NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
J Asbestos Control Pro__.
59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107 tll 14N1
Building Dept. or TRU No
ONLY FOR OFFICIAL USE ONLY
TYP '0b",~uhruvxon°`~o ASBESTOS PROJECT NOTIFICATION L
(ASBESTOS INSPECTION REPORT) 1
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 102-104 —FULTOW STREET-- ---__ Borough — MIJ Zip _ I O3S
F 3. Block 76 ___ 4. Lot _2 1
5. Type of Facility_COM ~^ERCt ~- _ — 6. Name of Building -- ----_-----____
II. BUILDING OWNER
7. Name LEG S't-12e eT CeeP_------ 8. Contact Person YAI R --- ~_
9. Tel.#_t5i6)46-6-490)2 --Fax# tS(6)466=4952
10. Address III h1Fcu= Qp2__ sn 2 C S City ~CIQc-AT i1}>=C --_ State N Y _Zip _ i l ?L___
III. GENERAL CONTRACTOR
Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Br-w~A~LN kt+2Z5AN 4 5oN OCOT20L_ --_13. Contact Person _IRNNIeo
-------------------------------
14. Federal Employer ID. #l_ _. ____ __ 15. Tel. # =2920 — Fax # C i 2 -J '.
16. Address _L2g_ 2A~PN _Ave NuE-- __------ City __~rz~I« rN _--_ State . L_ Zip _I 12 36---
V. THIRD PARTY AIR MONITOR
17. Name _WQMEN @ PF►N2tQ ENE. I µ~tzs --18. Contact Person _MICR NE L NCL.AO
19. Federal Employer ID. # P.~~ `—_ 20. Tel. # C 212) 922-007
L_____ Fax #
21. Address _ Ttit S TTaa T City __N 1- _____--_ State _ P! _ Zip _J_00!7_ _
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24.. Starting date for this portion of work _ 0r_z?~u2 Projected completion date
Asbestos work schedule ® Monday 13 Tuesday ® Wednesday ® Thursday ® Friday ® Saturday EI Sunday
Shift from: — i_ ®am ❑ pm to _ 8 ff " ❑ am ®pm
If other,
specify ------------------------------------ _ REcEIVEO
Access to inspect the premises must be provided during the work schedule indicated in this item. j U1 2 2 2002
„~Mn
25. Total amount of asbestos-containing material to be abated during this work ^ro' ti
TAL,
—C __ Square Feet, and/or_ o Linear Feet
ACP 7
212001
~A,.z s 1140.
1PJ 2 .
NYC-WTC 000128659
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