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� , 3. Company and/or individual that conducted the building inspection and the procedure used to determine�the presence or absence of ACM(including analytic method): 'Prior to demolition alI buildings must be inspected by sn LPA accredited inspector. 4. Description of planned demolition and the specific method(s) that will be used: 5. If the demolition was ordered by a government agency, ptease identify the agency and attach a copy of the order: Name: Title: Authority: Date of Order(M/D/�: Date Ordered to Begin(M/D/1�: * Notification for an emergency demolition must be submitted as early as possible before demolition begins,but not later than the following working day. A demolition is considered an emergency ONLY when the facility has been deemed structurally unsound and in danger of imminent collapse. If the structurally unsound building is known to coatain any reeulated ACbf or is suspected to contain any regulated AC�f,special procedu�es bIUST be followed. If you are unaware of the special procedures, instructions/regulations can be obtained by contacting the 1�iPCA at Ehe address or phone number listed below. 6. Description of procedure to be followed in the event that unerpected RACNI is found or Cat. II nonfriable ACNI becomes crumbled,puIverized or reduced to powder: 7. �Vaste Transporter Information: 8. �Vaste Disposal Information: Transporced Name: Landfill Name: Transporter Contact: OwnedOperator: Transporter Address:_ Address/Location: City,State,Zip: Ciry,State,Zip: Phone Number: Phone Number. ' ' 9. I certify that the above information is correct and I am a bonafide representative of the demolition contractor or building owner and have authority to enter into agreements for my emploper. Si�nature of Con�actor/Owner Date Send or Far to: For questions call: Asbestos Coordinator-Air Quality Division 612-296-7300 �i�T Pollution Concrol Agency 1-800-657-3864 520 Lafayette Road North Fa.r: 612-215-1593 St. Paul,1MI 55155-4194 *