NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ••
E /
ONLY .DPI
. Asbestos Control Progr{
59.17 Junction Boulevard, 8V' Floor. Coma .1.i t3~8.5107
izI . ..l_
ASBESTOS PROJECT NOTIFICATION
: ~~v
WR!TT{k (ASBESTOS INSPECTION REPORT) 1.
when submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original 'I
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 teas than one week in advance of the start of abatement activities.
L FACILITY
2. Address 4 t'P& . F.- C. Borough l zip J 0 E~
AKA 3. Block • I 4. Lot _
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name 1` ?LA CE ~*~ • ' 8. Contact Person
9.Tel.0 Fax#
10. Address +~ ~ State t' p --
111. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
V
12. Name -•F B e 1,O 13. Contact Person _ ,)
14. Federal Employer ID. # P11 15. Tel. # 7 i' 30 t 0 Fax #_57( - ?d/' - 3 'c5
16. Address. col //t! city TT7V7 State Zip 1 ?_
V. THIRD NITOR
t
17. Name
PARTY70:Z&J A lk7'{ ZFt2 l(a rwk ~S, PC 18. Contact Person ~I_t om - t`!0t-+ .
19. Federal Employer ID. # 20. Tel. # a fa - ~aa - D0 • Z Fax # fa 92P -O(G 3O
21. Address T
AT City ff Th t
2~ State 1 Zip oo
/
22. Sample Analysis Laboratory S? ? (7 lt~_ I. A7 9 7 lit- _ clt 23. NYS DOH ELAP # (1',' 0 .
VI. PROJECT INFORMATION
24. Starting date for this portion of work it4 Projected completion date
Asbestos work schedule 13 Monday D Tuesday D Wednesday D Thursday D Friday D Saturday D Sunday
Shift from: D am D pm to D am D pm
If other.
specify
I Access to Inspect the premises must be provided during the worst schedule lndraatedIn this item. i
25. Total amount of asbestos-containing material to be abated during this work
Jc 0 Square Feet, andJor Linear Feet
ACP7
tr in xEris 212001
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LE.
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NYC-WTC 000115896
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