NYC 9/11 Public Portal Document
Gam ,, NYC DEPARTMENT OF ENVIRONMENTAL PROTECT
Asbestos Control Program
59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107
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QQom ONLY 0:I)ttlll~lw ASBESTOS PROJECT NOTIFICATION
Building I. or TRU No
FOR OFFICIAL USE ONLY,
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\ FOR (ASBESTOS INSPECTION REPORT) I
www.nyc_Sev(dep..
AC fee schedule)
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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 12- ?Lc 1T SST Borough WIAN Zip i0038
AKA 1O G,OLD , (2— II FOLD 3. Block 6~ 4. Lot 23
5. Type of Facility CoMM ey-cu AL. 6. Name of Building
11. BUILDING OWNER
7. Name tO GoL12 LLC % iLaAMER. tEV ItJ 4 NAFrMJSi FRANWFL 8. Contact Person 8e )CE M.' W'e r L.L-
9. Tel. # t212) 7 15- 9155 Fax# (2►2) TIS -1572
10. Address ~1_ Tu t -PD AVENUE City kEW Yell — State _ 1) ? Zip 10022
III. GENERAL CONTRACTOR
11. Name__ , _ _ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name BF-WAMl .l URZBAtt I Soto CONTPOL ltst • 13. Contact Person Lou iE- 1ANNICO --~
14. Federal Employer ID. #1_P11__ . Tel. #. (1t ) 3l-29_ Fax # 209- i Sq_ ____
16. Address 124 ' 2ALP I-i AyEOLI E --- — City C2 kL? ►. _ State Zip ~ t2 ___
V. THIRD PARTY AIR MONITOR
17. Name ' l ga-ET► PPW-r E is i r4 etE.us 18. Contact Person M i Ctt A EL NDLA t.I —
19. Federal Employer ID. # L._._._._._._._.P! ._._._._._._._.; 20. Tel. # (212) g22 - oo?T _-Fax # .2% _ 2-03O
21.Address_ 22 0 EAsz 45Th STREET city~Ew •/02k. State_ Ie _Zip_tootT
22. Sample Analysis Laboratory _ — _— 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24- Starting date for this portion of work _1o(0a t 02. - Projected completion date t 1 _ 08102
Asbestos work schedule ® Monday © Tuesday 0 Wednesday tEl Thursday tEl Friday tEl Saturday 0 Sunday
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Shift from: -B IS am 0 pm to ___ ❑ am 0 pm
If other,
specify ---- —
Access to inspect the premises must be provided during the work schedule indicated in this item.
F/VE0
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25. Total amount of asbestos-containing material to be abated during this work
Square Feet, and/or 0 Linear Feet raiil~ dpi
ACP 7
2/2001
NYC-WTC 000114262
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