Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

a,~t.DEPA*j, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION .~`.° `+.0- Asbestos Control Program .k 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 — -- Building Dept. or TRIJ No /1 D ~ FOR OFFICIAL USE ONLY ONLY E rir# Ir'I+T dtATIC1s`ATInKI TYPEWRITTEN '°aMc"""oe c°~ ASBES-""' FORMS WILL BE ACCEPTED

When submitting this form at the NYC signatures are required. Submittal at ~ ~ ~ V form must be submitted to the NYC DE r~ (~ 1 Pr1 K,.dC( I. FACILITY '`

2. Address —L—~~

AKA ----------------

5. Type of Facility___ c )W 1 O iu £0

II. BUILDING OWN.ER.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-; \ 7. Name_

9. Tel. P-------- ----------- v = Fax i — - G t 2 k`titbC ~+

- - - 10. Address y._._._._.-......r..---- PII _____- __ L --- Ill. GENERAL CONTRACTOR

11. Name _______ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name (~J~ G~ _ . l._._._._._._. --------- 13. Contact Person _~p6 14. Federal Employer ID. #J P11 115. Tel. # p Fax # 5LL1 > 3dt~s

16. Address ol & e_------ City / ~/ State iL'f1Zip _LL223

V. THIRD PARTY AIR MONITOR

17. Name S~ - 18. Contact Person

19. Federal Employer ID. #L P11 -_ 20. Tel. # _!L Uaa =DO — Fax # - 'G6 O _

21. Address g L 1~{ —/~ City ---_ State Y Zip _(22L_

22. Sample Analysis Laboratory ~~=(£r( ( 7f - J Cd r -LE S v'c — 23. NYS DOH ELAP # Lr ~f —_

VI. PROJECT INFORMATION 24. Starting date for this portion of work ---_ Projected completion date r--1 Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday ❑ Thursday ❑ Fri

Shift from: __ ❑ am ❑ pm to 0 am ❑ 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

L 1f9... Feet, and/or Linear Feet 7 01 rt e 4 RCff'ikt

I'=fu"P.AAI Ipll

NYC-WTC 000111431