NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8ei Floor, Corona, NY 11368-5107
kl
DP ASBESTOS PROJECT NOTIFICATION (-
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
ITTEN ~raiiion~iA~
, MS WILL BE (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED '"-!-`!-°•t"r 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.
1. FACILITY
, /
2. Address _L _V S I __ I Borough N ' —(
Q s
Zip 1 O O'D
AKA --- 3. Block (> y 4. Lot
5. Type of Facility, 6. Name of Building
II. BUILDING OWNER
7. Name A~2Ct_Pt~{ VESc = r LC o 8. Contact Person
9. Tel.# 3— x# _
\'-
10. Address 1 e~'D wV\ l~M ~P -- City N — tale N" lzip _1 Q C
Ill. GENERAL CONTRACTOR
11. Name___.. .....____ ____________________ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
1.2. Name j 1—ICO_L------------13. Contact Person _L—
.~. ._.-_~._._._
14. Federal Employer ID. /#~= .-._.I ~ ._.._._.5. Tel. # J _- 7 ' 3
—06
_ C ~j --
F a x # _-- 3dC~s
7~1 ----
PI
/ n t1
16. Address ~(. O -- City J /7 - State N Zip LL22 3
) J' t --
V. THIRD PARTY AIRMONITOR
17. Name ) kid Z t e2 G r' Ft~ S rh C 18. Contact Person _~' l! L ~ 0 ("
19. Federal Employer ID. # — 20. Tel. # 12 (~=1aa OO Fax # a~=42 C
21. Address 2{EZ--- City _State i -~ Zip .j
2 1
22. Sample Analysis Laboratory— SC ( (« e `~(£S "r c 23. NYS DOH ELAP # _ L r o
VI. PROJECT INFORMATION
24_ Starting date for this portion of work a O2 _ Projected completion date _ 071 0
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday 0 Saturda p..$&nday
Shift from: __ ❑ am ❑ pm to ❑ am ❑ pm ...
If other,
specify
RIB
I Access to inspect the premises must be provided during the work schedule indicated in this item.
t`
Ju1 28 2002 v
P/1ANHM
25. Total amount of asbestos-containing material to be abated during this work
TRUG
t5.SD Square Feet, and/or Linear Feet
a::'. -is
tr. ,
NYC-WTC 000111905
OCR can misread numbers and units. Confirm readings against the page image before using them.