Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

2j o ~ d y,dry UE►A'tr~ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION r Asbestos Control Program 59-17 Junction Boulevard, 8'" Floor, Corona, NY 11368-5107

RITTEN P ASBESTOS PROJECT NOTIFICATION Building Dept. or TRU No FOR OFFICIAL USE ONLY

EMA _ ORMS WILL BE ACCEPTED www.nyt, ov/Oe (ASBESTOS INSPECTION REPORT) 1. ( 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 Alley 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

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. >k P II 15. Tel. # (718) 531-2900 Fax # (718) 209-1808

16. Address 1248 Ralph Avenue Citv Brooklyn State NY Zip 11236

V. THIRD PARTY AIR MONITOR

17. Name Warren & PanzER F" t tJL s ~ w— __ 18. Contact Person ICI t f AEL NOt.A t.t

19. Federal Employer ID. # PI ______ 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 6128 I0 2 Projected completion date OV 130102. 10 Z 3 Asbestos work schedule V1 Monday 0 Tuesday Wednesday (A Thursday V1Friday 1% Satua

Shift from: ❑ 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

14 185 Z Square Feet, and/or 0 Linear Feet

NYC-WTC 000111269