NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
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Asbestos Control Program 7(I[ /I~", s n
N,4 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107
Building Dept. or TRU Ne
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ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE
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(ASBESTOS INSPECTION REPORT) 1. 7 .-eJZjt (-
ACCEPTED
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.
I. FACILITY
2. Address I T ANN ST __ _ Borough N Ar --_. Zip I OD 3@
AKA - -- ------ ------ ------____3. Block _ ______ 4. Lot 23
5. Type of Facility___ MTxeD __usi — — 6. Name of Building --
11. BUILDING OWNER
7. Name -----------------------------8. Contact Person _-----
9. Tel. # ------------ Fax # _____j___ .
10. Address City —_ State _~,,,__ Zip _____
III. GENERAL CONTRACTOR
11. Name. —__------------------- --------- Tel. # --------------
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name 1SEN~AMIN — vrZZF3N~1 SC04 C:OtJ.zcP —NC•-- _13.Contact Person _LCukE--IANNIC4 ----
14. Federal Employer ID. # _......... PIL—.-.-. --- 15. Tel. # C11 t~) 531- 29eo _-- Fax # -~-
16. Address i241~ -RA
------
L.P-•t ANI:E
VE ------------ - City - L__ State ►^r -- Zip j1_ _
V. THIRD PARTY AIR MONITOR
17. Name —W Al u_ _ PANz —El-4±u Rs_ —__-----_18. Contact Person _M1 ot!AE1 ~bLA1J
19. Federal Employer ID. #.__ _ 20. Tel. # 2L2 7T___
!1_ fax #
21. Address 228 EAST 45Tlrt S -nsgr--T
----- City __u 1 og+L---- _ State _ _ Zip Tf~O lt__
22. Sample Analysis Laboratory__--__ _______--__-- ------- 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work _ to 1 y I O 7a_ Projected completion date JO LL _t22
Asbestos work schedule ® Monday 13 Tuesday MI Wednesday ® Thursday ® Friday © Saturday ® Sunday
Shift from: _r ___ ® am 0 pm to 8 __. 0 am ® pm
If other, r
RECEIVED
Access to inspect the premises must be provided during the work schedule indicated in this item.
f
i
rU~ 2 2002
25. Total amount of asbestos-containing material to be abated during this work 1 i
_225 Square Feet, and/or _—~— Linear Feet 1~~
IJI!
ACP7
~, 21200
iR112
NYC-WTC 000116442
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