc 23. NYS DOH ELAP # (/ S VI. PROJECT INFORMATION 24. Starting date for this portion of work Projected completion date _l0) 7 o- Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday

Shift from: ❑ am ❑ pm to El am ❑ pm H other. specify

Access to inspect the premises mast be provided during the work schedule indicated n It s Item. `~~~ curs `~f 25. Total amount of asbestos-containing material to be abated during this work

Square Feet, and/or Linear Feet BLS/ ACP 7 r►'~ir. 9 t 212WI

rout

NYC-WTC 000111314