Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

c~T.or. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION +~yO " Asbestos Control Program DA 1■~ 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY f I~ FOR OFFICIAL USE ONLY TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION FORMS WILL BE ~'vnNMrNruiae~~c°~ (ASBESTOS INSPECTION REPORT) 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

2. Address i i ~ —~— 1 Borough J" -- Zip L Oci

AKA —____-- 3. Block _ 4. Lot

5. Type of Facility__, 6. Name of Building II. BUILDING OWNER

7. Name t —L ' 8. Contact Person T- " &EfAL.

9. Tel. # Fax #

10. Address _~3SSW ' )Prb l} A'L — City — -- State Zip

III. GENERAL CONTRACTOR

11. Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name '—(L •E' %~`~'~__ -------- __13. Contact Person

14. Federal Employer ID. # PII .... -.-.-.-.-.-.-...-.-.-...-.-.-...-....!15. Tel. # 7_30g0 _ — Fax #_ c~I 7~~ ✓d~s 16. Address 01~~v~ ~ ------ City .J /! ~/ _—_ State /u'I Zip _LL22 _ V. THIRD PARTY AIR MONITOR

17. Name b~V ~ _ 8. Contact Person 19. Federal Employer ID. P11 _ 20. Tel. # a f~=1~a - DO Fax # 21. Address g L r~'~ —JJ-- City Lw -- - _ State Y Zip _00 _ 22. Sample Analysis Laboratory S`( ' /F«- G~ *Ig is (or- f~S v c — 23. NYS DOH ELAP

VI. PROJECT INFORMATION 24.. Startingdate for this portion of work Projected completion date r, r, Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Fri

Shift from: __-- ❑ am ❑ pm to --- ❑ 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

9c5— Square Feet, and/or _________ Linear Feet 7 8p?EA J ~r E!M1 71 4E.:1c~sz7~:.V i R^9MEgtpt Er~Fila.~&AEA7 ASa-cS!JS CCiIlNGL IOO

NYC-WTC 000111436