NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY
Asbestos Control Program Fee (If any) $
59-17 Junction Boulevard. 8°i Floor, Corona, NY 11368-51p7
ONLY
7YPEWPJ TEN
FORMS WILL ASBESTOS PROJECT AMENDMENT FORM
Amendm DOM -
ACCEPTED Information Only. ❑ Yes ❑ No
FOR FORM ACP 7
AVRUBN# Facility Address
Date ACP7 was filed
Was this ACP7 amended before? 0 Yes No If yes, specify date
Original Start Date O)_ Original Completion Date 02-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 ~1 &E ----L 13. Contact Person t r I CA1
14. Federal Employer ID. f P II _ 15. Tel. #(S1b) 9 t — 3 a0DFax k L-~.\ 7
16. Address 3a t o € %-1 dV s A.1Eu E ` City WA- t ACt H State _Zip tI 79
V. THIRD PARTY AIR MONITOR
17. Name WAL P 'err ? Z i2 C. 3 i,3fieA1•~1 f G 18. Contact Person ___ I C c' E- ~
`
19. Federal Employer ID. # 20. Tel. IR , ) 9 2 " iD 0 17 Fax # C'I 3) 9 3') cC,
21. Address 8• S • L[' City N State I zip ( 00' 3'
22. Sample Analysis Laboratory SG t~% L I!i.Pt%e Q ti$ ' 3. NYS DOH ELAP # % 19
VI. PROJECT INFORMATION ❑ Project Cancelled
24. Starting date for this portion of work 00 0 - Projected completion date OZ— ❑ Project Postponed
Asbestos work schedule 0 Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ rda ❑ Sunday
Shift from: ❑ am ❑ pm to 0 am 0 pm If other, specify
25. Additional asbestos-containing material to be disturbed during this work ( S~ ~b~r Fe~~A~•" "_ Feet
Reduction in the amount of ACM to be disturbed during this work Feet,,~J
l'tL ' Li eet
00 ~j
29. Abatement Procedure for Additional Material (Check all appropriate boxes) .~1F~SILE~t'
0 Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application to
Other Changes
30. Locations of abatement modified by above -P€ G _ Qct.XC _ (S
(For each floor list ACM quantity and t9
~ t
31/32. Name of Applicant! Owner ~' Tel. #1 7t ((S i s
Name of Company (If any) C LG P Fax # `
Address City State Zip
I hereby declare that the information provided herein is true and complete.
t CL
JoEye Signature of Applicant /Owner Date
ACP 8
pat
RE 15~_S' ~ ?12001
NYC-WTC 000100365
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