Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

O T aoay,u~r ar,~,pl~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION r. q. Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor, Corona. NY 11368-5107 o_____ TYPE A P ASBESTOS PROJECT NOTIFICATION Building Dept or TRU No

TYPEWRITTEN ' D~_ ~ ~hrarao~•ci FOR OFFICIAL USE ONLY FOR (ASBESTOS INSPECTION REPORT) 1. (Se tee 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 J1— ft 19~_ ~_ 5 ~ 1 —_ Borough —NJ ±-- Zip _P n AKA --.1 CiM l~ __—_ 3. Block — 4. Lot

5. Type of Facility 6. Name of Building

II. BUILDING OWNER

Name Ct —----- 8. Contact Person _ -- -- \= vI ` -- --1 9. Tel. # ~J — o _ l ax # -------------

10 Address _ (o 1 i~ g y -- State Zip O

III. GENERAL CONTRACTOR

11. Name-------------------- -------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Dell T---__---- .13. Contact Person

14. Federal Employer ID. # J P11 -15. Tel. # J L 6 _7'L ^ 3002_ Fax # 16. Address ------ City _—_ State /V Zip

V. THIRD PARTY AIR MONITOR / t 17. Name y ~ t ZE NG i" S r C _ 18. Contact Person

19. Federal Employer ID. # 20. Tel. # ar ~aa -20f_.. Fax #

21. Address g ~ ~ E =/ —/-- City [`~` ~1=~G State Zip 22. Sample Analysis Laboratory l ( ~G~^! b l -'A 7`r/C_S u c — 23. NYS DOH ELAP

VI. PROJECT INFORMATION ' ,, I 24.. Starting date for this portion of work __ 42_ 1 t72.- Projected completion date

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

Shift from: 0 am ❑ pm to _--__ ❑ am ❑ pm

If other, specify ----------------------------------------- t J Access to inspect the premises must be provided during the work schedule indicated in this item. 1 7 25. Total amount of asbestos-containing material to be abated during this work ` 1• -~Goq -- Square Feet, and/or _—_— Linear Feet jTTo\ 21200 Ir

NYC-WTC 000111134