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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_000111279–000111302

Folder label: “Zone II Originals

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NYC 9/11 Public Portal Document

rr', 1 - V~O qLOic NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION I Asbestos Control Program V 59-17 Junction Boulevard, 8111Floor, Corona, NY 11368-5107 Building Dept. orTRU No FOR OFFICIAL USE ONLY ONLY TYPEWR/T ASBESTOS PROJECT NOTIFICATION L— Eura (ASBESTOS INSPECTION REPORT) 1, FORM !_

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

I. FACILITY Borough Manhattan Zip 2. Address ~7 Ann S t — 3. Block 92 4. Lot 10 AKA

5. Type of Facility 6. Name of Building

II. BUILDING OWNER Lance Howard 7. Name 5 7 Ann S Realty Assoc .Inc c_/o -- 8. Contact Person -- —

9. Tel.# Fax# City State Zip — 10. Address _

III. GENERAL CONTRACTOR

11. Name __ —_ Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR Benjamin Kurzban & Son Control 13. Contact Person Louie lannico 12. Name _— _ -- - 209-1808 P 11 14. Federal Employer ID. # _._._._._._._._._._._._._._._ 15. Tel # (718) 531-2900 Fax # (718)

City Brooklyn — ___ State NY _ Zip _'11236 __— 16. Address 1248 Ralph Avenue `—_

V. THIRD PARTY AIR MONITOR __ - -18. Contact Person 17. Name Warren 8~ Panza (212) 922-0077 12 922-0630 PI I 19. Federal Employer ID. #1._._._._._._._._.__i _ 20. Tel. # -- Fax #(2 —)

St City New York __ State!'f!.._ Zip 10017 — 21. Address 228 East 45th 23. NYS DOH ELAP # 22. Sample Analysis Laboratory__--

VI. PROJECT INFORMATION 24. Starting date for this portion of work (Q( 1( 2 Projected completion date _ .LQ 2 0 Saturday 0 Sunday Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday 0 Thursday 0 Friday

Shift from: ❑ am 0 pm to ---- ❑ am ❑ pm

If other, specify -_----- - - ,/ RECEIVED Access to inspect the premises must be provided during the work schedule indicated in this item. ' • N fl 7 2002 ~NN•ti, work 25. Total amount of asbestos-containing material to be abated during this \ +cST6'S ~RGGRAh~ 144°95 "Square Feet, and/or ___2 Linear Feet ACE' 7 ~£ Z 2/2001

NYC-WTC 000111293

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NYC-WTC_000111293Source: NYC Law Department, mirrored locally

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