Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

NYCED_"iJ TMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8th Floor, Corona. NY 11368-5107 Building Dept. or TRU No FOR OFFICIAL USE ONLY 1~NRITTEN ASBESTOS PROJECT NOTIFICATION ORMS WILL BE" ACCEPTED 10' or de (ASBESTOS INSPECTION REPORT) 1. (Set 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 111 Nassau Street Borough Manhattan Zip

AKA 4 Theater Alle 3. Block 90 4. Lot 18 5. Type of Facility 6. Name of Building II. BUILDING OWNER

7.NameJamidaro Partners c/o Pilades Bros. 8.ContactPerson

9.Tel.# 212-227-9895 Fax# 10. Address City `State Zip

III. GENERAL CONTRACTOR

11. Name ` Tel. #

IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie Iannico

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 & PanziER E1t6rt~1Vepg IJC. 18. Contact Person 311C.uAEL KOLA 19. Federal Employer ID. #........_._._. PII._._._._._._.! 20. Tel. # (212) 922-0077 Fax it (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 0612.8102 Projected completion date _ OV $30102. { Asbestos work schedule Monday Tuesday Wednesday Thursday Friday ICI Satur day t .~ Shift from: ___ ❑ am ❑ pm to __ ❑ am ❑ pm

If other, specify Ri O Access to inspect the premises must be provided during the work schedule indicated in this item. J U N 2? 2002 ~K 25. Total amount of asbestos-containing material to be abated during this work :S1Es4ANIIM !! ~)T~uRA A0 V 14 185 R Square Feet, and/or 0 Linear Feet 2 01 6 ACP 7 212001

NYC-WTC 000111267