Asbestos Project Amendment form, Oct 2001

NYC 9/11 Public Portal Document r , pj.Cin Otis NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ~/ J I, l,V + •° ' ~"~ Asbestos Control Program 59-17 Junction Boulevard. 8'" Floor. Corona, , t07 i,Voo

DP • Building Dept. or TRU No FOR OFFICA1. USE ONLY ~N N ASBESTOS PROJECT NOTIFICATION WILL BE (ASBESTOS INSPECTION REPORT) EPTED _~•n~e:e.Iler . 1. 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 NYCOEP requires one copy of the form with original signatures. This form must be submitted to the NYC OEP not less than one week in advance of the start of abatement activities,

I. FACILITY .

2. Address LO 2 }} t{ Q,t=(4 — I (ZT ( Borough Zip _ —S'( r ~ f AKA 1 _ 3. Block - ~-7l 4. Lot

5. Type of Facility—, 6. Name of Building II. BUILDING OWNER

Name 2a _CL I S1' 9C I Ai £S W-l8. Contact Person

9. Tel. # Fax

10. Address _ L I+ Tape'. =t_ __ City -- ---_ State N _J Zip O C

Ill. GENERAL CONTRACTOR

11. Name ----_ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name (e1~ ~'UL_ ___ ------ 13. Contact Person

14. Federal Employer I0. # -----. 15. Tel. # J 16 - 1 0 Fax #

16. Address city —_ l Li7 `Z—_ State /v _ Zip _LL2 _

V. THIRD PARTY AIR MONITOR

17. Name y L _L 4_t 18. Contact Person ' 1 t L 1 I"

19. Federal Employer ID. # --------------- __ 20. Tel. 1 _QJ =04 — Fax #

21. Address City _t ~Y`~ _( 2 State l Zip _ 22 ( - 4 -- 22. Sample Analysis Laboratory—_ _~ ( ( <<-~^ ~~ `7-'/eS v 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work _Lf_ Projected completion date

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

0 Shift from: ❑ am 0 pm to 0 am 0 pm

If other, specify ----------- -- -------- --------- ;` ~+EV Access to inspect the premises must be provided during the work schedule indicated in this item. 1 ,

25. Total amount of asbestos-containing material to be abated during this work

;-irR-1_ — Square Feet, and/or _—_ Linear Feet ACP _ 2R0' ex:aai~7a~ -rc lye "f.j^ r:al3Gl Fn I.",

NYC-WTC 000111344