Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

1 ~y G.1! Ofrggr NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION f J N Asbestos Control Program 59-17 Junction Boulevard. 8h1 Floor. Corona, NY 11368-5107 Building Dept. or TRU No FOR OFFICIAL USE ONLY E ~r 'W[hrAI ASBESTOS PROJECT NOTIFICATION ILL BE (ASBESTOS INSPECTION REPORT) :, icic. /\ TED www.nyc.ler/dep

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

2. Address_25 MAIOE~t--t_NwE Borough NIAte --- Zip -- 003e --

3. Block _ 65 4. Lot

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

7. Name CEDAR MANAGEMENT ---_ ---_—_ 8. Contact Person _ R1Ct1RRD 1200th —_

9. Tel. # (2.i???' 32- 7'653 Fax # _-------N-

10. Address ------_' —EV STV r: --r City -- {O —_ State _ N~ _ Zip JQ23G

Ill. GENERAL CONTRACTOR

11. Name------ -------------- TeI. # ------------- IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ~a`^!N t5uCz _4 Sot, Cou;rr•o- 1 NC — _13. Contact Person - La ttc- tANNICC

14. Federal Employer ID. A!- - PII _ _--- 15. Tel. # Citt3? 2900 ---__ Fax # ~~ S) 1b28Q__ _

16. Address 124$ 2A~PN RvE13~E ----- City __~ _--- State N± _ Zip _ tt2:36 -- _

V. THIRD PARTY AIR MONITOR

17. Name _14AtLr~E-1J - _ PANZER —_ —_ — _18. Contact Person _ M(CVArEL- ~1 1C't_AtJ ---

19. Federal Employer ID. # P11 20. Tel # _(2!2~ 932=ooTY — Fax

21. Address ~1SItt__S;-ZZEEEET- — City _ N ~ --__--_ State N4 _ Zip IOOFI__—_

22. Sample Analysis Laboratory. 23. NYS DOH ELAP #

VI. PROJECT INFORMATION

24. Starting date for this portion of work _09118i c 2 _ Projected completion date

Asbestos work schedule 0 Monday IN Tuesday 13 Wednesday ® Thursday ❑ Friday IZI Saturday IR Sunday

Shift from: ©am ❑ pm to ❑ am ® pm ,2 ' y'u ; r If other, specify ----------------- ti/ RECEIVED CR Access to inspect the premises must be provided during the work schedule indicated in this item. F SEP 17 2002 25. Total amount of asbestos-containing material to be abated during this work ~1te~ " _J O Square Feet, and/or _____ — Linear Feet ACP 7 2/2001

NYC-WTC 000111320