Invoice from contractor to DEP for environmental services

NYC 9/11 Public Portal Document

FOR OFFICIAL USE ONLY , '~a"f OEPj NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION p_ /ice " Asbestos Control Program Fee (if any) $ l'. ( DM~r 1 59-17 Junction Boulevard. 8"' Floor, Corona, NY 11368-5107 ONLY ~/ / l, j Amendment Z_ TYPEWRI1TEN FORMS WILL BE u. ASBESTOS PROJECT AMENDMENT FORM Information Only O Yes O No ACCEPTED wrw.ayc.6ovfdap 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.

MAIDEN LAME Borough MAAi. zip 1O(3$ ACP7 TRU/BN# /V2Ogk 2))FacilityAddress 9 -II

Date ACP7 was filed Variance # (If any)

Was this ACP7 amended before? ❑ Yes [A No If yes, specify date

Original Start Date Original Completion Date from ACP 7, #24. A notification may be modified no more than twice. PLEASE ENTER THE INFORMATION THAT IS BEING CHANGED: Only the building owner may amend items IV and V. The original applicant or building owner may amend all other items. IV. ASBESTOS ABATEMENT CONTRACTOR 19 Name 13. Contact Person

14. Federal Employer ID. # 15. Tel. t Fax #

16. Address City State Zip

V. THIRD PARTY AIR MONITOR r2 17. Name 18. Contact Person -

19. Federal Employer ID. #____________________ 0. TeI. Fax #

21. Address { ~~ State - Zip

22. Sample Analysis Laboratory Z *• 23. NYS DOH ELAP #

VI. PROJECT INFORMATION ❑ Project Cancelled 24. Starting date for this portion of work 9P date ❑ Project Postponed

Asbestos work schedule O Monday O Tu edr ❑ Thursday O Friday O Saturday O Sunday

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

25. Additional asbestos-containing material to be disturbed during this work I O, BCD Square Feet, and/or a Unear Feet

Reduction in the amount of ACM to be disturbed during this work .Square Feet, and/or Unear Feet

29. Abatement Procedure for Additional Material (Check all appropriate boxes) ❑ Full Containment O 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 dedare that the information provided herein is true and complete. _102.. uYe t~'P t oid e Signature of Applicant /Owner Date .& C RF M 2= arzoo1

NYC-WTC 000101849