Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document v NYC DEPARTMENT 9F ENVIRONMENTAL PROTECTION Asb os Control Program Ar 59-17 Junction Boul v Floor. Corona, NY 11368-5107 Building Dept. or TRU No ONLY FOR OFFICIAL USE ONLY ASBESTOS PROJECT NOTIFICATION F (ASBESTOS INSPECTION REPORT) 1. ! f. : nyt tl _•/d•p (See fee schedul

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 1I J OilN STET Borough MN Zip __J 0038

AKA 3. Block T9 4. Lot IS

5. Type ofFacility AtE~tAI- 6. Name of Building II. BUILDING OWNER

7. Name CoJLEGtAl . Cttt112Cit Cogr. 8. Contact Person

9.Tel.# (212) 233-1%0 Fax#

10. Address A S 1o41N STRacET City _~3 uiotz t~ _ State _t _ Zip JQ36

III. GENERAL CONTRACTOR

11. Name_ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name 1361-UAMIN ¢ZAN 4 SON t✓orNr¢o1_ INC. 13. Contact Person Lmile I PNNtCo

14. Federal Employer ID. # PII __15 Tel # (1t8) S31- 2 00 Fax # C?t6) 109-11808

16. Address 124 _ City 82ooKly 1J _ State JL.. Zip !1236

V. THIRD PARTY AIR MONITOR

17. Name UJP%LtzEN \ PA►J2E7t_ E.1J(e1NFErtS 10C• 18. Contact Person MtW_Ae~ Nlou►N

19. Federal Employer ID. PII — 20. Tel.# (212) 922-oOT 'r Fax # 2j!) 922-o630

21. Address 226 EAST 45 T11 SrREE7 City NEW j _. State JL. Zip _I001'C

22. Sample Analysis Laboratory 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24- Starting date for this portion of work .13..LLL `T ~ Z Projected completion date q I -_Q 2-

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

Shift from: - S 18 am ❑ pm to S ❑ am I pm

If other, specify RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. 1 AUG 0 8 2001 her.' 25. Total amount of asbestos-containing material to be abated during this work to

_' t f0 Square Feet, and/or 0 Linear Feet \ iUG ACP 7 7 21200' 9 l Cf 4~::° ltlp(hTQ

tc., ,

2 NYC-WTC 000111231