NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbesto% tEqI Program
59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 Building Dept. or TRU No
FOR OFFICIAL USE ONLY
ONLY ~s
/' EN ~ nupd4e'~co
a ASBESTOS PROJECT NOTIFICATION
44/ILL BE (ASBESTOS INSPECTION REPORT) 1.
iEPTE/) !wv.nyi.sorJear . schedule)
When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original
requires one copy of the form with original signatures. This
signatures are required. Submittal at the NYCDEP abatement activities.
form must be submitted to the NYC DEP not less than one week In advance of the start of
1. FACILITY
S*Mr--ET Borough _(MS Zip 10038
2. Address — O Fti%_T ON
3. Block 7'e 4. Lot 28
AKA
5. Type of Facility MIXED c>ss` 6. Name of Building
II. BUILDING OWNER
7. Name --___- • ' 8. Contact Person
9. Tel # Fax #
City State ____ Zip
10. Address
III. GENERAL CONTRACTOR
Tel. #
11. Name__—__--_____________
IV. ASBESTOS ABATEMENT CONTRACTOR
SorJ Cary M T 20 f u E• ____13. Contact Person L IE IArhN tCo --
12. Name 3E*iJAavll at kogz8A 1
P11 _ 15. Tel. # c-It8) 53i_? _—_ Fax # ~"th8~_~9~
14. Federal Employer ID. #
Av u'~ City State L. Zip --U236 —_
16. Address 1248 P-A-F%k
V. THIRD PARTY AIR MONITOR
17. Name _ v) RRREis $ P_h_ _N_ _ _ _e.- s to 5 18. Contact Person _J_
PI I 20. Tel. # __ Fax # (712)
19. Federal Employer ID.
4S s•t I"LT City 0 Y State .L Zip _toot-r; _._._
21. Address _22h3 AST
M 23. NYS DOH ELAP #
22. Sample Analysis Laboratory—
VI. PROJECT INFORMATION 1
24. Starting date for this portion of work _ '`' t124 (2 ._ Projected completion date i'o 1?A 102.
I Friday ® Sat rrda Suniay.
Asbestos work schedule ® Monday 13 Tuesday ® Wednesday IN Thursday
Shift from: B ® am 0 pm to 0,°6 ❑ am ® 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
1 34. Square Feet, and/or v Linear Feet
p`;RErUnv ~e p
4r:
raq~M' ~t "£ht
NYC-WTC 000129324
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