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, 8th Floor. Corona, NY 11368-5107 Building O . or TRU o FOR OFFICIAL USE ONLY ASBESTOS PROJECT NOTIFICATION WILL BE (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 120 Nassau Street Borough Manhattan Zip

3. Block 92 4. Lot 27

5. Type of Facility 6. Name of Building

II. BUILDING OWNER

7. Name M i z r a c h i Realty Corp. 8. Contact Person 9.Tel.# 212-732-3889 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. #1-------._._. PII 15. Tel. it (718) 531-2900 Fax it (718) 209-1808 16. Address 1248 Ralph Avenue City Brooklyn State NY Zip 11236

V. THIRD PARTY AIR MONITOR

17. Name Warren & PanzWR Er,.3G, t pis fJt 18. Contact Person ~ct.Ir~t.1

_P 19. Federal Employer ID. # _ _ _ _ _ - - 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 _2IZ.4! ` Projected completion date L:3 0

Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday ❑ Saturday l., Shift from: 0 am ❑ pm to 0 am ❑ pm

If other. specify _ rV Rte Q

Access to inspect the premises must be provided during the work schedule indicated in this item. JV N 24 2002 25. Total amount of asbestos-containing material to be abated during this work `dc~OtRM` 3327 Square Feet, and/or 0 Linear Feet ACP 7 2/2001

NYC-WTC 000111281