NYC 9/11 Public Portal Document
~1J C,, „ ,, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
€9-17 Junction Boulevard, 8"' Floor. Corona, NY 11368-5107 30 Val
Building Dept. orTRU No
ONLY FOROFFICLAI. USE ONLY
TEN ASBESTOS PROJECT NOTIFICATION
• (ASBESTOS INSPECTION REPORT)
See fee schedule)
r1. FACILITY
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. This
form must be submitted to the NYC DEP not less than one week In advance of the start of abatement activities.
2. Address 9A R)LT044 STtgEET Borough t~+tAil Zip : 10036
AKA 3. Block 4. Lot
5. Type of Facility MtXED USE 6. Name of Building
II. BUILDING OWNER
7. Name ' 8. Contact Person
9. Tel. # - Fax #
10. Address — _ City State Zip
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name BEN.IAM►18 KQR.ZBArs 4 So' CooTw . j*rc 13. Contact Person L.OU1 Iarapitc0
14. Federal Employer ID. # .-.-.-.-.-.-.PII -.-.-.-.-.-.- 15. Tel. #. (its)5I-2O 0 Fax # ('116) 2091808
16. Address 1248 _tat_Pit 4%JeMUE City BROoKiY 14 State MY Zip i123G
V. THIRD PARTY AIR MONITOR
17. Name WAR.R.€1 4 PANZO. EUGrt3EEs 18. Contact Person MIC~iaEL Noun.
------------------------ -,
19. Federal Employer ID. fk I 20. Tel. # (212)922-00V( •Fax# (212) 922-o630
21. Address 228 EAST_ 4SM ST2 e1 City New Ya2 - State NY Zip loniT
22. Sample Analysis Laboratory — 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24_ Starting date for this portion of work 1O'2I102 Projected completion date t I __I102..
Asbestos work schedule ® Monday ® Tuesday ® Wednesday I Thursday ® Friday ® Saturda a. . Sunday
Shift from: __e ® am ❑ pm to 8 ❑ am ® pm
If other,
specity
I 'y 4
j RECEIVED
Access to Inspect the premises must be provided during the work schedule indicated in this item.
OCT 18
25. Total amount of asbestos-containing material to be abated during this work „r► -
Square Feet, and/or Linear Feet vu v '~
2/2001
tCradA
t 114
NYC-WTC 000127589
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