Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document

-. „~~, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION . :° • `~~.' Asbestos Control Program Dti~ 59-17 Junction Boulevard, 80' Floor, Corona. NY 11368-5107 — A Building Dept. or TRU No ONLY r~ FOR OFFICIAL USE ONLY TYPEWRITTEN f hM~~~~ n~°d' ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1 ACCEPTED ---(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 Q Q 2. Address 1 -_ l D -OA L~ 1~.~A '~— ---- Borough Zip

AKA

5. Type of Facility, 6. Name of Build II. BUILDING OWNER

c /~ (~ 7. Name _L- h"_1_ &C'S i ~`~ t " ► ;%c3 ~J 9. Tel. fi~o2~ ~~ a ~2 =a 03 —Fax # -------------

10. Address _ 21DL—USA" S f III. GENERAL CONTRACTOR _ City —__L 1~ 0 11. Name-------------------------------------- --- IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name _ ( eIL ,S 14. Federal Employer ID. # 15. Tel. # _ ( 2 _

16. Address o c~' 1Y~_--__--- City J —LL.

V. THIRD PARTY AIR MONITOR

17. Name I 3 ,tT(ZE2NG PC--18. Contact Person •-

19. Federal Employer ID. # _. ._._._._. 20. Tel. # aJ=~aa =00 — Fax # 21. Address g L L { —/-- City ' State L~ Zip ( - 22. Sample Analysis Laboratory c_(aq`~ (( ~C- G- 9 r-~ ~° -'«5 ~'~ 23. NYS DOH ELAP # _ I ( -____

Projected completion date

❑ Tuesday ❑ Wednesday 0 Thursday ❑ Fri,

Dam ❑pm

during the work schedule indicated in this item.

to be abated during this work

Linear Feet 7 )1

NYC-WTC 000111207