NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program ui&b
t 59-17 Junction Boulevard. 8"' Floor, Corona. NY 11368-5107
D Building Dept. TRU No
FOR OFFICIAL USE ONLY
ti ONLY
TYPEW.& ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1.
fee
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 124 Nassau Street _Borough Manhattan Zip
3. Block 92 4. Lot 29
5. Type of Facility 6. Name of Building
Il. BUILDING OWNER
7.Name Mr. Arnold Schwartz c/o Franc-Men R tPerson
9. Tel. # P11 Fax #
10. Address City _ State Zip
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie Iannico
14. Federal Employer ID. tk ._._._._._P1
._._._._._' 15. Tel. # (718) 531-2900 Fax # (718) 209-1808
16. Address 1248 Ralph Avenue City Brooklyn State NY Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name Warren & Panz g tEO4 tN f ER3 INC _ __18. Contact Person U i agp'm— NeLA"
1-----------.PII - - - -. 20. Tel. # (212) 922-0077 Fax # (212) 922-0630
19. Federal Employer ID. #
21. Address 228 East 45th St City New York State NY Zip 10017
22. Sample Analysis Laboratory_ 23. NYS DOH ELAP # _
VI. PROJECT INFORMATION
24. Starting date for this portion of work 2_LzI 02 Projected completion date 0/O Z
Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday O Saturday ❑ Sunday
Shift from: O am O pm to ❑ am O pm
If other, 6'
specify
Access to inspect the premises must be provided during the work schedule indicated in this i'tem.
25. Total amount of asbestos-containing material to be abated during this work
36O5 A Square Feet, and/or 0 Linear Feet
ACP7
2/2001
NYC-WTC 000111285
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