Asbestos Project Amendment form, Oct 2001

NYC 9/11 Public Portal Document

I

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY Asbestos Control Program Fee (if any) $ ~ 59-17 Junction Boulevard, 8"' Floor, Corona, NY 11368-5107 s ONLY // TYPEWRITTEN \ _/~? Amendment d/7 FORMS WI Mue10"=~ ASBESTOS PROJECT AMENDMENT FORM Information Only: ❑ Yes ❑ No ACCEPT FOR FORM ACP 7 iS \1P A modification is valid only If it is received by the NYCOEP prior to the previously filed date of \ completion, except for start date changes that must be received by the original start date.

ACP7 TRUBN# 12 25 M NO2 Facility Address 2-0 cLoA Sr 9-ei-r Borough M r.l. Zip 1 00014 Date ACP7 was filed 81Oq /02— Variance # (If any)

Was this ACP7 amended before? ❑ Yes QNo If yes, specify date

Original Start Date $ 1 q o 2- Original Completion Date IOC 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 Ci ry State Zip V. THIRD PARTY AIR MONITOR Oj

17. Name 18. Contact Person 19. Federal Employer ID. # 9I. # Fax # 21. Address State Zip 22. Sample Analysis Laboratory 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 5j ❑ Project Cancelled 24. Starting date for this portion of work Projected completion date 0 Project Postponed

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

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

25. Additional asbestos-containing material to be disturbed during this work BOO Square Feet, and/or 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) 0 Full Containment 0 Glovebag ❑ Tent 0 DEP Variance Application

Other Changes

30. Locations of abatement modified by above I i e m t'le. R . FrtcA o E / v r t2$ A-f 28 ~ Cr-000_ Roo(' (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.

nature of Applicant /O r 1 Z//O Date Ott u ACPs 2/2001 11~ f o 01

NYC-WTC 000111335