NYC 9/11 Public Portal Document
O~ 3 / NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
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Asbestos Control Program
59-17 Junction Boulevard, 8n Floor. Corona. NY 11368-5107
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Building Dept. or TRU No
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FOR OFFICIAL USE ONLY
M
ASBESTOS PROJECT NOTIFICATION .
ILL BE
.w.n <. ov/ae
(ASBESTOS INSPECTION REPORT) 1.5&c c
EPTED fee schedule)
copies with original
When submitting this form at the NYC Department of Buildings, the original form and three (3) signatures. This
Submittal at the NYCDEP requires one copy of the form with original
signatures are required. abatement activities.
form must be submitted to the NYC DEP not less than one week in advance of the start of
I. FACILITY
94 N a a a a I1 Si - r P P I- Borough Manhattan Zip
2. Address
129-133Fult9110skt 13
Fulton St, 40 Ann St, 91 4. Lot
AKA 129
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
Collegiate Church Corp. attn. DaviC~8116t~erson
7.Name
9.Tel.# 212-233-1960 Fax#
City State Zip
10. Address
III. GENERAL CONTRACTOR
•-
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
Kurzban & Son Control Louie lannioo
12. Name Benjamin 13. Contact Person
14. Federal Employer ID. #~ P11 15. Tel. it (718) 531-2900 Fax # (718) 209-1808
City Brooklyn State NY Zip 11236
16. Address 1248 Ralph Avenue
V. THIRD PARTY AIR MONITOR
__18. Contact Person Mt G1A 1, o1J%N
17. Name Warren & Panz>E2 CNU I1J EE P S -
P 11
19. Federal Employer ID. #------- -------
i 20. Tel. It 212) 922-0077 Fax # 212) 922-0630
State NY Zip 10017
21. Address 228 East 45th St City New York
22. Sample Analysis Laboratory __ 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work
O`(Iot 102 Projected completion date OT
13t (02
Wednesday Thursday Friday 19 rday Sunday
Asbestos work schedule ..Monday 19 Tuesday %
3 4
Shift from: $~ ,gam 0 pm to St'o ❑ am gi pm
t
as
If other,
specify RauEO
Access to inspect the premises must be provided during the work schedule indicated in this item. I
(JUN 27 2002
?PIBANHM V
1
ALJJ
_STOS/LEP:
25. Total amount of asbestos-containing material to be abated during this work ~OGRAM
TRUG 0
122 9 -&"square Feet, and/or 0 Linear Feet te 2
ACP7
212001
NYC-WTC 000111275
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