NYC 9/11 Public Portal Document
NYC PEPARTMENT OF ENVIRONMENTAL PROTECTION
, Asbestos Control Program
59-17 Junction Boulevard. 8°i Floor. Corona, NY 11368-5107
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ASBESTOS PROJECT NOTIFICATION
`'f (ASBESTOS INSPECTION REPORT)
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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
2. Address 205 PEARL STR.eE'f- Borough MAN Zip 10038
AKA 3. Block 68 4. Lot 'l50
5. Type of Facility 6. Name of Building
11. BUILDING OWNER '
7. Name _ 8. Contact Person
9. Tel.# Fax #
10. Address M M — City —~— _ State _--_ Zip
Ill. GENERAL CONTRACTOR
11. Name__ --M--_ Tel. # —
IV. ASBESTOS ABATEMENT CONTRACTOR
VU QZBAIs 8, Sc.N C~urs:.Ok. I ti C. — 13. Contact Person _ IC (A _CO --
12. Name 34EM-%04A tv
14. Federal Employer ID. #__. = J 1_ ___ 15. Tel. # Care) 53i - 2.2Q__ Fax# Ciiñ) 2o9L80~3 ___
16. Address 1 24S C-Au'M AUGNJ i✓ — City __ owt-1s N— ___ State h+.— Zip Y Z36 —_
V. THIRD PARTY AIR MONITOR
17. Name IN 18. Contact Person MI CU A LAN
922-o30 --
19. Federal Employer ID. # 1. _ P!!._._._._._._._. 20. Tel. # C2t2) 922- ~o -t T — Fax # C2 I2
21. Address _ 22e 51'ii S r City 114* cs '1'o 1 State N _ Zip J2t 7
22. Sample Analysis Laboratory_._ — 23. NYS DOH ELAP # --_
VI. PROJECT INFORMATION
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24. Starting date for this portion of work 09 1 10102 Projected completion date f o
Asbestos work schedule 19 Monday 10 Tuesday ® Wednesday 1Z Thursday L J Friday 0 Saturday ® Sunday
Shift from: # ®am 0 pm to s' ❑ am El pm
If other,
specify -----
Access to inspect the premises must be provided during the work schedule indicated in this item.
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25. Total amount of asbestos-containing material to be abated during this work { '
—. t5j'L Square Feet, and/or 0 Linear Feet
' ACP
2/200
NYC-WTC 000115083
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