Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

`oay,Citr 004 4 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor, Corona. NY 11368-5107 ONLY D/A.IP • ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU No FOR OFFICIAL USE ONLY TYPEWRITTEN OMeuiviionc FORMS WILL BE - (ASBESTOS INSPECTION REPORT) ACCEPTED _fir:^rc"se;ta<r 1 (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

AKA

5. Type of Faci:ity. II. BUILDING OWNER 1~ 7. Name--_._ & ,9- .. P 9. Tel. # _ _._.L I.I - ► Fax

P11 10. Address _...................................._._._._._._._._._..~

III. GENERAL CONTRACTOR

11.

IV. ASBESTOS ABATEMENT CONTRACTOR c o( B LC-) 1 ( 12. Name _ (h1etlG~' ~ 1bJ_________ ------y. — __ -- 13. Contact Person I ,346 cc 14. Federal Employer I0. # _ ...W__._._._P II 15. Tel. # ~! 7c~~ d _Fax # _ JL_ 2 __ 16. Address old v'> 1~_ N __ City j±1/L. State zip _LL2~

V. THIRD PARTY AIR MONITOR

17. Name ~,~ AtT(ZE2 fG1~! _? S+ _18. Contact Person

19. Federal Employer 10. # l ~z P~ y am _ 20. Tel. # a~~~aa oaf - _ Fax #

21. Address City `~~ ____ state L~_ Zip L°~ 22. Sample Analysis Laboratory_!L=( ( « ~^ A6 8 ~'rn~ £S 23. NYS DOH ELAP # _LL 1 _____

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

Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday

Shift from: ❑ 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

3?~ Square Feet, and/or__ _ Linear Feet '7 4~P 01 8J?rAll Or r9'.'IP 4 a ourr.:N & f,"FFMTrrAt O i PCS.6"r P6 P. thn29

NYC-WTC 000111426