NYC 9/11 Public Portal Document
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. N% DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
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59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107 /
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ASBESTOS PROJECT NOTIFICATION
FORMS WILL BE (ASBESTOS INSPECTION REPORT) 1.
P w nvr.R~olneP
(Se fee schedule)
y, I~ 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
I 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 83 Nassau St Borough Manhattan Zip p0313
AKA 3. Block 79 4. Lot 3
5. Type of Facility C6 LAMeeGAL 6. Name of Building LER NEe
II. BUILDING OWNER
7. Name S46tQ ASBet VB & -ME UMITEt7, tic 8. Contact Person ROB SOt-An30
9. Tel.# 614 — 4t5 —T000 Fax#
10. Address TNR.ee LIM I?ED ~Ii+axwiaY City CoL Umf5yS State ON Zip 432 30
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie lannico
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
V. THIRD PARTY AIR MONITOR
17. Name Warren Panz P EuG,M1aERs G NC . 18. Contact Person Ma CURE. IJttl 9
19. Federal Employer ID. # l._._._.__P-.-._._._._., 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 I 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work __I 0 I 2. 102. Projected completion date I1 1 ZI 102
Asbestos work schedule ® Monday ® Tuesday I@ Wednesday ® Thursday ® Friday Sunday
00
Shift from: B ® am ❑ pm to ❑ am ® pm
If other,
specify _
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 abated during this work 'al
7363 '*Square Feet, and/or 0 Linear Feet
ACP 7
212001
NYC-WTC 000100642
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