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ASN-6 OREGON DEQ NON-FRIABLE <br />ASBESTOS REMOVAL <br />c~ e~~ NOTIFICATION FORM <br />~•°`~~~ <br />For DEn use oniy <br />Oate Received: <br />Amount Received: ~ <br />Check Number. <br />Projeci Number. <br />ATTENTION!! This notification is not complete unless it is accmpanied by the required S35.00 fee and is <br />submitted 5days prior to the start date. All notifications submitted less than 5 days p~ior to the start date are <br />subject to a fee increase of 5096. ••• (PLEASE TYPE OR PRINT CLEARLY)••• <br />Is this a revision to a previous notification? Yes No ~ <br />Start date of project: Apri1 21, 1997 End date of project: June 23, 1997 <br />Days of week and hours to be worked: Mon-Fri; naY shifts, s~rin~ snifts, and Grave Yard Shifts <br />Project site name: Senator Biflg. Building Owner: Mariori County <br />Project address: 220 High St. NE <br />Clty: Salem COUnty: Marion State: <br />Type of non-friable material to be ~emoved: <br />OR <br />C~Yrent Asbestos Board <br />Zip; 97301 <br />Amount of non-friable asbestos material to be removed. Square footage; 160 <br />Contractor name:'~To be named as revision upon award of contra~h0~e' N/A-~ <br />Contractor address: N~AJ` " <br />City: N/A-; ~ COUnty: N/A-, State: N/A-, Zip: N/A-~ <br />Construction Contractors Board registration number: N/A-; <br />Waste disposal site: N/A-~ <br />Site address: ~~A~` <br />City: N/A- County: N jA: State: N/A: Zip: N~a: <br />Waste hauler: N~A'` ~ Phone: N/A-', <br />Sign below and send this form with your payment to: DEQ Business Office at 811 SW 6th, Portland, <br />Oregon 97204. Make checks payable to °DEa" <br />Name of owner, operator or contractor: <br />Name: David H~art <br />Signature: <br />Marion County Risk Management <br />Phone: (503)373-4424 <br />Date: ~,18' f `~7 <br />CAUTION!! If the material being removed is shattered, pulverized, or similarly handled i~ a manner <br />that causes the release of asbestos fibers, then only a DEQ licensed asbestos abatement contractor <br />may perform the removal work. Submit the proper notification and fee for a friable asbestos <br />abatement project in accordance with OAR 340-032-5630. <br />To +nquire about the waiver of the 5 day notice or general information ca11 1-800-452-4011 for the <br />phone number of your local regional DEQ office. <br />~visEn 6ro~ <br />