Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8" Floor, Corona, NY 11368-5101 ONLY : D :.P •. ASBESTOS PROJECT NOTIFICATION L Budding Dept. or TRU No FOR OFFICIAL USE ONLY)

(ASBESTOS INSPECTION REPORT) RI

When submitting this fom► 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 d the form with original signatures. This town must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.

1. FACILITY tt n 2. Address I ~ •e t i 12~- T Borough ` zip _10

AKA 3. Block 4. Lot

5. Type of Fadtity 6. Name of Building II. BUILDING OWNER

7. Name _ t - 1ci i 1 c- ! LL C- • ' 8. Contact Person _ QPS L w 9. Tel.# Fax#

10. Address t Tti I+t' S— t2 s 1 City N ' State PU'"Jzip o o3 III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name z ( 13. Contact Person 7 ) (1o5 //c C G 14. Federal Employer 10. # --- P11 ?15. Tel. # 61 ~+/- 7S"I-300 o Fax #_5.I '- ?Wi'-3 5 16. Address O Q A't city KJ _______State /) { Zip 117 3 %'. T:::RD r :TY AI)t MONITOR

17. Name 4 ZF2 - NG irk' S Pc 18. Contact Person _61' EL ( oL# . 19. Federal Employer ID. # 20. Tel. - 900) -00q- Fax# 2J '?22-063o 21. Address g~ City ( J~f- State ~ Zip 00 ( . / 22. Sample Analysis Laboratory, SG{fi(T/F(L L 6e rrl-S,~ c 23. NYS DOH ELAP # (/ 5~ d .

VI. PROJECT INFORMATION 24 Starting date for this portion of work

Asbestos work schedule ❑ Monday 0 J '9! )_(4 0 ) — Projected completion date 9

Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑Sunday > 02..-

Shift from: D am ❑ pm to ❑ am ❑ pm "

If other. f specify 'I 1 Access to inspect trie pramrses must be provided during the work schedule indicated in us item. Jçp

25. Total amount of asbestos-containing material to be abated during this work I~ Q V Square Feet, and/or Linear Feet ~p ° =~J—

N

NYC-WTC 000111306