NYC 9/11 Public Portal Document
~D 7 IN Boa• Gn oo~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECT
Asbestos Control Program
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59-17 Junction (+oulevard. 8"i Floor, Corona, NY ii' u
ONLY ASBESTOS PROJECT NOTIFICATION
Building Dept. ol'lRU 4
FOR OFFICIAL USE ONLY
F ~' : 7:7 °
(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
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 9 _ EPtb S l ~E-a Borough I Zip
AKA 3. Block 14_L) 4. Lot __________
5. Type of Facility___--- • 6. Name of Building
II. BUILDING OWNER
7. Name __WC LQ-S MOSkoW11Z._'8. Contact Person M'Y • IYfoS
Fax#
10. Address_ P11 — City -- N _1.._.__ State .f _ Zip 10012
III. GENERAL CONTRACTOR
11. Name __ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name •eit ---~- G%P
3 ~ ,'O
--------/
__13. Contact Person
/
14. FederalI Employer ID. #L, _ W _ PII 6` v - 7~1 - 3 060 .
_,15 Tel. # __--_ Fax _—___----
16. Address _ City / ! (i l _ State Zip .LL2 2
V. THIRD PARTY AIR MONITOR
17. Name L~~ &_ kri Zr tZ .fC, r
(~
~1 S+ PC_18. Contact Person Al (`~ f" Frl_
19. Federal Employer ID. # 20. Tel. # a( c -0O t Fax # -a — 9~a -06, 30
~{ State L` _ Zip 00
21. Address ~~ gk~1 City 4 J~
22. Sample Analysis Laboratory— S'C( i ((~(L ~ A-6 ?a~ ~`t'/~1 c.r c 23. NYS DOH ELAP # _ r o
VI. PROJECT INFORMATION
24.. Starting date for this portion of work 3' O Projected completion date
(_J_
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday,❑ Sunday
Shift from: 0 am 0 pm to ❑ am 0 pm
If other,
specify
C~RECEIVID
Access to inspect the premises must be provided during the work schedule indicated in this item.
2002
25. Total amount of asbestos-containing material to be abated during.this work
!I
G
Square Feet, and/or Linear Feet
ACP'
21200
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P^'1i•E7.^.AL
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NYC-WTC 000114486
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