Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

/7. ~,,,,,~~ YC DEPARTMENT OF ENVIRONMENTAL PROTECTION .!"~' '. '~~. Asbestos Control Program I a r~ ~' 59-17 Junction Boulevard. 8°~ Floor. Corona. NY 11368-5107

RITTEN ~ ~' ASBESTOS PROJECT NOTIFICATION t$.10RMSW1L1BE (ASBESTOS INSPECTION REPORT) CCEPTED

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 1 . Er 2 E E T Borough N ^' t zip _ 00 1 3 nn AKA _ tO t.J ' & 20 ll~ I 3. Block 4. Lot

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

II. BUILDING OWNER

7. Name t 01_ h1 ' X32 OAr A A 4_ L 1 C-O -k Contact Person 9. Tel. # — Fax # —

10. Address _ 1 Me~~C-~- City __j _ 1 State i3 Zip 00 -

III. GENERAL CONTRACTOR

11. Name_—_--- — _ -- — Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ete ,eo ------ ___13. Contact Person _2 21/ 14. Federal Employer ID. # 1. 15. Tel. # c~ _ 7jL30Q O Fax # _ JI 2I 385

16. Address QliU) ~ — -- City State U/ Zip IL?

V. THIRD PARTY AIR MONITOR Ar 17. Name _ 7 i~( 1~Zt:2 f(~i"k h r C 18. Contact Person !~~ ('( oL

19. Federal Employer ID. #__ 20. Tel. # a ( =~aa -OO ~ Fax# I cZ= ~ - O~ .3 O

21. Address ~2 g 1 1 —y -~ r 124Z___ City — State N Y_ Zip _ 00 ( .

22. Sample Analysis Laboratory—~j . (.&4rF(C_ (_5 23. NYS DOH ELAP # _ / f e d

VI. PROJECT INFORMATION 24.. Starting date for this portion of work _1Q 1 V_ ~,'G Projected completion date — OtOp

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

Shift from: __ ❑ am ❑ pm to ❑ am ❑ pm

If other, specify — v R r,~~ --------- ----- ~ -~' M[ Access to inspect the premises must be provided during the work schedule indicated in this item. 4 ?0OT --.. aSTj" M 25. Total amount of asbestos-containing material to be abated during this work , Ek . 0

!~_1_~ Square Feet, and/or Linear Feet ~f ,RUG ACP (!t

Pef.,;a;,fl rtin ~

NYC-WTC 000111126