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Get Utah Division Of Air Quality 10 Working Day Notification Form

UTAH DIVISION OF AIR QUALITY 195 North 1950 West 4th Floor P. O. Box 144820 Salt Lake City UT 84114-4820 Postmark Date Initials Fee Received Check Number 10 WORKING-DAY NOTIFICATION OF DEMOLITION - no asbestos removed no intentional burning 75 50 for each 5 000 sq. ft. of floor space above 5 000 sq. ft. 1 Fee See fee calculator at www. deq. utah. gov/eqair/haps/asbestos/index. htm 2 Facility Name Address City County Zip Code Part of Facility Involved e*g* floor room area etc* Age of Facility Size Present use of Floors Prior Use 3 Facility Owner/Operator Name Contact Person State Phone Number 4 Demolition Contractor Name Phone 5 Dates of Demolition Start Date 6 Asbestos Inspection Information Ending Date Date of Inspection Name of Utah Certified Inspector Analytical Method used for asbestos analysis Is asbestos present ID Number Was it sampled or assumed 7 Asbestos Containing Material to be left in the facility during demolition list types and amounts. roofing flooring other 8 Description of procedures to be followed in the event that unexpected RACM is found or generated during the project. attach additional sheets as necessary 9 I certify that the all the information in this notification is true and correct. Signature of Owner/Operator Print name and title of Owner/Operator Date OFFICIAL USE ONLY Date Accepted Date Rejected Acts Rejection Comments Reviewers Initials DAQA-424-12 Revision 7/1/12. ft. of floor space above 5 000 sq. ft. 1 Fee See fee calculator at www. deq. utah. gov/eqair/haps/asbestos/index. htm 2 Facility Name Address City County Zip Code Part of Facility Involved e*g* floor room area etc* Age of Facility Size Present use of Floors Prior Use 3 Facility Owner/Operator Name Contact Person State Phone Number 4 Demolition Contractor Name Phone 5 Dates of Demolition Start Date 6 Asbestos Inspection Information Ending Date Date of Inspection Name of Utah Certified Inspector Analytical Method used for asbestos analysis Is asbestos present ID Number Was it sampled or assumed 7 Asbestos Containing Material to be left in the facility during demolition list types and amounts. htm 2 Facility Name Address City County Zip Code Part of Facility Involved e*g* floor room area etc* Age of Facility Size Present use of Floors Prior Use 3 Facility Owner/Operator Name Contact Person State Phone Number 4 Demolition Contractor Name Phone 5 Dates of Demolition Start Date 6 Asbestos Inspection Information Ending Date Date of Inspection Name of Utah Certified Inspector Analytical Method used for asbestos analysis Is asbestos present ID Number Was it sampled or assumed 7 Asbestos Containing Material to be left in the facility during demolition list types and amounts. roofing flooring other 8 Description of procedures to be followed in the event that unexpected RACM is found or generated during the project. roofing flooring other 8 Description of procedures to be followed in the event that unexpected RACM is found or generated during the project. attach additional sheets as necessary 9 I certify that the all the information in this notification is true and correct.

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