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� <br /> 3. Company and/or individual that conducted t6e building inspection and the procedure used to determine the <br /> presence or absence of ACM(including anatytic method): *Prior to demolition aU buitdings must be inspected by an EPA <br /> accredited inspector. • <br /> /`/o�� ✓S�/J -- 2et� D�ccr <br /> 4. Description of planned demolition and the specifc method(s) that will be used: �c'7�� ..�y <br /> .���y e��aP�c-�.�r �c�� 7v e�6,',�a��� fJ�/,�- � siTe' <br /> 5. If the demolition was ordered by a government agency,please identify the agency aad attach a copy of the <br /> order: <br /> Name: ��� Title: � Authority: <br /> Date of Order(M1D/�: 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 the facility has been deemed structurally unsound and <br /> in danger of imminent collapse. If the structurally unsound building is known to contain any regulated ACM or is suspected to <br /> . contain any regulated ACM,special procedures hNST be followed. If you are unaware of the special procedures, <br /> instructions/regulations can be obtained by contacting the 1�fPCA at Ehe address or phone number listed below. <br /> 6. Description of procedure to be followed in the event that unerpected RACM is found or Cat.II nonfriable <br /> ACM becomes crumbled,pulverized or reduced to powder: <br /> i.W�G� �TvP .tio a�,c t �o�v�cY— l��7r C��.���rr�...-�.,,..5, <br /> � <br /> ?�"t !c i��:►�L �'A�o�!o� , <br /> 7. Waste Transporter Information: 8. `Vaste Disposal Information: <br /> Transported�Name: ��� ti�l,�e� �`Kf�f�/�"'� LandfillName: <br /> Transporter Contact:��"I'iv� s��,��q�. OwnerJOperator: _ <br /> Transporter Address:_ Address/I,ocation: <br /> City,State,Zip: ��(�D�-^e�✓�-,bN e �.�) City,State,Zip: s�—'�'��� � � <br /> Phone Namber. �j�"' f�f�D/D�' Phone Number. <br /> 9. I certify that the above information�s correct and I am a bonafide representative of the demolition <br /> contractor or building owner and have auth ri to enter into agreements for my emptoyer. <br /> Signature of Contractor/Owner Date �r? G'� <br /> ; <br /> Send or Fax to: For questions call: <br /> Asbestas GoaYdinator-Air Quality Division 612-296-7300 <br /> MN Pollution C'ontrol Agency 1-800-657-3864 � <br /> 520 Lafayette Raad North FaY: 612-215-1593 <br /> St.Paul, MN 55155-4194 <br />