Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

. oz5kJTc C1'! OP1AJ1 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program d0V 59-17 Junction Boulevard, 8' Floor. Corona, NY 11368-5107 _ ONL t t DP ASBESTOS PROJECT NOTIFICATION FOR OFFICIAL USE ONLY

Tr "'nuiiAn° BE (ASBESTOS INSPECTION REPORT) 1.

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

2. Address 2 O Ar L3 AC Borough Zip f O 0 D

AKA .Z" C 1 L xT I - - 3. Block 4. Lot

5. Type of Facility—_--- 6. Name of Building

II. BUILDING OWNER

7. Name Qt&4fd 421 1 8. Contact Person b A - Vi l) ~l ' •r 9. Tel. # [~-4) 3 L9thax # ee 10. Address 42 _i l`e-l-irCity --& ~— State /J /Zip

Ill. GENERAL CONTRACTOR

11. Name_--------- -- — Tel. # — —

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name -------- __13. Contact Person L_____

14. Federal Employer ID. # PII _;15. Tel. # ~i6-7~1-300o Fax # 51 ~•3dt1~'S 7 16. Address _o v' ~-- — City _______ State /v Zip IL?

V. THIRD PARTY AIR MONITOR ~, r 17. Name of ~t►(ZE2 Gt ??S ~C 18. Contact Person ! l-

19. Federal Employer ID. #_______ --- 20. Tel. # Fax # a - O( 3 a~ 21. Address = —/— City ~^~ _____State _ - Zip OO

22. Sample Analysis Laboratory— - ( ((r« h ,47 t 7 r L 1Z c 23. NYS DOH ELAP # _ ( f

Vt. PROJECT INFORMATION / 6 B / Lv O 2- 24.. Starting date for this portion of work _—,F / / 2 `'` 2" - Projected completion date

Asbestos work schedule ❑ Monday 0 Tuesday 0 Wednesday ❑ Thursday ❑ Friday 0 Saturday 0 Sunday

1 Shift from: 0 am 0 pm to ❑ am ❑ pm `,)- !

speaiy ---___--- --- -- DECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. II JUN j 7 2002 O 25. Total amount of asbestos-containing material to be abated during this work \ \

Square Feet, and/or— Linear Feet ' - %'lam„_ • ^ ~. ACP 'tP ± I 'W 21200 tM:P=A 1 J, f :: P 4fd':i' •:F.•9 3 f>j •:T214TA •:_fstfA7 c p~.~ spit

NYC-WTC 000111183