Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

.a''r '" a DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8°' Floor. Corona. NY 11368-5107 U.C4(7fl D"' ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU No FOR OFFICULL USE ONLr

RMS WILL BE r"r" j (ASBESTOS INSPECTION REPORT) 1. '. ACCEPTED 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 _.L 9 Borough I Zip __ I r _0t 3 AKA 3. Block t 4. Lot

5. Type of Facility--- 6. Name of Building

II. BUILDING OWNER n _ 7. Name 1 ' k V- S~ . Q~J A C_b'r`SD ' 8. Contact Person

9. Tel.# 5e?_4 t 3 ~ax# < j City -- _ State ,j1~ ip _ 0 L 10. Address _— S_ cO L —_

Ill. GENERAL CONTRACTOR

11. Name_— ------ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ----- _... .13. Contact Person ~ S~L_____ 14. Federal Employer ID. #' PII _ ~6- 1 7~i' -3000 15. Tel. # — Fax _----~

16. Address 3o1~i2 1t~— — City ) s ~[`__L --- State /v Zip 1[?3 '

V. THIRD PARTY AIR MONITOR ~r 17. Name G~ R Z~ NG r'Aa ? PC 18. Contact Person t 6 . 19. Federal Employer ID. #_____________ 20. Tel. # OOJ Fax # .JL a -O~ 3 0

21. Address 2I _ ' S1f // City ~~ State EL . Zip(Co 22. Sample Analysis Laboratory— _.i(f (L h*6! ~ iEST&f ( 23. NYS DOH ELAP # _L/~

VI. PROJECT INFORMATION 24. Starting date for this portion of work _ t42i_j_02 Projected completion date U o 0 Z

Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday 0 Sunday

Shift from: ❑ am ❑ pm to ❑ am 0 pm ., 6 If other, specify - ---- -- --- ~` v Ra g ((~In() Access to inspect the premises must be provided during the work schedule indicated in this item. ~f' J U I~ 2 4 2002 M II MEM~ Ca 25. Total amount of asbestos-containing material to be abated during this work ! e G TRUG t0 W_ Square Feet, and/or Linear Feet ? Ij I 0\ ACP J!P snoo CJetA'.1 Q,' 9St':C'-IF..YE't'.iP:!•;A£Kfi 3 E•,:P~E~4th7 PFf's ,L1 IPiI

NYC-WTC 000111122