204 BROADWAY 1001222, 79/21

NYC 9/11 Public Portal Document

FOR OFFICIAL USE ONLY Asbestos CorttrQ Program Fee•(lfany) $ Corona, NY 11368.5107 ONLY # D.P ) 59-17 Junction Boulevard, 8e Floor, Amendment f 7l ASBESTOS PROJECT AMENDMENT FORM Information only: ❑ Yes ® No ACCEPTED www.a c. ov ao FOR FORM ACP 7 A modification Is valid only it 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. O2. ACP7 TRUIBN# t Z 5 `/ M Facility Address 20 4 8 eos+.vw Borough MN Zip 1OO38

Date ACP7 was tiled Variance # (If any)

Was this ACP7 amended before? ❑ Yes ® No If yes, specify date

Original Start Date 08101(02. Original Completion Date e9IO.t 1 O2 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 12. Name 13. Contact Person

14. Federal Employer ID. # 15. Tel. # Fax #

16. Address City p

V. THIRDPARTY AIR MONITOR E1VED t 17. Name 18. Contact Personn - AUR 19. Federal Employer ID. # 20. Tel. # os co ha. 21. Address City p

22. Sample Analysis Laboratory 23. NYS DOH ELAP

VL PROJECT INFORMATION ❑ Project Cancelled 24. Starting date for this portion of work Projected completion date ❑ Project Postponed

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

Shift from: ❑ am 13 pm to ❑ am 13 pm if other. specify

25. Additional asbestos-containing material to be disturbed during this work 6'7'2 o Square Feet, and/or o Linear Feet

Reduction In the amount of ACM to be disturbed during this work Square Feet, and/or Unear Feet

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

Other Changes 30. Locations of abatement modified by above (For each floor fist ACM quantity and type)

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. ++ . ~ ~rsYcoEP a$I a8 tt om aEss~ ; Signature of Applicant /Owner Date • p~a ``{aa ~t~ ACPB P4 P Q4'

NYC-WTC 000123277