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 11366-5107

ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT)

When submitting this form at the NYC Department d 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 form must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.

1. FACILITY t 2. Address W N Si 2~r Borough N Z.ip C Dd O

AKA 3. Block 4. Lot

5. Type of Facility 6. Name of Building IL BUILDING OWNER A e (~ 7. Name i 'taxs ~-~.~ S. Contact Person C~-i ffNt-~ ~5 , 1q _ _ _ 9. Tel. DSb 10. Address 3'7 t( _ City ` State 's zip a I s~

III. GENERAL CONTRACTOR

11. Name Tel. #______________________

IV. ASBESTOS ABATEMENT CONTRACTOR T /~ 12. Name l- ____ _ 13. Contact Person / ) C' 14. Federal Employer ID. # ' P11 _. _._._._..15. Tel. # J 16 - ___ _ _0 Fax # S( - _?&'3c'85 16. Address 201b ~yP //Y E' City_State _ ZiP /(7

V. THIRD PARTY AIR MONITOR pQ r 17. Name R A ZF2 ~r 6r PC 18.ContactPerson I 6L (l '(OLi

19. Federal Employer ID. # 20. Tel. # a f3 - 9as - O0jZ Fax # 2/a -~aa -O6 3 O 21. Address *91P€ ItS1 i2fE7 City f'Y'~1~ - Per-1 State Zip 00 / 22. Sample Analysis Laboratory SC T(~tC— {. A t !~K'«S, ctc 23. NYS DOH ELAP #_(I £~Q

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

Asbestos work schedule 1 Off- Projected completion date

0 Monday IJ Tuesday ❑ Wednesday LI Thursday 0 Friday ❑ Saturday..D .Sunday (L")

Shift from: ❑ am 0 pm to ❑ am ❑ pm

If other, specify o Access to inspect the premises must be provided during the work schedule indicated in this Rem. !.w SEP 25. Total amount of asbestos-containing material to be abated during this work

Square Feet, and/or linear Feet

9 212001 e7"r•J S E .. it ~• t

NYC-WTC 000111308