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AS N- ~ OREGON DEQ NOTICE OF INTENT TO REMOVE OR. ENCAPSULATE FRIABLE ~ ASBESTOS-CONTAINING MATERIAL ~ ~~ For DEQ use only Date Received Amount Recaived Check Number Project Number ATTENTIONI This notification must be compiete and received by DEa at least 10 days before the start date of any asbestos abatement pro]ect and accompanied by the notification fee. (PLEASE TYPE OR PRINT CLEARLY) PROJECT CATEGORY AND NOTIFICATION FEE Emergency lEmaryency notifications nquln a 5096 t~s increasa~ A 335 for each project with less than 401inear or 80 squara feet of esbestos-oontaining matsrial end for each residentlsl abatement project. B. S70 for projects from 40 to 259 linea~ feet or 80 to 159 aquare faet of asbestos-containl~q matorisl. C,~ 5275 for projacts from 260 to 1299 linear fast o~ 160 to 799 square feet of asbestos-containinp material. D. 5375 for projects from 1300 to 2599 Unear fsst or 800 to 1599 square feet of asbestos•oontai~inq materiai. E. 8650 for projects from 2600 to 4999 linsar feet or 1600 to 3499 squa~e feet of asbestos-containinp material. F. 3750 for projects from 5000 to 9999 Iinear feet ot 3500 to 5999 square feet of asbestos-containinp material. G 51,200 for projects from 10,000 to 25,999 linsar fest or 6000 to 15,999 squars fset of sabestos-containinp material. N._ 32,000 for projects from 26,000 to 259,999 Iinear feet or 16,000 to 159,999 squars fest of asbeatoa-containlnp materiel. i. _ 52,500 for projacts 260,000 linearfest o~ more or 160,000 squars feet or more of asbesto~-containinq matarial. 1. Is this a revision to a previous notificationl Yes No X 2. Asbestos abatement project starting date: April 21, 1997 Completio~ date: June 23, 1997 3. Project site name: Goldberg Bldg. Address: 545-547 Court St. NE. Salem, Marion 97301 ~sa..u ~ra~ ~ca,~n~ u~e~ 4. Property Owner: rt,~ri ~ri cotmry 11. Abatement Contractor Name: ~ PropertyOwnerAddress: Marion County Courthouse ;To be named as a revision uvon award of contract. IGO Hi~h St. NE. Salem, Or 97301 Contractor mailing address: lCiry) ISUUI RIPI 5. Site Contact: David Hartwig Phone: ~503)373-4424 N/A~ N/a~: u~n:~: ~~n~ is~.ui ~z~ri 6. Describe physical structure of facility: Wood, Brick Pho~e• N/A-~ and Concrete Structure 7. Give present and prior use of facility: Present: Lawyers Office, Coffee Shop DEQ.license number: N/A'~ 12. Describe method of removal or encapsulation: Full Containments, Wet Methods 8. Will this be a complete demolition7 Yes: X No: If yes, give demolition start date: May 1~ 1997 9. Describe type and percentage of asbestos material and where it is located in.facility: TSI Assumed Silver Paint Roof Ducts 2%Chry, Floor Tile Assumed, Floor Tile Mastic Assumed, Fire Door Assumed 10. Quantity of asbestos material to be removed o~ encapsulated: Linear feet: 1, 000 Square feet: 500 13. Days of week and hburs of day to be worked: Mon-Fri; Dav Shifts, Swin~ Shifts, and Grave Yard Shifts will be used. 14. Oregon Certified Supervisor o~ this project: N/A* Ore. Certified Supervisor number: N% A-~ 15. Asbestos disposal site: N/A-'~ 16. Waste Hauler: N/A* Phone• N/A* 77. Name of owner, operator, or abatement contractor. CMarion Cou}~tv Risk Mana~ement) Dav~ d Hartw;_g (~ ~ 18. Si9nature: ~Y/ ~~ yd~ Date: 1 Phone: C 503 ) 373-4424 Sign this form and send with the appropriate fee to: DEQ Business Office, 811 SW Sixth Avenue, Portland, OR 97204. Make checks payable to "DEa". (Revised 5/98)