Indicate if the notice is an original, a revision, or a cancellation. ATTACH
A COPY OF THE ORIGINAL NOTICE TO ANY REVISED OR CANCELED NOTICE.
Name, address, phone number of the facility owner, operator, building manager,
removal contractor, and any other contractor.
Type of operation (demolition, renovation, ordered demolition, emergency
renovation, planned renovation).
Facility description including any building number, name, complete address
or site location, any floor or room number, building size, number of floors,
age of building, and prior and present use.
Analytical method used to detect the presence of asbestos should state
or similarly state, "Bulk Sampling using the method specified at 40 CFR
part 763, Section 1, Polarized Light Microscopy (PLM)" or "Bulk Asbestos
Sampling using Polarized Light Microscopy (PLM), (EPA Method 600/M4-82-020,
For samples that test under 10% asbestos content: Per the May 8, 1991,
Guidance, an owner or operator may (1) elect to assume material to be greater
than 1% asbestos, or (2), require verification by point counting in which
the point counting result will supercede the visual estimation. Either
choice and result should be stated on the notice when a sample is under
Estimate amount of RACM to be removed in linear feet (meters), square feet
(meters), and/or cubic feet (meters).
For demolitions only, also estimate the amount of Category I
and Category II non-friable materials that will NOT be removed prior
to demolition. (Consequently, removing Category I material by sanding,
grinding, abrading, drilling, or sawing or by inducing friability by breaking
and/or crumbling Category II materials, before demolition, shall be reported
Demo-Reno- Scheduled starting and completion dates of asbestos removal
work (including any work that would break up or disturb the materials).
Planned renovations- Report the beginning and ending dates of the operation
Scheduled starting and completion dates of the demolition itself or the
entire renovation time frame.
Description of demolition or renovation work, including methods, techniques,
and facility components affected. Some examples:
Demolition of storage shed using a bulldozer and a crane. Asbestos-containing
boiler to be transferred to another specified site for lining abatement.
Renovation of a warehouse for conversion into office space by removal of
old-interior non-load supporting walls, removal of all floor tile, and
plaster ceilings. Boiler and related piping also to be stripped, removed
Stripping and removal of ductwork in basement for installation of new ventilation
Description of work practices and engineering controls to be used to comply
with the standard including asbestos emission control procedures, and waste-handling
Removal of a boiler jacket containing RACM by adequately wetting the exposed
RACM, stripping the materials using knives and scrapers, wetting and sealing
the RACM in leak-tight containers, labeling with proper OSHA labels and
identification labels, as specified, and disposing the asbestos containing
waste at a landfill which fulfills the requirements of Section 61.154 of
the asbestos NESHAP.
Adequately wetting and stripping piping within a glovebag using knives
and wire cutters, sealing in leak-tight containers, labeling each bag with
the proper OSHA labels and identification labels, as specified, and disposing
of the waste at a landfill which fulfills the requirements of Section 61.154
of the asbestos NESHAP.
Name, complete address, phone number and contact person of the waste transporter(s).
Name, location (P.O. Boxes must also include a street address or specific
location), and phone number of waste disposal site.
For Ordered Demolitions Only- Attach copy of the official Order along with
the date of the Order, the date the demolition was ordered to begin, and
the name and title of the State or local government official who ordered
the demolition and the authority or statute.
For Emergency Renovations Only- Include the date, hour, and description
of the emergency. Also include a detailed explanation of how this emergency
qualifies as an emergency under this subsection. **Note: Claimed emergencies
will be investigated and fraudulent claims will be subject to the fraud
and false statement criminal provisions of 18 U.S.C. Section 1001. Some
Capitol City has one train station handling both commuter and Amtrak passengers.
A storm damages the station and the water damage causes sprayed-on ceiling
insulation to fall off beams onto ceiling tiles and into a high-traffic
boarding area below. Emergency renovation is required.
A boiler pipe breaks in a hospital. The pipe causes extensive damage to
surrounding pipes cutting off heat and hot water to the entire hospital.
The plumbing crew will not repair pipes until the asbestos is cleared and
abated. Emergency renovation is required.
School renovations to coincide with vacation breaks is NOT an emergency.
A demolition in which the financing has been cleared with the banks or
a bid has just been accepted by the general contractor does not qualify
as an unreasonable financial burden and is NOT an emergency.
Describe procedures to be followed should unexpected RACM be discovered
or Category II materials become crumbled, pulverized or reduced to powder.
Effective November 20, 1991- A certification that at least one on-site
person who is trained in the asbestos NESHAP provisions will supervise
any asbestos removal or stripping operations.