Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION +d" '+ Asbestos Control Program a 58-11 Junction aaaevard, 8" Floor, Corona. NY 11368-510?

°YPEEWRITTEN TY D ~~ rasa ASBESTOS PROJECT NOTIFICATION i FORD Ficw Oea sr ONLY

FORMS WILL BE NrA.r (ASBESTOS INSPECTION REPORT) 1. ~! (S fee se ACCEPTED "" -r !'•~"" original form and three (3) copies with original When eubmltting this norm at the NYC Department of 9undings, the signatures are required. Submittal at the AIYCDEP requires one copy of the form with odainal signatures. This form must be submitted to the NYC OEP not less than one week in advance of the start of abatement activ1iies .

I. FACILITY _ rte ` g ~— ~~ 1 Borough _.Jl._ — Zip 2. Address _ __ --~ _--- 3. Block ` `t 6 4. Lot _1 AKA ---------------— -- 8. Name of Building ,_— —_-- — 5. Type of Facility It..BUILDING OWNER ------_ 8. Contact Person _-- 7. Name ~.._ _ ~1L —

9. Tel. # _._._.~.-.-.-.-.-.-.ti-.-.P11 .-.-...- .ax # ------------- — 10. city _ ` --- State III. GENERAL CONTRACTOR ----- Tel. # -------------...... 11. Name -----------------------

IV. ASBESTOS ABATEMENT CONTRACTOR -----_..____13. Contact Person _ y ~ — 12. Name .. .i._

14. Federal Employer ID. # j------------------- 1 -15. Tel. # : ~E~J-3ao o _ Fax # City /~'r ---- State Iv Zip .iLZ - 16. Address Olc-)-& P ------- 1~~J~=-~

V. THIRD PARTY AI MONITOR . r 17. Name L 7~ ~_,._ t8, Contact Person

19. Federal Employer ID. # _______ _ - 20. Tel. # as _a0 — Fax # ~Pt-r zip AW City -CL ----- State 21. Address g rte _ 5?i.~—~{ -- oXf 23. NYS DOH ELAP 9_i r __.._ 22. Sample Analysis laborat ry__ .(

V1. PROJECT INFORMATION 0 Z 24.. Starting date (or this portion of work I Q? Protected completion date —3 r Friday O Saturday ❑ Sunday Asbestos work schedule Q Monday Q Tuesday ❑ Wednesday ❑ Thursday ❑ 2 3 s Shift from. _-- ❑am❑pm to ___ O am0pm

It other, RE O item. JUN 2 8 Access to inspect the premises must be provided during the work schedule Indicated in This 2002 u

25. Total amount of asbestos.containing material to be abated during this work Square Feet, and/or ___— Linear Feet ACP 7 1; 212001 Ala AJ or I M~ ~trry L (►;t;A~ Pr*0,1 m~ro

NYC-WTC 000111190