NYC 9/11 Public Portal Document
o icJ4-c-- NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8" Floor, Corona. NY 11368-5107
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RITTEN
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: DAP co`~ ASBESTOS PROJECT NOTIFICATION L_
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
RMS WILL BE (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED
(See
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 .
I. FACILITY
2. Address ~O __—C -I ' f'c 1 — Borough -- Zip ~~~ C
AKA 3. Block 4. Lot
5. Type of Facility. 6. Name of Building — ---__—
II. BUILDING L
OWNER
7. Name._._._.l T. .l~ g. 1. ._._._._._ Lam--- 8. Contact Person ----_—_
9. Tel. k -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-
10. Address[ City ---s-__ P11
—___State; ._._._._,_._._._._._._._._._._._._._._._.
I11. GENERAL CONTRACTOR
11. Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name _ (LJ eiL GY -' ~ 6U —_13. Contact Person
_3~6
14. Federal Employer ID. # P11 15. Tel. # 51 7~1 _ Fax #
_ ~ l
16. Address _3o1 a/ 2 _` -- State / Zip _LL2 --
V. THIRD PARTY AIRMONITOR
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17. Name ---1~" V) I ~_ PrtT(Z r2 IG i elt?? S f C
__—_18. Contact Person
19. Federal Employer ID. # P11 20. Tel. # ! ~n C - Fax #
21. Address _j-- City €1`~ __--_ State [`~ Zip
22. Sample Analysis Laboratory___ _~ 1 / «j 23. NYS DOH ELAP if _ I L___
VI. PROJECT INFORMATION
24.. Starting date for this portion of work _l;1.I_!_]j
r_ Projected completion date __2 IQ _
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday 0 Saturday ❑ Sunday
Shift from: __~— ❑ am ❑ pm to _--__ ❑ am ❑ pm i_ / 9y
If other,
specify - ------
--------------------------------- --- - - --
RrcovED
Access ro inspect the premises must be provided during the work schedule indicated in this item. ~"— I
J 1 Lu~~
-1
25. Total amount of asbestos containing material to be abated during this work
Square Feet. and/or _—_ Linear Feet 11 `
e,a=a,i~'e~
6 ' 21200
t
NYC-WTC 000127021
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