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, ' " ' <br /> 3. Company and/or individual that conducted the building inspection and the procedure used to determi�e the , <br /> presence or absence of ACM(including analytic method): •Prior to demolition all buildings must be inspected by an EPr1 <br /> accredited inspector. <br /> 4. Description of planned demolition and the specific method(s) that will be used: <br /> -"� ; ���L.��"�t,�-_ %lc'`CG�-�'_ �;C.'��_�,' ��:. ' L'� --�' - <br /> / ... C<;�.- c:i J' �� �t;�:-� ... � <br /> / h S <br /> %� �/ -2��..�'�' �.` .��G' -�12.C� <br /> � , <br /> 5. If the demolition was ordered by a government agency, pfease identify the agency and attach a copy of the <br /> order: <br /> Name: Title: Authority: <br /> Date of Order(M/D/'Y): Date Ordered to Begin(M/D/}(): <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 OYLY when the tacility has been deemed structurally unsound and <br /> in danger of imminent collapse. If the structurally unsound building is known to contain any regulated ACi1 or is suspected to <br /> contain any regulated AC�1,special procedures�NST be followed. Ifyou are unaware of the special procedures, <br /> instructions/regulations can be obtained by contacting the bIPCA at the address or phone number listed below. <br /> 6. Description of procedure to be followed in the evznt that unespected R4Cl�I is found or Cat. II nonfriable <br /> ACi�I becomes crumbled, pulverized or reduced to powder: <br /> 7. Waste Transporter Information: 8. �Vaste Disposal Information: <br /> Transported Name: Landfill Name: <br /> Transporter Contact: Oµ�ner/Operator: <br /> Transporter Address:.. Address/Location: <br /> City, Scate,Zip: Ciry, Scate,Zip: <br /> Phone Number: <br /> Phonc Number: ' <br /> 9. I certify that the above information is correct and I am a bonafide representative of the demolition <br /> contractor or building o�vner and ha � uthority to enter into agreements for my employer. <br /> Sijnature of Contractor/Owner <br /> Date c�z 7—:% I <br /> , <br /> Send or Fa�c to: For questions call: <br /> Asbestos Coordinator-Air Quality Division 612-296-7300 <br /> �f�1 Pollution Concrol Aoency 1-800-657-3864 <br /> 520 Lafayette Road IvTorth Fax: 612-215-1593 <br /> St. Paul, h�t 5515�-4194 <br />