NYC 9/11 Public Portal Document
O O2 NYCDEFt'ARTMENT OF-ENVIRONMENTAL PROTECTION
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Asbestos Control Program
59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107
But ding Dept. or TRU No
ONLY D~~ FOR OFFICIAL USE ONLY
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ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1. C
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♦ (Seqfee hedule
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 _ Beekman St Borough Manhattan Zip
AKA 119-133 Nassau St,10 Theater Alley, 3. Block 90 4. Lot 14
3 Beekman st
5. Type of Facility _ 6. Name of Building
11. BUILDING OWNER
7.Name 3/9 Beekman St LLC c/o/Shire Realty 8. Contact Person
9.Tel.# (212)564-1194 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 lannico
14. Federal Employer ID. # .-._.-.-._ - -.
11 15. Tel. # (718) 531-2900 Fax It (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 —
PI I
19. Federal Employer 1D. #_._._._._._-_._._._._._._.__ 20. Tel. # (212) 922-0077 Fax # (212 922-0630
) _ —
21. Address 228 East 45th St _ City New York State NY Zip' 10017 —
22. Sample Analysis Laboratory_ - — — 23. NYS DOH ELAP #
1VI. PROJECT INFORMATION
24. Starting date for this portion of work _~ 1Q~— Projected completion date
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Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday 0 Thursday 0 Friday ❑ Saturday 0 Sunday
Shift from: ------ 0 am ❑ pm to ------ 0 am ❑ pm
If other,
pspecifyty ----- - RECEIVED ', CO
Access to inspect the premises must be provided during the work schedule indicated in this item. ( _ ~1 j It Itj 1
2002
25. Total amount of asbestos-containing material to be abated during this work
152 II r Square Feet, and/or 0 Linear Feet O~ /
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NYC-WTC 000119021
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