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. � <br /> r ' r <br /> ��:� �' '"�nn��°t� P°"ut�°n Notification of I ntent to <br /> �- Can#r�l Agency <br /> 52dlatayetteRoadNorth Perfarm a Qemolition <br /> St.Paul,b1N 55155 419� <br /> Asbestos Program <br /> Goc Tyipr .Asbes:as a Gzrrvautix�l�menarnent: <br /> Type of notification: ❑ On�ginal ❑ :.rt�ended ❑ Proyect cancellation <br /> Notification must be postrnarked or received ten(10)working days before demditian begins.See Item 5 for emergency <br /> demoliRions_Both start and end dates should be amended in writing as necessary to reflect current project dates_ <br /> Demolition Contractor Building Information <br /> hame: Buflding name: <br /> Address AddresslLocaoon: <br /> Ci:y Sta:e.Zip: Ci:y.Sta:e.�ip: <br /> Phone number. County: <br /> Contad name: Phone number: <br /> Phon�numGer. R8e oE blcbg tyrs}: �ize of bldg i,sq kr. <br /> kumber pflbors.includin$basem+en�leveh,s;� <br /> Building Owner Present use ofbl•�g: <br /> f�ame: Prior use of bidg <br /> Address <br /> Ci.ry.Sc�:e,�iF: Dates of demolition or intentional buming: <br /> Phorm�umber. S:ar.date: '�nd date: <br /> Contact name rmi'�cYyy mrn�'ori'}�i' <br /> Phone num6�er. <br /> Note: If there�s >��C linear'Feet or�18C�sqvare fee:of�egulated Asbestos-Containing Material i;�ACti1i in the huii�in�to be <br /> demolished, d must be r�moved by a Iice�nsed asbestos oontrador prior ao demolition.The State of A1h-"�loflye a�fn�ent to <br /> Perform an,4sbestos F,bate�men��rojec^h�:r,�www.pca.sta^.e.mn.us;publicatianstvr-sw4-0E.doc mus E�e use�d;c+notiry for <br /> the asbestos remaval. <br /> Is non(riable ACM prcsent in the structure to be demolished? ❑ Yes ❑yo <br /> Will nonfriabFe ACM be prnsent in the strucOire at the time of demolition? ❑'Yes ❑No <br /> If Yes o�bath ques�ons above,com.ple6E�IterrNs 1-8. If No to Qither question,complete 12ems 3-8. <br /> 1. ff ACM will be left in place for tt�e dertwlition indicate the amaunt of Category I andlor Gategory II norrfriable ACM 4eft <br /> in place_ <br /> Categc��+I Linear feet Categrsry II Linear�eet <br /> Square feet Square f�ee: <br /> Cubic feet Cubir fee: <br /> Category 1 nonfriable ACM means asbes�os-containmg CateBory 11 nonfiable AGN�mEans any material,e�cck�ding <br /> packings,gaskets,resilient floor cavering,and asphal: Category I nontriable ACAI,con;aining more th,an one <br /> r�firr�producCs containing more than o�e peroent peroe�t Asbestc�s that,when dry,cannoc be crumbled. <br /> asbestos. pulvertzed.or reduoed:o a pawder by h�nd pressure. <br /> Category 1 nonfriable ACM is not allowed to remain C�egory 11 nonfriable ACM is nat allowed to rernain in <br /> in place for demolition iF it is in poor oondition. place for dertioli6on ifi it has a hi�probabiiity af becoming <br /> cn+r�bled,PuNermed,or reduced to a pawtier d�xing <br /> dert►d'Rion,transport or d'isposal`e-9-,traisibe,oernent, <br /> s1aEe roo6ng)_ <br /> www_pca.sta[e.rnn.�:> • 65�-Z96-6300 � 9QQ-657•38b4 . 1T�b�t-282•633�or 500-657-3864 • a+•ailatsl�e�alternatT��e fwmav <br /> �,�•nv;-Z� • 11r_-r t. Aage t o(Z <br /> l� <br />