Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8" Floor, Corona, NY 11368-5107 +~ays 3uilding Dept. or TRU wa FOR OFFICIAL USE ONLY ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) rwr.nyc.tv/dep (See 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 118 Nassau Street Borough Manhattan Zip AKA 3. Block 92 4. Lot 26

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

7.Name Vincent Mazzola 8. Contact Person 9. Tel.# Fax#

10. Address City State Zip III. GENERAL CONTRACTOR

11. Name Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

$2. 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 & PanzE2 ECG t ja 13 I N~ ~_18. Contact Person i~l tteAAa_L }OL,A_1 19. Federal Employer ID. #._._._._._._.P1 1 __ 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 _(pJ._i I ? _ Projected completion date _7l9IJ Z

Asbestos work schedule ❑ Monday 0 Tuesday 0 Wednesday ❑ Thursday 0 Friday 0 Sunday L Shift from: ❑ am ❑ pm to ❑ am ❑ pm

If other, specify - ti REED Access to inspect the premises must be provided during the work schedule indicated in this item. JUN 242002 ?/3ATJHA,~ 25. Total amount of asbestos-containing material to be abated during this work ;r:Sr_ _ 3 8 3-r IVSquare Feet, and/or 0 Linear Feet

!. ACP7 22001

NYC-WTC 000111279