Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

~;t;T.or,,,r NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION .° . 1* Asbestos Control Program D0 rP 59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY 1TI FOR OFFICIAL USE ONLY TYPEWRITTEN r.~:~on~cd` ASBESTOS PROJECT NOTIFICATION FORMS WILL BE - (ASBESTOS INSPECTION REPORT) ACCEPTED

When submitting this form at the NYC signatures are required. Submittal at I form must be submitted to the NYC OEI

I. FACILITY

2. Address

AKA —___--

5. Type of Facility__. II. BUILDING OWNER

7. Name `-

9. Tel. # Fax# .

10. Address _% 32 Sw _ p'

III. GENERAL CONTRACTOR

11. Name_—_ --------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name (iC 1L 0.1._ 13. Contact Person

14. Federal Employer I0. # _. _._._._._._._ PI I ._ . . . y 5. Tel. # c~ `16 - 7 -/ -3co O Fax #

16. Address _ I!~ ------City -- /~'~/ h--_ State /v Zip _LL22 _

V. THIRD PARTY AIR MONITOR rr 17. Name ~ ZE2 rGr S+ L—_18. Contact Person _~ --- - - -- 19. Federal Employer I0. # P11 i 20. Tel. # a ( =~9a = 20} Fax #

21. Address g L ✓~ _/-- City LL State 1~ Zip

22. Sample Analysis Laboratory__ _ .J (E« r *6 6 r- - A --' (£S — 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work _—__----_ Projected completion date

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

Shift from: 0 am ❑ 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

~— Square Feet, and/or _________ Linear Feet 7 8UP_A9 rEia~yk- ]1 4~.'.t:~:p71r.:Y 8 Erif;, . cNSA( 's Cc;gR. ..h? P6pCNAAI ~ rnn

NYC-WTC 000111435