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, Minnesota Pollution Control Agency <br /> Notification of Intent to Perform a Demolition <br /> '�� Type of NotiFcation [ ] Original [ J Amended [ ] Project Cancellation <br /> Demolition Contractor• Building Information• <br /> Name: � QA���+a1 �' S�`^S <br /> Building Name: <br /> Address: ���d� C.O • �� �'3 Address/Location:__�3�Z QAVN! �►�'� Q� <br /> � City,State,Zip: ���s . M N <br /> City,State,Zip:�AP���g _ M N S S3�13 county: �L���Q ��`^ <br /> Contact Person: h � Phone Number(s): N.�. <br /> Phone Number(s): 36q� SOZ t 'C�'�� Age of Bldg.(years): '? Size of Bldg.(sq. ft.): �� <br /> q'3$- �13�. �f�. <br /> Number of Floors Including B�sement Leve((s): �. <br /> Building Owner• <br /> Name: ��� � .�O�tA�w.� Present Use of B(dg.: C�"'�� <br /> c 6e�.�Q ,p�� <br /> Prior Use of Bldg.: �3���v�e� <br /> Add:ess: �$SZ ��es�^� C.: R�e. <br /> Dates when demolition or intentional burning <br /> will Begin �•10• a0 & End �0•10-00 <br /> City,State,Zip: Ee�Qv► �"i�►�i'�Q , MN SS3�'1�1 <br /> Notification must be postmarked or received ten(10)working days <br /> Contact person: �e�� Or ��7��►r►�C, before demolition begins. 'See item#5 for emergency demolitions. <br /> Phone I�'umber(s): �S Z— �y-`" �Z•�"�� Boch 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 (RAC1Vn in the buildine <br /> to be demolishe:;, it must be removed by a licensed asbestos contractor prior to demolition. The State of N�i 1- <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 �O <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 Linear Feet <br /> Square Feet Square Feet <br /> Cubic Feet Cubic Feet <br /> CateQ�I nonfriable A M means asbestos-containing packings, �tgQo�-v II nonfriable A .1��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 dry,cannot be crumb(ed,pulverized,or <br /> "Category I nonfriable AC�I is not allowed to remain in place reduced to a powder by hand pressure. <br /> for demolition if it is in poor condition. 'Category II nonfriable AC�I 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. (ez transite,cement,slate roofing) <br /> 2. Description & Locatio❑ of ACM remaining in place (including floor# and room #): <br />