Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

, 7 ?wcTcL or.yr NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59.17 Junction Boulevard. 8 now. Corona. NY 1138410? Inl1 Mu ONL BUlldInQO.pt.cqT Eoa O ICuu. usq TYPEWRITTEN Y FORMS W1u, 6E ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) L ACCEPTED =-c•;i•:~•,~• 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 NYCOEP requires one copy of the form with original signatures. This form must be subatitted to the NYC QEP not lets than one week in advance of the elect of abatement aciMilee . 1, FACILITY

2. Address I LE5 ~ $~.tJ 4 -- $ 1 t_, Borough Zip J O AKA --------- 3. Block 4 —_ 4. Lot -- — ----- of 5. Type Fa-.11lty_____, _ 6. Name of Building _-- -- __ It. BUILDING OWNER

7. Name i' --c 4 — S'`~r /~~" ~~Z...~ _ 8. Contact Person ~ —~ (►~ ~~~~ ~+ 9. Tel. # ~-1J-1T — i2 )-( Fax a 10. Address: ------.._— City --- -___,_-------------- --------- State __. .. ZI ill. GENERAL CONTRACTOR

11. Name -----~---------•-- --~~--~.----- Tel. # ------------------ IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ _--- 13. Contact Person lC 2L~ 14. Federal Employer ID. Tel, # Fax 16. Address oL yL lQ ~1~~—__— City ~s~L f12` L —T .. State .&_'(.zp ~Z _ V. THIRD PARTY AIR MONITOR

17. Name _-- t2 3+1 V krt Z~& C 8. Contact Person irtlCl} cL 19. Federal Employer I0. 0 ___ 20. Tel. # ara=dad _ 00 Fax t! ~1c~ 1~2 06 0 21. Address ~?~ r 1 f1 city [-~w ~s ~2 _---~ state Ct- _ Zip LooL _ 22. sample Analysis Lahoratory___ J{ rl J. A o X214 7t(E$ arc 23. NYS OOH SLAP VI. PROJECT INFORMATION er 24. Starting date for thisportion of work _-_I. /~ --~~ VZ 2 r.1 __ Projected completion date Z Asbestos work schedule 0 Monday 0 Tuesday ❑ Wednesday ❑ Thursday ❑ Friday d Saturda day Shift from: __—__Cam ❑ pm to __—,_ ❑ am ❑ pm

if other, N, p specify _„----.------ --------------------- — -- RE D Atcoss to Inspect she p:emfs.s must be provrded during the wwcr* schedule Indicated in this Item.

25. Total amount of asbestos•containing material to be abated during his work I1 JUN 28 2002 'EP/IANHM 1) ESTOS/jf . OGmA Square Feet, and/or Unbar Feet '. TRIJG M

•t Uu a' I ACP r %arnr 212001 rr A ,W m~i,' r

0£:Tj Z00 8L UnC ££bt-T9£-LtZ:Xpd 933 d3Q NYC-WTC 000111160