Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION .#`°" y4 Asbestos Control Program 59-17 Junction Boulevard. 8°i Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY DOP FOR OFFICIAL USE ONLY TYPEWRITTEN ~' ASBESTOS PROJECT NOTIFICATION FORMS WILL BE _ ` (ASBESTOS INSPECTION REPORT) ACCEPTED _...~ri.:•:~~.r, 1. _ (See tee 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

AKA L TC ~g S T -RE6 Borough

3. Block 1 1 w~' l Zip

4. Lot bD 7 5. Type of Facility_— 6. Name of Building II. BUILDING OxiINER

7. Name _— 8. Contact Person - -- v '

9. Tel. t F _ -• P11 -•— —NI Fax # .-.-.-.-.-.-.-.-.--............ -w............................................. p 10. Address ._._._._._._._._._ P11 -.-.-.-.-. City f X1L~ State __:f1

Ill. GENERAL CONTRACTOR

11. Name_-------- ~ —_ — — Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 4(h1E 1L ~I b - -------- _13. Contact Person

14. Federal Employer ID. # ._._._._._._._. PI1 715. Tel. # cJ/ _ 7~l_JOL 0 Fax #

16. Address 01 ~-- — City J /r7vl State /V Zip 1L22 3

V. THIRD PARTY AIR MONITOR

17. Name _ V Zl a 61 S Pc 18. Contact Person

19. Federal Employer ID. #L P -_ 20. Tel. # a(3-tea - 0O

21. Address Pt E —I-- City ~{fC State L~+ Zip _to ( T .

22. Sample Analysis Laboratory SC (9?l 7 (F -. 7 L cf c 23. NYS DOH ELAP # // R -L 1

VI. PROJECT INFORMATION

24. Starting date for this portion of work _— Projected completion date . - '7 f -9 Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday ❑ Thursday ❑ Fri

Shift from: __ ❑ am ❑ pm to ❑ am ❑ pm

If other, specify _----~ — —

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

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

Lam— Square Feet, and/or Linear Feet ,T 31

NYC-WTC 000111382