Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

r. oui t NYC DEPARTMENT OF ENVIRONMENTAL. PROTECTION ~ 4 Asbestos Control Program 59-17 Junction Boulevard, e" Floor, Corona, NY 113th-6107 owadlna Oept or1RO No FOR OFPICW. sat ONLY EWRITTEN ... ASBESTOS PROJECT NOTIFICATION FORMS WILL. B6 (ASBESTOS INSPECTION REPORT) ACCEPTEd 75s"•s 1L•~%~7r. ( e tee edlsdule)

When submimng tics form at the NYC Department of Buidings, the original form and three (3) copies with original signatures are required. Submittal at the NYCOEP requirea one copy of the form with original signatures. This form must be submitted to the NYC OEP not less then one week in advance of the start of abatement activities -

1. FACILITY

2. Address _L — — ~~Q & T& *LL Borough N ' — Zip AKA ---------------------- .._ ------- 3.810ek —J 3 ___,__ 4. Lot —_.. 5. Type of Facility_,___ 6. Name of Building -- II. BUILDING OWNER

7. Name C- ~~ .j~~. a.~S _ . Contact Person --- A. Tel. if ~= ~ , - Fax # _.-------- 10. Address S _ City ___L Zip —__ _—~i -- State M III. GENERAL CONTRACTOR

11. Name --- ------- Tel. la __,------- ------- ------ -- ,—.____.. IV. ASBESTOS ABATEMENT CONTRACTOR

12 Name _re C lc OL - —_ -- _____„13. Contact Person 14. Federal Employer ID. it L. P11 - 15. Tel, K Fax tr` 16. Address o1G& J Ve ______ City ~ State zip LL22L V. THIRD PARTY AI MONITOR

17. Name _J Q t _ Art cQ s ~_18. Contact Person 19. Federal Employer 10. # —_—__ 20, Tel. # ara_~aa:2Q._ Fax # 21. Address [ "' t .S?1 _.._ City _ State (~ Zip L~0 L 22. Sample Aneiysis Laboratory__. 1~ (c. 4IItj 1124-rwte~J c — 23. NYS OOH FLAP tt VI. PROJECT INFORMATION f ~ 24. Starting date for this portion of work ~_ TTT Z Projected completion date 111 Asbestos work schedule 0 Mor+day 0 Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturdays day

Shift from: _--_— ❑ am ❑ pm to _—_— ❑ am ❑ pm

If other. ~► r specify —__----- , ..__---...... ----- ~,...._--------------- RE , YeO '` Access to inspect the pnmises must be provided dlurn9 the work schedule Indicated in this Item. JUN 2 8 2002 25. Total amount of asbestos-containing material to be abated during this work ~ y a STS/IEMAr T !~ 7R21.1G OrWRAM Square Feet, and/or _—`—_ Linear Feet ~i 6 a Acp r e7s~AU 0.'EM1'h•gr•' ~1 V20i ~1GILs '.1::7.152di+N t ~„a,ILI r cry

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