Asbestos Project Amendment Form - Nyc Department Of Environment Protection
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1
2FOR OFFICIAL USE ONLY
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
Fee (if any) $ ____________
th
59-17 Junction Boulevard, 8
Floor, Corona, NY 11368-5107
ONLY
Amendment ____________
TYPEWRITTEN
ASBESTOS PROJECT AMENDMENT FORM
FORMS WILL BE
Information Only:
Yes
No
ACCEPTED
FOR FORM ACP 7
w w w . n y c . g o v /
d
e
p
A modification is valid only if 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.
ACP7 TRU/BN# _____________ Facility Address ____________________________________ Borough ____________Zip _____________
Date ACP7 was filed ________________
Variance # (If any) __________________
Was this ACP7 amended before?
Yes
No
If yes, specify date _______________
Original Start Date _______________ Original Completion Date _______________ from ACP 7, #24.
A notification may be modified no more than twice.
PLEASE ENTER THE INFORMATION THAT IS BEING CHANGED:
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 _______________________ State ______ Zip ____________
V. THIRD PARTY AIR MONITOR
17.
Name _________________________________________________________18. Contact Person ___________________________
19. Federal Employer ID. # ________________________ 20. Tel. # ______________________ Fax # ______________________
21. Address _____________________________________________ City _______________________ State ______ Zip ____________
22. Sample Analysis Laboratory_____________________________________________ 23. NYS DOH ELAP # ____________________
VI. PROJECT INFORMATION
Project Cancelled
24. Starting date for this portion of work _______________ Projected completion date _______________
Project Postponed
Asbestos work schedule
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Shift from: _______
am
pm to _______
am
pm
If other, specify__________________________________________
25. Additional asbestos-containing material to be disturbed during this work
________ Square Feet, and/or _______ Linear Feet
Reduction in the amount of ACM to be disturbed during this work
________ Square Feet, and/or _______ Linear Feet
29. Abatement Procedure for Additional Material (Check all appropriate boxes)
Full Containment
Glovebag
Tent
DEP Variance Application
Other Changes ____________________________________________________________________________________________
30. Locations of abatement modified by above ______________________________________________________________________
(For each floor list 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.
_______________________________________ _____________
Signature of Applicant /Owner
Date
Clear Form
ACP 8
2/2001
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