204 BROADWAY 1001222, 79/21

NYC 9/11 Public Portal Document ‘Ai FORMS WILL BE ACCEPTED ¢ (DEP) Aaheuies \ 00-17 unetion Boulevard. # Pos: ont ny 11360-6107 ae? ASBESTOS PROJECT AMENDMENT FORM GeaEETED FOR FORM ACP 7 A modification is valid onty if H is received by the NYCDEP prior to the previously Ged date of Complaton, except for start date changes thet must be received by the original stert date. ACP? TRU/BN# Faciity Addreas__2O4 Broamwa+ Borough _ MN Jp 10098 Date ACP7 was flied Variance # (If any) (39 s ee Was this ACP7 amended betore? C] Yes BI No tf yes, specify cate Original Start Date 2Blot 102 — originat Completion Dete osloriog from ACP 7, #24. PLEASE ENTER THE INFORMATION THAT i$ BEING CHANGED: A notification may be modiiied no more inan twice, Oniy the buliding owner may amend moms W end V. fv. ASBESTOS ABATEMENT CONTRACTOR The onginal applicant or buliding owner may amend eff other times. i2. Meme 13. Contact Pereon 14, Federal Employer (D. # 46. Tel. # Fax # 16. Address Chy State Zip V. THIRD PARTY AIR MONITOR 17. Name 18. Contact Person 19. Federal Employer 1D. # 20. Tel. # Fax # 21, Address City State Zip 22. Sample Analysis Laboratory 23. NYS DOH ELAP # Vi. PROJECT INFORMATION Project Cencelied 24. Starting date for this portion of work Preyected completiondate= ID Project Postponed Asbestos work schedule [1] Monday [] Tuesday [] wednesday [I thursday (2) Friday CI saturday CJ sunday 25. Additional asbestos-containing material to be disturbed during this work STZSO_ Square Feet, andor © Linear Feet Reduction in the amount of ACM to be disturbed during this work eeeninnirnn GG Feel, and/or Lirwer Feet 29. Abatement Procedures for Additional Material (Check all appropriate boxes! CJ Fun Containment [1 Giovetag (tent (©) vEP Variance Appication Other Changes 3). Locstions of ehatement modified by above (For @a@ch floor list ACM quariity end type) 31/22. Name of Applicant { Owner Tel. @ Name of Cornpeny (f any) Fax @ Address City Stete Zp (hereby declare that the information provided herein is true and complete. = a | { . A wyepePe oB@loBlozg ae Signature of Applicart (Owner Oats NYC-WTC_000123269