NYC 9/11 Public Portal Document
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
59-i7 Junctio.i Boulevard, 8"' Floor, Corona, NY 11368-5107
Budd+q Dept. or TRU No
FOR OFFICUL USE ONLY
R/TTEN f ~4g M~ ~ ASBESTOS PROJECT NOTIFICATION CDC-
ORMS WILL BE (ASBESTOS INSPECTION REPORT)
ACCEPTED www. v . 7° 1.
(S.r.e sdwd /.)
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
111 Nassau Street
2. Address Borough Manhattan Zip
AKA 4 Theater Alley 3. Block 90 4. Lot 18
5. Type of Facility 6. Name of Building
11. BUILDING OWNER
7.NameJamidaro Partners c/o Pilades Bros. 8.ContactPerson
9.Tel.# 212-227-9895 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
14. Federal Employer ID. /*._._._._._._PII_._._._._._. 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 & Panzt-lt 18. Contact Person M I C:1-t AEi. NOt.A
19. Federal Employer ID. #. 20. Tel. it (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 1&IOO22 Projected completion date _ Otj 13010 2.
Asbestos work schedule Monday 0 Tuesday (Wednesday Thursday Friday IGf Satur day
Shift from: ❑ am ❑ pm to ❑ am ❑ pm
Ifspecify
R VE0
Access to inspect the premises must be provided during the work schedule indicated in this item. JUN
27 2002
25. Total amount of asbestos-containing material to be abated during this work r SafST
REST0A1VHM V
Pfloa, L
MEAri
T
I4 (S5 Z Square Feet, and/or 0 Linear Feet 2uG
~! 6 ACP 7
2/2001
NYC-WTC 000099066
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