NYC 9/11 Public Portal Document
I4009 )It L a►,K, r NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
P 59-17 Junction Boulevard, 8"' Floor, Corona, NY 113685107
A
Building Dept. or TRU No
np o ASBESTOS PROJECT NOTIFICATION FOR OFFICIAL USE ONLY
AORA4
-. www.o c. ov Jet (ASBESTOS INSPECTION REPORT)
Nx ~
He
When submitting this form at the NYC Department of Buildings,
signatures are required. Submittal at the NYCDEP requires onethecopy
original form and three (3) copIes with Original
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 ofabatement activities.
1. FACILITY
2. Address 5 7 Ann S t .
Borough Manhattan Zip
AKA 92
3. Block 4. Lot 10
5. Type of Facility
6. Name of Building
11. BUILDING OWNER
7.Name 57 Ann St Realty Assoc Inc c/o Lance8Howarda
rson
9. Tel.# Fax#
10. Address City
State Zip
III. GENERAL CONTRACTOR
11. Name
Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Controi
------- 13. Contact Person Louie lannioo
14. Federal Employer ID. # L._._._._.P!.!._._._._._.` 15. Tel. # (718) 531-2900 Fax (718)209.1808
16. Address 1248 Ralph Avenue city Brooklyn State NY Zip 11236
THIRD PARTY AIR MONITOR
17. Name Warren & Panza
18. Contact Person
19. Federal Employer ID. ._._._._._P I I 20. Tel. # (212) 922-0077 Fax # (212) 922-0630 .~
21. Address 228 East 45th St y New York
State NY Zip 10017
22. Sample Analysis Laboratory
23. NYS DOH EI.AP #
VL PROJECT INFORMATION
24. Starting date for this portion of work ( ( 2= Projected completion date Q
Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑
Friday ❑ Saturday ❑ Sunday
Shift from: ❑ am 0 pm to _ 0 am o pm
If other,
specify / Y
U
Access to Inspect the premises must be provided during the work schedule
Indicated in this item.
25. Total amount of asbestos-containing material to be
):L)
abated during this work ;i'P/BANHM
4 S 5 "Square Feet, and/or 0 Linear Feet
7
1
NYC-WTC 000119710
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