Laserfiche WebLink
.A~SN-C) OREGON DEQ NON-FRIABLE <br />ASBESTOS REMOVAL <br />c~ e c~ NOTIFICATION FORM <br />~.v.~ w«~~,.. <br />~~ <br />Fo~ oen ~88 o~iY <br />Date Received• '~ <br />Amount Received: <br />Check Number. <br />Projec.t Number. <br />ATTENTION!! This notification is not compiete uniess it is accmpanied by ttie required 535.00 fee and is <br />submitted 5days prio~ to the start date. All notifications submitted less than 5 days prior to the start date are <br />subject to a fe~ increase of 50%. ••• (PLEASE TYPE OR PRINT CLEARLY)••• <br />Is this a revision to a previous notification? Yes No x <br />Start date of project: April 21, 1997 End date of project: June 23, 1997 <br />Days of week and hours to be worked: Mon-Fri; Day Shifts, Swing Shifts, and Grave Yard Shifts <br />Project site name: Goodman Bldg. Building Owner: Marion county <br />Project address: 525 Court St. NE <br />City' Salem COUnty: Maxion StBte: OY• Zip; 97301 <br />Type of non-friable material to be removed: <br />Cement Asbestos Board <br />Amount of non-friable asbestos material to be removed. Square footage: <br />155 <br />ContteCtor nam~~To -be namad .as revision upon- award of contrac~hOne: N/A-~ <br />Contractor address: <br />N/A-'~ <br />City: N/A ~ County: N/A-° State: N/A-~ Zip: N/AJ~ <br />Construetion Contractors Boatd registration number: ~~A'` <br />Waste disposal site: N/A-, <br />Site address: N/A-° <br />Clty' N/A;; COUf1ty: N/A'~ State: N/A~; Zlp: N/A%~ <br />Waste hauler: <br />N/A%° <br />Phone: N/A-` <br />Sign below and send this form with your payment to: DEa Business Office at 81 1 SW 6th, Portland, <br />Oregon 97204. Make checks payable to "DEa" <br />Name of owner, operator or contractor: Marion County Risk Management <br />Name: David Hartwig PhOne:~503)373-4424 <br />(PLEASE PRINn <br />Signature: <br />Date: ~ ~ <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 DEa 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 inquire about the waiver of the 5 day notice or general info~mation call 1-800-452-4011 for the <br />phone number of your local regional DEQ office. <br />~vcs~ 6ro~ <br />