NYC 9/11 Public Portal Document
z_c921tr NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
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Asbestos Control Program
~ 59-17 Junction Boulevard, 8°i Floor, Corona, NY 11388-5107
O Building Dept. or TRU No
r~ FOR OFFICAL USE ONLY
ASBESTOS PROJECT NOTIFICATION I
cc aE ~u _! (ASBESTOS INSPECTION REPORT)
P7ED ...,erc.iertaM.
fee 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 .
I. FACILITY
2. Address t t t ~o / 't .SR Borough Zip ) O b 13
AKA 3. Block I ', 4. Lot
5. Type of Facility 6. Name of Building
It. BUILDING OWNER
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7. Name s t fr(Z O ld C - • `8. Contact Person
9. Tel. # _ Fax#
10. Address City —Nr State Zip
III. GENERAL CONTRACTOR
11. Name_— --`— Tel. # — —
IV. ASBESTOS ABATEMENT CONTRACTOR
---- —__13. Contact Person /QI` c / /9
C
14. Federal ID. # P
r II j15. TeL # J — - 7~r ^~~ 0 0 ~~
Fax # ----
16. Address o1~~U e _— City ) /97 State v Zip 1L?
V. THIRD PARTY MONITOR
Al
17. Name _JL12 h
rC 18. Contact Person t ( l 0( k T(
19. Federal Employer ID. # ___— 20. Tel. # Q/2_ —a -J OO Z Fax # a - 0~ 0
21. Address 22 g [ City . State t _ Zip 00
22. Sample Analysis Laboratory_ S-(Ej~t7(FlL /~. p473 cIZA7 fE5 ~f c 23. NYS DOH ELAP # _ ( •y 0
VI. PROJECT INFORMATION
24.. Starting date for this portion of work 1 O O2 Projected completion date __L2 Z
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturday 0 Sunday
Shift from: ❑ am ❑ pm to DamDpm
If other, 4.
specify --- —
=/ RECEIVED
Access to inspect the premises must be provided during the work schedule indicated in this item. . r 0 2002 N
oo If 5
25. Total amount of asbestos-containing material to be abated during this work •' T At
2 _ Square Feet, and/or Linear Feet
9 ACP7
7 2/2OO'
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NYC-WTC 000114730
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