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1 ;�{' � ' _ ��E,�,�pI101'(➢GN- r Florid�["Department of DEP Form62-257.900(1) 0 Effective 10-12-OB � ' � Q=� Environmer�tal Protection Pagelof2 � �s -- �FLORfDA Division of Air F�esource Managemerit W - I NOTICE OF DEMOLIT ON OR ASBESTOS RENOVATION , - TYPE OF NOTICE(cHECK oNE oN�Y): � ORIGINAL � REVISED ❑ CANCELLATION ❑ COURTESY TYPE OF PROJECT(CHecK oNe oN�Y): � DEMOLITION ❑ RENOVATION � IF DEMOLITION,IS ITAN ORDERED DEMOLITION? ❑YES �NO IF RENOVATION: IS ITAN EMERGENCY RENOVATION OPERATION? ❑YES ❑NO IS IT A PLANNED RENOVATION OPERATION? ❑YES ❑NO � I. Facility Name Ze h rhills Public Libra Address 5347 8`h Street • City Zephvrhills State FL Zip 33542 �County Pasco SiteFormer Librarv � Consultant Inspecting Site The Ash Grouo. Inc. Building Size 4276 (Square Feet) #of Floors 1 Building Age in Years 53 Prior Use: ❑ School/College/University ❑Residence �Sm II Business ❑Other Present Use: ❑School/College/University ❑Residence �Sm�ll Business ❑Other II. Facility Owner Citv of Zephvrhills Phoi e(813) 780-0021 Email Address N/A Address 5335 S`"Street City Zephvrhilis State FL� Zip 33542 III. Contractor's Name JVS Contractina,Inc. Pho e(813) 514-8229 Email Address dorr@jvscontracting.com Address 1608 N.43`d Street City Tampa �- `� State FL Zip 33605 i Is the contractor exempt from licensure under section 469 002(4), F S.. ❑ YES � NO IV. Scheduled Dates:(Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start:N/A Finish. Demo/Renovation(mm/dd/yy) Start: 12/22/14 Finish:12/24/14 V. Description ofplanned demolition or renovation work to be perfo�rmed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. � Procedures to be Used(Check All That Apply) - I ❑ Strip and Removal ❑ Glove Bag I � Bulldozer ❑ Wrecking Ball � Wet Methad ❑ Dry Method ❑ Explode ❑ Burn Down , OTHER:- I VI. � Procedures for Unexpected RACM: Wet�contain, notifv Owne &revise Notification VII. Asbestos Waste Transporter: Name N/A � Phone( ) Address � City ' I State Zip VIII. Waste Disposal Site:Name Sun Countrv Materials Landfill � Class C&D Address 11457 CR 672 � City Zephvrhilis � State FL Zip 33569 IJC. RACM or ACM: Procedure,including analytical methods,empl yed to detect the presence of RACM and Category I and II nonfriable ACM. PLM . � Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in Block Below:(Print or Type) RACM ACM 0 0 square feet surtacing material Name: . ' 0 0 linear feet pipe Address: 0 0 cubic feet of RACM off facility components , 0 0 square feet cementitious material City: 0 0 square feet resilient flooring State/Zip: "Identify and describe surfacing material and other materials as appli`able. No ACM detected I I certify that the above information is correct and that an individual tr�ined in the provisions of this regulation(40 CFR Part 61,Subpart M)will be on-site during the demolition or renovation and evidence that the required tr�ining has been accomplished by this person will be available for inspection during normal business hours. a,,�d �— �t��r Y (Print Name of Ow erator) (Date) / i Ll l�y (Signature of Owner/Operator) ! (Date) ' DEP USE ONLY Postmark/Date Received ID# - _