NYC 9/11 Public Portal Document
,<cJ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program i i 1 c c W c
59-17 Junction Boulevard, 8"' Floor, Corona, NY.11368-51V7 Buftding Dept. or TRU No
FOR OFFIGAL USE ONLY
ONLY
TYPE
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:a?~`` ASBESTOS PROJECT NOTIFICATION
FOR ! BE (ASBESTOS INSPECTION REPORT) 1.
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n When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original
` S• 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 activkies .
1. FACILITY
2. Address (96 BROADWAY Borough MAN Zip
AKA 3. Block T9 4. Lot 16
5. Type of Facility (OMMEf;C* 6. Name of Building
If. BUILDING OWNER
7. Name 8. Contact Person
9. Tel. # Fax #
10. Address City State Zip
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
2SAW 4 Sds 13. Contact Person L OuIE %ANI31CO
12. Name a 33AMta Core-
14. Federal Employer ID. #,_ _ _ _._ _ _.PI I _.-15. Tel. # (.118) 531- 2900 Fax # C't 16 209-1806
16. Address 1246 RRtP1l AVENUE City BQ.00KLYN State Nib Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name tua _._._
E._._E.at.C;.t.NIEERS
B 18. Contact Person MtC.14AEt. NOL W
p
19. Federal Employer ID. #L.--._._._.r....._._._._._._._._.i 20. Tel. # L212) 222 — 0017 Fax # (212)922 0630
4S -M City Nees Yc e.' State _l _ Zip tooth
21. Address 22S EAST —MiEC r
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
Vi. PROJECT INFORMATION
24_ Starting date for this portion of work 1 0 Z Projected completion date Lo2.,
Asbestos work schedule 0 Monday ® Tuesday I Wednesday © Thursday © Friday ® Saturday ® Sunday
St I dic
Shift from: 8 ®am 0 pm to 8 ❑ am ® pm
.
If other, n
specify
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I Access to inspect the premises must be provided dwtng the work schedule Indicated in this Item. I AUG p 8
2002
25. Total amount of asbestos-containing material to be abated during this work
OStE,0
~tRAM
1t5 Square Feet, and/or _U Linear Feet r
ACP 7
V2001
8V^`A~t ,
bs
t 1~et5ta
NYC-WTC 000123146
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