Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

,Eo -o7c NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Cfl' Of Asbestos Control Program OW rlt)oL ~P t 59-17 Junction Boulevard, 8" Floor. Corona, NY 11368-5107 Building Dept. or TRU No FOR OFFICUL USE ONLY f "("re. ASBESTOS PROJECT NOTIFICATION WILL BE (ASBESTOS INSPECTION REPORT) 1. e~ CEPTED J 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 2 A NLJ— S T 2E t. T ---_—, --__ Borough ------Zip _--

9a 4. Lot L AKA ---------- --------------- ---- 3. Block -- Q 5. Type of Facility-------------------6. Name of Building ----__-------

II. BUILDING OWNER

•.. 7. Name _ —Zt _ANN— S-riz T_L®czJi.__----__—_ 8. Contact Person _------~---_

9. Tel. # ---------------- Fax # ------- ---- 10. Address -- City -------------- State --- - Zip ------- ----------------------- III. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR

kua213afu 5 SON Cc,N1LCt------- 13. Contact Person co---- 12. Name P N1At~!N

14. Federal Employer ID. # PII _-- 15. Tel. # Fax # _C7l ra)_2C9=1go? —_

16. Address _! e City Beeoi«LN ------ State JL. Zip

V. THIRD PARTY AIR MONITOR

17. Name U:APaEN ~AN2t't2 ENE, NcE1zs----------- 18. Contact Person _ LA11----

19. Federal Employer ID. #; _. _ PII __-_-___ 20. Tel. # f2t2 922-c9'f T Fax #C2t2) g?2 _0630 __—_

21. Address _ 22 d C-AsT 45T1l S~y„~~T ----- City __ ±-------- - State N4 Zip _ioQ'f__—_

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

VI. PROJECT INFORMATION 24.. Starting date for this portion of work _ 06 2 Io 2 Projected completion date

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

800 Shift from: ~~ I~ am ❑ pm to ❑ am pm 3 s If other, ^ \~ specify ---------- `;~ READ --

- 1 schedule indicated in this item. ~_ 1 u 2 8 2002 AAWh~•~ 25. Total amount of asbestos-containing material to be abated during this work - ; GRAA __ Square Feet. and/or __..__2_ Linear Feet ` RUG L

OtP 1r EN'01NNry at W S o'.: Mci -•7 OScOti:iCl : V '•Ut

NYC-WTC 000111265