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177 BROADWAY 1001077, 63/19

Label derived from the City's folder field. The City does not supply document titles.NYC-WTC_000122735–000122743
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NYC 9/11 Public Portal Document

O02 k T(? y ar► ooyf~ y. NYC DEPART) ENT OF ENVIRONMENTAL PROTECTION • op 4 Asbestos Control Program

RITTEN p 59-,T Junction Boulevard. a Floor. Corona, NY 11368-5107

ASBESTOS PROJECT NOTIFICATION or TRU No USE ONl Y

C EPTED ~w !w: iyt:j4e:)~ep (ASBESTOS INSPECTION REPORT)

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 1. (See

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 111 Th A Borough _. 3 '( Zip _Ii D f "

AKA 3. Block 4. Lot

5. Type of Facility 6. Name of Building It. BUILDING OWNER

7. Name CE r'31t t &;( LT aG 8. Contact Person

9.Tel.# 3 2k 'l — 1Tl ax# t 10. Address _ ((.O ! . Rd City - State p Zip _1bO2

Ill. GENERAL CONTRACTOR

11. Name Tel. # _

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _;t3E1l. u ~ ( 13. Contact Person __

14. Federal Employer 11. # _ _ _.-.-.-. PII.-.-.-.-.-.-.-.-._~' 15. Tel. # f 7~1,3Oc o ~ rd- Fax # ~2385 16. Address -Q.lb L City Z f State =-1--- Zip _J O

V. THIRD PARTY AIR MONITOR

17. Name_____ & Ai't -EQ.. j— NG i S Pe 18. Contact Person

19. Federal Employer ID. # 20. Tel. # a (3 -'79 D0i Fax # .2lc~ aa -063 O 21. Address g ( * iEE7_ City ` ~~ State ~_ Zip oO

22. Sample Analysis Laboratory SC(- 1'-(1( (C- 4- A aI____ _ 23. NYS DOH ELAP # /1

Vt. PROJECT INFORMATION i ~~ 2ooZ- 1's' 1002__ /' 24.Starting date for this portion of work +~ h _ii e Projected completion date

Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturda D Sunday

Shift from: 0 am ❑ pm to ❑ am ❑ pm

If other, specify

Access to inspect the premises must be provided during the work schedule indicated in this Item. ,.z

25. Total amount of asbestos-containing material to be abated during this work 0 '

If__ Square Feet. and/or Linear Feet AI P 2)2oc • nrr?f~tn ~ E,~~waFftrAf +•.S32S'~S 4 •:siRCi rots

NYC-WTC 000122737

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NYC-WTC_000122737Source: NYC Law Department, mirrored locally

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