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Asbestos Project Notification Form, Corona NY

Machine-extracted title · confidence 95%

Formal notification of asbestos abatement activities submitted to the NYC DEP for a Corona site.

NYC-WTC_000111190–000111194

Folder label: “Zone I Originals

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NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program D~ I p 59-17 Junction Boulevard, 80 Floor, Corona. NY 11368-5107 Building Dept. or TRU No u1 ONLY t>~ FOR OFFICIAL USE ONLY TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION FORMS WILL BE f'~~NM~Nru:~n~`°± - (ASBESTOS INSPECTION REPORT) ACCEPTED " ^y :'•1"°~. (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 wl Q 2. Address E LIB ~ Borough y1 1 -- Zip 0 0 (

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

5. Type of Facility — 6. Name of Building --- II. BUILDING OWNER

7. Name —_ 8. Contact Person

9. Tel. # . ......-.-.-.-.-.-.-.-._.-._.-.... -.-.-.-. .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.... -.-.-.-.-.-.-.-.-.-.-.-.-.-.... -.-.-.-.-.-.-. 10. Address; P11 L_ State -! Zip _I1_

Ill. GENERAL CONTRACTOR

11. Name_--__ -- Tel. # -----

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ( C'll - -c v`'.-- U ! ----_13. Contact Person ~ _~~ L/ ----` 14. Federal Employer ID. # ! P11 15. Tel. # c~ 1 - 7~r 34 60 — Fax # _ c cJI 7/ cs

16. Address ~ q C~ `~--__--- City —__ / --_ State /U Zip 1L2 _ V. THIRD PARTY AIR MONITOR

17. Name y ~~ h7'(Z~ 2 G i~k~~S 18. Contact Person _--________-------

19. Federal Employer ID. # 20. Tel. # J Jaa =00 — Fax # I=_~~~=G& O _ `_~ 21. Address g L ~'S!=f~ --- City CL`€b`~ State Zip 100 (

22. Sample Analysis Laboratory____ (tomf ( « G=*6a r -a~~`r'ie5 c 23. NYS DOH ELAP

VI. PROJECT INFORMATION 24.. Starting date for this portion of work - Projected completion date ----______- r-1 r-1 Asbestos work schedule ❑ Monday 0 Tuesday ❑ Wednesday ❑ Thursday ❑ Fri

Shift from: ❑ am ❑ pm to _--__ ❑ am ❑ pm

If other, specify _----_

Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work 3 515 — Square Feet, and/or _---~ Linear Feet '7 01 h7 dF:l.,3 G .S3vl

NYC-WTC 000111193

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NYC-WTC_000111193Source: NYC Law Department, mirrored locally

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