Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

I C . cw4A NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION u( P %. `•-. Asbestos Control Program 5917 Junction Boulevard, 81" Floor. Corona, NY 11368-5107 leafBuilding i Dept. orMAI ONLY Si ~ ASBESTOS PROJECT NOTIFICATION. FOR TRU No ONLY

OFFICIALLUUSEE (ASBESTOS INSPECTION REPORT) 1 0 D nyc i.er/eel . (tee 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

2. Address 102- 104 FULTON STREET-- ____ Borough -- MN-- - Zip 1003$—~_

AKA 3. Block T6 4. Lot 21 _ --------------- ----

5. Type of Facility_ —COt,A hnef-cl AL ----- — 6. Name of Building

II. BUILDING OWNER

7. Name LEG o.0 Y F ~: LTCN S. 2e eT CCe P. —~--_ 8. Contact Person YAIR L%VY

9. Tel.# - (Sir-) 4C-6_49c)2---Fax# t5i6) 466=4952 —

10. Address JJJ D — SutTE 2c5 City —~Qc-Az 13~cK --_ State Zip - 110 2 1 _--

III. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name B~_►a~A~vlLry kv22t3AN 500 Cearaet_ - -_13. Contact Person _LOQIE IANNtCO --------------- ------------------ 14. Federal Employer ID. # _._._._._._._!!!. .i____ 15. Tel. # X119) 573►=2900 ___ — Fax # c-tts>_2e9- ISOS

16. Address _L24 _ 2~1~PN _Ave NuE----------City — Baecku-~N —--- State Nti __ Zip _11 2 36—

V. THIRD PARTY AIR MONITOR

17. Name ---------- _18. Contact Person -MteapEL CLAo

19. Federal Employer ID. # P11 20. Tel. # c21~1 92z-ooT~' -- Fax # ---

21. Address 2 2& en_s_ 4 ;u 5.tz~T ----- City ti _IO ___—_ State _ 1L _ Zip _Loo!7 ____

22. Sample Analysis Laboratory 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work 2J__ Projected completion date

Asbestos work schedule ® Monday 13 Tuesday ® Wednesday 0 Thursday I 1 Friday 0 Saturdat Sunday

Shift from: 8"~ f ff L... ❑ am ® pm ® am ❑ pm to _—

If other, 4. .'~

specify ----------------------- --------- RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. JUL 222002 Sft1¢/ ti 25. Total amount of asbestos-containing material to be abated during this work \ TR11G __2_ Square Feet, and/or __....... ..9_Linear Feet ACP 7 2/2001

~?sQdSCC~c<.•„ .. •.,~. lPd l ~,

~J NYC-WTC 000111243