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) ~ ^ 72~ 2 _O _ Tel. O 26. Asbestos Mauler, ~~

Disposal Sites e2N _ _ NYS DEC Permit ew_~e s ?1&( 6 _ 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement f) n Other (Describe) ------------- ----------

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Otovebag ❑ Tent ❑ CEP Variance Application OO •

3U. i r yr DESCRIBE SECTION i AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING OF FLOOR CONTAINING ACM PERFORMED Floor(s) i SQUARE Llt4A (e.g. tunrolg cable. itnhailing Ike tprinklem, (e.J. entire. Mat u(ng, rpom C. (e g. Ppo logging. aline, pNnum FEET FEET mopj4 and møl ,n pollen, balesiocmjoDbv. •tc) ducts. t . tanks. didc. ale.)

knowledge. I am familiar with Federal, 31. 1 hereby declare that the information provided herein is true and complete to the best of my State and NYC laws and reauletiens aooliceble to asbestos related work

P.vt N Or/r7 b itot Ptin veme bb stop Contractor Print No of Ap nt (If oNar than Owner)

gnature • $ignatun

'0C -\D3-oa r `3- 0 2 32. 1 understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of with the Asbestos Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance declare that I have authorized the monitor who is completely Independent of all parties involved In the asbestos project. I hereby filing of tP notifi on for the work specified herein. -_^--- -- ` O.I. PriM Name Or Ottner $ignalvre AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE writing directly to the NYC DEP ACP. Anv modification of information provided on this form must be reported immediately in lawfully avoided or lessened The requirements of the Asbestos Control Program Rules may not be piecemeal fashion. through the p2Aorman_a of wrkin incremental or 2mc,

NYC-WTC 000111191