NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
• Asbestos Control Program
59-17 Junction Boulevard, 8 Floor, Corona. NY 11388-5107
Building Dept or TRU No
ONLY DA FOR OFFICIAL USE ONLY
EN ~ru'va4~0c
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1.
Yc.aovFde~
•.a }iTj ( fee Schedule)
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 I4L1V LTOJ 5•raEE-r Borough MN Zip
AKA 3. Block 89 4. Lot 2
5. Type of Facility MIXED '.SE 6. Name of Building
11. BUILDING OWNER
7. Name — fl
8. Contact Person _
9. Tel. # _ Fax #
10. Address City --__ --- State Zip __________-
III. GENERAL CONTRACTOR
11. Name ____ Tel. # _
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name BEN-SAcvt t W Kt1 R 2I3AU * S O3 co N•ra-oL. ___13. Contact Person
14. Federal Employer ID. # '_____ 15. Tel. # C-RS) 53 t - 29CO Fax # c-(9.) 2c 9- iSOS _____
16. Address i 24ta, t2At.P ►t 36NUc—___--_ City Orco►c~Y 14 __ State N Y __ Zip _ iL 2 36
V. THIRD PARTY AIR MONITOR
17. Name i►%A'f:.rs eO Pt:a zER G" 1 VEERS 18. Contact Person _
19. Federal Employer ID. # PII 20. Tel. # (212) hL2-oo'tz _Fax # _Czc2) g22- c~ 30
21. Address _21.8 E'As; A S Sxae et -- City New *& SaK — State _ Nom_ Zip _ J OC IT
22. Sample Analysis Laboratory ____ __ 23. NYS DOH ELAP # _
VI. PROJECT INFORMATION
i
24_ Starting date for this portion of work _ 912 ? lt Projected completion date ~! 7
Asbestos work schedule ® Monday ® Tuesday ® Wednesday ® Thursday I9 Friday ® Saturday Sunday
Shift from: ®am ❑ pm to $ ❑ am ® pm
If other,
specify
Access to inspect the premises must be provided during the work schedule Indicated iri this item.
d' 4w
25. Total amount of asbestos-containing material to be abated during this work ra ~oc9~~L~li
i298O Square Feet, and/or o Linear Feet
1ACP7
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E4vi
7Rpp
NYC-WTC 000127996
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