Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

'E O3COTC~.M NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107 ' D31 RU 4 Building Dept. No FOR OFFICLIL USE ONLY R/TTEN a ASBESTOS PROJECT NOTIFICATION MS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED " '° 1. ( e 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 88 Nassau St Borough Manhattan Zip

3. Block 78 4. Lot 42

5. Type of Facility 6. Name of Building II. BUILDING OWNER

7. Name Michael Pildes et al 8. Contact Person yu t' PLUSt.

9.Tel.# (212) 21SS-4232 Fax#

10. Address City L,nTLL. V1- k_ __State hi y zip Olh 47 —2,L0 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._ 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 Panzts ENfa twEEes INC. 18. Contact Person 1 Ct.l * QL. f .AN P11 19. Federal Employer ID. # _._._._._._._._._._._._._._._. 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 0 71021.22_ Projected completion date

Asbestos work schedule Monday Tuesday 0 Wednesday % Thursday Friday ' Saturday y ' Sunday

Shift from: 8`r am ❑ pm to ❑ am pm ,~ „~•~~

If other, //Y A. V_ specify RGffas 3 Access to inspect the premises must he provided during the work schedule indicated in this item. o2 2002 Cn 3UL L 25. Total amount of asbestos-containing material to be abated during this work DEP/MNHM _ SBESTOSILE~ o, PROGRAM 10 10 Square Feet. and/or 0 Linear Feet ! TRHG

Tj1 i ' / ACP 7 2/2001

v NYC-WTC 000111261