NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-11) Junction Boulevard, 8th Floor, Corona, NY 11368-5107 ding Dept. or IRU No
aR R OFFICIAL USE ONLY
ASBESTOS PROJECT NOTIFICATION L-
ruvi~ c
BE (ASBESTOS INSPECTION REPORT) 1.
0
. wYiw.nYt.aov/deft . , (See fee
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
PEA fz i_ ST ET Borough MM _Zip 10038
2. Address _ 3112-
3. Block TO 4. Lot 2C)
AKA _ _
5. Type of Facility D ItA a - _6. Name of Building
11. BUILDING OWNER
7. Name 8. Contact Person
9. Tel. # Fax #
10. Address City State ______ Zip
Ill. GENERAL CONTRACTOR
11. Name___ ___ Tel. #
W. ASBESTOS ABATEMENT CONTRACTOR
12. Name 3~t~~ ++~3z+tn?f~A ' * __LL' s J'C- 13. Contact Person _L- u.s~1~*+Ht cc_~_
M ----_—?_.-_ 15. Tel. # ]!
14. Federal Employer ID. # _.... - _P!' 5 i_ 2 c3 C0 __ Fax #
12 A $ _ R•A t-Pk AU cw c Y~ __ City __ _ __ State N'i _- Zip t t 2349
16. Address
V. THIRD PARTY AIR MONITOR
PI ZeQ..Er3GiPEES 18. Contact Person MtCtthet ►J~LAtJ
17. Name J2 L.4
2'C01'T 922—o630
19. Federal Employer ID. #L L-W= ___ 20. Tel. # (2+2) _ Fax # (2+
21. Address ? - ST 45 Tu S T2.EE T
2 t3 eA City ~49W ~otzd M State N'! _ Zip _%00t(
22. Sample Analysis Laboratory _ _ 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
0 ` 02.
24. Starting date for this portion of work 29 fi t)
02 Projected completion date i o i
® Monday ® Tuesday 0 Wednesday tEl Thursday ® Friday ® Saturday L Sunday
Asbestos work schedule
Shift from: to ❑am ® pm
i m0Pm
_—
"
Access to inspect the premises must be provided during the work schedule indicated in this item. 0C 12002
+ `• & C("
+aia 1j:
25. Total amount of asbestos-containing material to be abated during this work
48T5 Linear Feet ^~~ i
Square Feet, and/or
Act'
21200'
w. _
NYC-WTC 000115258
OCR can misread numbers and units. Confirm readings against the page image before using them.