NYC 9111 Public Portal Document
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V NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
" TM~~"` Asbestos Control Program
" ~ `L 59-17 Junction Boulevard. B°' Floor. Corona. NY 113665107 0 dwp Uv1 w TMU
FOR OFFICNL tl3E Cwtr
ASBESTOS PROJECT NOTIFICATION
•
` "____ (ASBESTOS INSPECTION RORT)
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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 94 NA Ss 11 St- r P P t- Borough Manhattan Zip
129-133Fult~r~ l t
AKA 129 Fulton St, 40 Ann St, 91 4. Lot 13
5. Type of Facility 6. Name of Building
If. BUILDING OWNER
attn. David UcrtYaaaPerson
7. Name Collegiate Church Corp.
9. Tel.# 212-233-1960 Fax#
10. Address City State Zip
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son
Control 13. Contact Person Louie lannico
PII `
14. Federal Employer ID. # ~------------------------------ 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 & PanzER et4EjjL 18. Contact Person Mt
19. Federal Employer ID. i i P 11 20. Tel. # (212) 922-0077 Fax # (212) 922-0630
City New York State NY Zip 10017
21. Address 228 East 45th St
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work O`t t o t 1 O 2- 13t 102
Projected completion date O T
Asbestos work schedule ..Monday EI Tuesday 0Wednesday I .Thursday %Friday 9 Saturday Sunday
4
Shift from: 800 _, ' am ❑ pm to 8 pO ❑ am $ pm 3
If r.
specify 1\t' EW is
Access to inspect the premises must be provided during the work schedule indicated in this item. JUN 27 2002
_P/BANHM , V
25. Total amount of asbestos-containing material to be abated during this work -' :STOS/LEt -
4OGRAM
RT2UG 00
12.29 Square Feet. and/or 0 Linear Feet !I ,`
, .
^71 ACP 7
2/2001
NYC-WTC 000099017
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