NYC 9/11 Public Portal Document
X002 w`~'G• .. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8°' Floor, Corona, NY 11368-5107
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FoROFFICW. USE CMV
ASBESTOS PROJECT NOTIFICATION
USE L8fQo (ASBESTOS INSPECTION REPORT)
TED (see tee schedule)
When submitting this form at the NYC Department of Buildings, the original forth 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
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2. Address _I £ -O Borough N ( zip 1C) 0
AKA 3. Block 4. Lot
5. Type of Facility 6. Name of Building
H. BUILDING `OWNER i~ t-( St f}e ,~
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7. Name__ h:Ue~z.•t~ t A -, 1~
t~ -t tt ' 8. Contact Person 2. l 2 'tq (O').
9. Tel. P11 Fax #
10. Address _, 3, ~ t2 0 Lv Ps "'fl City ____N _ State Lip O0 O
Ill. GENERAL CONTRACTOR
11. Name ___________ - Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name c.~'e1_ C )hi ' -- ___13. Contact Person
14. Federal Employer ID. # r15. Tel # - Fax #
16. Address OD! iD -- City J ![nU f'1~ State Zip _ L2
V. THIRD PARTY AIj2 MONITOR
17. Name _k, p? _~ Ze;2 14 1 C—_18. Contact Person V41f t i+ G N"(^Pr4 .
19. Federal Employer ID. # . _._._. PII —_ 20. Tel. # ara-'?D - 00 Fax #
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21. Address •22 g L i2E7 City ,(4r State. `4- Zip 00 t
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22. Sample Analysis Laboratory (t 77 (L G~A68 r tC Ttt t _23. NYS DOH ELAP # _ / l''I DSO
VI. PROJECT INFORMATION
24.. Starting date for this portion of work 17 2o— Projected completion date LZjL2 2 Z
Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday
Shift from: __ 0 am 0 pm to ❑ am ❑ pm
If other,
specify --~— ---____— —
t\Gl.LNED
Access to inspect the premises must be provided during the work schedule indicated in this item.
JUN 0 52002
25. Total amount of asbestos-containing material to be abated during this work '))EP/8ANHid ti
•:dESTOSit.E.
PROGRAM
Square Feet, and/or Linear Feet TRUG
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ACP 7
P 2/2001
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NYC-WTC 000122993
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