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Minnesota Pollution Control Agency <br /> Notification of Intent to Perform a Demolition <br /> �� Type of Notification [ ] Original [ ] Amended [ J Project Cancellation <br /> Demolition Contractor• Building Information: <br /> Name: ��c>�.� � L> +� ��G��' S Building Name: <br /> Address: Address/Location: <br /> NO)�Lr�tL� ; <br /> City,State,Zip: <br /> City,State,Zip: County: <br /> Contact Person: �'�' ���C`C-S oT�' Phone Number(s): <br /> Phone Number(s): Age of Bldg.(years): Size of Bidg.(sq.ft.): <br /> Number of Floors Including Basement Levei(s): <br /> Building Owner' Present Use of Bld <br /> g.: <br /> Name: J�i��a�..�� �}S t'�n N_r;'v� /�o, '-�f,S <br /> Prior Use of Bldg.: <br /> Address:_ �01 �_r����" L����:� ��', � �y/ <br /> �v��`, ���� r Dates when de ition or intention 1 b rning <br /> ��,N , 5�"� / will Begin_d ��o L f & End i� �` <br /> City,State,Zip: <br /> Notification must be postmarked or received ten(10)working days <br /> Contact person:_ l�o:� `Li�1�l S O /�> before demolition begins. 'See item#5 for emergency demolitions. <br /> Phone Number(s):_ ����' `fC��► (� (p C7t� ti �,1�<i,�p tiG��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 1�laterial (RAC1Vn in the building <br /> to be demolished, it must be removed by a licensed asbestos contractor prior to demolition. The State of NTi�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 ( ] NO <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 /> CateQorv I nonfriable A M means asbestos-containing packings, Categ�v II nonfriable ACN1 means any material,excluding <br /> gaskets,resilient floor covering,and asphalt roofing products Category I nonfriable AC�f,containing more than one percent <br /> containing more than one percent asbestos. �sbestos that,when <br /> dry,cannot be crumbled,pulverized,or <br /> •Category I nonfriable ACNi 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�1 is not allowed to remain in place <br /> for demolition if it has a high probability of becoming crumbied, <br /> pulverized,or reduced to a powder during demolition,transport, <br /> or disposal. (ex transite,cement,slate roofing) <br /> 2. Description & Location of AC�I remaining in place (includiag floor#and room #): <br />