NYC 9/11 Public Portal Document
~, ) a~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
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59-1 ~oulevard, Floor, Corona, NY 11368.5107
auddug Dept. or TRU N
ONLY FOR OFFICUL USE ONLY
ASBESTOS PROJECT NOTIFICATION
r {?~ ~ (ASBESTOS INSPECTION REPORT) 1.
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When submitting this torm at the NYC Department of Buildings, the original form and three (3) oopies with original
signatures are required. Submittal at the NYCDEP requires one copy ci the form with original Signatures. This
town must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.
1. FACILITY
2. Address b - > D D K- A-n-51 "'~ S'Lr o F" Borough Zip _1 C) 0 2
AKA f l © 1 LLI LS -v4 . 1 (2 C( 3. Block ) o Q 4. Lot 1
5. Type of Facility H aS P I i_ 4k— 6. Name of Building
11. BUILDING OWNER
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7. Name 1y - 1, Ft ,,v p g~ ~ INI ~ 8. Contact Person ~ 1~ L.._ rt L DIGS
9. Tel.# ( 1_ a Fax #
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10. Address I° . W1LU fit_- 1 - City N State 'Zip 1Q O
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name e _[._._._._._._._. 13. Contact Person / L'slf~
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14. Federal Employer IQ. # ~,._._._._._ P1~
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;15. Tel. # tJ 1 - -( -3O~ O f
Fax# / S
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16. Address.2o/b c)"' /71/e City kJ ~_ State /J ( Zip!? _
V. TH:R:. PARTY At MONITOR
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17. Name 2 ki4 Z.EQ_ (&# 4€ ~ S, _r 18. Contact Person r% c44 L, (O L hr1 .
19. Federal Employer ID. #_____________ 20. Tel. # OD_ _- Fax # 2.W Ua -O4, 30
21. Address pd € l±s ( 9 (- 7 City fY' 7W-1~ State ~ Zip 0
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22. Sample Analysis Laboratory ~C f (7 (C- L~ A t r-A lc~l>ESIZctt 23. NYS DOH ELAP # /l
VI. PROJECT INFORMATION
24_ Starting date for this portion of work Projected completion date O
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday D Sunday
Shift from:
If other.
D wn ❑ pm to ❑ am 0 pm
(7 T
specify v DECEIVED
Access to inspect the promises must be provided during the work schedule indicated in US Rem.
25. Total amount of asbestos-containing material to be abated during this work
4 I Sp 2ry1 2O02
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t47D Square Feet, and/or Linear Feet
1
NYC-WTC 000118784
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