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. � � �� a� o3 <br /> Minnesota Pollution Control Agency/ Minnesota Dept. of Health <br /> Minnesata Notification of Asbestos Related Work M i N N e s o T a <br /> Pollution , <br /> Contro� �Original �Amended# � Cancellation <br /> Agency DEPARTMENTorHEAITH <br /> �Residential XQ Nonresidential <br /> �bestos Abatement Contractor License#: 593 Building Owner: <br /> me: Veit Environmental, Inc, Name: Ms.eindy Piper <br /> Address: 23801 Industrial Boulevard AddresslLocation: 2505 Willow Drive <br /> Suite 100 <br /> ty, State, Zip: Rogers, MN 55374 City, State, Zip: Hamel,MN 55340 <br /> ontact Person: Roger pokken Contact Person: <br /> one Number(s): (763)428-2819 Phone Number(s): 763t473-2603 <br /> r IVlonitoring Contractor License#: Building Information: <br /> ame: Techtron Engineering, lnc. Building Name: Residence <br /> dress: 640 E. Main Street ' Address/Location: 1125 Spring HiII+Road <br /> City, State, Zip: Long Lake, MN <br /> City, State, Zip: Anaka, MN 55303 Counry: Hennepin <br /> �ntact Person: Mike Badnar Phone Number(s): <br /> one Number(s): 763/712-9502 Size of Bldg (sq ft): 5,OQ� Age of Bldg.(yr.) 5a ' <br /> xQair sampling analysis only Number of Floors Including Basement Level(s): � <br /> � Present Use of Bldg.: Unoccupied <br /> Prior Use of Building: Residence <br /> 1. T e of Project: check all that apply) <br /> Renovation x�Demolition Abatement �Encapsulation [� Permanent Enclosure <br /> , Emergency(#7 must be completed to validate and Emergency) <br /> Using MDH Demolition Abatement Rules (Minn. R. 4620.3585) <br /> 1 Amount(s)of RACM (Regulated Asbestos Containing Material)to be abated: <br /> friable nonfriable <br /> � 400 : Linear feet on pipes <br /> _ _ __ _ _ _ __ <br /> � `:'Square ft. on faciliry components (e.g. tanks, boilers, ceilings, ceiling tiles, flooring) <br /> Ceilings <br /> Cubic feet off facility components if linear or square footage cannot be determined. <br /> � Asbestos Abatement Activity Dates: <br /> a. Precleaning Work Area to Final Visual Inspection: Start: 9l16/02 End: 9/20/02 <br /> 1 b. Dates when RACM will be Disturbed: Start: � 9/16/02 End: '9/20/02 <br /> c. Workshifts, time and days (e.g. 7AM to 3PM Mon-Fri) Monday-Friday 7AM-4PM <br /> ,, Building Inspection: Priorto a renovation ordemolition,all building musf be inspected by an MDH accredited inspector. <br /> a. Company and/or individual that conducted the building inspectior�: Owner <br /> � b. Procedure, including analytic method, used to determine the presence of RACM: PLM Analysis <br /> � Description � Location of RACM to be abated (including floor#and room#): <br /> emoval of asbestos insulated pipe and fittings from Iower and sub level of`residence.: <br />