Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

c„r or~ur NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY IJ r FOR OFFICIAL USE ONLY TYPEWRITTEN ~~N~fNrw:~„~°~ ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED ""-" "yc.;° r9<c. (See fee 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 NYCOEP 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 _LD 5 ^ 1 _1_ LC Qr S ( --- Borough _ -- Zip _LO©I —_

AKA 3. Block ------4. Lot

5. Type of Facility, 6. Name of Building

II. BUILDING OWNER

7. Name._ I~ l ~1 ~ ~ --- —_ 8. Contact Person

9. Tel. ------------ 10. Address ~~~--~~~_~ ~1 ~~~ City -- N~ ~— StateN Zip _ t 9 0 t3 III. GENERAL CONTRACTOR

11. Name_—________ --- ---------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name elL ( ~U - -------- _13. Contact Person C~ _— ---------- - PII ?L( 14. Federal Employer ID. # _ _._ .x —yr '15. Tel. # c~` ___--- - 7~~-3000 J~ ,--`—____-- Fax# ___— ~~ JdC) ',S__ __~_--_ /__) 16. Address o (~~ ~ -- __--- City .J /[ 1/ 4_ —_ State /U Zip

V. THIRD PARTY AIRMONITOR

17. Name ------ 1~ ZC LNG i!~~ ≤ 18. Contact Person _V4 4- LAr'-1 19. Federal Employer ID. # -------------- 20. Tel. # a l a=a -moo Fax #

21. Address g Cl_S_ S? —// --city [`~?~7"~C------State L~ zip (- - 22. Sample Analysis Laboratory ~( *6 ?c 9A~ ( ~~ G~ -'LC-5 vC 23. NYS DOH ELAP # _L _ __

VI. PROJECT INFORMATION 24.. Starting date for this portion of work Projected completion date

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday O Thursday O Fri,

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

If other, specify _ ---_

Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work

Square Feet, and/or___________ Linear Feet '7 01 d Lla"95{^t.1RCi rru ~

NYC-WTC 000111143