Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

PROTECTION NYC DEPARTMENT OF ENVIRONMENTAL Al Asbestos Control Program • 59.17 Junction (3oulevnd. 801 floor. Corona,lJlf 11368.5/07 ewsrFfldGmA er TRlt !M DAtr~ ASBESTOS PROJECT NOTIFICATION •o ororwlowr

EWRJTTEN ~ , ~' JECTTa REPORT) 1. C FORMS WILL BE tM scrledlite) ACCEPTED ! rI' '( t• •

oftglnal form and three (3) ooaee fi e► original When submitting this Norm at the NYC Depertment of Buildings, It9e signatures are required. Submittal at the NYC0EP requires one copy of the form with original sigrtatutes. TNs form must be submitted to the NYC 0EP not less than one week In advance of the start of abetemem aCuvltls

1. FACILITY — Zip Borough 2. Address _L1_ a+~— ~►~.,~ ---~-- 3. Block 4. Lot ._ AKA ~_E? _L~~ 3 _~1~ —

5. Type of Facility_— — 8. Name of Building --

II. BUILDING OWNER T. Name c JL- L L 8. Contact Person _______—__--

9. Tel. # _ --- _____.Fax # -- City State Zlp—_--_ 10. Address

I11. GENERAL CONTRACTOR ------- Tel. # 11. Name------------- IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name f ee KO ._ - ----- —_13. Contact Person _ 7/... &11___

.------1 ! 15. Tel. # - Fax 14. Federal Employer 10. # j. State L' 2ip .L( Z2 16 Address •.?01 _1C1~ -~!~= ------- City _ )i -

V. THIRD PARTY AIj2 MONITOR I ~ tGf~rEL N° L- 17. Name .J/2 - 't*~~E Q iG"± S+1 ,.--18. Contact Person 19. Federal Employer 1O. # ___--- - 20. Tel, # J -qaa _ Fax # _____ Lam, Zip t t g City t C`- -4=1 ..5- " State t' 21. Address s 1.— ~'—'_"" ---- cl 1f' ••,i 4 L' ! c ._ 23. NYS OOM SLAP # Q_____ 22. Sample Analysis Laboratory

VI. PROJECT INFORMATION Q 2a„Starting date for this portion of work „ ~~ Z. Projected completion date _..2j loz

0 Monday ❑ Tuesday 0 Wednesday ❑ Thursday C Friday O.Saturday O nday Asbestos work schedule

Shift from — ❑ am ❑ pm to 0 am 0 Pm If other. specify --------------- ----- RF/'`''~~--~~~~~CC0 Access to inspect the premises must ee provided durtng the work schedule indicated in t► is item. ~ JUN 2 8 2002 P/BANHM 25. Total amount of asbestos•contalning material to be abated during this work ~ -ESTOS, o: TRUG IJ~ Square Feet, and/or ~._ . Linear Fool ~ r2T ACP 212001 -lip AEC' O C~A7 tin nuf fe'.1

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