Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

E03i 2- QY7?:-) O NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 6' Floor. Corona. NY 11368-5107 ONLY DP ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT)

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 ®~ E i OA -b -W cc F ( Borough Zip O

AKA s - _.C' - 0 tC.._ 3. Block 4. Lot

5. Type of Facility_-- _ 6. Name of Building

11. BUILDING OWNER

7. Name . 6!t' ( - 8. Contact Person r f to Cok . 9. Tel. # 17 LQ o~-~ Fax#

10. Address ij' - City -- _ I State ip_/00

III. GENERAL CONTRACTOR

11. Name_..........________________________-- Tel. # ----

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name £'ll l _Y 3 RO - --------... ._ 13. Contact Person I am- ) / _~ ` C 14 e Federal Employer 1D. # PI I 15 Tel. # c~ i 6 - 7~ 1^3000 Fax # ---------- J4 - 3d~s ---- 16. Address 3o1C~ j~v 1 `z_ - -city ) /!7v(/ _ —_ State Zip -L2

V. THIRD PARTY AIR MONITOR

17. Name y ,tr(Zt:2 PC 18. Contact Person A'1IU D fti D t^

19. Federal Employer ID. # _------ 20. Tel. # a ( La2 - ~Q Fax # -O 3 O

21. Address 22 g k~1 ~ /— City ~1_~ State )'~ _Zip L °° ^ 22. Sample Analysis Laboratory— l C (f ((~(L G (ES cr c 23. NYS DOH ELAP # _ / / ' i' C

Vt. PROJECT INFORMATION l 24. Starting date for this portion of workSQ V o1 _ Projected completion date

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday 0 Thursday ❑ Friday ❑ Saturda r D, Sunday

Shift from: ❑ am 0 pm to ❑ am ❑ pm

If other. specify

Access to inspect the premises must be provided during the work schedule indicated in this item. /$7' 1UgED ' 'iflO \ fl) 1 ` 25. Total amount of asbestos-containing material to be abated during this work

2J. , ~ODSquare Feet, and/or Linear Feet ACP 2/200 .a:'.)s ' ;RC•t Ifn

NYC-WTC 000111117