Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

u.. a,+n NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION T_ .)S L ~1~•►- Asbestos Control Program , 59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 —~~~C~~~ Building Deptor TRU No L D~P FOR OFFICIAL USE ONLY ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1 ~ EPTED . <p<a., / e<r • ( a tee 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 1_64 —lU f l.L1A I _ SsL Jr -------_— Borough M~ --- Zip 14438 2. Address 93 AKA -----------------------------3. Block -- --- 4. Lot _ 2A ----

5. Type of Facility__ M 1 x E o us t--------- 6. Name of Building ---------- —__—

II. BUILDING OWNER

7. Name SAL V n i c 1L&,— Po a To--------- - —_ 8. Contact Person _............. ---------------------------------------------- 9. Tel. # .PI!.-------------------s--- Fax # ------------

10. Address P11 City (N N I rr sca N E --_ State _N`!LZip __Lt 3 S 7 _

Ill. GENERAL CONTRACTOR

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

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name ( N~An~iy ky~t~g~—Sow—oN __ N~_---_ 13. Contact Person ~w~_ ANNA—__— g0 14. Federal Employer ID. # - PI I 15. Tel. # _~ tt6) 3 3 I=_? 9 ooM __ Fax # ~_«b ?~`~_! `3 -----

16. Address t 2<(> 2N~p►~ _~vE1JC c -- __-- -__-- City -- 41¢ic►~~ )J _--- State uj Zip - 112 36 ---

V. THIRD PARTY AIR MONITOR N~E!5 --_18. Contact Person _AI~eKne~ 1JC~A11 —__- 17. Name __ 19. Federal Employer ID. # PII 20. Tel. # C2121 22 a~L — Fax #

21. Address ?? EAsT__45 ~u s;-rzc-E -- ----- City __—~CiuYo(..K ---_ State _NL_ Zip _L 00 17 —_

22. Sample Analysis Laboratory___—_——__—_---------__--- 23. NYS DOH ELAP # VI. PROJECT INFORMATION 24.. Starting date for this portion of work _ i2±22._... Projected completion date

Asbestos work schedule ® Monday ® Tuesday I Wednesday ® Thursday © Friday ® Saturday ® Sunday CO. . g 10 Shift from: _ 8 ® am ❑ pm to _ 8 — am ❑ pm

If other, / specify -------------------- -------------- RECEIVEU \ Access to inspect the premises must be provided during the work schedule indicated in this item. AUG 0 5 2002 .• ~;, r~Hr.t 25. Total amount of asbestos-containing material to be abated during this work — ___230 Square Feet, and/or _—_— o Linear Feet ACP 2/211(

NYC-WTC 000111235