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; � ` i <br /> 3. Company and/or individual that conducted the building inspection and the procedure used to determine the � � <br /> preseace or absence of ACM(including analytic method): 'Prior to demolition all building�must be inspected by an EPA <br /> accredited inspector. <br /> � ` � � ` . <br /> � 'ei�l�ta <br /> 4. Description of planned demolition and the specifc method(s that will be used• <br /> // <br /> 'G � — <br /> 5. If the demolition was ordered by a government agency,please identify the agency and attach a copy of the <br /> order: <br /> Name: Title: ' Authoriry: <br /> Date of Order(M/D/�: Date Ordered to Begin(M/D/I�: <br /> * I�iotifcatioa for an emergency demolition must be submitted ss eariy as possible before demolition begins,but aot later than the <br /> following working day. A demolition is considered an emergeacy ONLY when the facility has been deemed structurally unsound and � <br /> in danger of imminent collapse. If the structurally unsound building is known to contai�any regulated ACrI or is suspected to <br /> contain any regulated ACri,specia!procedures iNST be followed. Ifyou are unaware of the special procedures, <br /> instructions/regulations can be o6tained by contacting the 1�IPCA at the address or phone number listed below. <br /> 6. Description of procedure to be followed in the event that unexpected RACM is found or Cat.II nonfriable <br /> ACM becomes crumbled,pulverized or reduced to powder: <br /> 7. Waste Transporter Information: 8. Waste Disposal Information: <br /> Transported Name: Landfill Name: <br /> Transporter Contact• Owner/Operator: <br /> Transporter Addrus:_ Address/Location: <br /> Ciry,State,Zip: Ciry,State,Zip: <br /> Phone Number. Phone Number. � <br /> 9. I certify that the above information is correct and I am a bonafide representative of the demolition <br /> contractor or building owner and have authority to enter into agreements for my employer. <br /> Signature of Contractor/Owner <br /> Date <br /> i Send or FaY to: For questions call: <br /> Asbestos Coordinator-Air Quality Division 612-296-7300 <br /> I�i 1 Pollution Control Agency 1-800-657-3864 � <br /> 520 Lafayette Road North Far: 612-215-1593 <br /> St.Paul,1�L�1 55155-4194 <br />