Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION .' O~' +• Asbestos Control Program D~ r~ 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY 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 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 pp . 2. Address _ii GG J C EOA~tJA --C Borough N , "1/ Zip t

AKA 3. Block 4. Lot 5. Type of Facility — — 6. Name of Building II. BUILDING OWNER

7. Name N ytJ -- .€ LL( .L.NG_ 8. Contact Person 9. Tel. # I,-, _631772 Fax #

10. Address _L O S —E i I0 A S1 —, City — — State. L Zip III. GENERAL CONTRACTOR

11. Name_-- --_~ — __----- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ eIL ?. .J_ _13. Contact Person 14. Federal Employer ID. # P11 ( 15. Tel. # J _1.i2 0 Fax 16. Address Oc vt , 1 ✓~------ City ______State A) Zip IL?

V. THIRD PARTY lit MONITOR A{ 17. Name — I_ ZE2 Gi TES f _18. Contact Person t4{ Et- ((O(^,

19. Federal Employer ID. # L,w,_._._._._P _ 20. Tel. # a(2 919 - O Fax #. 13~22 ' OE, O

21. Address ~~ g 1 1 '' -- City .. L 2eQ= State N'` _ Zip 00

22. Sample Analysis Laboratory— S`(~ (~~L h A6 C «S cr c 23. NYS DOH ELAP # _ / d

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: __ ❑ 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 3 7(2 Square Feet, and/or Linear Feet 7 p JItP )1 A ST S Erd;,ftEiCEAT

tpn 7

NYC-WTC 000111420