Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

1IL +pPy, CIlY 0G,4t NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ( 24 Asbestos Control Program 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 DP~ ASBESTOS PROJECT NOTIFICATION L. Pudding Dept. or TRU No FOR OFFICIAL USE ONLY C N'WyNfK fllD~ BE (ASBESTOS INSPECTION REPORT) 1. www.nyc.se+(a<r PTEO 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

202 BROADWAY -- __------- ----__ Borough MAN Zip _---_-- 2. Address

AKA ------------------------------3. Block r_ . __ 4. Lot _ 19 --

5. Type of Facility___ COMME2C!At- -------- 6. Name of Building

II. BUILDING OWNER :w. 8. Contact Person 7. Name - ________________

9. Tel. # _ -------------- Fax #

10. Address _--__—__— ---__—_ City State _____ Zip

III. GENERAL CONTRACTOR

11. Name------------------- -------- Tel. # - - IV. ASBESTOS ABATEMENT CONTRACTOR 13. Contact Person LC¼.E I AfLtJiCO -- ____- 12. Name 13F_M AM11N KU2Z6AN4 50N C RGL -----

14. Federal Employer ID. # P11 ___ 15. Tel # _Si!)_ 3i - __-- 2.Q.... ...... Fax # _~?i 5~2 °`~_I? g _____

16. Address ! 2A 8_ RFL LPN Av E NU c _------ City _ f3._'co►c~Y N__-- --_ State J~`c__ Zip _ i 12 3b-- _

V. THIRD PARTY AIR MONITOR

17. Name W ~ PANZER _ Ccwc-, t.►ce RS —__--__--_18. Contact Person _MICHAEL_ NCLAN ----

__ 20. Tel. # C'2r2) 922- 0-TT -- Fax Czlz) 9Z2- 063 c% 19. Federal Employer ID. # __ __ _ _ _PII ____ ___. -----------

21. Address 22 EAST 4i 1H — ~TZEET ----- City rlEw lbtsK __—__—_ State _NY _ Zip _ _--.

22. Sample Analysis Laborato __—__—__—__--------------- 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work j2 Q ?/ Projected completion date

Asbestos work schedule © Monday I Tuesday © Wednesday 10 Thursday Friday 121 Saturday © Sunday ~ G• Shift from: E—®am❑pm to ❑am®pm

If other, ' specify ------------------------ ----------------- QCC Access to inspect the premises must be provided during the work schedule indicated in this item. o . r- 4r✓f7 N

Ø 25. Total amount of asbestos-containing material to be abated during this work tSUIT44 S r —14 SSo — Square Feet, and/or . Linear Feet ACP 7 2!200 •

NYC-WTC 000111239