NYC 9/11 Public Portal Document
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ec wT e6,cn! NYC DEPARTMENT OF; ENVIRONMENTAL' PROTECTION
Asbestos Control Program
59-17 Junction Boulevard. 8° Floor. Corona. NY 11368-5107
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DAP Bul t or TRU
FOR OFFICIAL USE ONLY
Ryr~irion° ASBESTOS PROJECT NOTIFICATION
A U BE (ASBESTOS INSPECTION REPORT)
~U~ EPTED :.:•:rca~a~.r, 1.
(Sie fee 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 _IL l C- g --L 3 (" 2 ~~~ 1 Borough _ Zip O-
"
AKA I l4- C _ s sb te r 3. Block __ __(3 4. Lot
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name _Sr,LE M t I✓ ~~ . 8. Contact Person
9. Tel. #(-( a" Fax #
10. Address l i.o~- e ~$ _ City ~ State' Zip j D
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name ~IL -~%~_~~ ----- 13. Contact Person
14. Federal Employer ID. #j P11 15. Tel. # c? _ .i ^3060 Fax # J _2ff5 cf5
16. Address old vt ✓~-- — City ______State N Zip ii?
V. THIRD PARTY AIR MONITOR
17. Name b" { a A74 ZE t2
-(6 i Ak S rC 18. Contact Person rYt C44*EL
19. Federal Employer ID. #___ _________ 20. Tel. # a a - 0 0. t Fax -0&.3O
(~,=/ 7 Ô 72
21. Address ~~ - is ( City I`i ~ - 1~ State t _ Zip 0O
22. Sample Analysis Laboratory ~C(E~(((1(L 7 (~S itc 23. NYS DOH ELAP # (I
VI. PROJECT INFORMATION
X12
24 Starting date for this portion of work
>) I
~.~_ Projected completion date
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑
Shift from: ❑ am 0 pm to 0 am ❑ pm
If other.
specify
L' Rmo
Access to inspect the premises must be provided during the work schedule indicated in this item.
0 1 2002
P/BANHM
25. Total amount of asbestos-containing material to be abated during this work AC
OGRAM
Square Feet. and/or T2UG
Linear Feet
6 ACP 7
2)2001
:'.i5 i ..CY.t
NYC-WTC 000121810
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