NYC 9/11 Public Portal Document
U1t OVA NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
~`O"`" +•4 Asbestos Control Program
tar 59-17 Junction Boulevard. 8°i Floor. Corona, NY 11368-5107
•A Building Dept. or TRU No
ONLY FOR OFFICIAL USE ONLY
TYPEWRITTEN '' ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE - (ASBESTOS INSPECTION REPORT) 1
ACCEPTED =="►' -°`144r (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 b S T Borough t3 Zip 1 0 01_
AKA 3. Block 4. Lot
5. Type of Facility. 6. Name of Building
1I. BUILDING
7. Name PII _ 8. Contact Person
9. Tel. #
10. Address _._._.:City ~~L~~ State _ jZip _y
ao~
III. GENERAL CONTRACTOR
11. Name _ --N— Tel. # ---- N --_
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name -- ~ - ___._____13. Contact Person
14. Federal Employer ID. # ., PII Y15. Tel. # c1 -3000 Fax # J~ ~~ Jd~.s
rI
16. Address `Z — City J // _ State /UI Zip 11 7"3
V. THIRD PARTY Al)t MONITOR
17. Name ` ~~Q _ ATl ZE2 G r1 15+ r C_ 18. Contact Person _—i ;K _±-'
19. Federal Employer ID. # _I, =~ - 20. Tel. # a (P --5aa - 00 _ Fax # a=~ ' 06 3O
21. Address ~~ g > ~ ~— City L _State Zip _L 00 (
22. Sample Analysis Laboratory SC f ((f«- h *6 6 21 S J 23. NYS DOH ELAP # (/ 9- y -
VI. PROJECT INFORMATION
24.. Starting date for this portion of work _ _ Projected completion date
r -r r--r
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
4 s2 _ Square Feet, and/or Linear Feet
7
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NYC-WTC 000111418
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