Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

DEP ECB Fax:212-361-1433 Jun 28 2002 11:24 P.04

ASEE$TO$ INSPECTION REPORT (continued) p,e M ' ..2?Z ~' Gnv 7 26. Asbestos Hauler LG NYS DEC .e Permit —O Tet. . o j Disposal Site(s) a 5 1 ' `( Department of Buildings) 27. This asbestos abatement is part of a (Item a through a requires filing of this form wh NYC a) ❑ Demolition b) Cl Boiler#Repacement c) Cl Sprinkler Replacement . d) 0 Renovation/Alteration a) ❑ Fireproofing Replacement f) ❑ Other (Describe) ---

28. TYPE OF ABATEMENT (Check all appropriate boxes) Cl Enclosure Cl Encapsulation ❑ Repair ❑ Clean up ❑ Remora!

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ t3lovebag Cl mm ❑DEP Variance AppltcaGo ,QO

30. LOCATIONS OF ABATEMENT SCRIPI1ON OF WORK EING DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM CONTAINING ACM PERFORMED FEoon(s) OF FLOOR SOIJA E FEET u NIE/!R (e.g. nnnmi cable, l edmi O ens epanklui. (e.0. etMire. Belt *NQ, roans, (a9• p* i"OO~ ~. P!•ro+m FEET ' PEET r bobs, J

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of my knowledge. I- am familiar with Federal, 31. I hereby declare that the Information provided herein is true and complete to the best s...r n1W i. mr%A r n, dnNnna annNcable to asbestos related work.

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x~0-o3^ate_ )2. I understand that as the owner of a budding where asbestos abatement activity occurs, I W. responsible for the performance party or air Program Rules. I have contracted the third the asbestos abatement activities in accordance with the Asbestos Control hereby declare that I have authorized the monitor who is completely independent of all parties Involved in the asbestos project. I fil f this for the work specified herein ~~ nration Prht N.ns a Owner MUST BE AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS direCtly 10 the NYC DEP ACP. F_Any modification of Infórmatk,n providid on this Iorrn mut be r cdsd Immediately In wrWna The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened tbrounh the cerformance of WOrk in iQmenbb1or r

NYC-WTC 000111168