NYC 9/11 Public Portal Document
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1 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
1 `` , uiror~y r
Asbestos Control Program
59-17 Junction Boulevard, 8" Floor, Corona, NY 11368-5107
/5131(4
Building Dep%oror TRU No
FOR OFFICIAL USE ONLY
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ASBESTOS PROJECT NOTIFICATION L—
ILL BE
RMSRWTT "u
(ASBESTOS INSPECTION REPORT) 1,
ACCEPTED +4 tu rer . . (See fee
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 .
I. FACILITY
M___ zip _X00 3S __
2. Address _F3 "A fSS v. u_S'Tt2CEl Borough _
3. Block — _LS ___ 4. Lot __?____
5. Type of Facility_.. MM RCto.~—__—Y ___—_ 6. Name of Building
1I. BUILDING OWNER
7. Name _ u LL MAN 12EA. I —_____ 8. Contact Person t c ra a t2D M At2~ JS
9. Tel. # _t2t2) 3A3=1i L__. . Fax # _ _____
10. Address City NEvs YceK State _J4' _ Zip _1Q&-.___
III. GENERAL CONTRACTOR
11. Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name (BEN-iAMit,! ict1P-'z8 ~ Sc:n~ ~`-cwTVc, lµc _ - 13.ContactPerson_LaQ-~E IAuutCc
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14. Federal Employer ID. # .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-r— = 290b__-- Fax # cYtpsl_o~~If3c~$ —___
! _ — 15. Tel. # CZ18) 531
16. Address _ 124eRALa►1 AQE4QE ------ City _pQCflKL-4 N —____ State N!__ Zip 110.3 —_
V. THIRD PARTY AIR MONITOR
17. Name LUAePx'N~ PA NzC-Q- 1 a~1 t`t EE" _~ — _18. Contact Person _titCHAEL NIQ!,At —
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19. Federal Employer ID. # rt.-.-.-.-...-.-.-...-.-.-.-.-.-.....i--
' 20. Tel. # 12125 922-c~TY __ Fax # (2 12 ) 922 -oGo—- _
— ---
21. Address _??f$ EAST 45TH S;-.P ET _— City _NEw %oR1c State _N4__ Zip _ 100 1 C
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24.. Starting date for this portion of work _ 1 (a (0 ' Projected completion date
Asbestos work schedule ® Monday ® Tuesday ® Wednesday ® Thursday 12 Friday ® Satu . .Sunday
eca
Shift from: __aco 10 am ❑ pm to ❑ am ® pm
If other,
specify _______________ ____----- --
Access to inspect the premises must be provided during the work schedule indicated in this item.
25. Total amount of asbestos-containing material to be abated during this work
_.24Q.._. Square Feet, and/or _._2__ Linear Feet
ACP 7
2/2001
NYC-WTC 000111318
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