NYC 9/11 Public Portal Document
1Q" [t i «ems. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
Junction Boulevard. 8°i Floor. Comm NY 14368-5107
A r
tS 'fPEWRITTEN ASBESTOS PROJECT NOTIFICATION
FORMS WILL ee • (ASBESTOS INSPECTION REPORT)
ACCEPTED w...,yr2 ~id.~,
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 rot less than one week in advance of the start of abatement activities.
1. FACILITY
2. Address 12 5 FUL10 N SrR.EET Borough Zip
AKA 3. Block 4. Lot
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name G etN ' 8. Contact Person _ 'EC V6 E D I M 0%)
9. Tel.# tit8 3 72G-tTO© Fax#
10. Address r2's FOLT0A ST City t'4 State _ % Zip
III. GENERAL CONTRACTOR
11. Name Tel. #____________________
IV. ASBESTOS ABATEMENT CONTRACTOR
'Be3.. P '. , m I-csrtzt3Ats 4 sOI too-rl2.o t. 13. Contact Person L aui (A t.~ u I CO
12. Name
14. Federal Employer ID. # _________________
15. Tel. #. (118)531-2900 Fax# (1(8) 209 -1808
8R•o0%LL'~ 0 State N' Zip (1236
16. Address 1246 P.-AL,PA ~4~i NCE. City
V. THIRD PARTY AIR MONITOR
17. Name_ u A PAtPzeI Eo6+N€eS los 18. Contact Person UlCRArcl.. 13at~.t.1
19. Federal Employer ID. # 20. Tel. # (212.) 9 0OTt Fax # 2-12 922• - 2630
228 EAST 45'it4 SflEE City N State N9 Zip IDOIT
• 21. Address
22. Sample Analysis Laboratory 23. NYS DOH ELAP # _
VI. PROJECT INFORMATION „
24_ Starting date for this portion of work xo sz Projected completion date 01I 20L
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday 0 Thursday ❑ Friday 0 Saturday ❑ Sunday
Shift from: ❑ am 0 pm to ❑ am 0 pm
If
specify ( JUt'
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Access to Inspect the premises must be provided during the work schedule Indicated in this item. 8 zu©Z
Co
25. Total amount of asbestos-containing material to be abated during this work
38 2 . Square Feet, and/or _0 Linear Feet
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212001
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NYC-WTC 000127881
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