Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION ~'°.*.WTY,r, Asbestos Control Program c 44 ~ 59-17 Junction Boulevard, 8'" Floor. Corona, NY 11368-51O7 ' D~ A ASBESTOS PROJECT NOTIFICATION Building Oept. or TRU No fOROf 09CULUSEONLV

L` 4 WILL BE `"`"`"iO`~~c p.~rc aa.(a.r.. (ASBESTOS INSPECTION REPORT) 1 ______

SIC EPTED tee sehedu (See

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 -- 20'A - 13ROA Ot,x; A~ -- -----_ Borough — _MAty -- Zip _ ►a03'a --_

AKA 3. Block ----- 4. Lot

5. Type of Facility___ C:C4.AMEac; A.t- --- 6. Name of Building -----

II. BUILDING OWNER

7. Name _ C`.GLI.E~~~ATE ta•lt3Qc'i•+---------------- 8. Contact Person _— D J A il ----- _

9. Tel. # k 2121 2 33_ t 960 ---- Fax # ------------ 45 JCN N ST¢EE"= —__— ----__ City -- -- State ±L..._ Zip 10. Address

III. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR LourE__IANt~~co —__— 12. Name AMiW ieiiLLBAN q cmot J! _ 13. Contact Person_ i ------- - ---------1-1-1-1-1-.-.-.-...• 14. Federal Employer ID. # ._._._._._._._.P11 ;__ 15. Tel. # -t?It£?_ 331_ z 2 _-- Fax # ~ + ~?~`~= ~~ _____

16. Address _LZa8 rLA~..PN AvcN~ic------------ City —aaoc_V-" u __---_ State ..i _ Zip 1123E —_

V. THIRD PARTY AIR MONITOR

17. Name IR+AtZCrcA+ $ PAN2.E2 `fir a~cr~s _—__--- _18. Contact Person _M iC:taCt lk -AN ----

P11 ---- _ 20. Tel # l2 tz> 922- ,f.LL...__ Fax # 19. Federal Employer ID. # EAST 4511A s Tv-eer----- - City __ `tctN_1c ------- State NY Zip l 0o!__-- 21. Address _??

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

VI. PROJECT IITORMATION 24..Starting date for this portion of work _ cet_o3 2 _ Projected completion date __Q _csz -O2

Asbestos work schedule © Monday © Tuesday I I Wednesday 1I Thursday ® Friday I Saturday m Sunday

10 Shift from: _ 8Ci►A ® am ❑ pm to _ ❑ am © pm Jl . l If other, spec -------------------------------------------- RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. AUG •_, 0? 2002 25. Total amount of asbestos-containing material to be abated during this work 'aUG _J .12. Square Feet, and/or--- _ Linear Feet ACP 7 2noc

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