Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

jg5t I : , ARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program N'; 59-17 Junction Boulevard, 8"' Floor, Corona. NY 11368-5107 i ! Building Dept. or TRU No ONLY r,"p/ ^ ' FOR OFFICIAL USE ONLY y ASBESTOS PROJECT NOTIFICATION y pE WILL BE O""'~" ~ `' (ASBESTOS INSPECTION REPORT) ACCEPTED ..., ~.r___ i fee 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 21 1 Broadway _ BoroughManhattan Zip 10038 AKA_ St, Paul's Church _3. Block 4. Lot

5. Type of Facility__ 6. Name of Building II. BUILDING OWNER

7. Name 1i t' ` / CI u LC 8. Contact Person Dbwp It It I 1ti+t L4

9. Tel.# 21' 6 O2 9610 Fax#

10. Address 29 1 City M N State N 1 Zip I Q 00

Ill. GENERAL CONTRACTOR

11. Name__ _ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan 14. Fedoral Employer ID. P I.I._._._._._._._._.r—i 5. Tel. # 71 8 - 9 61- 41 0 0 Fax # 71 8 961 - 41 0 3

16.Address 14-20 129th Street CityCollege Point __StateNY Zip 11356

V. THIRD PARTY AIR MONITOR

17.Name Warren & Panzer Engineers, P.C. _18 Contact Person Michael Nolan

19. Federal Employer ID. # 20. Tel. # 212-922-0077 Fax# 21 2-922-0630 21.Address_228 East 45th Street city New York State NY Zip 10017

22. Sample Analysis Laboratory Warren & Panzer Engineers 23. NYS DOH ELAP # 11251 VI. PROJECT INFORMATION lA OL 24. Starting date for this portion of work Projected completion date i 3 t ) 43 -

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday Saturday iunday

Shift from: m ❑ pm to ❑am%pm

If other.

9AC 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

2 ,3 00 Square Feet. and/or Linear Feet 7 212001

NYC-WTC 000111245