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3. Company and/or individual that conducted the building inspection and the procedure used to determine the <br /> presence or absence of ACM(including analytic method): *Prior to demolition all buildings must be inspected by an EPA <br /> accredited inspector. <br /> 4. Description of planned demolition and the specific method(s) that will be used:—,��,�J1 r0,-1A 6-A,7- -_ <br /> l �- <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: Authority: <br /> Date of Order(M/D ): Date Ordered to Begin(M/D/Y): <br /> * Notification for an emergency demolition must be submitted as early as possible before demolition begins,but not later than the <br /> following working day. A demolition is considered an emergency ONLY when the facility has been deemed structurally 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 ACM,special procedures MUST be followed. If you are unaware of the special procedures, <br /> instructions/regulations can be obtained by contacting the NIPCA 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.H nonfriable <br /> ACM boxame§cru led,pulverized or redu d to powder: <br /> tgld/� -�_ 416 <br /> 7. Waste Transporter Information- S. Waste Disposal Information: <br /> m . <br /> Transported Naf Zog-s— <br /> Landfill <br /> Name:DE74�A <br /> _(�f(7/ <br /> ,,,Transporter Contact- — S D, <br /> � � Owner/Operator: <br /> '00, <br /> p�Tr�AsporttA�d)s3���/� � � c /14A ) <br /> Address/Location: <br /> City,State,Zip: QA4 City,State,Zip: e�,_ -S-5- � <br /> Phone Number:LP// �� — PO) — Phone Number: <br /> 9. I certify that the above informati c re t and I am a bonafide representative of the demolition <br /> contractor or building owner a aut ority to enter into agreements for my employer. <br /> Signature of Contractor/Owner Date <br /> Send or Fax to: For questions call: <br /> Asbestos Coordinator-Air Quality Division 612-296-7300 <br /> MN Pollution Control Agency 1-800-657-3864 <br /> 520 Lafayette Road North Far: 612-215-1593 <br /> St. Paul, MN 55155-4194 <br />