Invoice, Benjamin Kurzban & Son, Sep 2002

NYC 9/11 Public Portal Document

I+~ NYC 1 EPARTMENT OF ENVIRONMENTAL PROTECTION -• Asbestos Control Program v 59-17 Junction Boulevard. 8a' Floor, Corona. NY 11368-5107 or TRU N ' FOR O} USE ONLY

," \ EWRITTEN ~ a~u. ,` ASBESTOS PROJECT NOTIFICATION RMS WILL BE (ASBESTOS INSPECTION REPORT) 1• ____ CCEP TED rwM.nyt.=arrdeP.• (See

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.

1. FACILITY ST ET Borough _- .___Zip 1003£s 2. Address 2 i3 PC-AV_t_ 3. Block 69 4. Lot s AKA

5. Type of Facility 6. Name of Building

II. BUILDING OWNER

7. Name 8. Contact Person

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

Ill. GENERAL CONTRACTOR

11. Name. ... ._____________ Tel. # ____

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name t tJ KUc213AM $ Sou C"TIRCL I µC _13. Contact Person

14. Federal Employer ID. # PII __ 15. Tel. # Fax # < tt L+~~ 209 i t3c?E3 _____

i%3 City _Sucotu~ts _______ State U Zip i tt 236 16. Address 124 ~E P-At..pa AV ____

V. THIRD PARTY AIR MONITOR

17. Name IUAt iy 4 ~i i~t326R ei tt+ ___.18. Contact Person M+C$iAEL N0I.A is

19. Federal Employer ID. # ._._._._._._._.PIL_._._._._._._, _ 20. Tel. # t2t2) g22-oa tT Fax# (2t2) X22- Za3O

mss; ASTU S —'r City _.k14 'lc4 u____ State _!L_ Zip IOOt t - 21. Address 2z t3

22. Sample Analysis Laboratory— _ __ 23. NYS DOH ELAP #

VI. PROJECT INFORMATION f 10 1E.. _ Ia 11 0102 24. Starting date for this portion of work _~ Projected completion date

® Monday ® Tuesday ® Wednesday E Thursday IZI Friday ® Satufd"ay f Sunday Asbestos work schedule

Shift from: ®am ❑ pm to S ❑ am IN pm \ if other, EIVED Access to inspect the premises must be provided during the work schedule indicated in this item. , SEP 6 1?t1U4 25. Total amount of asbestos-containing material to be abated during this work f ,,. i O 7C Square Feet, and1or C Linear Feet ACP

NYC-WTC 000115229