NYC 9/11 Public Portal Document
8567685499 0000000 PAGE 02
(/2011 11:01
NYC DEPARTMENT tl ENVIRONMENTAL PROTECTION FOR OFrCaAL USE ONLY
59-17 JWfCtlon 8t>vtsvaed. 8 e F1OOt. Coen , NY 11365.5107 Fee Qf any) S______
ce~ ASBESTOS PROJECT AMENDMENT FORM Anux+ament
ACCEFr= ' 'TD FOR FORM ACP 7 kdamation Ont 0 Yes ❑ No
A mo01h;e lan is wend only t it is receMad by Me NYCOEP prior to the ptaviousiy
Glad date ci
O0 on. spt for alas date diangee lust mast be received by the originsl start date.
ACP7TRUfri3 *- — PadgtyAdd i02-1.04 Greenwich Street _BorotgtManhattan Zip 10006 M
gate ACP7 woes fbad _ _ Vadance # (it any)
ff /
Was tadsP P7 all9*" bafote? C1 Yes 0 No if1pes. apeWy date ^~
t Ql
Ordginat Start Oats 12/3/01 Otg1rciC,otttplstion Date 12 / 24/01 from ACP 7. #24. o(d/' "d~" / `•
PLEASE 7?E f~'ORMA11oN ttiAT is 8fs#NGr C~1 A nodliceUon may be modit ed no more than twice.
O y the bw7ding omw may amend Items IV and V.
W. ASBESTOS ARA'f EM NT Co rott «{pfaa ePpi ° or twAding ownet may a nand ab ocher items
12. Name
13. Contact Person
14. Federal F.trlpfpyer ID. # 15. Tel. # Fax #
16. Addeo
~y State _ Zip
V. THIRD PARTY MN MONITOR
17. Name
18. Contact Person
19. Fedensi E f I%w10. p
Z0. Tai. # Fax #
- - state Zp
22. Sample Mciysls taboratot
23. NYS Dori SAP #
Vi. PROJECT H I AflCN
13 Project Cancelled
24. Starting (tote thin portion of work Projected completion • 29 01 0 Prajad Postponed
Asbestos work adtechtle ❑ Monday L Tuesday ❑ Wednesday ❑ Thursday
Friday dSaturday ❑ Sunday
Shift from: am C1pm to ❑ am 4 pm if other, specify
25. Additiottm NkbMtO a ntdMng material to be disturbed during this wall
Square Feet. and/or Linear Feet
Reduction In V amount of ACM to be disturbed during this work
Square Feet. and/or Linear Feet
29. Abatement f oosdur. for Additionid Material (Check all
appropriate boxes)
C] FLA Cot imeri Q Giavebag C] Tent ❑ OEP Variance Application
Other Chars
we
30. Locations a aoptalernetat tieodifted by sbwe -w- ----
(For
31M Name ofAtp'fkpett/oww AEi2, LLC - Bernard McKenna Tel # 856-768-9200
tyameofCorrprrtlr(Natoll) AEi2, LLC
Address 43 Jefferson Avenue , Berlin
state NJ Zp 08009
I hereby declare that the kamlya5on provided herein is true
and cartptwte.
SlWwfure of Applicant Date
AQa'S
?12001
NYC-WTC 000128556
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