Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document DEPECB Fax:212-361-1433 Jun 28 2002 11:23 P.03 '%

ASBESTOS INSPECTION REPORT (continued) 28. Asbestos Hauler LO _ NYS DEC Permit - ~~ y Tel.'. 8~ >^X72^ 7

Disposal Sites) 3I _e2 *;u IE 9_ S * r (( 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) a Demolition b) ❑ Boiler Replacement o) ❑ Sprinkler Replacement d)11 RenovatiordAlteration e) ❑ Fireproofing Replacement I) ❑ Other (Describe) - - -

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up

29. ABATEMENT PROCEDURE (Chock all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application nn A 0%^ATI I O A! ~vv^I I An ATCAACtlT L DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING JV Floor($) OF FLOOR CONTAINING ACM PERFORMED SOUARIis UNEAR (e.p. nrnri,nQ osbie. intta5n9 fire sprinkitrs, (e.g. inure. east vying. room M. (e.g. ppt teggUg, ceding, pklwm FG&T gboners era. Eoier room lobby. et stage 5fl1t 5 flQ, sic) F69T tcmovnp sod I.a

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familiar with Federal. 31. 1 hereby declare that the Information provided herein is true and complete to the best of my knowledge. I am State and NYC laws and regulations applicable to asbestos related work.

P Name Ac COT s CoMre w ~(If ~MPrint NeI M ApO oilier than Owner) nt (If dher owner)

elute • 9tpnelurt Signature

~3~02 performance of 32. i understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the third party air Program Rules. I have contracted the the asbestos abatement activities In accordance with the Asbestos Control I have authorized the monitor who is completely independent of all parties involved In the asbestos project. I hereby declare that filing o(thIs notification for the work specified herein

SiQnetun Oete Pont NmJ of Owner THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT directly to the NYC OEP ACP. [7nv modification of Information provided on this form must be reixrted immediatelyIn writing

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NYC-WTC 000111150