NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-17 Junction Boulevard, 8s',Floor, Corona, NY 11368-5107 V HV~`r
auilding or TRU o
FOR OFFICIAL USE ONLY
ASBESTOS PROJECT NOTIFICATION
(ASBESTOS INSPECTION REPORT) 1 „r
( fee 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.
I. FACILITY
2. Address 120 Nassau Street Borough Manhattan Zip
AKA 3. Block 92 4. Lot 27
5. Type of Facility 6. Name of Building
1I. BUILDING OWNER
7. Name Mizracj1._Realty Corp. 8. Contact Person
9.TeI.# 212-732-3889 Fax#
10. Address City State Zip
Ill. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control _-13. Contact Person Louie lannico
PI I
14. Federal Employer ID. ti....................--... 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 8~ Panzer El l 1S s I IJC __18. Contact Person i1nJc t
PII
19. Federal Employer ID. t1}--------. ? 20. Tel. # (212) 922-0077 Fax# (212) 922-0630
21. Address 228 East 45th St _ city 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 2r01~ Projected completion date 7/30/0 t
Asbestos work schedule 0 Monday 0 Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday ❑ Sunday
Shift from: ❑ am ❑ pm to 0 am ❑ pm .~
If other, b
specify
Access to inspect the premises must be provided during the work schedule indicated in this item. 'its
NP~2 4 2002
25. Total amount of asbestos-containing material to be abated during this work o
:e£SToS/tF~.
c'
332 JW Square Feet, and/or 0 Linear Feet 2
G
(O
ACP 7
2/2001
NYC-WTC 000098786
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