NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
2 Asbestos Control Program
59-17 Junction Boulevard, 8e' Floor, Corona, NY 11368-5107
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DAP,: ASBESTOS PROJECT NOTIFICATION
Bulding Dept. RU ~o
FOR OFFICIAL USE ONLY
'WvitlTTEN axnu vtc~~°tea
tN/LL BE (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED www.nyc!.jso jda
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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 III FUL"TON STREET Borough MN Zip
AKA 15( LOLL M STREET 60 ANN SreFia''T 3. Block 4. Lot
5. Type of Facility CouME2CLAL. 6. Name of Building
II. BUILDING OWNER
BA 151 WLU. I)1 Ope2AnNC. U. SUSAN ®of30LWE
7. Name 224 W 30 LLC ' '8. Contact Person
9. Tel. # (212 )924 - 9690 Er ..32L. Fax #
10. Address (11 WETON ST32EET M— City _ New Yoaw- State I?`L_ Zip
III. GENERAL CONTRACTOR
11. Name ~~— ---~ Tel. # ___
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name k3EEWAMIA1 KLMZ6At3 4 SOO C0a1 eOL fJC —_13. Contact Person LOvtE AfsiJLC0 —
14. Federal Employer ID. # M. _ Pii
L __ 15. Tel # 11It3) 531~22Q9_
. ____ Fax #
16. Address 134 8 RAI-P►t AVE.Muc ~_— City Bann K LY 14 _ State N Y Zip _ 1 t a 36
V. THIRD PARTY AIR MONITOR
17. Name j j1pANISS FNG,113m As jNC~ _____—_18.ContactPerson M1CVAgL.. NcLAN —
19. Federal Employer ID. # . .__._ 20. Tel. # (2t2). 22 c c) 'T — Fax # C2 L2) 922-0690
21. Address _ S EAST 45TH STRtzY_ — City__ EU) 1 ___. —_ State iY _ Zip jOOI
22. Sample Analysis Laboratory — — —~—~ — 23. NYS DOH ELAP # ________ _____-
VI. PROJECT INFORMATION
24_ Starting date for this portion of work Ort Is 1o2- Projected completion date o t3 I 02
Asbestos work schedule ® Monday ® Tuesday IN Wednesday ® Thursday I Friday ® Saturday ® Sunday
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Shift from: ~ ® am ❑ pm to t3— ❑am® pm
If other,
specify — _
Access to inspect the premises must be provided during the work schedule indicated in this item. ill C 1 5 2009
ii! G
25. Total amount of asbestos-containing material to be abated during this work ES JL
.21 ,
PRt)&RAM
32 33 S, T2UG L
Square Feet, and/or — Linear Feet
' ACP 7
fi 2/2001
NYC-WTC 000128704
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