NYC 9/11 Public Portal Document
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY
Asbestos Control Program Fee (if any) $
59-17 Junction Boulevard, 8s' Floor. Corona. NY 11368-5107
ONLY l \ D;
TYPEWRITTEN \ ` _•~ _ ~~~ • Amendment iV- ),..
FORMS WILL BE_. ASBESTOS PROJECT AMENDMENT FORM Information Only: ❑ Yes ❑ No
ACCEPTED C c,sovle.pJ FOR FORM ACP 7
A modification Is valid only If It Is received by the NYCDEP prior to the previously died date of
completion, except for start date changes that must be received by the original start date.
ACP7 TRU/BN# 1)102. Facility Address 6 Borough N' Zip t
Date ACP7 was filed 7jO') Variance # (if any)
Was this ACP7 amended before? ❑ Yes 1lo If yes, specify date___________
Original Start Date ®'? - Original Completion Date9\9 \t t2 _fromACP 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 item.
IV. ASBESTOS ABATEMENT CONTRACTOR
t o•
i2. Name ~ .,E _ , 'dam ._._._._._._ 13. Contact Person t►J { ( St
14. Federal Employer ID. # . • 15. Tef. # ST s) Z~Si —3 ax #~ )7 k1-- C T
n
16. Address , o &rte 11- City lr Ai 1'4r t 1k ___State • Zip______
V. THIRD PARTY AIR MONITOR
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17. Name Q•_ )r, P Q- `,,i tgef 2 + i t. 18. Contact Person 1C n
19. Federal Employer ID. # 20. Tel. # MIA9 yL.-COfl Fax# '?.)< 7:Z-"'o6 At
21. Address City N y State 4 3 • AZip C3
r-- t t t
22. Sample Analysis Laboratory *~~ L eR t C.3 NYS DOH ELAP # \
VI. PROJECT INFORMATION El Project Cancelled
24. Starting date for this portion of work_1 ©"'Projected completion date "" ❑ Project Postponed
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday 0 Saturday ❑ Sunday
Shift from: 0 am ❑ pm to ❑ am ❑ pm If other, specify
25. Additional asbestos-containing material to be disturbed during this work C) SquareZe~t, a~~ r ' Line "deb
~
Reduction in the amount of ACM to be disturbed during this work Squa r!) ar eet
29. Abatement Procedure for Additional Material (Check all appropriate boxes)
❑ Full Containment ❑ Giovebag ❑ Tent 0 DEP Variance Application :_~ " :'j
Other Changes V 4 v/
30. Locations of abatement modified by above CQ
(For each floor list ACM quantity an )
31/32. Name of Applicant / Owner ___________________________________________Tel. #_c T I c— ~~
Name of Company (if any) Fax #
Address City State Zip
I hereby declare that the information provided herein Is true and complete.
Signet re of Applicant /Owner
ci:.1i
Date
} AC0
a' IQU Of Eto 2/20011
,. ~•F Z ; El~ti ~flrlir
4S .S*05 NAM
NYC-WTC 000127202
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