Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT Of ENVIRONMENTAL PROTECTION Asbestos Control Program

~► EWRITTEN ..DCP4 59.17 Jun tlon Boulevard, 8' Floor, Corona, NY 11338.3107 DuNdin /)apt. or TRU No FCR o 1Cw. U!! aww FORAMS WILL BE "•~S'0o ASBESTOS PROJECT NOTIFICATION ACCEPTED (ASBESTOS INSPECTION REPORT)

when submitting this form at the NYC Dapartment of Bul1dln9s, the anginal form and three (3) copies with or191 signatures an) required. Submittal at the NYCOEP requires forth must be submitted to the NYC DEP not one copy of the form with original signatures T lead than one week in sdvsnee Cl the stag of abatement activities I. FACILITY

2. Address _ at.4_,~ Borough —J1 —' Zi AKA p -----,--_ _"_ —_----- 3. Block --- i _ 4. Lot -- 5. Type of Facility_ ,_—_— 6• Name of Building — _ II. BUILDING OWNER ~~~ 7. Name — "_-_— -- ---- 8. Contact Person 9. Tel.' ---- --.--__, Faz # ,.-- ----~~.— 10. Address C hY — Stele ~-- Zip In. GENERAL CONTRACTOR

11. Name_ ----------- IV, ASBESTOS ABATEMENT CONTRACTOR 12 Name [e - ~O ._._._.-_._._._._.__.~._._._._._._._L~--M—_ 13. Contact Person _ 14. Federal Employer ID. # - -.-.- _ _ -_-. , 15. Tel # 2 j -3060 -- Fax 15. Address _ ~ / t-! — city f ~,% State - ! - 2~p L22 ~LZ -- V. THIRD PARTY Alit MONITOR

17. Name 18. Contact Person ----- 19 Federal Employer ID. Jf 20. TeL # alb ae7- OQ Fax # 21. Address L ~''"2€ City ~`~!.. ---~-- State > Zip 22. Semple Analysis Laboratory__..S -:L~f L ~, a !~'IEs rC 23. NYS DOH FLAP 3 / VI. PROJECT INFORMATION 24. Starting date for this portion of work _ ' j.2_J.. OZ Projected completion date Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday Q I I Thursday Q Friday ❑ Salu >ryr-~- nday Shift from: __~ _ ❑ am ❑ pm to _—__ ❑ am ❑ pm If other, specify ~-----~-~- Access to inspect the pr±mfsac must be provided ~..___--_---------,__ RE~vEO durrg the wdrk schedule IndicatedIn this /tern JUN 2 8 2002 2$. Totalamotant of asbestos-containing material to be abated during this work .ESTOStL V Square Feet, and/or Linear Feet TRUG

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