Invoice for asbestos work, 15 Ann St

NYC 9/11 Public Portal Document

(,A)72—' ~ C,aIOfnyrr~ a 'NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 0 Asbestos Control Program , VV a. Ar 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5l Building pt. or TRU No ON DI•r 0" Fh.,~ FOR OFFICIAL USE ONLY

N c" ° ASBESTOS PROJECT NOTIFICATION Na"trrru~~~ ILL BE (ASBESTOS INSPECTION REPORT) 1 --- (Se ee schedule)

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 .

1. FACILITY

2. Address _ iS ApN —S -Ti E'T Borough _&L_ Zip

AKA —_ 3. Block 29__._ 4. Lot fi g --__ - 5. Type of Facility___ VI e E o — USG __Y---- 6. Name of Building

II. BUILDING OWNER

7. Name ---_--------- 8. Contact Person

9. Tel. # ---------- Fax #

10. Address ____ ------_—____ City State ---_ Zip

III. GENERAL CONTRACTOR

11. Name _ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name t3 a fA rniN kur<2F~A __S.,A C.14MOL I NC • —_13. Contact Person -----

14. Federal Employer ID. #j._,_._._._._. _PLL `_ 15. Tel. # - C7tsN 531-29~__ —__ Fax# C-tt8) 29 _11308 __—_

16. Address 12- A f3 tz.At-Pt-t Av~ntUE ------- City B e,opltuy N __-- State f l`f Zip

V. THIRD PARTY AIR MONITOR

17. Name _WA - -E)4 PAIJ2E2 E f.1GINEtaeS _~ ---- _18. Contact Person _MLek4AEL oLAO 19. Federal Employer ID. # ~,_-_ __ 20. Tel. C2t?)922-dor7 -- Fax#_C2t2)_922-oE3d -- --------

21. Address _ 22 8 EAST A S Tt! SMIGE-r --- City _ Nib Y 012-v- ---- State t __ Zip _ IOO t1

22. Sample Analysis Laboratory__ _—___ ___— ------- 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 11 24.. Startingdate for this portion of work 02 (02 - Projected completion date

Asbestos work schedule ® Monday ® Tuesday ® Wednesday I Thursday © Friday 1 Saturday © Sunday

....... ........... ... Shift from: 7 4 g If other, specify ----------- -----------------------------------•

Access to inspect the premises must be provided during the work schedule indicated in this item. RECEIVED OCT. 212 25. Total amount of asbestos-containing material to be abated during this work

—_ 8$$(.I Square Feet, and/or ____--- Linear Feet ACP 7 ' 22001

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NYC-WTC 000116394