Agenda - Council - 11/22/2016 - Laserfiche WebLink

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Minnesota Pollution Notification of Intent to Control Agency 520 Lafayette Road North Perform a D e m o l i t i o n 5t.Paul,MN 55155-4194 Asbestos Program Doc Type: Asbestos&Demolition/Amendments Type of notification: ❑ Original ❑ Amended ❑ Project cancellation Notification must be postmarked or received ten(10)working days before demolition begins.See Item 5 for emergency demolitions. Both start and end dates should be amended in writing as necessary to reflect current project dates. Demolition Contractor Building Information Name: Building name: Address: Address/Location: City, State,Zip: City, State,Zip: Phone number: County: Contact name: Phone number: Phone number: Age of bldg (yrs): Size of bldg(sq ft): Number of floors, including basement level(s): Building Owner Present use of bldg: Name: Prior use of bldg: Address: City, State,Zip: Dates of demolition or intentional burning: Phone number: Start date: End date: Contact name: mm/dd/yy mm/dd/yy Phone number: Note: If there is>260 linear feet or>160 square feet of Regulated Asbestos-Containing Material (RACM)in the building to be demolished, it must be removed by a licensed asbestos contractor prior to demolition. The State of MN-Notice of Intent to Perform an Asbestos Abatement Project http://www.pca.state.mn.us/publications/w-sw4-06.doc must be used to notify for the asbestos removal. Is nonfriable ACM present in the structure to be demolished? ❑Yes ❑ No Will nonfriable ACM be present in the structure at the time of demolition? ❑Yes ❑ No If Yes to both questions above, complete Items 1-9. If No to either question, complete Items 3-9. 1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category II nonfriable ACM left in place. Category I: Linear feet Category 11: Linear feet Square feet Square feet Cubic feet Cubic feet Category I nonfriable ACM means asbestos-containing Category II nonfriable ACM-means any material, excluding packings,gaskets, resilient floor covering, and asphalt Category I nonfriable ACM, containing more than one roofing products containing more than one percent percent Asbestos that,when dry, cannot be crumbled, asbestos. pulverized,or reduced to a powder by hand pressure. Category I nonfriable ACM is not allowed to remain Category II nonfriable ACM is not allowed to remain in in place for demolition if it is in poor condition. place for demolition if it has a high probability of becoming crumbled,pulverized,or reduced to a powder during demolition,transport,or disposal(e.g.,transite,cement, slate roofing). www.pca.state.mn.us 651-296-6300 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats w-sw4-21 • 12127112 Page 1 of 2