NYC 9/11 Public Portal Document
.Eip3'U'l C NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Otty
'
D.P,
Asbestos Contrbt Progrdtn
59-17 Jtu>Ftton Boulevard, 8°i FI or Corona, NY 11368-5107 17E1W9i9&io
autb6tg Dept or
FOR OFFICW. USE ONLY
No
te , ASBESTOS PROJECT NOTIFICATION
__ !!°.
- . , (ASBESTOS INSPECTION REPORT)
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.
1. FACILITY
2. Address 122 F+ V t..1 a'4 S Ts2EE? Borough M t4 Ziip
3. Block 4. Lot
5. Type of Facility 6. Name of Building
It. BUILDING OWNER
7. Name 8. Contact Person
9. Tel. # Fax #
10. Address City State Zip
111. GENERAL CONTRACTOR
11. Name- Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name "" '*S_ ~vnzt as Sant C I CL 13. Contact Person _ 1-got>r _ _ LAANl cc7
14. Federal Employer 10. # 15. Tel. #. CA(g) 53t- 2 9O Fax# (-cc8) tag - Igce _
16. Address .,2 4 8 9s4, it _33urc.• City °8r~.— -q N State Zip t 1236
V. THIRD PARTY AIR MONITOR
17. Name WAtat—u ?ANZE& E:tYarts s -— 18. Contact Person 1AIWACL Noc.AN
19. Federal Employer ID. # ._._. P_I _ _ _ _ _ _ 20. Tel. # C2 t2) Y -oo -r7 Fax # (2121992-o3
21. Address 2 28 eAst 45Ttt T City % ynR- State AtiY Zip (tXMIT
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24.. Starting date for this portion of work cy 2a~02 Projected completion date o2 t 2c 102
Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday 0 Sunday
6
Shift from: i am 0 pm to S 0 am Pi pm
If other,
specify p
!\E Q
Access to Inspect the premises must be provided dudng the work schedule Indicated in this Item.
JON 1 8 2OO
25. Total amount of asbestos-containing material to be abated during this work DEP/8ANHr t
PEOGRA!
1113 t Square Feet. and/or Linear Feet T2itG •~
ACP 7
2/2001
NYC-WTC 000128967
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