NYC 9/11 Public Portal Document
BUREAU OF
AIR, NOISE, & HAZARDOUS
MATERIALS
Department of
Environmental
Protection ASBESTOS CONTROL PROGRAM TECHNICAL REVIEW UNIT
59-17 Junction Boulevard
ACP-7 CORRECTION FORM
Htuhkng, New York
11373-5108
PREMISES ADDRESS c 7aie
•Chr(stopher O. Ward BOROUGH ZIP CODE
Coniw1ssIoner
{ J CORRECT
START DATE /-2Y-O3 COMPLETION
CORRECT
DATE/ — ?
CORRECT ACM QUANTITY: i SQ. FT, AND/OR: ' LN. FT.
Correct Method of Abatement: -Q cl/
4
The undersigned affirms that she/he has been instructed verball,
and/or ACM quantity, by MsJMr. .Lie.4 "y % , who is
Organization/agency/company/corporation stated in the form i
facility address to be the (Please Check one box only):
[ ]' Asbestos Abatement Contractor [] Building Owner
[ ] Applicant for the asbestos project. U~o
The Undersigned is Employed by
J C3 tit i¢Z J 7 /.' C C v ritR . vc .
Organization/ Agency/ Company/ Corporation
Address
)' -Do ?7 2 s-V
Telephone #
Print Name Signa ure
Telephone: (718) 595-3652 Fax: (718) 595-3648
~4O"arcvr*1
www.ayc.6ov/deo
(718) 01P -HELP
$
NYC-WTC 000116314
OCR can misread numbers and units. Confirm readings against the page image before using them.