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Minnesota Pollution Control Agency <br /> Notification of Intent to Perform a Demolition <br /> '11111■1111110.0" Type of Notification [ 1 Original [ ] Amended [ ] Project Cancellation <br /> • <br /> Demolition Contractor: Building Inform 'on• <br /> Name: G� 1` U j it fro ✓t�] � <br /> 1�� Building Name: r/� <br /> Address: / 4111.4e <JA1,�� Address/Location: C G ( (1.r i l ��;2 S 7` jk-sf <br /> -?-i� f 1 $ 3 ! ! City,State,Zip: /9-7—)1- . <br /> City,State,Zip: 7 a� <br /> County: ( /' <br /> Contact Person: l SJ 125 e (Dec-, Phone Number(s): ( (°2 <br /> Phone Number(s): 76,3-28'6 4149. (Cid-(-095-1/5" Age of Bldg.(years): &7 p ze of Bldg.(sq. <br /> Number of Floors Including Basement Level(s): <br /> Building Owner: <br /> � �, Present Use of Bldg.: Q-P 'd 2N•.%-l-w->, <br /> Name: > 1/�Il€ 1A—C- A-, (9 <br /> Prior Use of Bldg.: <br /> Address: <br /> Dates when demolition or intentional burning <br /> will Begin f g/0 3 & End 17/-20/0 <br /> City,State,Zip: <br /> Notification must be postmarked or received ten(10)working days <br /> Contact person: before demolition begins. *See item#5 for emergency demolitions. <br /> Phone Number(s): Both Beginning and Ending dates should be amended in writing as <br /> necessary to reflect current project dates. <br /> If there is>260 linear feet or>160 square feet of Regulated Asbestos-Containing Material (RACM) in the building <br /> to be demolished,it must be removed by a licensed asbestos contractor prior to demolition. The State of MN- <br /> Notice of Intent to Perform an Asbestos Abatement Project must be used to notify for the asbestos removal. <br /> Is nonfriable ACM present in the structure to be demolished ? [ ] YES `" <br /> If YES complete items 1-9. If NO complete items 3-9. <br /> 1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category II <br /> nonfriable ACM left in place. <br /> Categ.I Linear Feet Categ.II <br /> Linear Feet <br /> Square Feet Square Feet <br /> Cubic Feet <br /> Cubic Feet <br /> Category I nonfriable ACM means asbestos-containing packings, Categoq'II nonfriable ACM means any material,excluding <br /> gaskets,resilient floor covering,and asphalt roofing products Category I nonfriable ACM,containing more than one percent <br /> containing more than one percent asbestos. asbestos that,when <br /> *Category I nonfriable ACM is not allowed to remain in place reduced to a powder by,hand pre surcannot berembled,pulverized,or <br /> for demolition if it is in poor condition. *Category II nonfriable ACM is not allowed to remain in place <br /> for demolition if it has a high probability of becoming crumbled, <br /> pulverized,or reduced to a powder during demolition,transport, <br /> or disposal. (ex transite,cement,slate roofing) <br /> 2. Description & Location of ACM remaining in place (including floor#and room #): <br />