Asbestos project notification form, Oct 2001

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION .+`d' Asbestos Control Program ~I Q' 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY Dgr FOR OFFICIAL USE ONLY TYPEWRITTEN ~ `' ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1. 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 n /J 2. Address Q~ P 1~.~► 1 -2.E ( Borough Zip /O O

3. Block 4. Lot

5. Type of Facility. 6. Name of Building

P 7. Name , w~ ,r , ~;~ x,~--„~=__ —Ws 8. Contact Person

9. Tel.Lw.- E= 1 PII - - - -._- - -.v- -' Fax # PII 10. Address _._._._._._._._._._._._._._._._._._._. City ___t_— _'State _P~!-IZip _Jy l3 Ill. GENERAL CONTRACTOR

11. Name_-- --__— _---------- -- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name J3'eetL &, k ------ __-- _ — _13. Contact Person

14. Federal Employer ID. # I_.____x P~~____.-.,~_.15. Tel. # c16 Fax # /_ 16. Address .?~v~ Ll~ ~ ----- City ) / ~/ , State Zip 12

V. THIRD PARTY AIRMONITOR

17. Name ~!1 hP(Zt rL jJ6 i ~F~T"T?S+ 18. Contact Person t~ L t

19. Federal Employer ID. # Pi~ 20. Tel. # OO~~-- Fax # Ala 0- 63o 21. Address ,~Q (— '` ~- E —_ City IL -P j --_ State _ Zip

22. Sample Analysis Laboratory_ t' f /~«-~ *6 c A r_r-/ES v (_ 23. NYS DOH ELAP # _ / / -9 VI. PROJECT INFORMATION 24_ Starting date for this portion of work _ _ Projected completion date —__---

Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 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

— oLO Square Feet, and/or Linear Feet 7 )l

NYC-WTC 000111390