NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
K . 59-17 Junction Boulevard, 8" Floor. Corona. NY 11368-5107
eueding Dept. or TRu No
FOR DFFCpµ USE Olt v
TYPEWRITTEN
FORMS WILL BE -r-'~•'"0
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT)
LI
~P3~ When submitting this form at the NYC Department of Buildings, the original form and three (3) copies
with original 'I
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures.
form must be submitted to the NYC DEP not less than one week in advance of the start of abatement
This
activities.
1. FACILITY
2. Address j I ii13 1) L1PcPi Z, ) E I Borough 1 ' 1 Zip JP 0 L3
AISA 3. Block 4. Lot L.
5. Type of Faclity S. Name of Building
II. BUILDING OWNER
7. Name _J ~l 1 iZ 1 ZE D I - • 8. Contact Person
9. Tel.# Fax
n
10. Address 5(, PGI> O UC M_ S 1 City
_ !V ` State Zip d- --
Ill. GENERAL CONTRACTOR
11. Name Tel.*
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name BEE _ _._._._._._._._ 13. Contact Person _/c- ) fC~S~/~
14. Federal Employer ID. # _PI I _ _ _ _ _ _ _ _ _115. Tel. # ! - 7~✓''3oa o Fax # 5I1 - ?c/ 3 ' 85
16. Address OLO/JS i4t cL) Ji194 State zip _117 3
V. THIRD PARTY Al MONITOR
'
17. Name Q$-t kit ZEe2 S r. IBS Pc 18. Contact Person ' 1C ~ r
~oLhr1-
19. Federal Employer ID. # 20. Tel. # a(a- 4aa- 0 O. Fax # 2.13 - C22 -OE, 3D
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21. Address s2 9 g -E /K1 al r' Sit2FEr City `i' T72# State Zip 00
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22. Sample Analysis Laboratory SG w4-r(-F!L {-,f7g t X-A '!,eI~Sv 23. NYS DOH ELAP # / f 1L 8d
VI. PROJECT INFORMATION
24. Starting date for this portion of work ~- O7— Projected completion date
Asbestos work schedule ❑ Monday El Tuesday 0 Wednesday ❑ Thursday 0 Friday ❑ Saturday 0 Sunday
Shift from: D am 0 pm to ❑ am ❑ pm
If other.
specify
Access to inspect the premises must be provided during the worts schedule indicated in this Rem. ié:/ 4?S)
25. Total amount of asbestos-containing material to be abated during this work
16 187 5 Square Feet, and/or Linear Feet
Arm 7
Wl2001
NYC-WTC 000126160
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