NYC 9/11 Public Portal Document
U7 U ar _NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
.~`~'`" ••''~!~. Asbestos Control Program
r 1. 59-17 Junction Boulevard. 8e. Floor. Corona, NY 11368-51D7
D0■~
ITTEN ln+~~ ASBESTOS PROJECT NOTIFICATION
RMS WILL BE (ASBESTOS INSPECTION REPORT)
" ACCEPTED " "r-` t°O'{a•4.
When submitting this form at the NYC Department of Bw7dings, 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 13
yy E Pi
. T 2E E I Borough `" ` Zip I O I2
^ nn
AKA LO — tO T li^J b (ZO t/J ~ 3. Block 1q 4.Lot
5. Type of Facility__ 6. Name of Building
It. BUILDING OWNER
_r _/ p
7. Name _ ~2 e~f~ ~t~ A } ~ - I 't C t.9. Contact Person
9. Tel. # Fax#
10. Address _ ~J {C~Qdt;-0-- City _ = State Zip OD 3
III. GENERAL CONTRACTOR
11. Name_. _.____ __ Tel. # _
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name t_ _t.~d (._._._._._._._._. 13. Contact Person 7k- ~ SL
14. Federal Employer ID.#; P I I 5. Tel. # ~ `j — 7~~ -346 O Fax # _~~ _7' "3 5
C 16. Address city State N Zip ill?
V. THIRD PARTY AIR MONITOR
~j
17. Name ({~1 ,_Pkr(ZEt2 j fG l P- PC 18. Contact Person 1t4 n. ("! . c(4 .
19. Federal Employer ID. # _________ 20. Tel. # _~8a -- q — Fax # 2Ja_ 22_0 .3o
21. Address 2 g _- City fr~ ' ~ State Nt _ Zip (00
22. Sample Analysis Laboratory_ Sclt ((1t — 4/- s7 _(±'«S cry 23. NYS DOH ELAP # If
VI. PROJECT INFORMATION
24.. Starting date for this portion of work_ . Projected completion date 0jôp
'_10_
1
Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday 0 Thursday ❑ Friday ❑ Saturday ❑ Sunday
Shift from: _ ❑ am 0 pm to ❑ am ❑ pm ~ r
If other,
specify
d
Access to inspect the premises must be provided during the work schedule Indicated in this item. JON ?
rsr°'w~,t 02
25. Total amount of asbestos-containing material to be abated during this work
Square Feet. and/or Linear Feet
ACP'
2700
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711E
NYC-WTC 000114747
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