Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program ..p 59-17 Junction Boulevard, 8' Floor. Corona, NY 11368.5107 Building Dept. or TRU No FOR OFFICu1L USE ONLY ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1. ACCEPTED :!•:~••~.

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 mint be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.

1. FACILITY

2. Address S ( e '— S9 W A1 n E..4J S I ~.E~7 Borough Zip IJ o o- AKA 3. Block 3 r C ,,,.4. Lot 10- 5. Type of Facility. 6. Name of Building 1I. BUILDING OWNER

7. Name S (,o Ai21S rJ AGt)NE1LS C0 -eT - ' 8. Contact Person

9. Tel. # Fax # /p~ __ '' ~p 1 ^~ 10. Address I A t ~~ f U ., &ity N' 1 State f" " Yip I t

Ill. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name , ~eIL O_~_._._._._._._,_ 13. Contact Person

14. Federal Employer ID. # P11 15. Tel. # - 751"30 00 Fax # JI l d 3 5

16. Address 0 L2 t City i' State Zip _I!?

V. THIRD PARTY AIR MONITOR

17. Name 4iAi && krt ZE G I "k Pc 18. Contact Person YV1ICfh EL NoC, hr4 . 19. Federal Employer ID. # 20. Tel. # ar3 - '1& - OO . Fax # -O 3O 21. Address T* E 7 City -A J K State Zip , gO f f .

22. Sample Analysis Laboratory SG(?'(fl - h. 23. NYS DOH ELAP # (I 'i O

VI. PROJECT INFORMATION 24_ Starting date for this portion of work 011_i '- Projected completion date ) .4)_(YI._b Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday 0 Sunday

Shift from: ❑ am 0 pm to - 0 am 0 pm

If other, specify kkECEIVED I Access to inspect the promises must be provided during the work schedule indicated in this item. I SEP 13 2002 25. Total amount of asbestos-containing material to be abated during this work tisats os 1175 Square Feet, and/or Linear Feet O1 ~ ACP 7 211001 Q74 A'.I arE 5 I.t ,s :'i5 i:'w:R{ ICu ~

NYC-WTC 000111324