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� . <br /> 3. Company and/or individual that conducted the building inspection and the procedure used to determine the <br /> presence or absence of ACM(including analytic method): *Prior to demolition all buildings must be inspected by an EPA <br /> accredited inspector. <br /> , <br /> , - -�,� �> �� • . <br /> ��� ,-.,� /,�� � <br /> � d., i/ � .. , . <br /> 4. Description of planned demolition and the specific method(s) that will be used: � ,� <br /> _.. � � . <br /> — ,� � ;, , � <br /> 5. If the demolition was ordered by a government agency, please identify the agencv and attach a copy of the <br /> order: <br /> Name: '�`��� `� Title: <br /> Authority: <br /> Date of Order(M/D/�: 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 ONLY when tfie facility has been deemed structuralty unsound and <br /> in danger of imminent collapse. If the structurally unsound building is known to contain any regulated ACbI or is suspected to <br /> contain any regulated AC�1,special procedures INST be followed. If you are unaware of the special procedures, <br /> instructions/regulations can be obtained by contacting the i�IPCA at Ehe address or phone number listed below. <br /> 6. Description of procedure to be followed in the event that unespected RACNI is found or Cat. II noafriable <br /> ACM becomes crumbled,pulverized or reduced to powder: <br /> � � i <br /> r� ri � i �� � � / i1 � i c � � c ol'JL <br /> 7. Waste Transporter Information: 8. `Vaste Disposal Information: <br /> Transported Name:__ \rhr-�-�_.�, �l�,�,��;,� Landfill Name:__ ' "; <br /> ��_�-��_t �;��.: <br /> Transporter Contact:_ �_�,n � �}-�.; •;yL OwnedOperator:_ i �= l-� 1 r-�1-��. <br /> Transportcr Address:_ l�� �� /r ` ,-�� �.�� <br /> Address/Location:_- l j-�,� _S �,�,� �f <br /> City,State,Zip:_ ��,"���� � G � - _ � <br /> Ciry,State,Zip:_ ���n fi��, r94q � '� . >",✓ <br /> Phone Number._ ' � �-� / )�i L`i �( �,J L7 _ , �� �/ <br /> -� Phone Number: + � <br /> 9. I certify that the above information is correct and I am a bonafide representative of the demolition <br /> contractor or building owner and have authority to enter into agreements for my employer. <br /> . _ <br /> Signature of Contractor/Owner —''�_ " ---_��- <br /> � Date_ ' %� <br /> Send or Fax to: For questions call: <br /> Asbestos Coordinator-Air Quality Division 612-296-7300 <br /> MN Pollution Con�ol Agency 1-800-657-3864 <br /> 520 Lafayette Road North Fax: 612-215-1593 <br /> St. Paul, l�i 1 55155-4194 <br />