Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

P• U NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 1*:: :; •;:r• r . 59-17 Junction Boulevard. 8° Fbor. Corona, NY 11313&8107 '1 JJ4u dr r.. , \ '3WTEWRI77EN ~ ASBESTOS PROJECT NOTIFICATION y~ FORMS WILL BE "'t"""O (ASBESTOS INSPECTION REPORT) 1. l~E ACCEPTED +3 j4~:ra.~ tee 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 of the start of abatement activities.

I. FACILITY A^ 1 2. Addresss I.w ,r 9'out/ Borough Iv Zip OO'0

AKA 3. Block I 4. Lot

5. Type of Facility 6. Name of Building II. BUILDING OWNER

7. Name 5 UC Vr ~ LC_ • 8. Contact Person ? c~r 9. Tel.# y) l —C l. Fax#

10. Address 5 3 City State 0' lip q

III. GENERAL CONTRACTOR

11'Name Tel. # _

IV. ASBESTOS ABATEMENT CONTRACTOR p /'~ 1 12. Name e1L ~._._._._._._._ __ 13. Contact Person ~ ) t~c~! /l r

14. Federal Employer ID. P II 15. Tel. # $16 - 7-(_- '300 0 Fax# 5 d 3` L 5

16. Address 0J~I(AZ S e _City ( State Zip I17 c3

V. THIRD PARTYA(lj~ MONITOR 1 b 17. Name ZED G r cP 18. Contact Person `r`l L 40(^ .

19. Federal Employer ID. # 20. Tel. # 0(a - 9&2-O0j Fax# a_4a -9_a -0630 21. Address City 9 -GP l 47 22tt. State Zip 00

23. NYS DOH ELAP # (I S O d

• Projected completion date J12 o Z cJ AA O% ❑ Wednesday ❑ Thursday 0 Friday ❑ SaturgX

2.Z5 J 3 lS e p am D pm

Rip the work schedule Indicated in this Item. JUN 28 2002 abated during this work ROGgM Linear Feet

NYC-WTC 000111177