Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

,j,.~r,V0,,.. NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION e° ''`.' Asbestos Control Program 59-17 Junction Boulevard, 8d' Floor, Corona, NY 11368-5107 — 8 ldin NO ONLY FOR OFFICIAL USE ON TYPEWRITTEN ~O MrNruoaon ccJ' ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1 ACCEPTED _ww.nr ese./aer • (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 form with original signatures. This form must be submitted to the NYC DEP not less than one week in advance o

I. FACILITY

2. Address _— L 1 - 2 tt'fJL 2 —A Ct N-- __ Br \ìUi t 1 rut► ( p AKA ---- 1 V7 _ M.

5. Type of Facility LS ------- 6. Name of Building a 4 TI 1I. BUILDING OWNER I~11 yy 7. Name ----A &A -1aPLZ 1 --- 8. C

9. Tel. # 34~ 31Z_g g -t- Fax # ------------- Cj react c S D 10. Address _1_~ O 3]r~ ~X 1~-Z _— City .I 1_ I(a t' III. GENERAL CONTRACTOR Uf 'h br {~o~ 11. Na bCi ~~V ca(( IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ( EIL GY2`' U _._._._._._._._ ---------_ 13. Contact Person _ _LJ/✓c~2L~__

14. e i15. Tel. # J l Federal Employer ID. # .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-., PI I — --_ ------- p Fax # ------------------ c~~ ~/ J d ~s -----/--) 16. Address O1c~ f (~ ~ City J ~/ _--_ State Zip

V. THIRD PARTY AIR MONITOR , 17. Name _~_{ _ rh (ZE12 t r~ft~S+~C_18. Contact Person 19. Federal Employer ID. # P 11 20. Tel. # a( 2PL_. Fax 21. Address g> _L__ S1✓~~ City L`L''~ _--_ State Zip _~00 (_ —/ 22. Sample Analysis Laboratory __ ~ (~` ~ / « h o 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work _—__----_ Projected completion date r-1 r' Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday 0 Thursday ❑ Fri,

Shift from: ❑ am ❑ 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__ -- Linear Feet 7 ^: 'JtP 31 ~~cF^~^fr• ~a~l"o1 ii. Yd rr n

NYC-WTC 000111169