NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
4 59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107
BuBdt Dept. or TRU No
ASBESTOS PROJECT NOTIFICATION
CO S (ASBESTOS INSPECTION REPORT)
~ ~ ~~ 1. a01(See
See fee ea,eaule)
form at the NY6 Department of Bt8dings, the original form and three (3) copies with gnat
red. Submittal at the NYCDEP requires one copy of the form with original signatures. This
to the NYC DEP not less than one week in advance of the start of abatement actwites
• l.F
2. Address 102 North End Avenue Borough_ Manhattan Zip 10280
AKA Lilies Noodle 3. Block 16 4. Lot 1001
5. Type of Facility Restaurant 6. Name of Building n/a
II. BUILDING OWNER
7. Name LII;es B.P.C. 25 Inc. 8. Contact person Mr. Ken Yin
9. Tel. # Fax# (212) 786-1213
10. Address 102 North End Avenue City Manhattan State M' Zip 10280
III. GENERAL CONTRACTOR
11. Name n/a Tel. #_________________
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Fiber Control, Inc. 13. Contact Person Mr. Richard Daly
14. Federal Employer ID. # 15. Tel. # (516) 781-3000 Fax # (516) 781-3085
16. Address 3010 Bums Avenue City Wantagh State NY Zip 11793
V. THIRD PARTY AIR MONITOR
17. Name Clean Air Testing Labs 18. contact person Mr. Lance Tuckruskye
19. Federal Employer ID. 9 P II 20. Tel. # (516) 546-2640 Fax # (516) 546-2640
21. Address 1111 Steele Blvd City Baldwin State iY Zip 11510
22. Sample Analysis Laboratory same 23. NYS DOH ELAP # 11242
VI. PROJECT INFORMATION
24. Starting date for this portion of work 1 1l 01... Projected completion date it
Asbestos work schedule El Monday © Tuesday El Wednesday 10 Thursday El Friday © Saturday ❑ Sunday
Shift from: 6:30 dam ❑ pm to 3:00 Dam ©pm I \ -•---- .,~,~
If other, fO
specify ~j
D
J "' l
Access to Inspect the promises must be provided during the work schedule Indicated In this item. ' 0 s 2QQ2
25. Total amount of asbestos-containing material to be abated during this work
4,000 Square Feet, and/or 0 Linear Feet 6
2!2WI
NYC-WTC 000116066
OCR can misread numbers and units. Confirm readings against the page image before using them.