204 BROADWAY 1001222, 79/21

NYC 9/11 Public Portal Document Á26W NYC DIEP MINTAL PROTECTION FTTEN IS WILL BE RGEPTED DEP HCNIAPOTE w.rys.gov/dxc. 59-17 Junction b rd, 8 Floor, Corone, NY 11368-8107 ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) ORE 1.- See fee sch 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. 3 7 I. FACILITY 2. Address 204 BROADWAY Borough MAN AKA 5. Type of Facility- II. BUILDING OWNER _3. Block Zip_ 10038 4.Lot COMMERCIAL _6. Name of Building 7. Name COUEGIATE CHURCH 9. Tel. #. (212)233-1960 10. Address 45 JONN STREET : 8. Contact Person_D. RINNAR Fax # - City _ Nzi YCRE State_NT_Zip_10036 III. GENERAL CONTRACTOR 11. Name_ • Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR 12. Name BENJAMIN RURZZAN 9 ECN CONTROL LINC. -13. Contact Person_LQUiE_lANivICO PII 14. Federal Employer ID. # 15. Tel.# (116) 531-2900 Fax#_1118)209-1808 16. Address_1248 RALPH AVENUE CityBECOKLYN __ State NY__Zip 1123€ V. THIRD PARTY AIR MONITOR 17. Name WARREN. §PANZER ENGINECRS _18. Contact Person_MICHAEL NCLAN PII 19. Federal Employer ID. #L. 2=/20. Tel. #1212)922-001T -Fax#(212) 922-0630 21. Address 228 EASI 45TL STREET City New lecr _ State_NY_Zip_1COiT 22. Sample Analysis Laboratory. 23.NYSDOH ELAP # VI. PROJECT INFORMATION 24. Starting date for this portion ofwork_C8-0T-02 Projected completion date c9=7-02 Asbestos work schedule Monday E Tuesday Wednesday I Thursday E Friday Saturday E& Surday Shift from: ECSA If other, specify om to _ECc D am # pm 181/19, 110 Access to inspect the premises must be provided during the work schedule indicated in this item. RECEIVED AUG 07 2002 25. Total amount of asbestos-containing material to be abated during this work 1233C_ Square Feet, and/or - _ Linear Feet E NYC-WTC_000123267 AC"