Us Epa Notification Of Demolition And Renovation Form Page 2
Download a blank fillable Us Epa Notification Of Demolition And Renovation Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Us Epa Notification Of Demolition And Renovation Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2U.S. EPA NOTIFICATION OF DEMOLITION AND RENOVATION
Page 2 of 2
X.
Description of planned Demolition or Renovation work to be performed and method(s) to be employed, including demolition
or renovation techniques to be used and description of affected facility component s:
XI.
Description of work practices and engineering controls to be used to comply with the requirements, including asbestos
removal and waste handling emission control procedures:
XII.
Waste Transporter #1
Name:
Address:
City:
State:
Zip Code:
Contact:
Telephone:
(
)
Waste Transporter #2
Name:
Address:
City:
State:
Zip Code:
Contact:
Telephone:
(
)
XIII.
Waste Disposal
Name:
Address:
City:
State:
Zip Code:
Contact:
Telephone:
(
)
XIV.
Emergency Demolition (complete Item XIV only if this project is an Emergency Demo.)
1. Attach a copy of the Order to this notice.
2. Name of Authority Issuing Order:
Title:
3. Authority of Order (Citation of Code):
4. Date of Order (MM/DD/YY):
Date Ordered to Begin
XV.
Emergency Renovation (Attach separate sheet with the following information if project is Emergency Renovation.)
1. Date and Hour of the Emergency:
2. Description of the Sudden, Unexpected Event:
3. Explanation of how the event caused unsafe conditions or equipment damage or an unreasonable financial burden.
XVI.
Description of procedures to be followed in the event that unexpected RACM is found or non-friable ACM becomes
crumbled, pulverized, or reduced to powder.
XVII.
I certify that an individual trained in the provisions of NESHAP (40 CFR PART 61, SUBPART M) will be on -site during the
Demolition or Renovation, and evidence that the required training has been accomplished by this person will be
available during normal business hours.
Signature of Owner/Operator
Date
Type or Print Name and Title
XVIII.
I acknowledge the existence of laws prohibiting the submission of false or misleading statements, and I certify that facts
contained in this notification are true, accurate, and complete.
Signature of Owner/Operator
Date
Type or Print Name and Title
ADVERTISEMENT
0 votes
Related Articles
Related forms
State Form 44593 - Notification Of Demolition And Renovation Operations - Indiana Department Of Environmental Management
Legal
Form Yg(4674eq) F2 - Notification Of Installation And Undertaking To Maintain A Septic Tank And Soil Absorption System
Legal
Form Yg(4673eq) F2 - Notification Of Installation And Undertaking To Maintain A Sewage Holding Tank
Legal
Related Categories
Parent category: Legal