NYC 9111 Public Portal Document
EJ WTC NYC DEPARTMENT OF ENVIRONMENTAL PROTEC
Asbestos Control Program
59-17 Junction Boulevard, 8°1 Floor, Corona, NY 11368-5107
N1PP ASBESTOS PROJECT NOTIFICATION L.
BE (ASBESTOS INSPECTION REPORT) 1.
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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 5T Ap lg 5'ercE-r Borough Mara Zip 10098
AKA 3. Block 4. Lot
5. Type of Facility ?A9v-%f4c2 6. Name of Building
II. BUILDING OWNER
7. Name• LI1TLE MA0 ?l A - t NG_ Uh C. 8. Contact Person
9. Tel. # Fax# p.
10. Address 2V2. fitTt AaersuF- 4n4 r-u.CR City I EU. /c izx State N1i Zip 1 O00 t
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name '8E31A54I N __Zt3AW 4 SM CO T(Zc)L INC 13. Contact Person LcwE I ANNiCO
14. Federal Employer lD. # PII v 15. Tel. # (11$)_531-2900 Fax# f '1t8)209-t€08
16. Address 1248 R pr- AVON UE City eCCV-i-4 State NY Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name tx:~3.I 4 PANrrZ eI 6WEEuS 18. Contact Person alt CttAa. t..tcu
19. Federal EmployerID.#, ___ 20. Tel.# (212)922 Fax# (212)922 —O D
-------- L
21. Address 22 8 irs s •T A Tit Stu T City wee Yc'Z.u- State lay Zip r OO tT
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work II 103 ( 0
2• Projected completion date ii 1og (02 I
Asbestos work schedule ® Monday 0 Tuesday 0 Wednesday IN Thursday 0 Friday 0 Saturday ®'Sunday
Shift from: 8 El pm to 8 ❑am® pm
If other,
specify
. Access to Inspect the premises must be provided during the work schedule Indicated in this Item.
25. Total amount of asbestos-containing material to be abated during this work
15.4 0 Square Feet, and/or 0 Linear Feet
ACP 7
2/2001
NYC-WTC 000119705
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