NYC 9/11 Public Portal Document
//2801 11:01 8567685499 0000000 PAGE 02
NYC DEPARTMENT OF ENMR~MENTAL PROTECTION FOR OmOJAL USE ONLY
y P 59-17 Jwrceon 8ovtsvaed. a Floor. Corona. NY 11368.8107 f Y) $-
w' ASBESTOS PROJECT AMENDMENT FORM
Acc&'Ti:O • • •• FOR POW ACP 7 S Irdarrratton Ortiy: O Yes ❑ No
A man is veld ogly if it is rece i ed by rne NYC0EP prior the pmvioudy bled dots d
----- c ele6on, e>mept far stwt date thanges that meat be received m by the original start date.
ACP7TRWI31—I }._ PadltyAddru s102-1.04 Greenwich Street Borotg*1anhattan Zip OOQ6 M
Date ACP7 woes fled _ _ Variance # (if any)
Was this ACP7 *rngn td bstota? ❑ Yas Q No If yes. speafy tide
~~,
4 Q
Ortginai Start Ohs 12/3/01 Otigind CorWw on Oahe i2/24/0i troutACP 7,024.
Came/ dii,3 `•
PLEASE ENTER T!E VIFORMI1t1ON THAT is BANG CH t ,inn: A n brio t on may be modired no more than halve.
t~rNy the building owner may amend (terns IV and V.
W. ASBESTOS ABATEMENT CONi1iACrOR The cd l apØicant or twidrrg owner may amend all oiler items.
12. Name
13. Contact Person
14. Federal Erepicyer ID. # 15. Tel. # Fax #
16. Atitlrtlas
CRy State _ Zip
V. THIRD PARTY ANt MONITOR
Name V V V
17. 18. Contact Person
19. Federal Eta rIO er 1O. U
20. Tel. # Fax#
21. Address' _ V
State p
22. Sample
23. NYS Doti ELAP #
Vi. PROJECT #9Ola1A'n0N
_ - ❑ Project Cancelled
24. StaRlrtg ds06 fbP Qua poAiott of work _ Projected completion .2/29/03. ❑ Project Postponed
Asbestos work edtedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday Fnday ❑ Saturday O Sunday
Shift front: Ea am ❑ pm to ❑ am 0 pm If other, apedfy
25. Additional Wbetoa'c nth#ning material to be disturbed during this work
Square Feet. and/or Linear Feet
Reduction in this amount of ACM to be disturbed during this work
Square Feet. and/or ___... Linear Feat
29. Abatement PMoosdure for Additional Maletird (Check all
appropriate boxes)
❑ i tit Cn 1Jnent Q Giovebag ❑ Tent O OEP Variance Application
Other Cftaroe
30. Locations ofIKNlemet* modified by above -w- ----
(For each Veortf~t ACM quantity and type)
31/32. NormoIA0pl of/Owner AE12, LLC — Bernard McKenna Tal # 856-768-9200
Name of ca prtfr(9er>al) AEi2, LLC
Fax# 856-76A—
Address 43 Jefferson Avenue cy Berlin State NJ Zp 08009
t hereby declare that tto kWbrtnatiart provided herein is true and
comptwte.
t '
_
Signature of Applicant Date
ACP6
NYC-WTC 000128556
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