Asbestos project amendment form, Oct 2002

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY In t Asbestos Control Program Fee (if any) $ II 59-17 Junction Boulevard, 8°i Floor. Corona. NY 11368-5107 ONLY r. \\ 7YP RITTEN Amendment OV `2//~7 FORMS WILL BE MK exo ASBESTOS PROJECT AMENDMENT FORM Information Only: ❑ Yes ❑ No ACCEPTED Cwww. yt.{o/Uep_l FOR FORM ACP 7

A modification Is valid only if it Is received by the NYCDEP prior to the previously filed date of completion, except for start date changes that must be received by the original start date.

ACP7 TRUBN# 1624 MN a2 Facility Address 24 Job-t3 S-Mc--e7r Borough !A Ail Zip 10a3e Gc Date ACP7 was filed IO- 02 - 0 2 Vari4 # (If any) f -E 192 w TC

Was this ACP7 amended before? 0 Yes 0 No If yes, specify date

Original Start Date jOt 2 ( Original Completion Date 10, 31 102 from ACP 7, #24.

PLEASE ENTER THE INFORMATION THAT IS BEING CHANGED: A notification may be modified no more than twice. Only the building owner may amend items IV and V. IV. ASBESTOS ABATEMENT CONTRACTOR The original applicant or building owner may amend all other Items.

12. Name 13. Contact Person

14. Federal Employer ID. # 15. Tel. # Fax # 16. Address City State Zip V. THIRD PARTY AIR MONITOR \~O 17. Name 18. Contact Person

19. Federal Employer ID. # TfJ i I Fax # 21. Address State Zip 22. Sample Analysis Labor 23. NYS DOH ELAP #

VI. PROJECT INFORMATION `°~.[ ~9 ~~ ❑ Project Cancelled 24. Starting date for this portion of work o• oiected completion date ❑ Project Postponed

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

Shift from: ❑ am 0 pm to ❑ am ❑ pm If other, specify,

25. Additional asbestos-containing material to be disturbed during this work 2030 Square Feet, and/or C' Linear Feet Reduction in the amount of ACM to be disturbed during this work Square Feet, and/or Linear Feet 29. Abatement Procedure for Additional Material (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

Other Changes

30. Locations of abatement modified by above (For each floor list ACM quantity and type)

31/32. Name of Applicant / Owner Tel. # Name of Company (If any) Fax # Address City — State Zip

I hereby declare that the information provided herein is true and complete. rCD~ Signature of Applicant /Owner r,PSU of tNVROfQME!n L REMEOlA v~ v ACP 8 105 p~l.`1iRol 2/2001 PROrRW IRU2

NYC-WTC 000094388