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Document / 24 pages

Asbestos Project Notification Form, DEP Box 39

Machine-extracted title · confidence 95%

NYC DEP form for notifying the department of an asbestos inspection project at a facility.

NYC-WTC_000111279–000111302

Folder label: “Zone II Originals”

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NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program ui&b t 59-17 Junction Boulevard. 8"' Floor, Corona. NY 11368-5107 D Building Dept. TRU No FOR OFFICIAL USE ONLY ti ONLY TYPEW.& ASBESTOS PROJECT NOTIFICATION (ASBESTOS INSPECTION REPORT) 1. fee

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 124 Nassau Street _Borough Manhattan Zip

3. Block 92 4. Lot 29

5. Type of Facility 6. Name of Building

Il. BUILDING OWNER

7.Name Mr. Arnold Schwartz c/o Franc-Men R tPerson

9. Tel. # P11 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 Iannico

14. Federal Employer ID. tk ._._._._._P1 ._._._._._' 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 & Panz g tEO4 tN f ER3 INC _ __18. Contact Person U i agp'm— NeLA" 1-----------.PII - - - -. 20. Tel. # (212) 922-0077 Fax # (212) 922-0630 19. Federal Employer ID. #

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 2_LzI 02 Projected completion date 0/O Z

Asbestos work schedule ❑ Monday ❑ Tuesday 0 Wednesday ❑ Thursday ❑ Friday O Saturday ❑ Sunday

Shift from: O am O pm to ❑ am O pm

If other, 6' specify

Access to inspect the premises must be provided during the work schedule indicated in this i'tem.

25. Total amount of asbestos-containing material to be abated during this work

36O5 A Square Feet, and/or 0 Linear Feet ACP7 2/2001

NYC-WTC 000111285

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NYC-WTC_000111285Source: NYC Law Department, mirrored locally

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