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NYC 9/11 Public Portal Document

54/ w7ç NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8" Floor. Corona. NY 11368-5107 Butdlng Dept. orlRtJ No FOR OFFICIAl. USE ONLY N ~EW ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1.

When submitting this form at the NYC Department of Buildings, the original tams 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.. FACILITY `` < 2. Address _ __L . _ ?M. -K .o U1 go ,gt N • , RICA t Il - ' TAT - 3. Block 4. Lot 5. Type of Facility 6. Name of Building N. BUILDING OWNER

7. Name U!,)1 -b iQQ_1C-` 4-- • ' g. Contact Person 9. Tel. # Fax # - i l .. f`, 10. Address ..,_~._ -`'i~....(.,.--- - --Y~ -_. Crly . tJ • State Zip ~iL' Ill. GENERAL CONTRACTOR 11. Name Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR 12. Name J L3Z' G 37 o (_ _ 13. Contact Person 7 C...o _ 14. Federal Errtployer ID. # ._._._._._._._._._ PI I -15. Tel. # $16 7i ~3--' d Fax # 5? ?i ' 3c' S 16. Address 3016 &),()S /ye City State . , zip I t V. THIRD PARTY Al MONITOR l •17. Narrle ZEQ$I6t4ac, Pe 18. Contact Person tc44*E . (!0 L. hrL -

19. Federa! Employer iD: # ._. .- _ _ PI I 20. Tel. # ara - 99o~ 00 Fax # 9D -06 3O 21. Address g ?( if 15 City, 1 lfG. State Zip oo I )) 22. Sample Analysis tatiora2ory S%lf '(1W(C - ,h A_6 a VA r£S, crc 23. NYS DOH ELAP # ! t £s'd - - VI. PROJECT INFORMATION 24.Starting date for this portion of work 213 Projected completion date b 3 Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saar%x-Qunday

Shift from: .O am D pm to ❑ am1] pm If other. specify

Access to Inspect the premises must be provided ducting the wa►* schedule h* lcated In this ken. 11 a"~Cp CFA 25. Total amount of asbestos-containing material to be abated during this work '~r8 I e - --a Square Feet, anWor linear Feet ACPy e%°fAJO(~tt•„v ?2001

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NYC-WTC 000115752