Asbestos Project Amendment form, Oct 2001

NYC 9/11 Public Portal Document

I3 ç -j ~ ~v.` °~`' ~l NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 1 Program 59-17 JunctionAsbestos 8°r ~oiona, NY 11368-5107 c,DP t Boulevard, ONL ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) `1`ED Tire• 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 nn n - 2. Address nir_. W A-22€ Borough I I Zip 10 00

AKA 3. Block _I3 4. Lot f~ 5. Type of Facility 6. Name of Building II. BUILDING OWNER

7. Name')-- 1A.I rfZ e.. In Lk P LL- L • 8. Contact Person

9. Tel.# Fax#

10. Address 2 3I fNri t So .y Rs-d rF_ City _1' State I Zip 10 0

fit. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ twee C rte(_._._._._._.. 13. Contact Person /C7 ) (mac___

14. Federal EmF►oY er IB. # _r...-.-.-.-._.PI I_.-.-.-._._._ . ' 15. Tel. # J I - 75-/ 300 0 ` (~ Fax # —J~ ; 3_5 / ' 16. Address 0 e City - ) ! State Zip _II? '

V. THIRD PARTY AIR MONITOR A r 17. Name _V0 krl ZE2 G~ ~'5,f P C —18. Contact Person r'`t l- (1OL#4

19. Federal Employer ID. # 20. Tel. # ' aP- OOJ' Fax # 0630 21. Address . 2 ij City !Y"cp TE21~ State _Zip 0Ot )) 22. Sample Analysis Laboratory S .(£~(T~L /~ h r/ESTJ.r 23. NYS DOH ELAP # ( I5 g - C VI. PROJECT INFORMATION 24. Starting date for this portion of work fl )-- Projected completion date ? O

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

Shift from: ❑ am 0 pm to 0 am ❑ pm . 1E ~ 2 N If other, v' 4 specify `~' ItECEIVED Access to inspect the premises must be provided during the work schedule indicated in Nis hem. 1 sip ii. 2002 A

25. Total amount of asbestos-containing material to be abated during this work 1 pSBES pMMM I7II I Square Feet. and/or Linear Feet ACP 7 2r2001 1• f ' •...LcY.:u

Ipn ~

NYC-WTC 000111336