Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

£° NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8°i Floor. Corona. NY 11368-5107 Building Dep(. or TRU No l FOR OFFICLAL USE ONLY ITTEN ASBESTOS PROJECT NOTIFICATION ~►, MS WILL BE 'gNfK n~ (ASBESTOS INSPECTION REPORT) ? ACCEPTED 1 "'—"•"Ys'.!•n~<r. es fee schedule)

When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This form must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities.

FACILITY ` / 00 2. Address [ g V S £ S 1 Borough N '' Zip 1 p AKA 3. Block v 4. Lot

5. Type of Facility.._.__. — 6. Name of Building

H. BUILDING OWNER

7. Name CA4- A-'( VASE--( LL-C- O • '8. Contact Person

LLL_.&tfl 9. Tel. # 1U) — `t' O x# _

10. Address l j 3 . ' lam) __ City 1èi.,rt tate N Zip __lt

III. GENERAL CONTRACTOR

11. Name._______ _________________ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _EeIL --. 'O .(_._._._._._._._ _ - 13. Contact Person ------/ P 1~ _._._._._ _. ;15. Tel. # --1--J1- ' 56 36>0 0 Fax # ~~'P— _----_____ 14. Federal Employer ID. # — --

16. Address _3Q1e~v &k — --- City ~_ __ State /V Zip i[ 23

V. THIRD PARTY AI MONITOR

17. Name ~~ ~ ~~ ~ n S+ r C 18. Contact Person ,! V~1 ~-1.1-~EL ---- o f" ~

19. Federal Employer ID. # ___---- — 20. Tel. # a ~~=SAP -' O0 Fax # a ~P - 0(.3 C

21. Address /_ City _.6L cr~ State ~ _Zip _ DO

22. Sample Analysis Laboratory— SC1 (/Fl L GAt ~!A ,-tX't£S c-r c 23. NYS DOH ELAP # - (f 0 Vi. PROJECT INFORMATION ll Q Q 24. Starting date for this portion of work i T t1~ O 2 _ Projected completion date U a I 0

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturda unday

Shift from: — 0 am 0 pm to ❑ am ❑ pm

If other, ~ specify --- — — — ' "'~~a /W ~r Access to inspect the premises must be provided during the work schedule indicated in this item. (-1 JU M 28 2002 25. Total amount of asbestos-containing material to be abated during this work `~~ .. oGRIL A' TANG Square Feet. and/or Linear Feet ACP 2/200 4 ' C'ae:`f i nF'~'EF~fAT

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NYC-WTC 000111151