Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler - i ES i N~ ----__ __—~ NYS DEC Permit # NJ - 4 6 2 —_ Tel.# (718) 522-2263 -

Disposal Site(s) BLUE Q(D6E LA►oD I ~—L PO 80x 399 —,------- —'

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration

e) 0 Fireproofing Replacement f) ® Other (Describe) _c~EAN= u _—_----------- --- -

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation ❑ Repair Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application &A ' f1A A .S 1 ' 'T A.P \ 3U. LV\.N I IVIrJ 'Jr MOI11 G1v1 1\ 1 .-^ ` ^^ _

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING OF FLOOR CONTAINING ACM PERFORMED Floor(s) SQUARE LINEAR (e.9 running cable. installing fire sprinklers. (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum FEET boiler room, lobby, etc) ducts, storage tanks, decking. etc.) FEET ' removing and replacing boilers, etc.)

FACADE Sojnt FAC E ( teEEr) 1230 Pao_ Suk_^ 2625 F 1 -DGE 33U tt PA QAPET

tl PAQAPEf WAtt_ G

It A/C ow ITS 600

It Doer WC CK 500

It E,(TEt.1D'cD LUAU. 4O

I am familiar with Federal, 31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. States and NYC laws and reaulations aoolicable to asbestos related work.

(L)AQ2tr1d ~AW7 EtitC~rut S _4 LEtJJAMt~1 V1Q2BAN S _ Print Name of Air Monitor Prin Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature ~~ ignature

a6~ ' oz. o•Z — — Date --- Oate Date

am responsible for the performance of 32 I understand that as the owner of a building where asbestos abatement activity occurs, I the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air in asbestos project.. I hereby declare that I have authorized the monitor who is completely independent of all parties involved the filing of this notification for the work specified herein. oCo 2G Signature Date Print Name of Owner AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE writing directly to the NYC DEP ACP. Any m dification of information provided on this form must be reported immediately in avoided or lessened The requirements of the Asbestos Control Program Rules may not be lawfully fashion. At; through the performance of work in incremental or piecemeal 2r

NYC-WTC 000111266