Asbestos Project Amendment form, Oct 2001

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program S9-17 Junction Boulevard, 81 Floor. C.'.11368-5107 Budding Dept or TRU No FOR OFFICIAL USE ONLY I p ASBESTOS PROJECT NOTIFICATION BE NfM (ASBESTOS INSPECTION REPORT) 1. G ACCEPTED (S fee 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 DEP not less than one week in advance of the start of abatement activities.

I. FACILITY

2. Address - LT M t.4 W Borough N Zip bp0,0

AKA 3. Block (3 3 4. Lot

5. Type of Facility. 6. Name of Building

II. BUILDING OWNER

7. Name 4 1. r S 4r &'C tC1 - ' 8. Contact Person tk-r

9. Tel. # Fax #

10. Address - .vY City State Zip 10A III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name. 1€ c l_ ro ( 13. Contact Person ____1

14. Federal Employer 10. # _~._~ P1.~_._ ._._._._._._._.: 15. Tel. # c 6 - ~ 1 7i1-3000 Fax# 511_? f'3c85 / ~ ~ 16. Address 201 ~! ~ _City k J / ~ State Zip II? ? V. THIRD PARTY A17 MONITOR

17. Name ~J&Z.R&J O T A74 -E V- 6 r Pf Pc 18. Contact Person h1t4 EL (.. O L. hrl .

19. Federal Employer ID. # 20. Tel. # a(3 - AP- O0j- Fax # .2Ic3 - ~o~ -0r✓ 30 ' 00 ( . 21. Address ~2 g 1 H / J r` _Tice(_City S' tV l' 7= ~i - State _ Zip

22. Sample Analysis Laboratory Sal r%(~(G f! I4i e 7L'A /><S arc 23. NYS DOH FLAP # _ti S~ 0

VI. PROJECT INFORMATION t9 24. Starting date for this portion of work Oa-- Projected completion date O ( Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday 0 Thursday ❑ Friday ❑ Saturday 0 Sunday

10 Shift from: 0 am 0 pm to 0 am 0 pm

If other, Q1 specify Access to inspect the premises must be provided during the work schedule indicated in this hem. LW~i U6 21 25. Total amount of asbestos-containing material to be abated during this work

Square Feet, and/or Unear Feet ACP 7 V2001 tT 12..'•5 isN:R:{ frCC.;J.1 IGu ~

NYC-WTC 000111342