Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

E0 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 8' Floor, Corona. NY 11368-5107 DAP ASBESTOS PROJECT NOTIFICATION FOR OFFICIAL USE ONLY

N 'i°~~` WILL BE (ASBESTOS INSPECTION REPORT) 1. ACCEPTED "" "rS !_•'r~~r,

original When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with 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 o Zip 2. Address ~E f—~ C E € _- r Borough N '

_ 3. Block ) 4 .( O 4. Lot 1 co 3 AKA

5. Type of Facility 6. Name of Building

II. BUILDING OWNER

7. Name 1 ©4 1 -t?A 1 - f "mot . Contact Person 9. Tel. # 2 4t D — KV Fax#

Q — City — N State & Zip _ Ob 10. Address _L a ,

III. GENERAL CONTRACTOR

11. Name_ _______ — ----- Tel. #......

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ee ' -1_.------------- —13. Contact Person Q1 S~L_____

14. Federal Employer ID. # b PI I 15. Tel. # J L — 2~I_ 300 0

City _____--- State zip IL? 3 16. Address ~?0~L1~ 1 r e ------

V. THIRD PARTY AI)R MONITOR ,, r 17. Name ~~ P. ! Q AT-(ZE ---- G --- S PC — 18. Contact Person V'4( 4 *EL. ',. °L' i'd rSFr'--~—

19. Federal Employer ID. # ___--- 20. Tel. # ' (Laa - 001~-- Fax # ?la~~ -o . :30 City ~ +W ~! State Zip _ 00 1 21. Address ~~ g ~ 1 ~1—~ ~ r {~

22. Sample Analysis Laboratory— ~( ~ h 23. NYS DOH ELAP # - (1

VI. PROJECT INFORMATION 24-Starting date for this portion of work _ OZ_ Projected completion date 213O 102 Sunday Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday 0 Thursday ❑ Friday 0 Saturday ❑

Shift from: _ 0 am 0 pm to ❑ am ❑ pm 'S If other. specify ---- --- — — ---- N R48VED -4 Access to inspect the premises must be provided during the work schedule indicated in this item. JUN 2 42002 r GWilk cb 25. Total amount of asbestos-containing material to be abated during this work ,SI'ROGRS MEN:. So 0 Square Feet. and/or Linear Feet 7AUG ACP 7 I I 2t2t0t .Jtp

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NYC-WTC 000111128