Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

0øtCrY OCPA1/ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8"' Floor. Corona, NY 11368-5107 Building Dept. or TRU No ONLY f. DAMP FOR OFFICIAL USE ONLY TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION FORMS WILL BE AM`"r" jµ° (ASBESTOS INSPECTION REPORT) ACCEPTED (See tee 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 NYCOEP 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 .

1. FACILITY

2. Address _ VJA "L_ Borough N - Zip P

AKA 3. Block 4. Lot

5. Type of Facility, 6. Name of Building I =IIJl!R1 L L.1!iPI~:7

7. Name Cb. h- 1QtC~sm-i _ i&E 8. Contact Person

9. Tel. 21 :L,.)-L91 Fax# —__—

10. Address L USA— ___~t._ —^ City _____L State _JL 1 Zip _Q~

III. GENERAL CONTRACTOR

11. Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ CO03 1CO e~ --13. Contact Person _~ /t~~

14. Federal Employer ID. If P11 ' 15. Tel. If J ` 6 - -3460 Fax

16. Address 01C~~(~ /~ city L L._. scare N zip _LLZL'- _

V. THIRD PARTY AIft MONITOR

17. Name (z _ AT(Zt 2NG i 2 S+ __18. Contact Person w1~c-~+;~fL ►y G (^ _

19. Federal Employer ID. i P!I L 20. Tel. # a ~ =1aa - oh Fax # 21. Address g ~ L✓ --- City L^_ ____ State Zip

22. Sample Analysis Laboratory_ ( E5 v _ 23. NYS DOH ELAP # _L ~ 2 ____ VI. PROJECT INFORMATION 24. Starting date for this portion of work Projected completion date r -I r1 Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Fri

Shift from: _ 0 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

Square Feet, and/or-- Linear Feet 7 BUP.£AU Or EtNIM11M.El )1 45'.t£Ci:iif.•V i ENFilVC TAL A-ii TOS CO:+tROIM P60CRAN (011 2

NYC-WTC 000111451