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Asbestos Project Notification Form, DEP Box 39

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NYC DEP form for notifying the department of an asbestos inspection project at a facility.

NYC-WTC_000111275–000111278

Folder label: “Zone II Originals

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NYC 9/11 Public Portal Document

O~ 3 / NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION

ey~ Asbestos Control Program 59-17 Junction Boulevard, 8n Floor. Corona. NY 11368-5107 4g Building Dept. or TRU No ~ 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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NYC-WTC_000111275Source: NYC Law Department, mirrored locally

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