Asbestos roof cleanup invoice for multiple sites, June 2002

NYC 9/11 Public Portal Document

orron,y NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program a 59-17 Junction Boulevard, 8"' Floor, Corona. NY 11368-5107 D Building Dept or TRu FOR OFFICIAL USE O v Ir7EN ASBESTOS PROJECT NOTIFICATION ORMS WILL BE "r"`"° (ASBESTOS INSPECTION REPORT) ACCEPTED _"_dri;la~l~e w ee fee s I ule)

When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original 1 signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This I f• 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 _ ~-c~ — ~D Dt~a Borough 1' • (__ Zip I a 0 AKA 3. Block 4. Lot

5. Type of Facility___--------- _ —_ 6. Name of Building BUILDING OWNER 1

7. Name _ — ?fLD~ ~ _CA -r 8. Contact Person____________

9. Tel. # Fax # _—T _

-1O 1 10. Address o+ 1~ ~D -~ t~ City --N --- State ~, ~ Zip

III. GENERAL CONTRACTOR

11. Name----- Tel. # -------- ------------------------- IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name (~ ' ~C. ---__-----13. Contact Person _ _ _C 5/ _—

14. Federal Employer ID. # P11 15. Tel. # _ 1 _1L — Fax # Sl 3dcs )) t, 16. Address _01 8(~ c , , 'Z City !J `Z State /v zip _LL22 _ V. THIRD PARTY AIR MONITOR

17. Name ___1 2 kr cD ?? C 18. Contact Person

19. Federal Employer ID. # P 20. Tel. # a r - 00 — Fax # 213__9 ~O _

21. Address L S' ~~ ~ City ---_ State L~~` Zip ( DO -- 22. Sample Analysis Laboratory—_ ( ,f ( - G 9 79A S J — 23. NYS DOH ELAP # _ I (L &- V __—

VI. PROJECT INFORMATION

24_ Starting date for this portion of work _~p,~-1°200 Projected completion date +ryy( + z1au

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑Saturday ❑ Sunday

Shift from: __—_— ❑ am ❑ pm to _--__ ❑ am ❑ pm 9 o !O If other, !~~/ specify ------------------ ---------- - --- Access to inspect the premises must be provided during the work schedule indicated in this item. C>J 202 25. Total amount of asbestos-containing material to be abated during this work Ep~BAPJHt•' ti 1. .:BESIOSiLE^ S., C Square Feet, and/or_ —_ Linear Feet pp.OGr` t' Tn'JG "9 i; ACP 7 ec^ eu p E;; - „t 212001

7.'fd r i fll

CC A-# l~lr NYC-WTC 000122381