NYC 9/11 Public Portal Document
231 M~NTIitL~t CTiON
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Asbestos Control Program
59-17 Junction Boulevard, 8°t Floor, Corona, NY 11368-5107 igli
Building Dept. or TRU No
1l J;
FOR OFFICIAL USE ONLY
EWRiTTEN Ra- %;i ASBESTOS PROJECT NOTIFICATION
~FORMs WILL BE
ACCEPTED L www.nyc.6rJdep J
(ASBESTOS INSPECTION REPORT) 1. LL1 I
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 5° PI rte 9'V -ET Borough MAN Zip 10055
AKA 3. Block 4, Lot
5. Type of Facility ~i 4 ^4SP-ct -L- 6. Name of Building
II. BUILDING OWNER
7. Name EiFt-Y PINE STRt€ T PAtz -,pie- s L. P. 8. Contact Person c-K2ts T IOE 14'"
9.Tel.# t2t2)643-1711 Fax# (212) 643- 0333 t
10. Address ZCt3 WEST 3c T' ( ST r s ir re 1204 City _ {3eu-' Yo flat State wY Zip L0001 -49CT
III. GENERAL CONTRACTOR
11 Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name P aAMIN 1<URZC3AW ~ S•ON Co4r¢GL IIJc 13. Contact Person LQ jI . ~ANNICa
14. Federal Employer ID. # ._._._._._._._PI I_ ._._._._ 15. Tel. # (118) 5 3i- 29 SO Fax# (r tf3) 2c V - 11308
16. Address 1248 RALPH AUENL:E City arcokL.'( N State b Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name W ARaZI-1 4 P AU Z- -2 18. Contact Person M CN A €_ L t`! C L-A►t
19. Federal Employer ID. # i.-------- Pu --------- - ` 20. Tel. # (z 12-) 922- 00rr Fax # (212.) 922- 0630
21. Address 228 rcAS. 45TIi S -MeET City NEW '/c State N'Y Zip too tT
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work Ii - 20- 02. Projected completion date 11-3Q-02
Asbestos work schedule ® Monday El Tuesday Wednesday ® Thursday ® Friday I Sunday
Shift from: 6e" ® am ❑ pm to 8o0 ❑ am ® pm
If other,
specify
RECEIVED
Access to Inspect the premises must be provided during the work schedule indicated In this Item.
NOV 192002
25. Total amount of asbestos-containing material to be abated during this work
6,042. +Square Feet, and/or 0 Linear Feet
ACP 7
2x2001
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NYC-WTC 000114831
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