NYC 9/11 Public Portal Document
r ,r,4M NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
ydM • bye Asbestos Control Program k {
ouilbrtQ Dept. er TRU No
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58-17 Junction Boulevard. 8o Floor, Corona. NY 11368-5107
ASBESTOS PROJECT NOT%FICATlON
FOR 0 F{dAL USE ONLY
Nrg'. n~~ (ASBESTOS INSPECTION REPORT) 1.
FORMS WILLLL BE .. tS teee VMdule)
ACCEPTED '!' ^_e._e•J!rs.
or10Ina1
Buildings, the original form and three (3) coplas with
When eubmltting this form at the NYC Depertrment of of the form with orginal signatures. This
requires one copy
signatures are required. Sutmittal at the NYCDEP week in advance of the start of abatement setivtlies .
form must be submitted to the NYC DEP not less than one
I. FACILITY
2. Address d —___ ~ C -- Borough _ - L. - Zip — -
3. Block — — ~ 4. Lot _j
---
8. Name of Building
5. Type or Facility
II. BUILDING OWNER
8. Contact Person ---- ------
7. Name SL'r .!,. — ALL` - ' ----------
9. Tel. #
PI1 ax
_-_._._._._._._._._._
=._._._W
._. ~~~~=_ _ _ _-,
,~~___=s,~,.,....Pl City — N _ __ state __ .Zip
10. Address I- ------- - - - - - - - - -
Ill. GENERALI CONTRACTOR
IV. ASBESTOS ABATEMENT CONTRACTOR
13. Contact Person
12, Name ----- ----w----r
_ ' _340 0 d`3r_ 5--
14. Federal Employer ID. # P11 s. Tel. # `? _ —3~---- Fax # _ I --?/-—
/~ Zip _t12~
16. Address _ 1 _ 1~i` -------- — City
~,,~" 1~ ~'L---- State —
V. THIRD PARTY AI Ft MONITOR
Contact Person
17_ Name ' I ----- ~` ------ -L ---t6.
19. Federal Employer ID. # ____~~____— _.._-
20. Tel. # (3~ — 0 — Fox # as
- r Zip~'_,~~~00
2 -- City !&.--
1Q!&._- State Lam _
21. Address g 188.- --Wt
22. SamplelAnaiysis Laboratory__ 'C!€ S
l _ t'G-~I d 1 (*Xo L-5 ` .r . — 23. NYS DOH ELAP
VI. PROJECT INFORMATION
24.. Starting date for this portion of work _ .—_ Projected completion date — g .l__ O Z
Thursday ❑ Friday ❑ Saturday ❑Sunday
AsbestoS work schedule Q Monday ❑ Tuesday ❑ Wednesday ❑
3l
Shift from. ❑ am ❑ pm to--- ❑ am ❑ pm ~y2 s
I r other,
Rip s
work schedule indicated in this item.
Access to inspoct the premises must be provided dug the JUN 2 8 2002
ILE
E9STOS/EA'
abated during this work
25. Total amount of asbestos-containing material to be
p1JGAM V
Square Feet, and/or —__ Linear Feet
G~ ? ACP l
Fi 2/2001
o Et or fMnap4y.~NT
ab'!,(L~1~;J 6 (~A:Krkrlrr
l'd MG,Gatlkk
14
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NYC-WTC 000114684
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