NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
s P p 59-17 Junction Boulevard, 8°i Floor. Corona. NY 11368-5107 0
Building Dept. or TRU I
FOR OFFICIAL USE ONL
ASBESTOS PROJECT NOTIFICATION
ILL BE ""'AL (ASBESTOS INSPECTION REPORT) 1.
TED .. r .i> /e
See fees
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
2. Address __35 Ann S t Borough Manhattan Zip
AKA 104-108 Nassau St 3. Block 92 4.Lot 23
5. Type of Facility 6. Name of Building
11. BUILDING OWNER (. O V (( :
f
7. Name Abacus Federal Savings Bank 8. Contact Person:. Z-( Z , 2 Sc~ S `t(1 10
9.Tel.# (212) 285-4770 Fax L'G) CIt-,e'' ', XLiD7
10. Address City M State Zip V
III. GENERAL CONTRACTOR
11 Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie lannico
14. Federal Employer ID. #~_._ _ _ .P11_ 15. Tel. if (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 & Panza 18. Contact Person
19. Federal Employer ID. # L _ _PI _; 20. Tel. # (212) 922-0077 Fax # (212) 922-0630
21. Address 228 East 45th St City New York State NY Zip 1'0017
22. Sample Analysis Laboratory. 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work _(E.J/2 /Oa Projected completion date i 2 ' UZ
Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday 0 Thursday 0 Friday ❑ Saturday
Shift from: ❑ am ❑ pm to ❑ am ❑pm -` r"
$t
V
If other,
specify _ co ' `"W"
Access to inspect the premises must be provided during the work schedule indicated in this item. JUN 0 7 2002
'3ANNt'
25. Total amount of asbestos-containing material to be abated during this work ! GROGRAM -
TRUG
8 Ig Square Feet, and/or 0 Linear Feet 2
ACP7
212001
NYC-WTC 000116528
OCR can misread numbers and units. Confirm readings against the page image before using them.