Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY Asbestos Control Program Fee (d any) S . _ .59-17 Junction Boulevard, 6°i Floor, Corona. NY 11368-5107 ONLY !Wi9-,2'Q7 Amends FORMS yy~~.. ^"a.v ASBESTOS PROJECT AMENDMENT FORM Information Only: ❑ Yes 0 No ACCEPT? - ....e.~. .r 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 dianges that must be received by the original start date.

ACP7 TRUIBN# Fadlity Addr9ss ))2. W 11-L/ ATY) ST Borough n1 ' Zip /003a -

Date ACP7 was filed 0 Variance # (If any)

Was this ACP7 amended jefore ❑ Yes (o If yes, specify date

Original Start Date 3 D Original Completion Date /O1from ACP 7. #24.

PLEASE ENTER THE INFORMATION THAT IS BEING CHANGED: A notification may be modified no more then twice. 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 __ `` ctt 12. Name L.Q- l 13. Contact PPersoon tO V t CoS 14. Federal Employer ID. -P11 _ 15. Tel. # T b j' T&i #. 16. Address o lO (L' r•xs t .Q-w~ .. city War ,d' 4e..1* state N' zip______

V. THIRD PARTY AIR MONITOR p ,, A ~, (~ 17. Name ~ QS~Y PPS C+ ~,, Crn4tN2fc~8 ( f 18. Contact Person 1y11C1ns

19. Federal Employer ID. # 20. Tel. # ->l 1 •-0071 Fax # t,tZ~~ 7- - ""~~'

21. Address city t ` State N -' kZip 1001I- n. 22. Sample Analysis Laboratory C ~N 1~ ~-Y3. NYS DOH ELAP #_I

VI. PROJECT INFORMATION ❑ Project Cancelled 24. Starting date for this portion of work _/ Projected completion date /D 30 D ❑ Project Postponed

Asbestos work schedule ❑Monday ❑Tuesday ❑Wednesday ❑Thursday ❑Friday ay Q Sunday

Shift from: ❑ am ❑ pm to ❑ am ❑ pm ff other, specify '

25. Additional asbestos-containing material to be disturbed during this work '`1 Squi (d /or cry Unear Feet

Reduction in the amount of ACM to be disturbed during this work - Sg 4t~ar Dor near Feet

29. Abatement Procedure for Additional Material (Check all appropriate boxes) G. ❑ Full Containment 0 Glovebag ❑ Tent ❑ DEP Variance Appl pnSR

Other Changes

30. Locations of abatement modified by above ES j f1-rl E4ST CAS t! (For each floor list ACM quantity and type)

31/32. Name of Applicant! Owner ~1~t50 Pi%u / /~) 4 1 Tel. #~~ ~J- r 2<

Name of Company (if any) N `7 Fax # U ri City State Zip

I hereby declare that the Information provided herein Is true and complete. l o~-- Signs re of Applicant /Owner e a rarwpa~owctr+nrorocra i n r 22001

NYC-WTC 000110383