NYC 9/11 Public Portal Document
rc—
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59.17 Junction Epulsvard. 9" Floor, Corona, NY 1136&3407
lTTEN ASBESTOS PROJECT NOTIFICATION
outs wru eE "-" (ASBESTOS INSPECTION REPORT)
ACCEPTED :-• a~ i•iar..
When submitting this form at the NYC Department of Buildings. the original form and three (3) copies with original
signatures are required, Submlltal at the NYCOEP 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.
1. FACILITY
2. Address _
-----Borough h __— Zip _----
AKA _ t Se..J ---- -- 3. Block — 4. Lot _____
"-{
S. Type of Facility -- --__, S. Name of Bui ding —
II. BUILDING OWNER
7. Name 4 L - - tPr
L Contact Person _-----._ —_-
9. Tel, # ~ L1 Fax # ,
r5 --------
10. Address i$ .... ~ z —k-_. _~~, _. _` City 1~ ------ State
III. GENERAL CONTRACTOR
11. Name Tel. #
---__—_,_ ---------
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name -e ~-_v_ _~_`_' ~U _--__—`----_13. Contact Person
14. Federal Employer ID, ft P1 -- 15. T et. #. c7 =_7~ 2....._ Fax it i< ;, s
16 Address ~ f~ ~ ------- City ) —_ State AL. zip 1L2 _
V. THIRD PARTY At MONITOR
,nA t 1
17, Name , _ kN ZQ(G rr )QS e—_18. Contact Person!r t~
19. Federal Employer ID. # ------------------ 20. Te!, # ( Q - OD Fax #
21 Address g 1 l t2 7 _`— City '~~ State zip LL~_
22. Sample Analysis Laboratory___CCI TI 'L' ! "f c1e — 23. NYS DOH FLAP #~
VI. PROJECT INFORMATION
Qp
24.. Starting date for this portion of work 7 4_
_ 2.
Projected completion date —_O -1 P2.
Asbestos work schedule ©Monday ❑Tuesday ❑Wednesday ❑Thursday ❑Friday 0 S tird*y Q t'~nd
Shift from: Q am ❑ pm to CI am 11 pm %`
I! other, M
specify ~1fJ7
RA
-----.w~-------- ------------.--_—
Access to inspect the promises musf be provided during the work schedule indicated in this item. JUd 2 8 2002
} EP/BANkir1
25. Total amount of asbestos•containing material to be abated during this work ' 3ES1.OS40
!l Pf10RUGM {
5*'3 Square Feet, and/or Linear Feet
ACP 7
au PpjOIrN:P>,ir
list
212001
r S &WQC 4LYr
mat
71 -4 _- J? Lck'. ' U1lr 171-t4c-217:x12
NYC-WTC 000115958
OCR can misread numbers and units. Confirm readings against the page image before using them.