Asbestos project amendment form, DEP Box 39

NYC 9/11 Public Portal Document

c~ir~n,6Pry NTGLJEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY r'►? 0 • Asbestos Control Program Fee (if any) $ ONLY ', ", TYPEWRITTEN '~4i D/A~/P ;~;I ~cr 59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107 Amendment G r~ ~d /' 7 FORMS WILL BE ASBESTOS PROJECT AMENDMENT FORM Information Only: ❑ Yes ❑ No ACCEPTED ' ++•••r •r•~l•w 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 TRU/BN# 1 _O _40I_Facility Address 151— - Sa- c iR}_ M1166 SL Borough N , 4 Zip 100 ~_____

Date ACP7 was filed _I3 - Variance # (If any) _

Was this ACP7 amended before? 0 Yes 1Io If yes, specify date

Original Start Date Original Completion Date _ 3 0 —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. The original applicant or building owner may amend all other items. IV. ASBESTOS ABATEMENT CONTRACTOR r 12. Name f~.2y- ~ ~-t ''~ __ f)J 13. Contact Person _______

14. Federal Employer ID. # " 15. Tel. # s ^ 3Cr' CFax~~ 1=~JO f~ ' 16. Address L ~-wr •x.g V ~-v~• ~~- City V,)r i'14 -e.E 1'* _ State ~' Zip _ _

V. THIRD PARTY AIR MONITOR

17. Name. (~1 Y L 1 e- rJ2~•2~ ~r 18. Contact Person , L_ —

19. Federal Employer ID. # _ _20. Tel. # _>) Cj ^ X72 Fax # N 119, aa. - Q(o

21. Address ~`~~ _E- City t ' _—_ State N " kZip _L~1 _ 22. Sample Analysis Laboratory_~C_t ~~ i I ~~C, t 21 , t~1_C33. NYS DOH ELAP # ~~

VI. PROJECT INFORMATION ❑ Project Cancelled 24. Starting date for this portion of work a! ~L~~- Projected completion date p I so2- ❑ Project Postponed

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

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

25. Additional asbestos-containing material to be disturbed during this work eel nd/or Linear Feet i Reduction in the amount of ACM to be disturbed during this work e re v ear Feet

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

Other Changes

30. Locations of abatement modified by above _Q!N gi~-CK- sE I g ACJC.. (For each floor list ACM quantity andtype)

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. '~_ _ fir dZ_ Signature of Applicant /Owner qat )r.0 ACP 8 ;nq 9f E+wP(NMfNtAL 2/2001 !rY: P. t?JTPt II! T • i•95 C^.N i?Ol o•^;PAST

NYC-WTC 000111073