Laserfiche WebLink
� •, � . <br /> . . . <br /> 3. Company and/or individua]that conducted tbe building inspection aad the procedure nsed fo determine the . • <br /> presence or absence of ACM(including analytic method)z *Prior to demolition all�buildingi rpust be inspeeted by ad Epp <br /> accredited Inspector. <br /> r <br /> 4. Description of planned demolition and the specific method(s)that will be useds <br /> �C'a �f3� �Ru�OMP�v� <br /> i <br /> 5. If the demoIition was ordered by a government agency,please identify the agency and attach a copy�of the. . <br /> order• <br /> Name: Title: � Authori • <br /> �� ..' <br /> Date of Order(M/D/�: Date Ordered to Be in � <br /> g (Min�: - <br /> * Notification for an emergency demolition must be submitted as early as possible before demolition begins,but not later than;he . <br /> following working day. A demolition is considered an emergency OIYLY when the faciliry has been deemed structuraliy unsound and <br /> in danger of Imminent collapse. If the structurally unsound building is known to contain any regulated ACM or:is suspected:to' <br /> contain any regulated ACr1,special procedures hIUST be followed. If you are unaware of the special procedures, <br /> instructioas/regulations can be obtained by contacting the hIPCA at Ehe 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: Ui/i���Pv �u c,,.51,C � � <br /> Land611 NamE:_ �Q,�1.�0 ti <br /> Transporter Contact: OwnedOperator � <br /> TransporterAddress:_ Address/I;ocations <br /> CitY.State;Zip: �� /Da�NQ /�� s l�' � Z Ciry,State,Zip: . �(o � <br /> Phone Number�- 9�'L — �/6 6 � .�es 5,3 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 Con�actor/Owner . <br /> Date <br /> Send o�Fa�c to: For questions call: <br /> Asbestos Coordinator-Air Qualiry Division ` 612-296-7300 � <br /> MN Pollution ControI Agency � 1-800-657-386� <br /> 520 Lafayette Road North Far: 612-215-1593 <br /> St.Paul,NiN 55155-4194 � <br />