NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8e Floor, Corona, NY 11368-5107 ku~856/~f~a,
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
ITTEN ASBESTOS PROJECT NOTIFICATION
S WILL BE (ASBESTOS INSPECTION REPORT)
ACCEPTED (See tee
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 _—_ - YvA 5 ~~E. 2 (Borough _Lf__ Zip to O
AKA 3. Block 4. Lot
5. Type of Facility_____ — _ _--- 6. Name of Building ---_
II. BUILDING OWNER
7. Name s - So 1_(Z 8. Contact Person
9. Tel. # -----------------------------
10. Address. P 1 1 City ---~--~ \__—_ State __ Zip _ jO 13_
Ill. GENERAL CONTRACTOR
11. Name--------------- ------ Tel. # -----------
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name `(~il ______ ~_ U --- _13. Contact Person _ / __-
14. Federal Employer ID. # PI I 15. Tel. # J 6 - 7~(~3v6 0 Fax #
16. Address 1 City l ~ l'j_--_ State /~! Zip ~ 2LG
V. THIRD PARTY AIR MONITOR
17. Name V0 ~f - ~-- ~ -n - NG i~k ~S r C 18. Contact Person j ¼61
19. Federal Employer ID. - -1!!!-------------------.20. Tel. # —(3----_~—
~~ - GO Fax zla a -G~ D
21. Address L "' ~ r~ _/-- City _ __—_ State jt ( _ Zip
22. Sample Analysis Laboratory— _(f1 ~ h ?C - ~° -«S 23. NYS DOH ELAP #_
V1. PROJECT INFORMATION
24.. Starting date for this portion of work CU ~Z Projected completion date
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturday ❑ Sunday
Shift from: __—_— ❑ am ❑ pm to _—__ ❑ am ❑ pm
sped pC
CO
Access to inspect the premises must be provided during the work schedule indicated in (his item. r ... JU 1'i 1 '002
25. Total amount of asbestos-containing material to be abated during this work \T---\
LAS — Square Feet, and/or Linear Feet k6
t ACP
r I ~1
a 2!200'
NYC-WTC 000127062
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