NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL
PROTECTION
DAP Y
Asbestos Control Program
59.17 Junction 8oulevara, 8a Floor, Corona, NY t
13iS84107 ~oay~
euN0lfe Dept. o► TRU No
Root Wien use ONIr
FORMS WILL BE aYt':y ao ASBESTOS PROJECT NOTIFICATION
ACCEPTED (ASBESTOS INSPECTION REPORT)
t II. •w+wu~•)
Wher submitting This forin at the NYC
Department Buildings, the anginal form andwith
signatures are required. Submittal at the NYCDEPofrequires three (3) copies with original •
form must be submitted to the NYC DEP not one copy of tits fm original aiDtlaluru. This
less then one week In advance of the start of abatement
activities.
I. FACILITY
2. Address" .rw k
AKA
3. Block _ 4. Lot _~~
5. Type of Facility --,— — — 6. Name of Building y —
H. BUILDING OWNER '___"—
7. Name
-'— ------ --._ 8. Ccntact Person
9 Tat, >Y ~~~---
---- --- Fax # ----
------
10.Address~—_.~_..
—
----------~—C►h---,----- -_,._ State ~__ Zip _,—,---
III. GENERAL CONTRACTOR
11. Name_
---------------- ——.._
IV, ASBESTOS ABATEMEPIT
CONTRACTOR
12 Name A3_ 1 sC0 ( 13
-------- y . Contact Person
14. Federal Employer 1Q, U I I-.-.-.-. i5. Tel #
.15. _ 7~~ ~c3ooQ Fax
1S. Address J~ --
City zip 1
StateAL 3
V. THIRD PARTY Aljt MONITOR
17. Name krl
~ ---Z---
E~ I(
- _-- S
~C -18. Contact Person _ Wtc-l+'k' 4ou
19 Federal Employer ID. R ------ ~lL- ae~ _ O~
21. Address ~~
20. TeL --- Fax # _: X2`7 `_
b O
L ~L~
City
22. Sample Analysis Laboratory c- j f1"/;~lL kj 4 l~ti>t$ 23. NYS DOH FLAP S
VI. PROJECT INFORMATION
24.. Starting date for this portion of
work . 1 a~O
TTT"` Projected completion date _241a )..Q2.
Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday ❑ Thursday 0
Friday 0 Sat sy nday
Shift from: ❑ am 0 pm to ❑ am 0 pm
If other, s
Access ro inspect the Promis.s must Oe provided
RE~tvEO
dudrp pie %0& schedule lndlea(ed fn this #sm N JUN 0
28 2002
25. Total amount of aabestos-containing
material to be abated during this work
r V
.tEp Square Feet, and/or STO M ~
Linear Feet o TRUG
2 -a
ate,;r 01
'~' tur r7 u
.,YE, Pl• fYhr+li G ACP7
~5:2^••. ~cb::xla 4i2ooa
fRa.Ru~
(T 'A J7: TT 7f7 S7 tJYlfCCtT—TQC-7T7:XLP-I fa"rQ A'a(T
NYC-WTC 000126291
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