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1 . . <br /> 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 ail buildings must be inspected by an EPA <br /> accredited inspector. � <br /> __ Av+�rO� �v�Aly'1�CA1 ��a.0 <br /> ee O.ct�ed <br /> 4. Description of planned demolition and the specific method(s) that will be used: �rOG� ��_ <br /> � ,00►�� ��'�0 avw.ls "�f v�S �.1y il b4C� �►O�, <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: N./4. Title: <br /> Authority: <br /> Date of Order(M/D/Y): Date Ordered to Begin (M/D/I�: <br /> * Notification for an emergency demolition must be submitted as eariy 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 ACbf or is suspected to <br /> contain any regulated ACb1,special procedures 1IUST be followed. If you are unaware of the special procedures, <br /> instructions/regulations can be obtained by contacting the bfPCA at the address or phone number listed below. <br /> 6. Description of procedure to be followed in the event that unexpected RACNI is found or Cat. II nonfriable <br /> ACM becomes crumbled, pulverized or reduced to powder: <br /> C°'`�� {�`^!1.S'��v�^ 1'�hA�`/T�CA� ��� a J�S t° . <br /> 7. Waste Transporter Information: 8. `Vaste Disposal Information: <br /> Transported Name: O����a �' SOr►T Landfill Name: <br /> Transporter Contact: Owner/Operator: <br /> Transporter Address Address/Location: <br /> City,State,Zip: Ciry,State,Zip: <br /> Phone Number: 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 owne d ha author'ty to enter into agreements for my employer. <br /> Signature of Contractor/Owner Date 5-Z 6-00 <br /> Send or Fax to: For questions call: <br /> Asbestos Coordinator-Air Quality Division 612-296-7300 <br /> I�IN Pollution Control Agency 1-800-657-3864 <br /> 520 Lafayette Road North FaY: 612-215-1593 <br /> St. Paul, i�1 55155-4194 <br />