Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

/ e ,i ~ 4,.,,~~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION t0 W

D • ..Q P Asbestos Control Program 59-17 Junction Boulevard, 8 Floor. Corona, NY 11368-5107 auiilding Dept or TRU No 51 TYPE r ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1 -• • •,~ •/:•' tee schedule) 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 NYCOEP 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 S Q I1 n$ (\ Borough zip______ AKA 3. Block 4. Lot 5. Type of Facility 6. Name of Building U. BUILDING OWNER , ,~ /~ ,,~ 7. Name 2O` V~'~'rR-n i~r `ci: c&a- b t:.1--~ : S. Contact Person A16 -N P -L I t4f. 9. Tel. #P\1 ctogsa Fax j A)-- - g _ c;;— 1 10. Address '3T ¶Ldt City 1 State 1J '_ Zip I ~~— III. GENERAL CONTRACTOR

11. Name Tel.*_____________________ IV. ASBESTOS ABATEMENT CONTRACTOR

f 12. NameE 'c)/ .,.,.,.,. 13. Contact Person /Q?J Cs/4 1 14. Federal Employer I0. # _._._._._._._._ _P.1.._._._._._._._._. 15. Tel. # c7' 6 - 1S-f ca( — ? , 3 S 300 o Fax # _ / 7~ ~ 16. Address o~b itQ)!) A)S t State zip _I l ? -i ? V. THIRD PARTY AIR MONITOR pp A 17. Name Q A ~Tj ZEi¢. pC 18. Contact Person tM1llcr4 -E1, t`r 0LA r 19. Federal Employer ID. # 20. Tel. # 2(3 - 9aa- 00 Fax # .2J — 22a -Os✓,j0

21.Address2P kSi H-.l idEE7 City ~`S' ~~1=~t~ State Zip 22. Sample Analysis Laboratory Sc(f1`(T l L / e ~~t=S~ c r c 23. NYS DOH ELAP # f / 4L - •

VI. PROJECT INFORMATION 24. Starting date for this portion of work _ /2& 0 A Projected completion date

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

Shift from: D am 0 pm to El am 0 pm If other. specify Access to inspect the premises must be provided during the worh schedule indicated in this Nor".

25. Total amount of asbestos-containing material to be abated during this work Lj000 Square Feet. and/or Linear Feet

NYC-WTC 000111310