NYC 9/11 Public Portal Document
Eo1- (.oR2 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 80i Floor, Corona, NY 11368-5107
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
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ASBESTOS PROJECT NOTIFICATION /-
ILL BE (ASBESTOS INSPECTION REPORT)
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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 _—~ DUIG.( Si Q'EET Borough 1A N Zip
AKA — 1 /2 DUTC.f STPsc-ET 3. Block _I $ 4. Lot 2(0
5. Type of Facility_-12.J DE7J'T ) A L 6. Name of Building
II. BUILDING OWNER
7. Name 8. Contact Person
9. Tel. # Fax #
10. Address City State --_ Zip
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR -
12. Name BU -34A M ItJ — (Cx1EZSAN 4 SCIM Co►.i
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i- INC. 13. Contact Person -
14. Federal Employer ID. # P!! 15. Tel. # C`118) 531 - 2900 Fax # _J ti t) 2 09 -1808
16. Address —L~ 2— LPt1 Ad EU~1r__ — City ¢[o1C L `r —_ State JL Zip 1123 '
V. THIRD PARTY AIR MONITOR
17. Name 11.AMAEM ` A M zap = Ew--~ I N E+~1ZS 18. Contact Person M l Ctl r~,-Z W OLAO
19. Federal Employer ID. # P II 20. Tel.# X212) 92 - c 7 — Fax # _L2J 9'32 - 06 3 0 _
21. Address 22F3 EA- 31 AS*rU Smolt - City 15Cil 1 —_ State _U~f _ Zip
22. Sample Analysis Laboratory-- __— ___ ------ 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work _°I' Lq(02. Projected completion date ? ? 5 ~O Z
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday
Shift from: []am[] pm to — ❑ am❑ pm
If other, 4.
specify -- -- - - -- - / RECEIVED
Access to inspect the premises must be provided during the work schedule indicated in thrs item. f J IU
21 V2002 CU
'• ''BAtiHt.'
25. Total amount of asbestos-containing material to be abated during this work 1, iTOS~I'c::
1 3.45 Square Feet, and/or Linear Feet TAUG
3
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NYC-WTC 000130755
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