Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

urrar NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8"' Floor. Corona, NY 11368-5107 — -_ Building Dept. or TRU No ONLY D ~ ~ FOR OFFICIM. USE ONLY TYPEWRITTEN ~%raN«rNrµ ~co~ ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1. ACCEPTED _=.eri:;e,ie~r, (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 1 ___P An -94c— ~~~1 Ct Borough _— Zip t O 00

AKA l t0 "' lu LI IL L ________3. Block 4. Lot —

5. Type of Facility. 6. Name of Building II BUILDING OWNERQ,, `` 7. Name BIV ~~> _ZLLJ_ 8. Contact Person ---

9. Tel. # 31 Z= Fax # _----

10. Address _F_ 60% -1 — City \OAL- E-S —C—E N State j j Zip _ll ea -

III. GENERAL CONTRACTOR

11. Name-------------------- ---------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name --[L~tl ~-~~' _____— - ----13. Contact Person

14. Federal Employer ID. #j Tel. # 7~ 1-3000 Fax

16. Address _ oc f> v~ ----- City — --_ State /v Zip _(l?

V. THIRD PARTY AIR MONITOR ,~ r 17. Name ~'► ZI NG i )'fc:-18. Contact Person

19. Federal Employer ID. #_____ 20. Tel. # ara=~aa- OO. 1: Fax 21. Addressg ✓ City IL — State ~~ Zip _L00 (L-

22. Sample Analysis Laboratory— .~C (e t tEC— G- a ~?LES v — 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 0 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

~ 5 Square Feet. and/or Linear Feet 7 8!JrAtI Sr e;p~, r )t Cs„tiGN i 6 tAt pjF:c;.irhT Ago-c`Li3 'rgl7i{ P6C 2 rn1 9

NYC-WTC 000111445