Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program Wrw 38.17 Junction Bpulawrd 9" Floor, Corona. NY 11388.5107

ASBESTOS PROJECT NOTIFICATION tMAIS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED u•& ..Ic.

When submittMg this form et the NYC Department of Buildings, the original toms and three (3) copies with original slgnelurea are requered. Submittal at the NYCOEP nsquites one copy of the tote► with OtipMal atgnatures. This torte must be submitted to the NYC DEP not Less than one week m edvaroe of me start of abatement ietMtiea . I. FACILITY st_ r + 2. t Pe Tie`tc /~C goro -- Zip Addr'eas' I + pc then '+l S.-1 3-. 3. Bl ck -- 4. Lot S. Typo of Facility. B. Name of Butding _ II. BUILDING OWNER 7. Name !-4 #41~ ~~ ~, I.rl~ 1• . Contact Person -------- 9. Tel. lit ) " _ 11N~Fex # 10. Address _ city t~ = State ___.. Zip______ III. GENERAL CONTRACTOR 11. Name -- Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR 12. Name - t x.~Ll~l.C~U .~ -- ~ M 13. Contact Person ~!~ -3? /Or -- _ 14. Federal Ernptoyer ID. a , _._._._._._._._._ P11 y8. Ter. #. @~ 36 00 _Fax it _..5/ •~ - 16 Address L~? tzt ! — City ,., State _______State Zip 1 t.Ll '_ V. THIRD PARTY AI MONITOR ~A 17. Name ►V _ k1~t Z IL j~.6 fNt6r'leS C__18. Contact Person rrtlC 19. Federal Employer ID. # ___— 20. Tel. # a ( _ as - DO H1'_ Fox # d2 a ' 9d2I - b 30 21. Address ~~ g 1 S'(1 ~ city State Xiptoo

22. Semple Analysis Lat~oratory Gl I IGL14 a 7¢r4 l t'ES7,c 23. NYS DOH ELAP ft 11% -L ___ VI. PROJECT INFORMATION 24.. Starting date for this portion of work -_I 2402 Protected completion date O Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday D Thursday ❑ Friday 00tturdsyy Q -

Shift from: _~— ❑ am ©pm to _ ❑ am 0 pm

sfpecifY Mika Access to inspect the prenusos must oe provided durinc the wcrdr sclredvlo Indicated in this;tern. 1U% Z 0 2002 "•!P/BANI+rf - 25. Total amount of asbestos-containing material to be abated during this work ESTOS/ EA Square Feet and/or Llneet Feet TRUG

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