Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

1;;.)1 a2:iL.Y C._ Øøc' °'a NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8' Floor. Corona, NY 11368-5107 Building Dept. or TRU No w FOR OFFICIAL USE ONLY L ~~~0 ~atiruiRo~°c~ ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) I CEPTED ^r<:<<re<r

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

2. Address ___19f__ ~rto AD W A -- --------__ Borough — MN_ --- Zip

AKA —____-- 3. Block _._.L__ 4. Lot _ I IB ----

5. Type of Facility__ e:O#AME¢G AL- 6. Name of Building

II. BUILDING OWNER

7. --_ Gluectx — CO---____------_ —___--_---- Name000LrcGtIs+.TE 8. Contact Person

9. Tel. # C 196p__ Fax #

10. Address AS JOU N S -reEE'T --____----- City — New yOt2it:---- _ State Nti! Zip

III. GENERAL CONTRACTOR

11. Name---- ----------------------------------- Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR CoNrw_oL W C - -_13. Contact Person _ LOUIE IANI.rlCO 12. Name i3E1t.AMtN1 Nuezt3Fw ` —So,. ------------ - ..-.-.-.-. 14. Federal Employer ID. # __ 15. Tel. # CTtf3)Sal-2gCo------ — Fax #

16. Address _! 49 RAL.PN AVC-AIJE _ City Beao~c~~N _---_ State j_ Zip _ 11296

V. THIRD PARTY AIR MONITOR

17. Name WARt2EN PAN2Ett EN6I - -_18. Contact Person MICHAEL NOIAN ---

19. Federal Employer ID. # PII _ 20. Tel. # Fax #

21. Address _ _?E East-- 45 f1_ ---- City New Voex____-- _ State JL_ Zip _I .21L__

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

VI. PROJECT INFORMATION Projected completion date 5^ 24.. Starting date for this portion of work

Asbestos work schedule ® Monday IN Tuesday I Wednesday ® Thursday IN Friday © Saturday ® Sunday

Shift from: —8~ © am ❑ pm to 8❑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 ,EJ x_,24 S8 Square Feet, and/or Linear Feet i ACP 2/200'

NYC-WTC 000111241