Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

an«. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ~"ie~► ~``•q Asbestos Control Program

WRITTEN Dip~;~' 59.17 Junction Boulevard, V Floor, Corona, NY 1,1368.3107 OUMOIrq Dept. er TRU o fatort:w USE OK ' NY" Fobs WILL 8E N►~.~ ASBESTOS PROJECT NOTIFICATION ACCEPTED ~tr~'j~•:r~.r (AMBESTOS INSPECTION REPORT) 1. when submitting this rpm at the NYC Department of signatures are required. Submittal at the Bultdlnps, the original form and three (3) copies with orI9inal NYC0EP requires one copy of the form with orlgInal signatures. This form must be submitted to the NYC DEP not Iese than one week in sdvence of the start of abatement activities . I. FACILITY

2. Address r Borough —N ' ` Zip . _ AKA ___-

--- ---- --- —_ 3. Block i..- 4. Lot 5. Type of Facility ._—~— 6. Name of Building _____— H. BUILDING OWNER

7. Name —"_-_------- ---- 8. Contact Person 9 Tel. X Faz !f ,.-- ---- ------- ----~~.— 10. Address ~~..,._—_.. --------------,— Stets Zip - CitY-~,------ In. GENERAL CONTRACTOR

11. Name • ------------------~ --------------__— Tel. IV, ASBESTOS ABATEMENT CONTRACTOR

12 Name _ 2A3_ W ---- ~t7 ._._._.-_._._._._._ _.~._._._._._._._Lw--M—_. 13. Contact Person `~3 ______ 14. Federal Employer ID. # PI I 15. Tel tt _ 7I~~3o~0 Fax # r (`V 1S. Address _ - '-! -- t-! rU,+ V. THIRD PARTY AI MONITOR i!----- City / — ~_...-- State AL12rp 112 t

17. Name __ - -------- Contact Person 19 Federal Employer ID. # _ ---___ 20. Tei. # al~ae7- OQ ~~ Fax #~!" 21. Address j2p ~7 L_- S'r2~E i _-- City LA-r — - 1~__-~-- State zip L2LL 22. Semple Analysis L a LaSora!ory— J ??7 l~/E 4. c 23. NYS DOH ELAP f! VI. PROJECT INFORMATION 24. Starting date for this portion of work _' 1b OZ Projected completion date Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday Q Friday ❑ Sat sy-Q- nday Shift from: _ ❑ am ❑ pm to ____ ❑ am O pm If other, s ---------------- RENEO Access to inspect rile pr±mfses must be proveded during the week schedule Indicated in this /tern fr - ' JUN 28 2002 25. Total amount of asbestos•containing material to be abated during this work ^ ROGfWL V Square Feet, and/or _ Linear Feet ! T RUG

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