Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

DEP ECB Fax:212-361-1433 Jun 28 2002 11:26 P.08

ASBESTOS INSPECTION REPORT (continued) ¢~ 2 72' c ~~ 7 26. Asbestos Mauler, LC _ NYS DEC Permit w0 _Tel. 0

Disposal Site(s) QU peke t 5 ~-~ L. EIL _ 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) e) 0 Demolition b) ❑ Boileriepleeement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration a) 0 Fireproofing Replacement ff ❑ Other (Describe) —__--_ ._--- -----------

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Otovebeg ❑ Tent ❑ CEP Variance Application 100 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING i PERFORMED Floor(s) OF FLOOR I CONTAINING ACM (a.p. antis. seat wing, room «. (e-g Pps legging. aline. pbnum SQUARE Llh5AR (e.g. running cable. initialling firs eprinklas, sic. FEET FEET mo: and aci polt•rs. biller A . etc ducts. • nk m + L

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knowledge. I am familiar with Federal, 31. t hereby declare that the information provided herein is true and complete to the best of my StatA and NYC laws and reputations aooliceble to asbestos related work

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a C -~o3 -O 32. 1 understand that as the owner of a building where asbestos abatement activity occurs. I am responsible for the performance of Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance with the Asbestos declare that I have authorized the monitor who is completely Independent of all parties involved In the asbestos project. I hereby filing of tl s notifi on for the work specified herein. --^--- }~ __ 1 oat• PnM Name Or Orrner Sgnalvr• AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE writing directly to the NYC DEP ACP. Any modification of information provided on this form must be reported immediately in Ac.? ante,

NYC-WTC 000111191