NYC 9/11 Public Portal Document
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t NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
'"\ 59-17 Junction Boulevard, 8°i Floor, Corona, NY 11388-5107
-TYPEWRITTEN ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE "` (ASBESTOS INSPECTION REPORT)
ACCEPTED •," cev
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 49 Ann St Borough Manhattan Zip
AKA 3. Block 92 4. Lot 14
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7.Name 49-51 Realty Company. LLC 8. Contact Person
9. Tel. # Fax #
10. Address City State Zip
111. GENERAL CONTRACTOR
11. Name TeI. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie lanni(o
14. Federal Employer ID. E.__._._.__._ _._._PI ._._._. _._._ _ _ 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 8' ParuA._._._._._._._._._._._._._._._._._._., —18. Contact Person ____--
19. Federal Employer ID. i _._._._._._._ .I.I._. 20. Tel. # (212) 922-0077 T Fax # (212)
T
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
24. Starting date for this portion of work / / Q Z- Projected completion date ?Lo L 0 -2----
Asbestos work schedule 0 Monday 0 Tuesday ❑ Wednesday ❑ Thursday ❑ Friday 0 Saturday 0 Sunday
Shift from: ______ ❑ am ❑ pm to __ ❑ am ❑ pm
If other, . >U
I~ECE►11ED
specify C„r[
Access to inspect the premises must be provided during the work schedule indicated in this item.
i UN 1 0 2002
25. Total amount of asbestos-containing material to be abated during this work
9034 "Square Feet, and/or 0 Linear Feet t RU 5
2 ~.
ACP 7
- ~r 2/2001
NYC-WTC 000119540
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