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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 Receivad Chack Number ~ Project Number ATTENTIONI This notification must be complete and ~eceived by DEQ at least 10 days bafore the start date of any asbestos abatement project and accompanied by the notification fee. (PLEASE TYPE OR PRINT CLEARLY) PROJECT CATEGORY AND NOTIFICATION FEE Emerpenoy (Em~rye~cy notificatioru nquk~ ~ 609G" f~~ incnss~) A S35 for each projact with less than 401insar o~ 80 squars foot of asbasto~-oontaininp mat~~isl and for each residontial abatement project. B. S70 for project~ from 40 to 259 Ilnes~ feet or 80 to 159 square feet of asbestos-containinp matsdal. C. 5275 for projects fram 260 to 1299 lineer feet o~ 160 to 799 squars fsst of asbestos-contalniny materisl. D. $375 for projecta from 1300 to 2599 Uneer f~~t or 800 to 1699 square feet of asbestos-aontalninp mate~iel. E. 3650 for projects from 2600 to 4998 linea~ feet o~.1600 to 3499 squar~ fest ot ssbestos-oantaininp materiel. F.~ 8750 for projocts from 5000 to 9999 linaar feet or 3500 to 5999 squars feet of ssbssto~-containinq mate~iei. G. E1,200 for projeots from 10,000 to 25,999 linear fest or 6000 to 15,999 squars fsst of asbestos-contalninp material. H. 32,~00 for projects from 26,000 to 259,988 Upsu feet or 18,000 to 168,899 squan fe~t of asbsstos-oontafnlnq materlel. 1. _ 52,500 for proJects 260,000 linearfeet o~ more or 160,000 square feet or more of acbestos-oontai~inp materla~. 1. Is this a revision to a previous notificatfonl Yes No X 2. Asbestos abatement project starting date: April 21, 1997 Completion date: June 23, 1997 3. Project site name: LIU Bldg. Address: 551-563 Court St. NE Salem, Marion 97301 ~sa«u ~acv- ~c«,~N- u~~ 4. Property Owner: rt~~r;.~,; c'~nnty 11. Abatement Contractor Name: Property OwnerAddress:_ Marion County Courthouse *To be named as a revision uvon award of contract. 100 Hi~h St. NE. Salem, Or 97301 Contractor mailing address: Ickr1 (SUU) tz~PJ 5. Site Contact: David Hartwig Phone: ~503)373-4424 N/A~ N~A:~: N~A:': (qcY) tSt~ul RIP1 6. Describe physical structure of facility: Wood, Brick ' Phone: N/.A* and Concrete Structure DE~..license nUmber:~ N/A* 7. Give present and prior use of facility: Prior: Apts, ~2. Describe method of removal or encapsulation: Wine Store and.Liquor Store Present: Vacant Full Containments, Wet Methods 8. Will this be a complete demolitionl Yes: X No: 13. Days of week and hours of day to be worked: If yes, give demolitian start date: May 1~ 1997 Mon-Fri; Dav Shifts, Swin~ Shifts, and Grave 9. Describe type and percentage of asbestos material and Yard Shifts will be used. where it is located in,facility: TSI Assumed, ~ Floor tile 10-20% Chry., Floor tile Mastic 10-15% Chry., Drywall/Taping Compound 2% Chry., Ceiling tile 2% Chry.,Ceiling tile Mastic 3% remo., ire 10. Quantity of asbestos materiai to be removed or encapsulated: ~ Linear feet: 1, 000 Square feet• 4092 14. Oregon Certifled Supervisor on this project: N/A*` Ore. Certified Supervisor 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 Management) nav; c~ Hartw;$ 18. Signature: ,~51~~~2~ ~~ Date: ( _Phone:C503)373-4424 Sign this form and send w(th the approprlate fee to: DEQ Busi~ess Office, 811 SW Stxth Avenue, Portland, OR 97204. Make checks payable to "DEO.". ;Revised 5/98)