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From: 01/08/2013 14:09 #148 P.0021005 <br /> Florida Department of bEPFortn82-257.900(1) <br /> seean��a�s-oe <br /> � Environmental Protec#ion �9e1of2 <br /> A ' Divlsion of Air Resource Management <br /> NOTICE OF DFMOLITiON OR ASBESTOS REN�VATION <br /> TYPE OF NOTiCE(CHECK ONE ONIY): � IGINAL ❑ REVISED � CANCELI.ATEON ❑ COUR7ESY <br /> TYPE OF PROJECT{CWECK Ot�E ON�Y): DEM�LETION ❑ RENOVA_Ti�tO" <br /> IF DEMOLITION,IS IT AN ORDERED DEMOLITION7 �YES Cf�o <br /> IF REN�VATION: <br /> IS(T AN EMERGENCY RENOVATIQN OPERATION? �YES ❑NO <br /> ►S IT A PLANNED REI�OVATION OPERATION? ❑YES ❑NO <br /> I. Facflity Name �QuJf���e� 7YJt��e S � C�n� <br /> Address �•�`f b- �`!a� �o,l l 1✓ • 1 n i�-- �.�— <br /> Ciry ��� State�Zip 33 S'� 1 County <br /> Site ' Consultant inspecting Site <br /> Building Size (Square Feet) #of Floors_L ullding Age in Years <br /> Prior Use: ]] School/College/University ❑(tesidence Small Business ❑other _ _ <br /> Present Use: ❑School/College/Universityn (,], Residence ❑Small Business ❑Other ACQ t1 <br /> II. Facifity Owner Yr e W t�'�'��+� L�-� Phone(�10 ) b b 7' S g"� <br /> Address '�.ZS �n S h oC e!� S}a P.�• <br /> City al C n w State-t-�-- Zip { OOy <br /> III. Contractor's N e f C i 1-utf0� v�a►o Phone(��) �7y-�� <br /> Address SO 1� S. S 0.� ' 1� <br /> Ciry J� State Zip � <br /> Is the contractor exempt from ftcEnsure under secdon 469.002(4),F.S.? ❑ YES NO <br /> N. Scheduled Dates:(Notice musi be postmarkeci 10 working days before the project sfart date) <br /> Asbestos Removal (mm/dd/yy) Start: Finish: Dema/Ranovation(mm/dd/yy) Start 2 � Finfsh: � �3 <br /> V. Descriptfon of�lanned demolitton or renovation worlc to be pertomiad an met ods to be employed,inc�udt molition or re vati n techniques <br /> to be used and descnpoon`—'�or ane«a acility components. Q W0.�I ; � e Ce� f; d Ge;`• ;� ` �x}y , <br /> Procedures to be Used(Check Atl That Apply): � �^`� « �� J dst C��� �q u�P�M��I- <br /> t� t� . <br /> Strfp and Removai Gfove ag �Ildozer Wreddng gap <br /> Wet Method Dry Methad Explode 9um Down <br /> QTHER: <br /> VI. Procedures for Une�ected RACM: <br /> VII. Asbestos Waste Transporter: Name Phone�) <br /> Address <br /> Clty State Zip <br /> VIII. Waste Dlsposaf 5ite:Name Class <br /> Address <br /> City State Zip <br /> IX. RACM or AC1A: Procedure,including analydcal methods,employed to detect the presence of RACM and Category f and II nonfdable ACM. <br /> Amouni of FtACM or ACM' X. Fee Invoice Wili Be 3ent to Acldress in Block Below:(Pr1M or Type) <br /> square feat surFaang material <br /> linear feet pfpe <br /> cubic feet of RACM off faalfty components <br /> square feet cementiHous mater}a1 <br /> square feet resilient ftooring <br /> square feet asphalt rooflng <br /> "iden�fy and describe surfacEng materiai and other materials as appecable: <br /> I certify that the above informaUon Is correct and that an indivtduaf trained in the provisions af this regulation(4p CFR Part 81,Subpart M)will be on-site <br /> durfng tt�e demolitio or renovati and evidence that the required training has been aocomplished by this person wiil be available for inspection during <br /> normal business h � '� ' '_� � <br /> (Print Name / rator) (Date) <br /> I ► - i1- 13 <br /> (Signat re of / r) (Date) <br /> DEP.[fSE ONL Postmark/Date Recelved Y>: ID# <br /> M1'COMMISSiON H EE 088451 <br /> * * CXPIRES:April28,2015 <br /> �^rFOF F`�,FG Bonded Thru Budget Nofary Sernces <br />