NYC 9/11 Public Portal Document
WTC FME~ 11FACENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-.7 Junction Boulevard, 8" Floor. Corona, NY
ONLY
TYPEWRITTEN fk
D1~/ P 11368.5107
Bktrn9 Dept• or TRU No
FORMS WILL BE ' " NFAL
/ ASBESTOS PROJECT NOTIFICATION FOR OFFICIAL USE ONLY
r ACCEPTED (ASBESTOS INSPECTION REPORT)
1.
When submitting this form at the NYC Department of Buildings, the
signatures are required. Submittal at the NYCDEP requires original form and three (3) copies with original
form must be submitted to the NYC DEP not less than one one copy of the form with original signatures. This
week in advance of the start of abatement activities.
I. FACILITY
2. Address 121 Fulton St
Borough Manhattan Zip
AKA 48 Ann St. '123-Fulton-St'
3. Block 91 A I .,• 9
5. Type of Facility
6. Name of Building
ii. BUILDING OWNER
7. Name Cedar Managaement Corp
8. Contact Person
9. Tel. # (212) 732-7653 Fax #
10. Address
City State Zip
III. GENERAL CONTRACTOR
11. Name
Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban B.Son Control._._._
_ 13. Contact Person Louie lannico
14. Federal Employer ID. _._._._._._._.__P
I I_._._._._._._._.' 15. Tel. # (718) 531=2900
Fax it (718) 209-1808
16. Address 1248 Ralph Avenue
Ciry Brooklyn
Y State NY _ Zp 11236
V. THIRD PARTY AIR MONITOR
17. Name Warren & Panztig2 Eu .Ll1k 18. Contact Person U l Ct1 A>ct
19. Federal Employer ID. #1L................P.~
I.-............. . 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 #
VI. PROJECT INFORMATION
M
24. Starting date for this portion of work 6 I "l 1 0 2.
`
Proj ed completion date 06 I Ii 102..
Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday 0 Sunday
Shift from:
____ ❑ am O pm to ____ D am D pm
7i
If other,
specify ~O
Access to inspect the premises must be provided during the work schedule indicated in this item. (RE
CEI EO
25. Total amount of asbestos-containing material to be 1 3 2002
abated during this work
~~~ R.iflF~t,•
-- _ Square Feet, and/or 0 Linear Feet
ACP7
l l 2/2001
IfJ2
NYC-WTC 000119502
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