Financial- Oregon State DEQ - Laserfiche WebLink

Home Browse Search

`J ASN-1 ~ ~~ OREGON DEQ NOTICE OF INTENT TO REMOVE OR, ENCAPSULATE FRIABLE ASBESTOS-CONTAINING MATERIAL For DEQ use only Date Received Amount Recaived Chack Number Project Number ATTENTIONI This notification must be complete and received by DEa at least 10 days before the atart date of any asbestos abatement project and accompanied by the notification fee. (PLEASE TYPE OR PRINT CLEARLY) PROJECT CATEGORY AND NOTIFICATION FEE Emergency (Emeryancy notiflcations nquire e 5096 f~e incrsass) A S35 for each project with less than 40 linear or 80 square foot of asbestos-conteini~p matarial and for oach resida~tisl abatement project. S. 870 for projects from 40 to 259 linoar fsot or 80 to 159 squara foet of asbastos-co~tainlnp material. C. 5275 for projects from 260 to 1299 linear feet or 160 to 799 aquara feot of asbesto~-containiny material. D. 5375 for projacta from 1300 to 2599 Iinea~ feet or 800 to 1599 square feet of asbsstos-aontaininq material. E.~ $650 far projects from 2600 to 4999 linsar fset or.1600 to 3499 squa~s feat of asbestos-aontaininp material. F. 5750 for projects from 5000 to 9999 linear feet or 3b00 to 5999 square feet of asbestos-containinp material. G 51,200 for projects from 10,000 to 25,999 linsar feet or 6000 to 15,999 ~quars fsst of asbe~tos-containlnp material. H._ 32,000 for projects from 26,000 to 259,999 Iinsar fest or 18,000 to 159,999 square feet of asbestos-co~teininq material. 1. _ $2,500 for projects 260,000 linear feet or more or 160,000 squars taet or more of asbestos-conteininp materisl. 1. Is this a revision to a previous notificationl Yes No X 2. Asbestos abatement project starting date: April 21, 1997 Completion date: June 23, 1997 3. Project site name: Goodman Bldg. Address: 525 Court St. NE. Salem, Marion 97301 Isa«u lary- ICwoty- a1P1 4. Property Owner: M~~ri ori C~tmtv 11. Abatement Contractor Name: Property Owner Address: Marion County Courthouse '~To be named as a revision upon award of contract. 1G0 Hi~h St. NE. Salem, Or 97301 Contractor mailing address: IGHI lSUUI RIPI ~ : N/A" NjA:: N/a: 5. Site Contact: David Hartwig Phone: C503)373-4424 lGryl ISUUI IZIPI 6. Describe physicat structure of facility: Wood, Brick Phone: N/A-~ and Concrete Structure DEQ.license number: N/A-~ 7. Give present and prior use of facility: Prior: Dentist ~2, Describe method of removal or encapsulation: Office, Present: Vacant 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.facitity: Sheet Vinyl, 20% Chry. , Floor Tile 12% Chrv., Floor Tile Mastic 20% Chry., Furnace Lining 80% Chry., TSI Assumed 10. Quantity of asbestos material to be removed or encapsulated: Linear feet: 400 Square feet: 2, 745 Full Containments, Wet Methods 13. Days of week and hours of day to be worked: Mon-Fri; Day Shifts, Swin~ Shifts, and Grave Yard Shifts will be used. 14. Oregon Certified Supervisor on this project: N/A* Ore. Certified Superviso~ number: N% A'~ 15. Asbestos disposal site: N/A-° 16. Waste Hauler: N/A* Phone: N / A'~ 17. Name of owner, operator, or abatement contractor: CMarion Countv Risk Mana~ement~ Dav; d Hartw; g 18. Signature: ,~ i J~~~"~ ~~ ~ Date: •~ Y~ Phone: C 503 ) 373-4424 Sign this form and aend with the appropriate fee to: DEQ Buslness Office, 811 SW Sixth Avsnue, Portland, OR 97204. Make checks payable to "DEQ". ~Revised 5/98)