Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

.1 rCT 0O NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program '~ ■~ 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 V0Tq 111*0 A Building Dept. or TRU Po FOR OFFICIAL USE ONLY ASBESTOS PROJECT NOTIFICATION ILL BE (ASBESTOS INSPECTION REPORT) EPTED Cwww. v g ) 1. See fee dule)

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 -_-35_Ann_ _ St Borough Manhattan — Zip

AKA 104-108 Nassau St 3. Block 92 4. Lot 23 5. Type of Facility 6. Name of Building II. BUILDING OWNER t iL ~~:_ '.t f' Name _Abacus Federal Savings Bank C)- )c) 8. Contact Person 2 (Z' 9.Tel.# (212) 285-4770 Fax# ( r,t`^I _._._. 10. Address City State v J Zip P III. GENERAL CONTRACTOR

11. Name Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Benjamin Kurzban & Son Control 13. Contact Person Louie lannioo 14. Federal Employer ID. #1.-.-.-.-.P~.~.-.-.-.-.` 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 & Panza 18. Contact Person

19. Federal Employer ID. #._._._._.PII._ _ -- 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 _ /i.2 /Oa2 Projected completion date _~/ Z .UZ—

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

i :'`r Shift from: 0 am ❑ pm to 0 am 0 pm

If other, specify

Access to inspect the premises must be provided during the work schedule indicated in this item. 0 ^j Q 7 ZUU1 25. Total amount of asbestos containing material to be abated during this work J 8 19 8 Square Feet, and/or 0 Linear Feet

~F I 2/2001

NYC-WTC 000111287