Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

2— r7 NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program t 59-17 Junction Boulevard, 8"' Floor. Corona. NY 11368-5107 Building Dept. or TRU No FOR OFFICIAL USE ONLY

hMearA<rtoR ASBESTOS PROJECT NOTIFICATION ~' (ASBESTOS INSPECTION REPORT) ACCEPTED fee schedule)

three (3) copies with original When submitting this form at the NYC Department of Buildings, the original form andwith original signatures. This signatures are required. Submittal at the NYCDEP requires one copy of the form start of abatement activities . form must be submitted to the NYC DEP not less than one week in advance of the

I. FACILITY

_. N 5'_Iz.CT -------------- Borough . L. ......._ Zip 2. Address _—j 5 3. Block _L 9...____ 4. Lot _j4_______ AKA --------------- ----

5. Type of Facility___---__------_ 6. Name of Building

II. BUILDING OWNER 8. Contact Person 7. Name _------ —

9. Tel. # ----------- -- Fax #

City State _____ Zip 10. Address _-----

Ill. GENERAL CONTRACTOR Tel. # 11. Name---------------------

IV. ASBESTOS ABATEMENT CONTRACTOR -G----------13. Contact Person 12. Name ~'

14. Federal Employer ID. # P11 15. Tel. # _ CZ ) s3i - c9e~ _-- Fax # _tll$l —_____

___-- City — 6 * ----_ State NY__ Zip _iti 3E_—_ 16. Address _ 12A E_ RR~Ft1_J1vi CE

V. THIRD PARTY AIR MONITOR e"iissees 18. Contact Person _1+rtC12aE =__ LAa 17. Name (~iAR E6 _ _pAN2~t2 -----

2) LL.___ Fax 19. Federal Employer ID. # _P- __ __ 20. Tel. # L2i

2_Lfs t _r _gSTli S_ReET ----- City __ ~c•(zit _ State _NL_ Zip _IGaIY __—_ 21. Address _ 23. NYS DOH ELAP # 22. Sample Analysis Laboratory

VI. PROJECT INFORMATION q _Z Projected completion date __L5?_ p 24.. Starting date for this portion of work 4 91 Q 1

Wednesday ❑ Thursday 0 Friday 0 Saturday ❑ Sunday Asbestos work schedule ❑ Monday ❑ Tuesday 0

Shift from: — © am ❑ pm to _-8— ❑ am ® pm

If other, specify ________ -- RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this

25. Total amount of asbestos-containing material to be abated during this work item. •jt i i !°° 1t ) __2 Z QOd __ Square Feet, and/or _ o — Linear Feet 7 ` ACP 21200 m; P f`t^ nr'Etit~SCFMCE MT •~• ; iRul

NYC-WTC 000111237