NYC 9/11 Public Portal Document
• NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
D P
Asbestos Control Program
59-17 Junction Boulevard, 8e Floor, Corona, NY 11368-5107 __ __' l
Building Dept or TRU No
FOR OFFICIAL USE ONLY
ONLY
TYPEWRITTEN
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ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE -- (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED (See 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 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
2. Address 1 44 .J$ I S TBorough -- Zip I O O O7
C.
AKA --- 3. Block 4. Lot
Type of Facility, 6. Name of Building
II. BUILDING OWNER
7. Name ~._._ ._ _ --- ._._._._._. _._._._._.~_ _.W._._.~_._. 8. Contact Person
.-.-.-.-. ...
9. Tel. - ---------------. P I 1
------------------w - - - ---------- ------- --------------------------
10. Address P1I City ---IL State .t ' Zip
t.---------- -• -.-...-.-.-.-.-.-...-.
III. GENERAL CONTRACTOR
11. Name _--- — Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name -~ - - -------_13. Contact Person
14. Federal Employer ID. # _ __ 15. Tel. # J! _7 J -30o 0 — Fax # 5L L2I _
)
16. Address 0 1is ~-- — city / _ State /V Zip
V. THIRD PARTY AIR MONITOR
,
17. Name !~ ~ kZ.E- J6it4%7° S C 18. Contact Person
19. Federal Employer ID. # ._. 20. Tel. # ai 4- 0O _ Fax #
21. Address g `' ~Er City II State -
L7 _ Zip _( 0 ( _
22. Sample Analysis Laboratory— Sc( c((F«- h A6 t A7fY!LE1Titt 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24.. Starting date for this portion of work Projected completion date
Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Fri
Shift from: — 0 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.
25. Total amount of asbestos-containing material to be abated during this work
0 (' Square Feet, and/or Linear Feet
7
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NYC-WTC 000111400
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