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
/ I
NYC-WTC 000115752
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