Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 0 Asbestos Control Program 59-17 Junction Boulevard. 8'" Floor, Corona, NY 11368-5107 ITTEN " DAP ASBESTOS PROJECT NOTIFICATION Building Dept. TRU 0 FOR OFFICIAL USE ONLY aiiQ cam MS WILL BE M (ASBESTOS INSPECTION REPORT) 1. ACCEPTED _ .^r5 :o+/ 4•r, 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 _-111.—F uLTON STREET —____ Borough MN--- Zip

AKA JLJ1U,IAM STREET ---SZO AWN Snte-VT _--_ 3. Block --__—__ 4. Lot

5. Type of Facility— COMMe2C1AL_----- — 6. Name of Building

II. BUILDING OWNER

7. Name X24 W 30 LLC 06A IS! WlW AM OPetx~►nNG LLC —_18. Contact Person _ SusAa—OOWG4tUE

9. Tel. # 12421924 - 9690 EKr .2T _ Fax #

10. Address _ 111 f iU=N STREET _ _ —_ -- -City _—~)tu Yc --___ State L... Zip

Ill. GENERAL CONTRACTOR

11. Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name l3E13.IAMlM VURZBAsl 4 SOW CoweOL I t•1C 13. Contact Person LoutE _ IANNiCO_____— ----------------------- ----- ----- ; 14. Federal Employer ID. #[----------------------------------.__ 15. Tel. # (119) 531_ 2 00 ___ — Fax

16. Address _I3 4 3~ -4PN A, t UIE -- City _6 Roo K L-Y rt —_ State N Y _ Zip

V. THIRD PARTY AIR MONITOR

17. Name lAARaE~► Pha2E¢ EWf, 1►~EERS 1aC_— __--_18. Contact Person _M ti1WAEL CLAO

19. Federal Employer ID. #:.----- PII 20. Tel. # j 2 3.) 2 .±2.!j__. Fax

21. Address _22 g EAST 4S TU STR SQ T City 21Ew Yorsac__--- _ State NY Zip L ....

22. Sample Analysis Laboratory__--__---___---_---------- 23. NYS DOH ELAP # ___-----

VI. PROJECT INFORMATION 24.. Starting date for this portion of work =113I 92 _ Projected completion date _ o ! IL) 02 _

Asbestos work schedule I I Monday I I Tuesday I Wednesday I Thursday 0 Friday I Saturday © Sunday n/ Shift from: _ g`~ I am ❑ pm to _ 8 ° O 0 am ®pm 1

If other, 0 specify N Access to inspect the premises must be provided during the work schedule indicated in this item. M!!0 L02 L CC0)FP/ T8ANmM ti 25. Total amount of asbestos-containing material to be abated during this work A~

32 331 — Square Feet, and/or Linear Feet ti ACP 7 t 212001

NYC-WTC 000111253 2