Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

£ô7 Jr_.? . O1 . NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor. Corona, NY 11368-5107 Building DepL or TRU PPM FOR OFFICIAL USE ONLY rlirile~~ ASBESTOS PROJECT NOTIFICATION I- (ASBESTOS INSPECTION REPORT) 1

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

I. FACILITY r - , / 2. Address UP V E 5 ~ ~- g ~~ T Borough ' 1 Zip O AKA 3. Block 'O 4. Lot p p~ 5. Type of Facility e_-Q$tn.CO.. _ 6. Name of Building II. BUILDING OWNER

7. Name C-A S —(Sq 0 SfI~2 1 ' ' 8. Contact Person 9. Tel. # P 11 ;Fax#

10. Address V€£1 S 1 2 I -E( City -f 3 ' State Zip I t sO

III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Ja~1L l.Jd ~U _._._._._._._.______ --`— __13. Contact Person _____ P11 ' 14. Federal Employer ID. # 15. Tel. # J L 6 - 7J_ 30o O Fax # / 1 ,1 _ City ~.J /~~ State N ~ Zip IL?~_

V. THIRD PARTY Al MONITOR 1 &! n 17. Name ~' &'4 l pC 18. Contact Person Ac" -6L 1'l 0 L, kr4 . 19. Federal Employer ID. # 20. Tel. # ar3 - '19_00? ooh Fax # 2J? _ 22 -O 3 0

21. Address s~2g 1 1 4-J' ( r— City _7 (? State _ Zip 00

22. Sample Analysis Laboratory #4 1 .!1ES c rc 23. NYS DOH ELAP # (f'/_ C2

VI. PROJECT INFORMATION r~ 24_ Starting date for this portion of work 1 Projected completion date a 0

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday 0 Saturday ❑_ Sunday

Shift from: ❑ am ❑ pm to ❑ am ❑ pm

If other, specify — N Rip s Access to inspect the premises must be provided during the work schedule indicated in this item. JUN 28 2002 oEP/gm 25. Total amount of asbestos-containing material to be abated during this work l ~fESTpRREAO 13_00 Square Feet, and/or 'Linear Feet TR6!!Q 2'

CJPAI , lP^• 6 ACP 7 2/2001 ;I•F7rAl . a::.•i s . :RC.t Cdc.)S ;CRCI EA7 IRll

NYC-WTC 000111153