NYC 9/11 Public Portal Document
wn NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
: ~ ' ". I' As1 ,Control Program
Miri 59-17 Junction Boulevard, 8~ Floor. Comm, NY 11368-5107 Building Dept. or TRU No
FOR OFFICIAL USE ONLY
ASBESTOS PRQJECT NOTIFICATION,
•
~
ltt BE ' 90.O (ASBESTOS INSPECTION REOORT) 1.
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TED (See
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.
1. FACILITY
2. Address 5 5 1?V I,T O W ST R I Borough MAN _ Zip _10038
AKA 80~G ot.D Sr r 3. Block 94 4. Lot t
5. Type of Facility _on'r 1-OCKeg 6. Name of Building
II. BUILDING OWNER
7. Name 5CUTU 5.4D fi 1o13 ES _ 8. Contact Person - lo *rY Mgpcts A
9. Tel.# Fax #
10. Address _ 80 GoL0 Sit ZaWr M City__ New Yottt_ State _KY Zip _! 3S
Ill. GENERAL CONTRACTOR
11. Name_____ _ Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name .1AMtN,LCu¢Z18AV1 4 SOI* C0__r~ot- lac __13. Contact Person L.outGc 1ANt3Co
14. Federal Employer ID. # ._._._._._._._._._Pli_._._._._._._._._ _ 15. Tel. # C4it?) SatY 29oo __ Fax #
16. Address 1.t 4@ R~rLPu Ag6906 Y -- City—__B Dow- -Y _ State J.L. Zip
V. THIRD PARTY AIR MONITOR
17. Name WAR N~ PANZicta; 6N6i4A1r,1- 18. Contact Person _MICKAIRI- Not rt ___
19. Federal Employer ID. # a W._._._._PII ._._._._. 20. Tel. # qty) !x2- oaYT _Fax # c&&i) 9 2 2-a 6$9,..,_____
21. Address 2X45 046T 46TFt ST¢sc~T City maw Yo¢tc _ State ,j!,'L., Zip jcorT
22. Sample Analysis Laboratory_.__ -
-- 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24_ Starting date for this portion of work ___O 1z t 102 Projected completion date t b kt 1 oz
Asbestos work schedule 1 Monday IN Tuesday IN Wednesday ® Thursday IN Friday I I Saturday ® .Sunday
gOO
Shift from: © am 0 pm to 8 °O 0 am I pm
If other,
specify
Access to inspect the premises must be provided during the work schedule indicated in this item.
25. Total amount of asbestos-containing material to be abated during this work
85cS — Square Feet, and/or _a Linear Feet
ACP 7
212001
utr
BUREAU Or ENV;R0sMENTA!
REMEOtATICiN & ENFopcEM£Nr
ASEESrOSCONTROL
PR4,RAM
TR'f7
NYC-WTC 000128146
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