Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

( W `` czi // ,n, O ~"',, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard. a Floor. Corona, NY 11368-5107 Building Dept or TRU No FOR OFFICIAL USE ONLY EN f ~ i ASBESTOS PROJECT NOTIFICATION ILL BE (ASBESTOS INSPECTION REPORT) EPTED ( é 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 foram must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities .

1. FACILITY ,r __ !I 2. Address ~~ t~f~'~'''1~L S "~ 1 Borough ~~ Zip

AKA, 3. Block R 7 4. Lot 2 2..-

5. Type of Facility 6. Name of Building

11. BUILDING V1M R_ 3 (0 7. Namee m M ' 8. Contact Person

1 (P-4-4 0D 9. Tel. # J2 Fax # ww `~ ~~(( ~ (~'~ 0 ~"' 10. Address L ~ ^'_' _- :L'__$_- City —~"_` tt State N ZZip -- .CQQ -- III. GENERAL CONTRACTOR

11. Name_. ._. .___,.._..____________________ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ~~ -------- 13. Contact Person ~07~ ~"S~L______

14. Federal Employer ID. # 1......._._._._ WPII W_ _. 15. Tel. # --7~1c----3O00 16 - 51_e Fax # _--__--- 345 16. Address Qlv lLL~t ~_— --- City —_ / ~/ _ State N Zip 11 3

V. THIRD PARTY AI)2 MONITOR ,, r 17. Name rh(ZElL Gi-AtTT_S hh rC 18. Contact Person L ("

19. Federal Employer ID. #_____._______ 20. Tel. # a r3=~aa - 00~~ Fax # z13 2 -0630 State ~ Zip 00 21. Address 2 I_4 -- City ~-rrW~

22. Sample Analysis Laboratory— C( f (1 c 23. NYS DOH ELAP # -

VI. PROJECT INFORMATION 1 _ Q 24.. Starting date for this portion of work o~ Projected completion date 0

Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday Saturday 0 Sunday

Shift from: __ ❑ am ❑ pm to 0 am ❑ pm

If other, p . specify -------- -- — — RED s Access to inspect the premises must be provided during the work schedule indicated in this Item. - JUN 8 200? o, 25. Total amount of asbestos-containing material to be abated during this work pESQNM

Square Feet, and/or _ Linear Feet T?~CAMfA V a ACP: 6 ?1200 aJe ev n• E,,?".?pFr. i:i,.gas RC.1. PFf.~A;,f.l IAlly

NYC-WTC 000111200