NYC 9/11 Public Portal Document
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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__
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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.
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25. Total amount of asbestos-containing material to be abated during this work
0 '
If__ Square Feet. and/or Linear Feet
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NYC-WTC 000122737
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