Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

co• vy, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor. Corona, NY 11368-5107 7't/ 38 A,c1L' IuI LY D Building Oept. TRU No

4 FOR OFFICIAL USE ONLY WEIVRITTEN LL ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1. ACCEPTED • "xs:!'-!'!c. 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.

I. FACILITY

2. Address _ I — I )- C-rrrl-v►~~f-(L S I i Borough ' 1 Zip (0O Of

AKA _g wES S O Ar tr3 PJ -( 3. Block 4. Lot

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

Name •1'T bGAA Q1 1J &L PO 2) CO 1= 8. Contact Person MY /' q 9.Tel.#(?4 ) 1 L", 1' 4 4ax#

10. Address_ 1 a -~ S 4S V City N ' State Zip

III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR {~ 12. Name 'e1L /lam_ 1,O __ 13. Contact Person Cam-

14. Federal Employer 10. # _L_._._._._._._ PII 15. Tel. # c~ - Fax # 5I'~ 'midi' 3cc15

16. Address 0L - ~~ /V City _) ( State Zip V. THIRD PARTY AI MONITOR

17. Name 1r~ k7(ZE2 G r -7 ~C 18. Contact Person 1t44 mil- 0L 1-

19. Federal Employer ID. # 20. Tel. # _a(2 O L Fax # 2i 222 0 21. Address 22 g i S( 4L City _ - (cr- State Zip 0 i-fEr // 22. Sample Analysis Laboratory ti -- L ' r 1 S(Trc 23. NYS DOH ELAP # (/ -d

VI. PROJECT INFORMATION 24. Starting date for this portion of work 2 2.14 0 7 "" Projected completion date A 0 2 --

Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday Sunday

Shin from: ❑ am ❑ pm to ❑ am 0 pm /

~co specify '

Access to inspect the premises must be provided during the work schedule indicated in this Item. r)~ pU6 INL:

25. Total amount of asbestos-containing material to be abated during this work 13 S1 Square Feet, and/or Linear Feet \

IRf.~F.J.I tRn ~

NYC-WTC 000111332