NYC 9/11 Public Portal Document
(Jill W /
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 841 Flow, Corona, NY 113885101
ft DPI BuSdingDept. crtRU No
FOR OFFICIAL. USE ONLY
7-rPEwwT 8V ~ ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1.
ACCEPTED w••e c. ovIore
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 55 Ann St Borough Manhattan Zip
AKA 3. Block 92 . • 4. Lot 13
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name 5 5 Ann St Co c/ o Schus s e l 8. contact Person
9. Tel. # Fax #
10. Address city State Zip
III. GENERAL CONTRACTOR
11. Name Tei. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Sort Control 13. Contact Person Louie latnico
14. Federal Employer ID. # __P.11 15. Tel # (718) 531-2900 Fax # (718) 209-1808
16. Address 1248 Ralph Avenue Brooklyn State NY Zip 11236
V. THIRD PARTY AIR MONITOR
17. Name Warren & Panza 18. Contact Person
19. Federal Employer ID. 9.._._._._. 20. Tel # (212) 922-0077 Fax # (212) 922-0630
21. Address 228 East 45th St City New York State NY Ziif.10017
22. Sample Analysis Laboratory 23. NYS DOH ELAP # _
VL PROJECT INFORMATION
24. Starting date for this portion of work • 3 LO2 Projected completion date - - i/i?j(Y2
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday 0 Thursday ❑ Friday 0 Saturd~ Sunday
Shift from: 0 am ❑ pm to ❑ am 0 pm
If other,
specify
I Access to inspect the premises must be provided during the work schedule indicated in this Item. I
25. Total amount of asbestos-containing material to be abated during this work
4 290 Square Feet, and/or 0 Linear Feet
NYC-WTC 000119633
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