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Asbestos project notification form, Oct 2001

Machine-extracted title · confidence 90%

Department of Environmental Protection asbestos inspection report notification form for a facility.

NYC-WTC_000111382–000111451

Folder label: “Zone I Copies”

←Page 35 of 70→
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NYC 9/11 Public Portal Document z

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ~`•"~' '~` l' Asbestos Control Program ' 9 59-17 Junction Boulevard. 80' Floor. Corona, NY 11368-5107 A Building Dept. or TRU No ONLY Daw FOR OFFICIAL USE ONLY TYPEWRITTEN ,,, 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 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.

FACILITY //~~ n 2. Address _ I —2P"&~ L Borough Zip

AKA 1U CHUL(LH I I( _ 3. Block 4. Lot

5. Type of Facility N ~ 6. Name of Building II. BUILDING OWNER

7. Name Z~ ~L_I~C~ ~c -(Ai 2S PC: 8. Contact Person

9. Tel. # (p7 0 Fax # n '1 10. Address v1 O _ t EE 15JL! ~ City p ray. t&Lt(ts State Zip

III. GENERAL CONTRACTOR

11. Name_— --_____— Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ €'IL 1Ko __13. Contact Person -----C 14. Federal EmoI varI13-#.- _._._._._._. P I I .-.-.-.-. 115. Tel. # c7 16 - 7 -346 p Fax # _ 5LL2~ 3ds5

16. Address ? -P ) ! _ State N Zip 1L -.-.-.-.-.-.-.-.-.-.-.-° — City L/974 - V. THIRD PARTY Alit MONITOR L 4. 17. Name JL t _18. Contact Person V4t44#ft- ( -.-.-.-.-.-. ----.-.-.-. 19. Federal Employer ID. # ---------PII 20. Tel. # ' (aga_-OQ~

21. Address 2I X 4 I 4 —//_ City ..L — State (L _ Zip L 00

22. Sample Analysis Laboratory S'e- ( r (f«- F A3 E r`rr£S a ` — 23. NYS DOH ELAP # I rf L)

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

Asbestos work schedule ❑ Monday 0 Tuesday 0 Wednesday ❑ Thursday ❑ Fri,

Shift from'. 0 am 0 pm to ❑ 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

15 at Square Feet, and/or Linear Feet 7 Di

PF.u?;RI fFn

NYC-WTC 000111416

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NYC-WTC_000111416Source: NYC Law Department, mirrored locally

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