NYC 9/11 Public Portal Document
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NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
~, Asbestos Control Prog~
alllil 5917 Junction Boulevard.? Floor, Corona. NY 11389.5107
rfpEwRiTTEN ~ ASBESTOS PROJECT NOTIFICATION LL`dRO
FORMS Witt, 8E `Oa (ASBESTOS INSPECTION REPORT)
ACCEPTED ~^ ^!~,i4't•r~. I.
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 NYCOEP requires one Copy of the form with original signatures. This
form Must be submitted to the NYC DEP not Toss then one week in advance of the alart of abatement activities.
1. FACILITY
2. Address 'tYtta1~Q$f "' Borough I`✓ ` Zip______
AKA -- -- — 3. Block _ J_tf 4. Lot .
6. Type of Faclllty„. 6. Name of Building M .,,
It. BUILDING OWNER
7. Name *"
_C,+wwt41Z —S i r Ci,f io ' ' 8. Contact Person _
9. Tel.#L~ pb T?!Fax1 T
10. Address __„_„ „_ City, State ____ Zip _
lit. GENERAL CONTRACTOR
11. Name_____, TeL #
— ~___"-----
'IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name 1 t~ 13. Contact Person %C7 ` _
14. Federal Employer 1D. # '
.-.
P 11
-.-.-. .- -. .. -t 5. Tel, ;#. j ' 7 1~ 04 0 Fax # S 3
16. Address____ . () City ! 7I4 Sste.L1Zip 11223-
V. THIRD PARTY AIR MONITOR
17. Name i~ ' V 2R .t c j,_ krt Z- L, +fit --18. Contact Person tG{ EL N OL. A r .I .
19. Federal Employer 10. tt __-- -~_ 20. Tel. # (3_~8~_rep — Fax # d QOiQ.
21. Address $ 1 —--~ City_________ State 1`t_ Zip
22. Sample Analysts Laboratory G r~ lG- h~a 47a-9/C-$ ctlt — 23. NYS 0011 ELAP # ! O
VI. PROJECT INFORMATION
24. Startin9 date for this Aortion of work 21 t7 Z
—. Projected completion date
__S1J
Z
Asbestos work schedule [j Monday 0 Tuesday 0 Wednesday 11 Thursday ® Friday ❑ Saturda day
Shift from: __ 0 am ❑ pm to O am ❑ pm \?
" J
If other,
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Access to inspect the premisos must be provided during me worry schedate Indicated In this lam.
JUN Z $ 2002
25. Total. amount of asbestos•containing material to be abated during this work 'FA/IANHM
ESTOS/LE~
02-1 ~5 Square Feet, and/or Unbar Feet T2
8t+,Rrrvty r ,. 2/2001
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NYC-WTC 000127308
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