NYC 9/11 Public Portal Document
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NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbeslo Control Program
59-17 Junction Boulevard. 8" Floor, Corona, NY 11368-5107
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ASBESTOS PROJECT NOTIFICATION
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Building Dept or TRU No
F0ROFF)QAIUSEOMY
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FORMS (ASBESTOS INSPECTION REPORT) 1
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When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original
VW 1. FACILITY
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 rot less than one week in advance of the start of abatement activities .
2. Address _y-9 — 5 W A- e r to s 92€ T Borough N' 1 zip ( o
AKA _S I 3. Block 3 3 4. Lot
5. Type of Facility 6. Name of Building
11. BUILDING OWNER
7. Name ) 41 eE-A-t-1 -{ - L. G B. Contact Person
9. Tel. #
10. Address; PII Crty~? P11 State P11 Zip P11
Ill. GENERAL CONTRACTOR
11. Name Tel.#
IV. ASBESTOS CONTRACTOR
12. Name _E ABATEMENTp
Q~IL ►<'. i.~. f2.1._.-.-.-.-.-.-.-. 13. Contact Person rte ) C. 's' I
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14. Federal Employer ID. # _ .-.-.-...-.-.-. p
r I I . .. j15. Tel. # $ / 6 - 7~f -3 ~ 0 0 Fax # JI ?d .5
16. Address/ ~l )yEft /IY City KJ J~ zip1!?
State ?
V. THIRD PARTY AI MONITOR
17. Name _S _Pc 18.ContactPerson V 44 7
19. Federal Employer ID. # 20. Tel. # a 13 - ' - OOJ Z Fax # £1a — -O- 3 D
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21. Address c2 € 7EkS1 t S ( ifs 7 City f -cp cr-K State ~ Zip ~ (
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22. Sample Analysis Laboratory SC f ( iC- L t 6 ~x'/£S I J c 23. NYS DOH ELAP # ( I r
VI. PROJECT INFORMATION
24. Starting date for this portion of work I
ID ). D ~-- Projected completion date !+
Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday 0 Thursday 0 Friday ❑ Saturday ❑ Sunday
Shift from: ❑ am ❑ pm to 0 am ❑ pm
If other.
specify iED
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I Access to inspect the promises must be provided during the work schedule indicated in this Item. I
25. Total amount of asbestos-containing material to be abated during this work .a eua~ 6Mgw
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t` Square Feet, and/or Linear Feet //
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NYC-WTC 000113291
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