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� 3. Company and/or individual that conducted the building inspection and the procedure used to d'etermine the i presence or absence of ACM(including analytic method): 'Prior to demolition ali buildings must be inspected by an EPA accredited inspector. � 4. Description of planned demolition and the specific method(s) that will be used: 5. If the demolition was ordered by a government agency, please identify the agency and attach a copy of the order: Name: Title: Authority: Date of Order(M/D/Y): Date Ordered to Begin (M/D/'Y): * Notification for an emergency demolition must be submitted as early as possible before demolition begins,but not later than the folfowing working day. A demolition is considered an emergency ONLY when the facility has been deemed structurally unsound and in danger of imminent collapse. If the structurally unsound building is known to contain any regulated ACN1 or is suspected to contain any regulated ACNf,special procedures i�fUST be followed. If you are unaware of the special procedures, instructions/regulations can be obtained by contacting the NIPCA at the address or phone number listed below. 6. Description of procedure to be followed in the event that unexpected RACN1 is found or Cat. II noofriable ACM becomes crumbled, pulverized or reduced to powder: 7. Waste Transporter Information: 8. `Vaste Disposal Information: Transported Name: �vV�Du1' �1�GL.� J�c�C(/✓` Landfill Name:�,�(�PY�S✓� �Jp �Q/'1f �l y L�� Transporter Contact: Owner/Operator: Transporter Address: Address/Location: City, State,Zip: City,State,Zip: PhoneNumber:��c� ' /o�p�— � �3 PhoneNumber: ��— � [ U-��5_tJ 9. I certify that the above information is correct and I am a bonafide representative of the demolition contractor or building owner and have authority to enter into agreements for my employer. Signature of Contractor/Owner Date Send or Fax to: For questions call: Asbestos Coordinator-Air Quality Division 612-296-7300 MN Pollution Control Agency 1-800-657-3864 520 Lafayette Road North Far: 612-215-1593 St. Paul, MN 55155-4194