Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

~►RTMENT OF ENVIRONMENTAL PROTECTION E ~ 0 ~/ w 7T C ~. 1 Y Asbestos Control Program ru /5o6NiJa1z D r * 59-17 Junction Boulevard. 851 Floor. Corona, NY 11368-5107 Building Dept or TRU No ONLY . FOR OFFICUL USE ONLY TYPEWRITTEN ~ ASBESTOS PROJECT NOTIFICATION FORMS WILL BE ""` jO (ASBESTOS INSPECTION REPORT) ACCEPTED =•' ~~!'~t. (Sedlee 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 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.

1. FACILITY

2. Address S 1 DC S 1 - (2 T Borough '1. Zip < r AKA 3. Block `0 2 4. Lot t

5. Type of Facility 6. Name of Building 11. BUILDING OWNER

7. Name - .'-LE- 'S "' "~ 8. Contact Person

9. Tel. .~ (off{-- l Fax # , t 10. Address 5 b I( S i 2~ ~-r City 1~► State Zip _1toü7

Ill. GENERAL CONTRACTOR

11. Name TeI. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 13. Contact Person ~~> C1__ $/,9

14. Federal Employer 10. # P11 15. Tel. # - 713"°0 Fax # cS~ ~d~ 3 .5 / 16. Address.2Q/y r~~ 2" City J, I — State Zip !12 r-'

V. THIRD PARTY AIR MONITOR

17. Name \J ZEt2 Gig l'S Pc 18. Contact Person t__ L 19. Federal Employer ID. # 20. TeI. # afP ' _'19- 0 0 Fax # .2I_ _ _ -01 30 -O(;3O

21. Address 2f g City ~~ 1(k1 State Zip (00 ( . ~~ ~F AST _i Lf 22. Sample Analysis Laboratory _S. (f?(1 L' — rI ? C_ _(_S I 23. NYS DOH ELAP # / ' VI. PROJECT INFORMATION 24_ Starting date for this portion of work 9_ O Projected completion date 9_)> __0)..... Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday D Sunday r" .

Shift from• ❑ am ❑ pm to ❑ am ❑ pm

specify / \'" Access to inspect the premises must be provided during the work schedule indicated in this Item. l } i6

25. Total amount of asbestos-containing material to be abated during this work ; t S Square Feet, and/or Linear Feet 1`` - i ACP 7 tt 2/2001

IFf,~c;,fd

NYC-WTC 000111330