Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ,EO 74 Asbestos Control Program C 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 Building Dept or TRIJ No DA FOR OFFICIAL USE ONLY ' PEW' RITTEN '+, ASBESTOS PROJECT NOTIFICATION FORMS WILL BE " (ASBESTOS INSPECTION REPORT) www.ePe.~~r (yep 1 ACCEPTED ________________

( lee 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 ~T- 2. Address _I 9 C *4w'i n 4~ ~ S I (`~- T Borough ' Zip _000 ' t- AKA -- 3. Block ( T c — 4. Lot

5. Type of Facility----- 6. Name of Building II. BUILDING OWNER

7. Name l! J S PC'~'OS[C 8. Contact Person

9. Tel. # ( ~ 3 ~ - b`G' G Fax #

10. Address _jL9. c, City ---~v ' — State j.L2jip _! &

III. GENERAL CONTRACTOR

11. Name_--_,------ --- -- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name eiL ( Z0 -----13. Contact Person ~~`, szL 14. Federal Employer ID. # J L J 15. Tel. # J I 7~~_'3400 Fax #

16. Address o v 1 ~_-- City _ State N Zip IL? 3

V. THIRD PARTY AIR MONITOR r 17. Name _— kr(ZE2 C, i ~S PC 18. Contact Person Ih11C.I+;~EL (V o("p~_

19. Federal Employer ID. # ___--__---~ 20. Tel. # ai _has - O0~ —Fax # 13 - a -o 3o 21. Address City L i . State tL _ Zip _ 00 ( .

22. Sample Analysis Laboratory— SC (- (i (~« ( o °-9(E5 cr c 23. NYS DOH ELAP # - (fI 7L V O VI. PROJECT INFORMATION r-~ 24.. Starting date for this portion of work - I 2 0 Z Projected completion date _. L5)O Z

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday 0 Thursday ❑ Friday ❑ Saturda unday 7 I Shift from: ❑ am ❑ pm to ❑ am ❑ pm

If other, specify ---- -- — ---- R&&p f`

Access to inspect the premises must be provided during the work schedule indicated in this Item. JUN? 8 2002

r ''n~NHM 25. Total~ammount of asbestos-containing material to be abated during this work M al L O I ✓ — Square Feet, and/or Linear Feet ~U rRURG ..2 ACP; .P 21200 :•i'.Z. 35,t':El467 Gu.aJS i.'.:[ACi Pfr,,;a,;LI Inn ,

NYC-WTC 000111155