NYC 9/11 Public Portal Document
I7 4 c NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8ei Floor, Corona, NY 11368-5107 Buldlng Dept. or TRU No
FOR OFFICIAL USE ONLY
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1,
PTED • eti' schedule)
1~. V
When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original
This
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures.
form must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.
I. FACILITY
3A PARK Borough Mm Zip 10038
2. Address .oW
aE1I.4A44 s..rRE-sr ...3. Block 9 4. Lot 13
AKA ot3s
5. Type of Facility C.oMMeie`.0 ^%- 6. Name of Building
II. BUILDING OWNER '
7. Name _ 8. Contact Person
9. Tel. Fax #
City State ______ Zip
10. Address
III. GENERAL CONTRACTOR
11. Name_ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
!* Ku ¢.z54 N J SoM C'OmMOt_ 1I3 . 13. Contact Person -LOU tE 1 A*►u t Co
12. Name
14. Federal Employer ID. # rt PII 15. Tel. # C-itS) 931;2 900 — Fax #
uE N___ _ City B2oL'L' `_ State NY Zip Jj236 N
16. Address
V. THIRD PARTY AIR MONITOR
17. Name u?+> RRIK" ~A~1x•E:e €* ,tUt ~ __18. Contact Person µICAO? 3Vo —
212) 922- ooT 'C _ Fax # a _
19. Federal Employer ID. # lam- -_ 20. Tel. # L! 063
IFksr 457'9 S -t>a.'+~-ES City N+ % ?c2. _ State ithL. Zip J IT _
21. Address _? 2•$
22. Sample Analysis Laboratory_________________________________ . 23. NYS DOH ELAP # _
VI. PROJECT INFORMATION
24_ Starting date for this portion of work 09 (Zs 102. Projected completion date i2124 102
Asbestos work schedule ® Monday 13 Tuesday ® Wednesday ® Thursday ® Friday IN Saturdai
ao
Shift from: 8~ ® am ❑ pm to g ❑ am ®pm
r
If other,
specify r/
Access to Inspect the premises must be provided during the work schedule Indicated in this item. I
I
25. Total amount of asbestos-containing material to be abated during this work
8000 Square Feet, and/or Linear Feet '•..~ ~,
,,
~
ACP'
21200
RVR'aj OF EkWppl
^SAc. Ai'tN7 R ENF EP✓fat
p~EMfYr
A' aFRO
PSCM
NYC-WTC 000115398
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