177 BROADWAY 1001077, 63/19

NYC 9/11 Public Portal Document

DEPARTMENT OF ENVIRONMENTAL,PROTECTION FOR OFFICIAL USE ONLYi .._ Asbestos Control Program ONLY 7YPEWRI7TEN D n 11P ) 59-17 Junction Bourevard, a'" Fbor, Corona, NY 11368.5107 F (if any) $

FORMS WILL. BE ASBESTOS PROJECT AMENDMENT FORM ACCEP77:Q t FOR FORM ACP 7 Information Onlyy0 ❑Yes No A modification Is valid only If It Is received by the NYCDEP prior to the previously tiled date completion, except for start date changes that must be received by the original start date. of

ACP7 TRU/BN# _1 -U%6&acillty Address_Ill fccIcItCoA.4 Borough _t ' Zip Date ACP7 was filed OZ Variance # (If any)

Was this ACP7 amended before? ❑ Yes JfJo if yes, specify date Original Start Date tO I a 2 Original Completion Date a b2 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 ~*~..te_ _._._.~. ~'' a t e: C~ 13. Contact Person _ fa N 1 14. Federal Employer ID. #.~.,.-.- ._._._ P . ._._ .ç. . ----- ."' 15. Tel. 451 b -7 T " 3 ~ ODFax ~~• g " 3ag 16. Address 3Q ( ar A & Eu E City r..~ i ACt E{ State Zip 1 3 V. THIRD PARTY AIR MONITOR

17. Name WAL P PMZ i2 tt S eAU t #' G 18. Contact Person M t C. - 19. Federal Employer ID. # 20. Tel. è3I4d12.. oD17 Fax # 4)) c ~, _ oC 3r'C) 21. Address _3.& S ° 4.S1 S* City N ' Statj, ' I_ Zip 1DO T 22. Sample Analysis Laboratory $.t C.I. 1 is G. (1.Ate Q t{~ i CQ3. NYS DOH ELAP # g~ tt VI. PROJECT INFORMATION 0 Project Cancelled 24. Starting date for this portion of work I e 2-- Projected completion date )_3) !_' '- 0 Project Postponed Asbestos work schedule 0 Monday ❑ Tuesday 0 Wednesday 0 Thursday 0 Friday 0 Saturday ❑ Sunday

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

25. Additional asbestos-containing material to be disturbed during this work 3o Q "' Square Feet and/oRECElVEllinaar Feet Reduction in the amount of ACM to be disturbed during this work Square Feet, anA 1 4 6r Feet 29. Abatement Procedure for Additional Material (Check all appropriate boxes) ~, FPJE rt.' + • ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application TG .. I3 Other Changes 2

30. Locations of abatement modified by above - (For each floor list ACM quantity a d ) 31/32. Name of Applicant! Owner_Tel. # 17 I() 95 Name of Company (If arty) Fax # Address City State Zip

I hereby declare that the Information provided herein Is true and complete. ,A U y Sig ature of Applicant /Owner Date ~cr►a 212001

NYC-WTC 000122742