Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

(oJiic NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor, Corona, NY 11368-5107 03fI%*) EN fh' ~P o`t ASBESTOS PROJECT NOTIFICATION Building Dept or T No FOR OFFICUIL USE ONLY

WILL BE INOAtT ~ (ASBESTOS INSPECTION REPORT) C EPTED www,nyt.Rw/ae 1. (6e 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.

1. FACILITY

2. Address 86 Nassau St Borough Manhattan Zip

AKA 3. Block 78 4. Lot 40

5. Type of Facility__—` _ 6. Name of Building II. BUILDING OWNER

7. Name HBS Equities LLC 8. Contact Person

9. Tel. # (212) 963-0241 Fax #

10. Address ~ ~ ~~~~-~_ ¶rI..F F I City ,"{ K State Zip 1003 372e! 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. i -------- P11 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 Pang E.Nf, t Qa,S LC . 18. Contact Person t CN Et_ IJct-A 1.1 19. Federal Employer ID. #c P11 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 C.LL C 2 102. Projected completion date CE IC t 102.. Asbestos work schedule IA Monday 'Tuesday I~ Wednesday Thursday $ Friday 0 Saturday Sunday

Shift from: __ Pr am ❑ pm to ❑ am $pm

If other, '~ 1' specify

Access to inspect the premises must be provided during the work schedule indicated in this item. " JUl 02 2002 25. Total amount of asbestos-containing material to be abated during this work o~ JEI'NSANHM ~~ESTO MOGAAMA'' 6T72 * Square Feet, and/or 0 Linear Feet TRUG 05 6 2 ACP 7 22001

NYC-WTC 000111259