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�� p"Q�R� Florida Department of DEP Fortn 62-257.900(1) <br /> t Environmental Protection Effectivel0-12-08 <br /> = Page 1 of 2 <br /> �a s �' <br /> � FLOA A ' Division of Air Resource Management <br /> NOTICE OF DEMOLITION OR ASBESTOS RENOVATION <br /> TYPE OF NOTICE(CHECK oNe oN�v): � ORIGINAL ❑ REVISED ❑ CANCELLATION ❑ COURTESY <br /> TYPE OF PROJECT(CHeCK orve oN�v): � DEMOLITION ❑ RENOVATION <br /> IF DEMOLITION,IS ITAN ORDERED DEMOLITION? ❑YES �NO <br /> IF RENOVATION: <br /> IS ITAN EMERGENCY RENOVATION OPERATION7 ❑YES ❑NO <br /> IS iTA PLANNED RENOVATION OPERATION? ❑YES ❑NO <br /> I. Facility Name Former Wachovia Bank 5'"Avenue CES Job#13-0237D <br /> Address 38421 -5`"Avenue <br /> City Zeahvrhills State FL Zip 33542 County Pasco <br /> Site Drive-Thru Buildina Consultant Inspecting Site Apollo Environmental. Inc. <br /> Buiiding Size 1.000 (Square Feet) #of Floors 1 Building Age in Years unk <br /> Prior Use: ❑ School/College/University ❑Residence ❑Small Business �Other Commercial <br /> Present Use: ❑School/College/University ❑Residence ❑Smali Business �Other Vacant <br /> II. Facility Owner Clvde A.Biston/TAK Properties Phone(813) 783-1688 <br /> Address 13010 US Hiqhwav 301 <br /> City Dade Citv State FL Zip 33525 <br /> III. Contractor's Name Cross Environmental Services.Inc. Phone(813)783-1688 <br /> Address P.O.Box 1299 <br /> City Crvstal Sprinas State FL Zip 33524 <br /> Is the contractor exempt from licensure under section 469.002(4),F.S.? ❑ YES � NO <br /> IV. Scheduled Dates:(Notice must be postmarked 10 working days before the project start date) <br /> Asbestos Removal (mm/dd/yy) Start: Finish. Demo/Renovation(mm/dd/yy) Start:07/25/13 Finish:07/28/13 <br /> V. Description of planned demolition or renovation work to be perFormed and methods to be employed,including demolition or renovation techniques <br /> to be used and description of affected facility components.Wet demolition of drive thrus. <br /> Procedures to be Used(Check All That Apply): <br /> ❑ Strip and Removal ❑ Glove Bag � Bulidozer ❑ Wrecking Baii <br /> � Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down <br /> OTHER: <br /> VI. Procedures for Unexpected RACM: Stop work immediatelv. Contain. Notifv DEP immediatelv <br /> VII. Asbestos Waste Transporter: Name N/A Phone�) <br /> Address <br /> City State Zip <br /> VIII. Waste Disposal Site: Name Anqelo's Recvcled Materialsl Class III <br /> Address 41111 Entemrise Road <br /> City Dade Citv State FL Zip 33525 <br /> IX. RACM or ACM: Procedure,including analytical methods,employed to detect the presence of RACM and Category I and II nonfriable ACM. <br /> Survev&PLM <br /> Amount of RACM or ACM� X. Fee Invoice�II Be Sent to Address in Block Below:(Print or Type) <br /> square feet surfacing material CROSS ENVIRONMENTAL SERVICES, INC. <br /> linear feet pipe <br /> cubic feet of RACM off facility components P. O. Box 1299 <br /> square feet cementitious material Crystal Springs, FL 33524 <br /> square feet resilient flooring <br /> square feet asphalt roofing <br /> "Identify and describe surfacing material and other materials as applicable:NO ACM <br /> I certify that the above information is correct and that an individual trained in the provisions of this regulation(40 CFR Part 61,Subpart M)will be on-site <br /> during the demolition or renovation and evidence that the required training has been accompli,hed y this person will be available for inspection during <br /> �rmal business hours. ` � � <br /> ����t�— ��L�l„ U7'1 `'� j t �� <br /> (Print Name of OwnedOper for) (Date) ' <br /> ' ' �G� ����O��cS�`�"-� � r r 13 <br /> (Signature of Owner/Operator) (Date) <br /> DEP USE ONLY PostmarWDate Received ID# <br />