NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8 Floor, Corona. NY•11368-5107
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ASBESTOS PROJECT NOTIFICATION
FORE ILf~ SE (ASBESTOS INSPECTION REPORT) 1.
eve / ter
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
form must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities. /ta
I. FACILITY
2. Address (96 BitCAOU AY Borough MAN Zip
AKA 3. Block T9 4. Lot 16
5. Type ofFacility__C0 ME ¢ c t At-- 6. Name of Building
I1. 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
12. Name 3►JAMca ituR2 Ai3 9, oK tier20l. 13. Contact Person_ LOUIE IANPICO
14. Federal Employer ID. P11 15. Tel. # ('1l8) 5'3%- 2900 — Fax # (1I ) 209- 18018
16. Address 1246 1ALPta AVEµUE City 8>~00KL.YIt State 11Y Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name _ WRcta.~u ._._.Q9. 2i (t_._. .N. ~.tlEERS 18. Contact Person MIC.uAEL NCLAM
19. Federal Employer ID. # ._ _._._._._._ P I I _._ _ _._._.; 20. Tel. # (212) 22 -0O71 — Fax # (212) 922 -0630
21. Address _?28 EAST 45 Ttt :3ZRrcET —^ City N+Ew Yeate _ State _W`_ Zip _it1OIT
22. Sample Analysis Laboratory — 23. NYS DOH ELAP # _
VI. PROJECT INFORMATION
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24_ Starting date for this portion of work 1 0 Z Projected completion date _ 1 f02'
Asbestos work schedule ® Monday © Tuesday ® Wednesday 1 Thursday © Friday © Saturday f1 Sunday
Shift from: _8 ® am 0 pm to 8 0 am IN pm gal,
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If other,
specify R",rrl 'p
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Access to inspect the premises must be provided during the work schedule Indicated in this item. I 4U60 2002
25. Total amount of asbestos-containing material to be abated during this work
32l5 Square Feet, and/or c Linear Feet S tUg
ACP 7
NYC-WTC 000123132
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