Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

++~ "CV by NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION

D oo Asbestos Control Program 59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 '~93/~iJd Building Dept. or TRU No ONL FOR OFFICIAL USE ONLY V N ASBESTOS PROJECT NOTIFICATION .TYPY e ~' ~ MME (ASBESTOS INSPECTION REPORT) 1. tee When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This 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 4 7 Ann St Borough Manhattan Zip AKA 3. Block 92 4. Lot 17 5. Type of Facility 6. Name of Building II. BUILDING OWNER

7. Name —AL Ann S A c i t e s LLC _ 8. Contact Person 9.Te1.# (212) 706-3030 Fax# 10. Address _ City State Zip III. GENERAL CONTRACTOR

11. Name Tel. # __ IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Benjamin Kurzban & Son Control _13. Contact Person Louie lannioo _ ~~ 14. Federal Employer ID. #'_._._._._._.PII __N 15. Tel. # (718) 531-2900 Fax # (718) 209-1808 248 Ralph Avenue 16. Address 1 City Brooklyn State NY Zip _11236 V. THIRD PARTY AIR MONITOR

17. Name Warren & Panza _ 18. Contact Person 19. Federal Employer I0. # ._._._._._._PI _ __ 20. Tel. # (212) 922-0077 Fax # (212) 922-0630 21. Address 228 East 45th St City New York _ State NY Zip 10017 Y 22. Sample Analysis Laboratory 23. NYS DOH ELAP # VI. PROJECT INFORMATION

24. Starting date for this portion of work __14_1 2 Z l02 Projected completion date

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑ Saturday 0 Sunday

Shift from: 0 am ❑ pm to ❑ am ❑ pm

If other, specify

Access to inspect the premises must be provided during the work schedule indicated in this item. RECEIVEO ;A JUN 202002 25. Total amount of asbestos-containing material to be abated during this work -.~;BAflha• 40 A5 $ Square Feet, and/or 0 Linear Feet RUG 2 ACP7 y 2/2001

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NYC-WTC 000111297