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� Minnesota Pollution Control A;gency <br /> Notification of Intent to Perform a Demolition <br /> �� Type of Notification [ �Original [ ] Amended [ }Project Cancellation <br /> �emolition Contractor• Building InformaHon: <br /> � � <br /> Name•_ - BuildingName•_ _ � >' +' /, <br /> . ' � � ��� <br /> Address: '�`�� � " ,`, <br /> ���� ' Address/Location:_ ���f�`I�S <br /> City,State,Zip: � '- � ,� ,•_ �� ) �� -_�,:� - / <br /> City,State,Zip:_ 9��_rr,<�� ./� ✓i�,z. '� • - � - �� � <br /> �=—� County:_ �1' ;X., ��_ � ,`. <br /> ContactPerson:_ �� i�, ti _.; • �= �}����„y- �, PhoneNumber(s):1 �� :-�..� �) ;/ -1.�/ ' ��" �l� <br /> Phone Number(s): t ��% 2 ) �� -i - `f�°;�"���y' Age of Bldg.(years): ��� � Size of Bldg.(sq.ft.): �-���v�� <br /> Number of Floors Including Basement Level(s): � ' <br /> Building wner• , � , �_� <br /> Present Use of Bidg.: <br /> Name: f �: •' �-��_" ' <br /> �� � Prior Use of Bldg.: <br /> Address:_ � /- , � ,�'", r <br /> '� Dates when demolition or intentional burning <br /> will Begin ` & End � <br /> City,State,Zip: � _ _ ; j / <br /> Notification must be postmarked or received ten(10)working days <br /> Contact person: before demolition begins. 'See item RS for emergency demofitions. <br /> Phone Number(s): �'�r�� �/ f ;c ;� Both Beginning and Ending dates should be amended in writing as <br /> necessary to reflect current project dates. <br /> If there is>2601inear feet or>160 square feet of Regulated Asbestos-ContaininD Material (RACIV� in the building <br /> to be demolished, it must be removed by a licensed asbestos contractor prior to demolition. The State of NTiY- <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 /> IfYES complete items 1-9. IfNO comp(ete 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 Cate .II <br /> 8 Linear Feet <br /> Squue Feet Square Feet <br /> Cubic Feet Cubic Feet <br /> at gorv I nonfriable A .I��means asbestos-containing packings, CateQon II nonfriable AGM means any material,excluding <br /> gaskets,resilient floor covering,and asphalt roofing products Category I nonfriable ACM,containing more than one percent <br /> containing more than one percent asbestos. a�bestos tha[,when dry,cannot be crumbled,pulverized,or <br /> *Category I nonfriable ACb1 is not allowed to remain in place reduced to a powder by hand pcessure. <br /> for demolition if it is in poor condition. �Category II nonfriabie AC�I is not ailowed to remain in place <br /> for demolition if it has a high probability of becoming crumb(ed, <br /> pulverized,or reduced to a powde�during demolition,transport, <br /> � or disposal. (ez transite,cement,slate roofing) <br /> 2. Description & Location of ACiYI remaining in place (including floor#and room #): <br /> — � 1 L ` � �__ <br />