Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

0Cily CXrtivr NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 — ONLY D~A.IP Building Dept. or TRU No FOR OFFICIAL USE ONLY TYPEWRITTEN ''~ MINrLLVWRic ASBESTOS PROJECT NOTIFICATION FORMS WILL BE ' (ASBESTOS INSPECTION REPORT) ACCEPTED _-_-':"y f0tif° •C. (See fee schedule)

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 --__ 1~E ~? LL4~ -- Borough Fv 1 Zip

AKA ----------------------------3. Block ------- 4. Lot

Type of Facility. 6. Name of Building

II. BUILDING OWNER

7. Name 11 -- --_ 8. Contact Person _' _ ~✓ —

9. Tel. # P11 ; Fax # ___ --- ----------------- - - - - - - ----- 10. Address P11 I City P11 Statt P11 Zip_ P11 III. GENERAL CONTRACTOR

11. Name-___ --- ---------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ~T- _ _----- _13. Contact Person

14. Federal Employer ID. #1---------------- P11 _15. Tel. # cJ -306 0 Fax # r' — -- 16. Address o~ ~ 1!~_--__--- City ~ State Zip _LLZLL _

V. THIRD PARTY AIR MONITOR

17. Name---l~y~ 2 _ Z~rL 1(~r ??S+_F≤_

19. Federal Employer ID. # 20. Tel. # ~(3_

21. Address L— r —JJ-- City i!€

22. Sample Analysis

VI. PROJECT INFORMATION

24.. Starting date for this portion of work ____--_----_ Project

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday

Shift from: __—_— ❑ am 0 pm to ❑ am ❑ pm

If other, specify

Access to inspect the premises must be provided during the work schedule inmcateo in (015 Item.

25. Total amount of asbestos-containing material to be abated during this work 35 — Square Feet, and/or _—_-- Linear Feet 7 P 91 B7^FAB 11' 'I t Rr . S' .cFn! :L~ f3~.Ei.'khT '71 tCu 7

NYC-WTC 000111192