Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program DA P 59-17 Junction Boulevard, 8'" Floor. Corona, NY 11368-5107 Building Oept. or TRU Owy A/ For OFFICM USE ONLY TYPEWRITTEN ~ ASBESTOS PROJECT N FORMS WILL BE r̀"`°AO (ASBESTOS INSPECTION Ch?o~v+bers ACCEPTED 5 When submitting this form at the NYC Department of Buildings, the oi Cs r signatures are required. Submittal at the NYCDEP requires one co form must be submitted to the NYC DEP not less than one week In adv

I. FACILITY Son 0. CD V 2. Address _ I II AKA 5. Type of Facility 6. Name of B II. BUILDING OWNER /~_ 7. Name 1' rVl!$r Q, 'T W Cl 9. Tel. # Fax # 10. Address L -.-.-.-.-.-.- -.-.-.-.-.-.- -.-.-.-.-.-P 1 _ City _ III. GENERAL CONTRACTOR 11. Name _ _ Tel. # _

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 1€ka C-C 1~ec~ _ 14. Federal Employer ID. # PI. .15. Tel. # c~ t 7<

16. Address od l —_ _ CI ry ~ ~._~` V. THIRD PARTY AI MONITOR

17. Name__ k . ilT(ZEtZ (i t__ 5~ 1 _ 19. Federal Employer ID. # P11 20. Tel. # a (~ r- 21. Address J g 1 — City t`l'cr 22. Sample Analysis Laboratory__ ! ?7FC - G- *6 &7AT6rZfl

VI. PROJECT INFORMATION 24..Starting date for this portion of work _____ _ ProjectE

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday U Fri

Shift from: _ ❑ am 0 pm to 0 am 0 pm

If other, specify _ _— Access to Inspect the premises must be provided during the work schedule Indicated in this item.

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

Square Feet, and/or Unear Feet 7 BJRrAH or EICVtIRO4M )1 YEtA:C?;.RfaP & ESfURt;( ~ PFC CCdrROL rRCQy~'~

NYC-WTC 000111162