Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

X -1 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8°i Floor, Corona, NY 11368-5107 vv ONLY i DONO ASBESTOS PROJECT NOTIFICATION Building Dept. a FOROFFICUt oriRTRU Pro ONLY

FOR SE (ASBESTOS INSPECTION REPORT) eerNep A — _ "Yc (See fee ule)

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 NYCOEP 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 196 6RCADU AY Borough MAN Zip

W~1 3. Block T9 4. Lot j66

5. Type o(Facility_ COMMERCl At-- 6. Name of Building II. BUILDING OWNER

7. Name 8. Contact Person

9. Tel.# Fax#

10. Address City State _ Zip

Ill. GENERAL CONTRACTOR

11. Name . N Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name, AM114 K-U1023Am 13. Contact Person Lcu1E IA0141CC

14. Federal Employer ID. # PII 15. Tel # (1 IB) 58t- 2900 Fax # C11t3~ 2C9~i 806

16. Address 1246_~ALE AVENUE __ City 6¢coKt_YN State _ !L. Zip if23G

V. THIRD PARTY AIR MONITOR

17. Name WQRREtJ PAa2ER E N61 NEE RS 18. Contact Person MICLIAEL NCu.N

19. Federal Employer ID. # ` P11 20. Tel. # (212) 22 - 0011' — Fax # (212) 922 -0690

21. Address 228 EAST 45'T►1 15=sET City NEw Ycazse _ State _ _ Zip _ joo$T

22. Sample Analysis Laboratory_ — 23. NYS DOH ELAP # ___________-

VI. PROJECT INFORMATION 4 24_ Starting date for this portion of work 1 QZ Projected completion date ~O

Asbestos work schedule El Monday © Tuesday ® Wednesday ❑X Thursday © Friday © Saturday 0 Sunday

Shift from: 8 ® am 0 pm to 8 0 am ® pm

If other, cc specify ---~ RC~iVED N / 'AUTj 0 p 2002 Access to inspect the premises must be provided during the work schedule indicated in this item. -

^AfiHtvf )::-]) 25. Total amount of asbestos-containing material to be abated during this work '41 AO `UG 2it5 Square Feet, and/or 0 Linear Feet S '(, ACP 21200

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NYC-WTC 000111229