NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
11 .~ Asbestos Control Program
59-17 Junction Boulevard, 8°i Floor, Corona, NY 11368-5107
Building Dept. or TRU No
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ASBESTOS PROJECT NOTIFICATION _1 .! I— A
(ASBESTOS INSPECTION REPORT) 1. l)
www.a C. ov/de
TED (See ffe schedule)
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 127 Fulton St Borough Manhattan zip 1G`o36
AKA 42 Ann St, 3. Block 91 4. Lot 122
5. Type of FacIlity 6. Name of Building
If. BUILDING OWNER
7. Name Collegiate Church Corp, 8. Contact Person DAvID 12I'I4M
9. Tel. # (212) 2334960 Fax #
10. Address 45 JO1It$ S1Ize'r City NY State lJY Zip 1CO36
III. GENERAL CONTRACTOR
11. Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie lannico
14. Federal Employer ID. # 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 & Panzwe Et 1 W E __jzs 18. Contact Person M id _Aer` NoLA4
19. Federal Employer ID. #_ _ _P _ _` 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 ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work 08-22-0 2. Projected completion date a9_92- a2
Asbestos work schedule 19 Monday ® Tuesday IN Wednesday ® Thursday IN Friday
Shift from: SOO ® am ❑ pm to 8`c' ❑ am ® pm
If other,
specify
Access to inspect the promises must be provided during the work schedule indicated in this Item.
25. Total amount of asbestos-containing material to be abated during this work
T2er Square Feet, and/or 0 Linear Feet
ACP 7
2/2001
NYC-WTC 000127921
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