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� � <br /> � Minnesota Pollution Control Agency <br /> ' Notification of Intent to Perform a Demolition <br /> �'� Type of Notification [ ]Original [ ]Amended [ ]Project CancelIation <br /> ,� Building Information: <br /> Name: ► ` � C�6✓ , Building Name: <br /> Addras: ^�- Address/Location: ���I� r�lli0/�� 1 (�l Q !�r <br /> • cicy,stace;z;p:�C. u a s�r-�L.� /�rL., �5�5"3�l J <br /> City,Statq Zip: W � County: ! <br /> Contact Person: � �' Phone Number(s): ' - a <br /> Phone Number(s): �7 J ' ��� l Age of Bldg.(years):� Size of B(dg.(sq.R):._ DD D 5� <br /> Number of Floors Includin Base ent Levcl(s): � <br /> � Q �V � � <br /> �J Present Use of Bldg.: <br /> Name• O!/1 ///� ,�eLN jL f t� ` <br /> Prior Use of B(dg.: <br /> Address:�_��f �C�> n �r L h, , . <br /> . Dates when demolition or intentional burning <br /> � � wiIl Begin,� -/,S•a G & End�a �_-a ° <br /> c�ry,stac�,z�p• o , �� 3 6 S� <br /> Notification must be postrnarked or received ten(10)working days <br /> Contact penon:��.(�f �� �.e.�.r v� � � before demolition begins. 'See item RS for emergency demolitions. <br /> Phone Number(s): �,Z�� 7�� Both Beginning and Ending dates should be amended in wridng as <br /> necessary to reflect current project dates. <br /> If there is>2601inear feet or>160 square feet of Re;ulated Asbestos-Containing Material(RACI� in the building <br /> to be demolished,it must be removed by a.licensed asbestos contractor prior to demolition. The State of MN- . <br /> Notice of Intent to Perform an Asbestos Abatement Proje.ct must be used to notify for the asbestos removal. <br /> Is nonfriable ACM present in the structure to be demolished ? [ ] YES [ ] NO <br /> � If YES complete items 1-9. If NO complete items 3-9. <br /> 1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category II <br /> nonfriable ACNI left in place. <br /> Categ.I Lineu Feet Categ.II Linear Feet <br /> Square Feet Square Feet <br /> Cubic Feet Cubic Feet <br /> �'.atee�i nonfriable AGM means asbestos-containing packings, Cate,porv ti nonfriable ACM means any material,excluding <br /> gaskeu.resilient floor covering�and asphalt roofing products ' Catcgory I nonfriable AC�1,containing more than one perceat <br /> containing more than one percent asbestos. asbestos that�whrn dry,cannot be crumbled,pulverized,or <br /> "Category I nonfriable ACNI is aot allowed to remain in place rcduced to a powder by hand pressure. <br /> for demolition if it is in poor condition. *Category II nonfriable AC�I Is not allowed to rematn in place <br /> for demolition if it has s high probability oPbecoming c�umbled, <br /> pulverized,or reduced to a powder during demolition,transport, <br /> , . or disposal. (ex transite,cement,slate roofing) <br /> 2. Description & Location of ACM remaining in place(including floor#and room K�: <br />