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 1 ko osrC ,DP. ITTEN ASBESTOS PROJECT NOTIFICATION Building Dept or TRU No FOR OFFICIAL USE ONLY

^4NfK n~ MS WILL BE (ASBESTOS INSPECTION REPORT) ~1X 111 ACCEPTED "'—" "~-` ~!•/'<C• ea 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. 'I

FACILITY ` / 2. Address e V S s 1 Borough N '' Zip I a O Q AKA 3. Block v 4. Lot

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

H. BUILDING OWNER

7. Name___ CL '( '( S LLC- • ' 8. Contact Person 3 V,, — (O 9. Tel. # 1 41Lt L ` ~rr O x# _

10. Address l~~ P' V\ lam) ~~ ~ _ City L f JL 1èi.,rt tate N• l ip _ 11 0 '4 III. GENERAL CONTRACTOR

11. Name ____ _____ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _Ei l 1'6 .(_._._._._._._._------ __13. Contact Person / 5!6'7~~_3p60 -,35__ 14. Federal Employer ID. #_L. . . . .!.!.!. . _15. Tel. # Fax # ~~ ~~ _____

16. Address oc v ~~ City ______ State /~! Zip

V. THIRD PARTY AI MONITOR

17. Name ~ ~~ ~_ kr(Z E 2 C, Pc S+ h C 18. Contact Person (h1 ! U}~EL o ff' ~

19. Federal Employer ID. # — 20. Tel. # a ~3=~aa -4 OQ Fax # ,4 - O. -3 O

21. Address ~ g 1 1 ' /= _ City ~'~w wJS State ~ _ Zip _ OO

22. Sample Analysis Laboratory_ SC( ( /FtL G , c -9A r °X'~£S c 23. NYS DOH ELAP # - (f (9

Vi. PROJECT INFORMATION Q Q 24 Starting date for this portion of work _7111 O2 _ Projected completion date U QI 6 1 Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturda _ t

Shift from: 0 am 0 pm to ❑ am 0 pm ,f. \, If other, !~ specify _ _ REcwp Access to inspect the premises must be provided during the work schedule indicated in this item. nr~ u,y 28 2002 zP1#AINMM 25. Total amount of asbestos-containing material to be abated during this work '. STOS✓LEA' T 21,GM 4 i 5.51) Square Feet. and/or Linear Feet i ' ACP 2/200 a1vAI3:E~ P'EcNT~ '. a.,.'8s C.' ,:RGi fRil)

NYC-WTC 000111151