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For DEQ use only ASN-1 ~~~ OREGON DEQ NOTICE OF INTENT TO REMOVE OR~ ENCAPSULATE FRIABLE ASBESTOS-CONTAINING MATERIAL ~ Date Received Amount Received Check Number Project Number ATTENTIONI This notification must be complete and received by DEQ at least 10 days before the start date of any asbestos abatement project and accompanied by the notification fee. (PLEASE TYPE OR PRINT CLEARLY) PROJECT CATEGORY AND NOTIFICATION FEE Emergency (Emeryency notifications nquin s 5096 f~e increasa) A S35 for each project with less than 40 linear or 80 square feet of asbestos-containing material and fo~ oach residentisl abatement project. B. 370 for p~ojects from 40 to 259 linear feet or 80 to 159 square faet of asbsstos-containinp mate~ial. C. 5275 for proJects from 260 to 1299 linear fest or 160 to 799 squars feet of asbestos-containinfl material. D. 5375 for projects from 1300 to 2599 Iinear fsst or 800 to 1599 squars feet of asbestos-oontaining mate~ial. E.~, 5650 for projects from 2600 to 4999 linear feet or 1600 to 3499 square feet of asbestos-containinfl material. F. 5750 for projects from 5000 to 9999 linear feet or 3500 to 5999 squars feet of asbestos-containinQ material. G 31,200 for projects from 10,000 to 25,999 linea~ fest or 6000 to 15,999 square fset of asbeatos-containiny matarial. H._ 52,000 fo~ projects from 26,000 to 259,999 linear feet or 16,000 to 159,899 squars feet of asbssto~-aontaining materiel. I. _ 52,500 for projects 260,000 linearfeet or mors or 160,000 square feet or more of asbsstos-containinp material. i. Is this a revision to a previous notificationl Yes No X 2. Asbestos abatement project starting date: Apri 1 21, 1997 Completion date: June 23 , 1997 3. Project site name: BFRI Bldg. Address: 255 Church St. NE. Salem, Marion 97301 tsa«u ~cai ~c«,~a~ u~~ 4. Property Owner: M:_ri nr ~o„nty 11. Abatement Co~tractor Name: PropertyOwnerAdd~ess: Marion Countv Courthouse -~To be named as a revision upon award of contract. 1G0 Hi~h St. NE. Salem, Or 97301 Contractor mailing address: lCiry) (St~ul ~ RiPI N/A~ N/A:~: N/a-', 5. Site Contact: David Hartwig Phone: ~503)373-4424 lCicyl ISUUI IZIPI 6. Describe physical 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: Storage 12, Describe method of removal or encapsulation: of Marion County Records, Present: Vacant 8. Will this be a complete demolition7 Yes: 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: Friable built=up roofing 10% Chry., Fire door assumed 10. Quantity of asbestos material to be removed or encapsulated: Linear feet: Square feet: 3, 000 Full Containments, Wet Methods 13. Days of week and hburs 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 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 Countv Risk Mana~ement) D v~ d Hartw;_g 18. Signature: ,N, `< ~~ ~~?~1•~ ~ Date: ~ •'~ l`( ~ Phone: C 503 ) 373-4424 Sign this form and send wlth the appropriate fee to: DEa Business Office, 811 SW Sixth Avenue, Portland, OR 97204. Make checks payable to "DEa". {f~evised 5/98)