NYC 9/11 Public Portal Document
/iJ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
' Asbestos Control Program reAA 6 a
DONLY
59-17.function Boulevard, S Floor, Corona, NY 11368-5107
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
7YP ~ ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT)
www.n c.6ov/ap
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.
1. FACILITY
2. Address 124 Nassau Street Borough Manhattan Zip
AKA 3. Block 92 4. Lot 29
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7.Name Mr. Arnold Schwartz c/o Franc —Men R S.ContalctPerson
9. Tel. # 212-929-9807 Fax#
10. Address City State Zip
Ili. GENERAL CONTRACTOR
11 Tel. #
r
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control _13. Contact Person Louie lannico
14. Federal Employer ID. ifi P11 ' 15. Tel. # (718) 531-2900 Fax # (718) 209-1808
16. Address 1248 Ralph Avenue City Brooklyn State NY Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name Warren & PanzM (5366 t$$ t i !3C 18. Contact Person I lo. i.Lfr . WeLA*4
19. Federal Employer ID. #L
-...--.....P..
........... 20. Tel. # (212) 922-0077 Fax it (212) 922-0630
21. Address 228 East 45th St City New York State NY Zip 10017
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work Co 2 lo Projected completion date /1 0 0 Z .'
Asbestos work schedule 0 Monday 0 Tuesday ❑ Wednesday 0 Thursday 0 Friday 0 Saturday 0 Sunday
Shift from: ❑ am ❑ pm to ❑ am ❑ pm 4 S7
If other, 6'
\7
specify if' .U
t 1 "1
Access to inspect the premises must be provided during the work schedule indicated in this item.
25. Total amount of asbestos-containing material to be abated during this work ; '~ T0H4q
__3665 X Square Feet, and/or _ 0 Linear Feet N _J~
ACP 7
2/2001
NYC-WTC000098737
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