NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
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''rw, Asbestos Control Program
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59-17 Junction Boulevard. 8m Floor, Corona, NY 11368-5107 Bulding D 1. a TRu o
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ASBESTOS PROJECT NOTIFICATION
r ILL BE ___ (ASBESTOS INSPECTION REPORT) 1.
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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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