Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

,sr NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION '*a Asbestos Control Program stilts " 59.17 Junction Boulevard. 8° Floor. Corona. WY 113118.5/07

EWRITTEN +~, ri~ ASBESTOS NOTIFICATION FORMS WIrL SE PROJECTION H INSECTTa ACCEPTED ^_r1:t~Yf.r~.•

and three (3) cop»t with original When submitting this form at the NYC DeQenment of Buildings, the original form form with original aignaturrs. Two signatures are required. Submittal at the NYCOEP requires one copy of the O€P not less then one weak In advance of the start of ebrtement ectMtbs . form must be submitted to the NYC

1. FACILITY `` !! ^^ {} Borough 13 ZIp 2. Address _l ---~-- 3. Block 4. Lot ._ AKA ~_p _L=~_— ~ —

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

H. BUILDING OWNER ~ 8. Contact Person______ 7. Nerve !~~.~s t~~ {., _

9. TeL # _ Fax # -- — City-------.___... State ..._...— Zip . --- 10. Address

Ill. GENERAL CONTRACTOR ------- Tel. # 11. Name-------------

IV. ASBESTOS ABATEMENT CONTRACTOR ee " Co ._ - ---------_13. Contact Person 7 4L :;._.— 12. Name PI I 15. Tel. # _J~~_ 14. Federal EmPloyer t0. # •_Q'—~~.-.....w. /f~ State,t~k- Zip1(„Z2 16 Address •.?01_1f1~, N J ------- City .1

V. THIRD PARTY AIt2 MONITOR ,. t~+t- 17. Name _ ~J) .? .., — 't*t~E ±S +L~ —_18. Contact Person 19. Federal Employer ID. # ------- --- _ 20. Tel, # 2 (,4 - _ Fax # _=

1—I?1~ City -r ~ -I-°1`. 11S— State zip 21. Address g 1~— ----

22. Sample Analysis Laboratory Gf .- 23, NYS DOM ELAP # _ 11 _____

Vt. PROJECT INFORMATION 24„ Starting date for this portion of work „ a t L ~~ Z Projected completion date _..2_j Z

Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday ❑ Thursday C] Friday ❑.Saturd~ L Shift from: — ❑ em 0 pm to 0 am 0 Pm If other. specify 4 N Rt&o inspect the pramises must be provided during the work schedule indicated in trio item. JUN Access to 282002 P/BANHM 25. Total amount of asbestos•contalning material to be abated during this work \ l i •_~STOS/LE4 'tOGRAM, " TRIJG p1__•0~ Square Feet, and/or Linear Feel i OT'T ACP 7 212001 stay a (i , fNtA ' 4c•av sRe;f~ , rxuc~,er , arraa~ uro: Mm;,n*4

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