NYC 9/11 Public~Portal Document
4: C) NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8°i Floor, Corona, NY 113 '
/(ot 6Kn~0:
Building Dept. or TRU No
LY FOR OFFICIAL. USE ONLY
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) ii
vrwr.ntt.Eorida~.
.y i:A G1.F a".Y
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 _ 44 GO L.D S rurr eT Borough MN — Zip
3. Block 76 4. Lot 2S
AKA
5. Type of Facility___— ' 6. Name of Building
II. BUILDING OWNER
7. Name _44 Covw-r y _ASS5 ' ATTS ' 8. Contact Person
9. Tel:# (2t2) 19T ,(3 Fax# ,.r
i
10. Address r ____ City__—_ __ State ______ Zip
III. GENERAL CONTRACTOR
11. Name_ N _ ____ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name 8Fm-SAM1 P Ku¢z6 4 Saw C6 N-rtzzLL frsc __13. Contact Person _Lov,EJah1N t c )
14. Federal Employer ID. # _ _ _ _ _ _ _ P11 _ N_ 15. Tel. # .I2Lt)_s 31- ? _cx~______ Fax #
16. Address 12tt 8 +?A ' A'4EN0E _ City g ~+-y
`~ ' State N~ Zip tt23' --
V. THIRD PARTY AIR MONITOR
17. Name QAat r+ ~aNzeR E►,rMEL—WS ~ 18. Contact Person ldlcup tJor _
19. Federal Employer ID. #1. __._._._._.PII._._._._._._._._.1 20. Tel. # Jitz) 922 - c<,-r7 _ Fax # (212? 922..6 3o
21. Address _ ? EAS'+ A'S -rte Sr¢g r __._.____ City ____ NY __-State +AY _ Zip 100('r
22. Sample Analysis Laboratory __________ 23. NYS DOH ELAP #
Vi. PROJECT INFORMATION
24_ Starting date for this portion of work ! 2..? ( 0?- _ Projected completion date 9 27 IC) 2-
Asbestos work schedule ® Monday ® Tuesday ® Wednesday © Thursday ® Friday © Saturday"® Sunday
Shift from: _ $ Oe' ®am ❑ pm to B c ❑ am 0 pm ~ 4
r
If other,
specify
Access to inspect the premises must be provided during the work schedule Indicated h. this item.
25. Total amount of asbestos-containing material to be abated during this work
162.0 Square Feet, and/or 0 Linear Feet
ACP ,
21200'
BUREAU OF ENIRONMENIAL
PEMEDMLON s ENFORCEMENT
q,BE; erg COMRJL
PRGGR.M
NYC-WTC 000128118
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