Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

D "" Th ' NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION °" 4 Asbestos Control Program DAr~ a 59-17 Junction Boulevard, 8°i Floor, Corona, NY 11368-5107 /~'''~ •~v C Building Dept. of TRU No t>r FOR OFFICIAL USE ONLY RITTEN ' ASBESTOS PROJECT NOTIFICATION NfK ~ WILL BE (ASBESTOS INSPECTION REPORT) 1 j~~~VWCEPTED — - (See fee le)

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 NYCOEP 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 stag of abatement activities.

I. FACILITY

2. Address _LEL. ~I th A Pr C Borough Zip Jb D, _

AKA 3. Block 4. Lot

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

II. BUILDING OWNER

7. Name _g J 1L( -_C a>Ac{__I- fJG 8. Contact Person p 9. TeI. #

10. Address _ j 1 —lS — City _4. State 0 Zip - I O2 Ill. GENERAL CONTRACTOR

11. Name___—__—

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ee 1 __ -------- -13. Contact Person PII 14. Federal Employer ID. # i._._____,,.______._.,,,~15. Tel. # cj16 - 71 1' 3400 Fax

16. Address ol~J2 --- City ~ __—_ State N Zip 1[L

V. THIRD PARTY Al MONITOR rr 17. Name kr(ZE2 6 i4 'S PC 18. Contact Person _

19. Federal Employer ID. # ___---- 20. Tel. # a r3_J91P - OOJ Z— Fax # a_~a O. 30 'O

21. Address gK1 City _Tx State ` Zip _ OO ( .

22. Sample Analysis Laboratory_ -(E?(1l;<« h L x'«S ~c 23. NYS DOH ELAP # _ 9-0

VI. PROJECT INFORMATION 7 i 80 24. Starting date for this portion of work _ li 12aoi Projected completion date /, /Zoo z Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturda ❑ Sunday

Shift from: ❑ am ❑ pm to ❑ am ❑ pm •~~,~- ~i.;

If other. /~ \'\f` \`\ \ - r E( t 1`

Access to inspect the premises must be provided during the work schedule indicated in this Item. ` .._ LI IV 1 7 2002 25. Total amount of asbestos-containing material to be abated during this work ; :

Square Feet, and/or Linear Feet 2 7~ ACP 22O( S o: p . E• ?~ :1 ~I.^.4L lS3c:'Jj Cr.:BGI trill

NYC-WTC 000111185