Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program ___ 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 4 /I i building OepL or TRU No ONLY FOR OFFICIAL USE ONLY ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) (Ste 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 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 10 Maiden Lane • _ BoroughManhattan Zip 1 0005 64 3. Block 4. Lot 21 5. Type of Facility___ 6. Name of Building _ _ II. BUILDING OWNER

7. Name Lillian Seril c/o LPB Mgmt. Co. 8.ContactPerson

9. Tel. # Fax #

10. Address City State Zip III. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan 14. Federal Ernp!oyerlD ._._._._._._._._PII 15. Tel # _7! .2 1-4100 Fax# 718-961-4103 16. Address?4-20 129th Street CilyC011ege Point _State NY Zip 11 356 V. THIRD PARTY AIR MONITOR

17. Name Warren & Panzer Engineers, P.C. l8 Contact Person Michael Nolan 19. Federal Employer ID. # 20. Tel. # 21 2-922-0077 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

24. Starting date for this portion of work 2C c 1— Projected completion date

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday 19 Saturday IN Sunday

Shift from: _0am ❑pm to 2 Dam pm 3 9 t^~ If other, specify Ra vEM Access to inspect the premises must be provided during the work schedule indicated in this item. _! I l) 1 9 2002 C~ - ,PrBANN~ 25. Total amount of asbestos-containing material to be abated during this work • J,SO ) Square Feet. and/or Linear Feet 3 TRUG

Z ACP 7 moot

NYC-WTC 000111247