NYC 9/11 Public Portal Document
It , vv NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 3'" Floor. Corona, NY 11368-5107 rpjj i iHio4
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
N ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1. C
a+, ACCEPTED fee schedule)
(S
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 _-1'2I— P1 L D STTL "r Borough M0 -- Zip
AKA 3. Block 4. Lot
5. Type of Facility__ 6. Name of Building
1I. BUILDING OWNER
7. Name CE~A¢— juI~WA'r eme).tT cc'R-P~--- ' 8. Contact Person
9. Tel. # - C2f2) 7 32- T653 Fax # —
10. Address _20 VIESSEN S -T 2*aE C --_ City --N`L —_—__ State NY _ Zip
Ill. GENERAL CONTRACTOR
11. Na Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name (3E'WtckAI Vl V-7-8Lt1._. ,_.SbN C`m Tv- L- --13.ContactPerson LbutE IANNICO
14. Federal Employer ID. # _ ►(S) 531- 2900
15. Tel. # - C- — Fax #_C-it£s) ±o__
C 16. Address _1245 —
V. THIRD PARTY AIR MONITOR
-P" A\j c- 1=E_------ City JEW_____ State JL Zip 11236
17. NameWawz P't-1z✓2
~N6ilut RS (ti1C 18ContactPerson lcttAEL NbLAN
19. Federal Employer ID. # P (~ ._._._._._._._.. 20. Tel. # (2 t2) 922_00'('7
21. Address ?? ~ _ A 5 T11 ST1 Et — City ~ yotz ac --- State _.L Zip _ (001"i
22. Sample Analysis Laboratory_—_ --- --_ — 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24- Starting date for this portion of work _ d 6 (2 3 (02 Projected completion date _I%
oz j2. ._.
Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday ❑ Thursday 0 Friday 0 Saturday ❑ Sunday
Shift from: 8 ® am ❑ pm to ❑ am pm 6
If other,
specify ---- ---- pC~q 1r~
---- ---- 1\L~- '-O
Access to inspect the premises must be provided during the work schedule indicated in this item. + Q 2002 c~
JU
nEP?BAfJNt;',
25. Total amount of asbestos-containing material to be abated during this work =E570S114
cJ PROGRAM'
Square Feet, and/or _— O— Linear Feet T R~G
—
a" 'O rvn p ~' Zl 2/2001
0 V~
1 ' ' I
Rl,t ~ lr i l` 1 t
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NYC-WTC 000119504
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