Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

E o' (- • 'IFy~9. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program O 1' ~k0 59-17 Junction Boulevard, 8°' Floor, Corona, NY 11388-5107 DAP,. Building Dept or TRU N FOR OFFICIAL USE ONLY EN • ASBESTOS PROJECT NOTIFICATION WLL BE (ASBESTOS INSPECTION REPORT) 1. I Onr 91 rMor, D :tYS'.J. , (See be 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 Q 2. Address Jo+ f-- S 2_E E_T Borough N ' Zip 1 0 0

AKA 3. Block I L ' 4. Lot SO 3

5. Type of Facility. 6. Name of Building

II. BUILDING OWNER ~,~ ,— ',~O 7. Name L 10 L+ 'L ©g ~~~c ~" t ~~` L L"'~'"'e• Contact Person

9. Tel.# t©~~ Fax# nn —((► ► 10. Address L!~--tZ~ dL4~ S'( City ----IJ ~ ~ -- State ~ Zip OO

III. GENERAL CONTRACTOR

11. Name_._______ — Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ~O ----- __13. Contact Person

14. Federal Employer ID. #;, .~._._. PII ;15. Tel. # ~j -- ~~ ----- Fax # _-- ,3d~5 ' r 16. Address 3o1~~_v_f 1 ~_---- City J JL / 72 _ State /J Zip iiz T3

V. THIRD PARTY AIR MONITOR

17. Name 1rv) R-8`R Sj ~!1'12E~ NCir 'T r C_18. Contact Person L t a(" '

19. Federal Employer 10. # ___------_ 20. Tel. # a (~-~aa - OOH — Fax # a a ' O6 3 0

21. Address 22I 1 t` City State ~_ Zip _(00

1 r` c k `K'f~S Jc 23. NYS DOH ELAP # _ I I 11 22. Sample Analysis Laboratory—

VI. PROJECT INFORMATION 24. Starting date for this portion of work — 0 1- Projected completion date A 30 102- Asbestos work schedule ❑ Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday ❑ Saturday ❑ Sunday

Shift from: _ 0 am 0 pm to 0 am 0 pm

If other, specify ---- -- — --- t1 Ra]YfQ Access to inspect the premises must be provided during the work schedule indicated in this item. JUN ? y 2002 25. Total amount of asbestos-containing material to be abated during this work ,S#wtE 1So -0 Square Feet, and/or Linear Feet rRbG 2 ro ACP 7 2/2001 CJp: 1' JtP 4 'i t 73'.f Ei4;AT • i; •' iS i;•+CBGL F6r,~P;,t.1 IRn

NYC-WTC 000111130