Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

(/61 4 ~. ocrM NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION 1. D

~' Asbestos Control Program 59-17 Junction Boulevard, 8m Floor, Corona. NY 113685107 D' v1► a 41 DON A ,+ Ar ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU o FOR OFFICIAL USE ONLY

(ASBESTOS INSPECTION REPORT) 1 e- e.lee (S fee schedule)

When submitting this form at the NYC Department of Buildings, the original loan 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 80 Nassau St Borough Manhattan Zip AKA 80-84 Nassau St 3. Block 78 .4. Lot 7503

5. Type of Facility_ 6. Name of Building I1. BUILDING OWNER

7. Name Nassau St Equities LLC do Time Equities 8. Contact Person

9. Tel. # (212) 207-6000 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 Panzg2 OC~igEE12s 18. Contact Person I41 .tAEL MOLAR 19. Federal Employer ID. # PII 20. Tel. # (212) 922-0077 Fax # (212) 922-0630

21. Address 228 East 45th St cif , 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 OZ I c 1 102 Projected completion date 0 Z 13 t ' O 2

Asbestos work schedule Monday Tuesday Nednesday 4 .Thursday Friday , Saturday b Sunday ev Shift from: a _I am ❑ pm to t3 ❑ am$pm

If other, specify Rf"/' D (( f Access to inspect the premises must be provided during the work schedule indicated in this item. I Jil Q 1 20Q2 25. Total amount of asbestos-containing material to be abated during this work eESTOS, M TR I J AMEAD 17T'2.2 Square Feet, and/or 0 Linear Feet Ol 2VG ACP 7 22001

NYC-WTC 000111263