NYC 9/11 Public Portal Document
O2' W NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program /ud O00 MAJIN
• ~1 DA 59-17 Junction Bouevard, B°i Floor. Corona, NY 1136801117 Burldkp Dept. orTRU No
FOR OFFICIAL USE ONLY
r ASBESTOS PROJECT NOTIFICATION
tNIIL BE (ASBESTOS INSPECTION REPORT) 1.
PTED . ~... de
with original
When submitting this form at the NYC Department of Buildings, the original form and three (3) copies This
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures.
activities .
form must be submitted to the NYC DEP not less than one week in advance of the start of abatement
1. FACILITY
2. Address 119 Fulton St Borough Manhattan Zip
AKA 50 Ann St 3. Block 91 _ 4. Lot 8
5. Type of FacIlity 6. Name of Building
II. BUILDING OWNER
7. Name Luby Realty Associates 8. Contact Person
9. Tel. # Fax #
10. Address city State Zip
III. GENERAL CONTRACTOR
11 Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
Kurzban & Son Control Louie lannico
12. Name Benjamin 13. Contact Person
14. Federal Employer ID. #
PH
.-...-.-. .... 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 & PanzER t IN EIS IN C 18. Contact Person M l I(A% L. NQL.AN
19. Federal Employer ID. # _ _ _ _ _
P ____ 20. Tel. # (212)
922-0077 Fax # (212) 922-0630
City New York State NY Zip 10017
21. Address 228 East 45th St
22. Sample Analysis Laboratory 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
Projected completion date t Ii I o 2
24. Starting date for this portion of work '1 1 2
Asbestos work schedule ❑ Monday 0 Tuesday 0 Wednesday 0 Thursday ❑ Friday ❑ Saturday ❑ Sunday
Shift from: ❑ am ❑ pm to ❑ am ❑ pm
if Other,
specify CREAE
ect the premises must be provided during the work schedule indicated in this item.
25. Total amount of asbestos-containing material to be abated during this work
1O 200 Square Feet, and/or 0 Linear Feet
ACP 7
212001
EMR0.~~t
t+u0.EpU 6 ~ SHl0.-
REME~
p l
NYC-WTC 000119589
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