Asbestos Project Notification form, Corona NY

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NYC DEP Asbestos Project Notification form for inspection report submission.

NYC-WTC_000111229–000111266

Folder label: “Zone II Originals”

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NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program gelw ' 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 or TRU No FOR USE ONLY ONL ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1 C~E w.eyc.=e.ld ♦p (Seb fee schedule)

original When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with This signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. 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 I82 6ROAD W A4 ----__ Borough — _M__.._ Zip _-----_

AKA — 2 _ you t3 S c¢EEr -------------_ __-- 3. Block -- 65 w 4. Lot ----

5. Type of Facility___ CoMMEf-C4A _ —__---N— 6. Name of Building ------------

II. BUILDING OWNER

7. Name _F o_J28_ ►M C"- Al —_ • 8. Contact Person Rtc MAR.D MAR. us

9. Tel. # --__----__--- -- Fax #

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

III. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name BE►»A" i Ku2ZBA N L S cw COu-rru_ - 13. Contact Person :.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.- 14. Federal Employer ID. # -i.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-r-- PII 15. Tel. # ~2i8) 53L _2%ro_____ Fax # L!2 _ o—_____

16. Address 124 £i 2s.i-P11 /.vim►, G — City __BaW + rS—__--_ State NL __ Zip _ff2 36--_

V. THIRD PARTY AIR MONITOR

J!3C_—__--- 18. Contact Person --- 17. Name WA2RE1J fi PAN _•s¢ E

19. Federal Employer ID. # P11 } 20. Tel. # L 212? q 2 ?=!T -- Fax # S?t2?_92;0 a63 `_'_____

21. Address 2x8 e<.s: 45T1 Srtza ------ City __ q+ Y=om __ —_ State _N`L. Zip - 100 .I--_

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

+. VI. PROJECT INFORMATION / , / ) 2- U Z 24.. Starting date for this portion of work __71[[ Projected completion date _!-2~ / 0 -- -

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

0 am ®pm a s~ Shift from: — ®am ❑ pm to —g

If other, 4 specify --------------- ------------------------ R`[ CEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. JI I 1 1 7 2002 : '3ANHt' cSiOSiI:_ 25. Total amount of asbestos-containing material to be abated during this work !P.OGR:w / i RJ G h 2S22T — Square Feet, and/or _---d Linear Feet ACP 2/200

NYC-WTC 000111249

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NYC-WTC_000111249Source: NYC Law Department, mirrored locally

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