1 PARK ROW 1085949, 90/1

NYC 9/11 Public Portal Document

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kga4/ W7J NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 83-17.krnctlon Boulevard. e" Floor. Corona. NY 11368.3107 FOR'O DcFI .v ASBESTOS PROJECT NOTIFICATION LL BE (ASBESTOS INSPECTION REPORT) 1.

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.. FACILITY j~~ 2. Address - L__ -LA +=K_ O uS Borough N • zip IC) C)

AKA I " I I -A iii 14 S T2 -1 3. Block 4. Lot 5. Type of FacIlrty 6. Name of Biding N. BUILDING OWNER

t 7. Name 1AsN t 3) 2 LLfE ~~•~- • a Contact Person 9. Tel. # Fax # . - - tr 10. /4ddress ___t ~7 ._~ - -~Ircp - Gdy State j Zip 111. GENERAL CONTRACTOR 11. Name Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR p / /s 12. Name t ' rQEll. c1' 3 7 ( - -. 13. Contact Person 7 '-fC.~ J 14. Federal Employer 10. # P1 -.- -.-.-.-.- 5. Tel. # ~c i G 7f '3 0 00 Fax # 16. Address _ dl it )o~, /7Ye City LJ State /J { rrp [? V. THIRD PARTY Al MONITOR I 11 ,1 •17. Name 1r y R~ P#]~ A *T 4 ZE2 (~ir ep 18. Contact Person ~ tIC4{11fL (i!0G. cr4 .

19. Federal Employer ID. . - - - 1'! I ._- _-J ' 20. Tet. # .) t a7^ - 9aa 00j Fax # !3 - a - 06 o 21. Address g /K/_ 4L f City _l(' )o T 4721t. State tJ Zip (Cot f. 22. Sample Analysis Laboratory SG(f141t - LA6, ( 5 'tEs,Tctc 23. NYS DOH FLAP # _ (r t 6-Q - - VI. PROJECT INFORMATION • = 24.Starting date for this portion of wort_ D3 Prqected completion date _i\ 3

Asbestos work schedule ❑ Monday D Tuesday ❑ Wednesday D Thursday D Friday ❑ Saturdd

Shlf from: .D am D pm to ' D am1D pm If other. r specify Access to 125psd The premises must be provided during the work schedule lord in this hem. 25. Total amount of asbestos-containing material to be abated during this walk = Square Feet. srtdlor Lktear Feet

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NYC-WTC 000115794