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'" Floor. Corona, NY 11368-5107 TNLY YPE D ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU No FOR OFFICIAL USE ONLY TYPEWRITTEN h~O~rrira~vaon~cc FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED 1 (See 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 f ires. This form must be submitted to the NYC DEP not less than one week in advance of t' I

I. FACILITY

2. Address 4 1 n W~I~_ 2-~~~ 7 AKA

5. Type of Facility 6. Name of Buildinc

II. BUILDING OWNER ^' ,~ 7. Name _—! L1~ —&r s.i1--' __----- 8.

9. Tel. # Pj1 0 1c0 Fax # ---- N — ---(-

10. Address _1i . __ C rn &_ L. City --

III. GENERAL CONTRACTOR

11. Name-------------------------------------

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name (~J~1~ ( iC0 — --- _13. Contact Person P11 Fax # JI _ 14. Fecteral Employer ID. #_._._._._ _. ._. - 15. Tel. # 7J_-3d~5__ 16. Addr ss _ olcJ_v_ i ------City J 3L _--_ State /v zip 1L22- V. THIRD PARTY AIR MONITOR

17. Name Lkr(2~2 L /J 1~(t`1?S+~C c — _1t

19. Federal Employer ID. # --------------- 20. Tel. # a (= o \, k. Jff 21. Address L-- ~t►f ~Sr={ City _~'.€l"~_( " --- 22. Sample Analysis Laboratory—__~C_( (( «- f1_S l. VI. PROJECT INFORMATION

24.. Starting date for this portion of work _—__~---_ Projected comp ,~

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thur. ~ v Shift from: ❑ am 0 pm to _—M ❑ am ❑ pm

If other, specify _----_

Access to inspect the premises must be provided during the work schedule indicated in this i

25. Total amount of asbestos-containing material to be abated during this work

Square Feet, and/or_—_—_ Linear Feet 7 D1 81' 4I3rEfl'.'R^' -7i.t.3E fJc::i.121T 4Ea4 fnruP;41 rru~

NYC-WTC 000111157