NYC 9/11 Public Portal Document
A. ,*y" YC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
P 59-17 Junction Boulevard, 8°i Floor, Corona. NY 11368-5107
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ASBESTOS PROJECT NOTIFICATION
Building Dept. or TRU N,
FOR OFFICIAL USE ONLY
ITTEN
RMS WILL BE """"`"1O (ASBESTOS INSPECTION REPORT)
ACCEPTED (See ee 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
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2. Address [9___E4- S 2_~-~~ Borough N ' Zip (1
AKA 3. Block t 4. Lot C1
5. Type of Facility___-- 6. Name of Building
11. BUILDING OWNER
7. Name 1 1 y --QcJ Cary JD 8. Contact Person
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9. Tel. # _ ) o 7 = D 3 $ax #
10. Address ~o L'.Qc StI -- City --, _ _— State j ip I 0 rJ
Ill. GENERAL CONTRACTOR
11. Name_ --- Tel. # ----
IV. ASBESTOS ABATEMENT CONTRACTOR -
12. Name eiL W~ (--------C--_13. Contact Person L-r✓ L
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P11 N 5. Tel. # J
14. Federal Employer ID. # .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-) — - 7~~ ^300 O Fax # --~f' --- Jd5.s
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16. Address 301D L2 — —City ) / ~ —_ State. N Zip JIZ
V. THIRD PARTY AIR MONITOR
17. Name ~~~ PC 18. Contact Person 11~F EL (~loL,p~.(
19. Federal Employer ID. #_____ 20. Tel. # a - OO ' " Fax # te a= 2 -O D
21: Address g 1 r City _N 3'- 12 State IL _ Zip f90
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22. Sample Analysis Laboratory_ ~ -( 17 I ~ (E5 c 23. NYS DOH ELAP # _ f ! Lo
VI. PROJECT INFORMATION
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24.. Starting date for this portion of work _ __21 0 Z.. Projected completion date U °
Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday 0 Saturday 0 Sunday
Shift from: ❑ am 0 pm to ❑ am ❑ pm
/..... 1S
If other, ••. 4
specify ------ -- c- -
J
REMW -i
Access to inspect the premises must be provided dung the work schedule indicated in this item. JUN 24
2002
25. Total amount of asbestos-containing material to be abated during this work STO$ILEAG
oRC G AM
3 ~~
( ,, ,5 Square Feet. and/or Linear Feet ~~
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P I II I 3\
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PF 71.1
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NYC-WTC 000114644
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