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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

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 3tOT w ''rw, Asbestos Control Program p

59-17 Junction Boulevard. 8m Floor, Corona, NY 11368-5107 Bulding D 1. a TRu o " ~ FOR offx:wL USE ONLY ASBESTOS PROJECT NOTIFICATION r ILL BE ___ (ASBESTOS INSPECTION REPORT) 1. ( c2 ) teeschedule) EPTED " `'`°"I0e

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

I. FACILITY

2. Address A 4 N a G s "' S tre e t Borough Manhattan Zip 129-133Fu1 .biokt 91 4. Lot 13 AKA 129 Fulton St, 40 Ann St,

5. Type of Facility 6. Name of Building

11. BUILDING OWNER attn. David 8"PtaPerson 7.Name Collegiate Church Corp.

9.Tel.# 212-233-1960 Fax# City State Zip 10. Address

Ill. GENERAL CONTRACTOR

11. Name Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR lannico 12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie

14. Federal Employer ID. #L._._._._._. P 11 15. Tel. # (718) 531-2900 Fax # (718) 209-1808

City Brooklyn State NY Zip 11236 16. Address 1248 Ralph Avenue

V. THIRD PARTY AIR MONITOR

CN& l (JEERS 18. Contact Person M I (!UAL IJOLA r1 17. Name Warren & PanztEQL 19. Federal Employer ID. #' _ _ _ _ _ P11 20. Tel. # (212) 922-0077 Fax # (212) 922-0630 St City New York State NY Zip 10017 21. Address 228 East 45th

22. Sample Analysis Laboratory 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24. Starting date for this portion of work O t toI I O2 Projected completion date O T 131 102. Tuesday P( Wednesday .Monday ( .Thursday -Friday Ihl. Saturday Sunday Asbestos work schedule pm 3 Shift from: a~ ,J am ❑ pm to _ 8~_ ❑ am o 4 S

If other. specify RE6"o Access to inspect the premises must be provided during the work schedule indicated in this item. f i UN 2 7 PlBANHM 2002 25. Total amount of asbestos-containing material to be abated during this work pGRAMA TRUG 122 9& 8 Square Feet, and/or 0 Linear Feet ll. 2 w f t-T'' ACP7 2/2001

NYC-WTC 000111277

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NYC-WTC_000111277Source: NYC Law Department, mirrored locally

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