Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document /,

`Oqunovyr~h. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. 81" Floor, Corona. NY 11368-5107 DAP ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU No FOR OFFICIAL USE ONLY \ Sm' .ft S WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED 1 (Sea 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 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.

FACILITY n 2. Address i T3 C S I f2 - Borough Zip 00

AKA _ 3. Block _40 4. Lot

5. Type of Facility 6. Name of Building II. BUILDING NamefL ` Uov 7. Name L~ LA 'Sc ' 8. Contact Person 9. Tel. 4)) q l 25— ll1S Fax # AA 11 10. Address LS1, AS o sT( 1C;ty _— 'v State f I- OO 13 III. GENERAL CONTRACTOR

11. Na Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ------ _13. Contact Person _.13. ~> ~L/~+~—

14. Federal Employer ID. # _ P11 1 ' .15. Tel. # __--_ 7~L-300 0 Fax c~f ! _--— ; df' 3 0 5

16. Address 3~1~ v ✓—~ -- City L _ State N Zip 1L22 3

V. THIRD PARTY Alit MONITOR Ar 17. Name ZE t2 /./GI ~' PC_18. Contact Person V~11C44*-EL ''` O (" krI 19. Federal Employer ID. # ___---- 20. Tel. # a r3=~aa - OO ~— Fax # 2Ia ",, 2 -06-30 21. Address J22i? S l ~={ -- City L -€~"~ IQ = — State j' _( _ Zip L00 ( .

22. Sample Analysis Laboratory— S'~l (l~(L i-,4 r-A 7!1ES A_r 23. NYS DOH ELAP # _ f' d

VI. PROJECT INFORMATION 5~ ~Z 24. Starting date for this portion of work _ Ia _ Projected completion date ~1 jJ

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

Shift from: ❑ am ❑ pm to ❑ am ❑ pm

If other. specify — -----_-- — LP N RAVED Access to inspect the premises must be provided during the work schedule indicated in this item. JAN 28 20OZ a ANHM amount 25. Total of asbestos-containing material to be abated during this work ST AO pA~6RAM LS Square Feet, and/or Linear Feet T2uc ACP 2/200 rJP:A'I;Ir Ee:~ 1••

Mal

NYC-WTC 000111145