Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

E. i(p i ``~` '`•.a NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program — Ar 59-17 Junction Boulevard, 8' Floor. Corona. NY 11368-5107 i9 /'i IV V (~~0rvp, ONLY IJ uI coO TYPE N ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1. be When submitting this form at the NYC Department of Buildings, the original form end 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.

I. FACILITY

2. Address W i Borough N ' Zip _t O OC)'

AKA 3. Bloch 4. Lot

5. Type of Faality 6. Name of Building 1I. BUILDING OWNER Q , _ (~ 7. Name ~~ -e-~ Tom' ~ ( ZJS LL .6 Contact Person Fn (~ '~ l' A- 1) d~

9. Tel. # t4

10. Address 3 ^ SS rL _4 :Ai - City f ' State Zip

Ill. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR _ /► 12. Name AIL l tom✓ ~0 13. Contact Person 7 _) ` C'& 14. Federal Employer 10. # P_ 11 15. Tel. # c '~6 - 7~I -340 0 Fax # _ J~ / W/ 3 5 d J 16. Address 0 /7Y~' City I State Zip 11?_L. V. THIRD PARTY AIR MONITOR ~I 17. Name ¶*?4 ZE2 nibi4 ) S, Pc 18. Contact Person

19. Federal Employer ID.# 20. Tel. # a (3 -UP- O0? Fax # .2J - a -O(' ?30 21. Address F1' if67 City_ Th t2 . State Zip

22. Sample Analysis Laboratory S2 ti !L {. AS & e,-01=Sf J ~ 23. NYS DOH ELAP # (/'f d

VI. PROJECT INFORMATION 24_ Starting date for this portion of work ~` Projected completion date 1_'>7

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday 0 Thursday 0 Friday ❑ Saturday D-Supday Shift from: ❑am0pm to Elam0pm

If other. specify ( " RECEI VED Access to inspect the premises must be provided during the work schedule indicated it firs Rem. SEP 20 2002 e 25. Total amount of asbestos-containing material to be abated during this work ~, t Square Feet, and/or Linear Feet

4-:u --r,,; ':4 IF.~➢ Jl

NYC-WTC 000111312