Asbestos Project Amendment form, Oct 2001

NYC 9/11 Public Portal Document / 1 S2 1C_i .mo o, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program Z, '-- XJ rda e' Floor. Corona. NY 113665107 c . 59-17 Junction E Bung Dept or TRU No ON ASBESTOS PROJECT NOTIFICATION Pcq orrsc&*i. USE o.&v

CUBE ''T'" (ASBESTOS INSPECTION REPORT) 1. Whedule)

When submitting this form at the NYC Department of Buildings. the original form and three (3) copies with original signatures. This signatures are required. Submittal at the NYCDEP requires one copy of the form withoforiginal activities. form must be submitted to the NYC DEP not less than one week in advance of the start abatement

1. FACILITY t —0 S 1 Borough Zip ` ©O 2. Address~ S

AIfA 4 — t 7., b to i Lt E S e E: 3. Block 4. Lot

5. Type of Facility. 6. Name of Building

It. BUILDING OWNER

7. Name V/ I L —1 t4V . S 1 'A c0 Gt A Et • e. Contact Person

£. Tel. # Fax #

P Kam— Mate Zip 10. Address . uh t e v i city

III. GENERAL CONTRACTOR Tel.* 11. Name

IV. ASBESTOS ABATEMENT CONTRACTOR p 12. Name AIL iCO 1// 13. Contact Person ,q 7

14. Federal Employer 10. t> P!I h5.Tel. # —7 3O 0 Fax# ~ — ?d 345

16. Address 2QLb Ale Q-,/~ City +~ ) r r "r' State Zip _ V. THIRD PARTY AIR MONITOR r (~l 0L,i4t4 . 17. Name Z&J ►(Z'e2 E G l mil' S . PC 16. Contact Person t l'

19. Federal Employer ID. # 20. Tel. it at3- gas-ooh _Fax # 21a __3 0 21. Address 19 7 f a" S( f ( City _gin, State _ Zip (00 t'

22. Sample Analysis Laboratory S2 f(T(F(L I e 4 -0lr=Sf ctc 23. NYS DOH ELAP # (Iq 0 -

VI. PROJECT INFORMATION 0 0 24_ Starting date for this portion of work Projected completion date

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

Shift from: ❑ am 0 pm to 0 am 0 pm

If other. specify Access to inspect the premises must be provided during the work schedule indicated in this item. I

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

etp

£ :'.)s C a:a t ton ~

NYC-WTC 000111340