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ASnI-~ OREGON DEQ NO71CE OF INTENT ~ TO REMOVE OR ENCAPSUI_ATE FRIABLE ~'~ ASBESTOS-CONTAINING MATERIAL ~I1 For DEQ use or~y De[e Received Amoun[ Receivad Check Number Project Numbar _ 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 X Eme~goncy lEmerpency notificationa require a 50% 1ee increeae) A._ S35 for each project with less then 40 lineer or 80 square feet o( asbas[os-containing material and for each residential abateman[ projcc[, B. 970 for projec[s from 40 to 259 linaer fee[ ot 80 to 159 square fee[ of asbes[os~con[aining material. C. $275 for projects from 260 to 1299 linaer (aet or 180 to 799 square fee[ of asbestas-conteining material. D. $375 for projects from 1300 to 2599 linee~ faat or 800 to 1599 squara feet of esbestos-containing mecerial. E. $650 for projects from 2600 to 4999 linenr feet or 1600 to 3499 square taet of esbostos-conlaining matarial. F. X 4750 for projects irom 5000 to 9999 linear feat or 3500 ro 5999 squere feet of asbes[os-containing me[ariel. G._ 91,200 for projoc[s from 10,000 to 25,999 lineer fae[ or 6000 to 15,999 squere faet of as6estos-conteining meta~iel. H._ 52,000 tor projects from 28,000 to 259,999 linesr fae[ or 16,000 to 159,999 squere faet of asbastos-conteining mecerial. 1. _ 32,500 for projects 260.000 linaer fae[ or mora or 160,000 square feet or more of esbestos-containing matarial. 1. Is this a revision to a previous notificationl Yes No x ~ 2. AsGestos abatement project starting date: 6'10'97 Completion date: 6-12-97 3. Project site name: Carmcnitv Develo~ent BuildinG Address: 285 Church Street Salem i"arion CR 97301 ISPaep ICrtyI ICu+vyl 2v1 4. Property Owner: Marion County 11, Abatement Contractor Name: Ptoperty Owner Address: 100 Hiqh Street ~YE Precision Industrial Constructors, Inc. Salem OR 97301 Contractor mailing address: IGry~ ~Sle~q ~ZIPI . Site Contact: ~ve Hartwi5 Phone: ~03-373-4424 1395-D LUwnriver Drive Woodland, WA 9E67~ Ic~rl ~sie~e~ 2J: 6. Describe physical structure of faciliiy: h`oa7, Brick and Phone: 360-225-7955 Concrete Structure DEQ license number: FSC-645 7. Give present and prior use of facility: Karion Countv 12. Describe method ot removal or encapsulation: 9uilding - Clirrently Vacant Flill il~eqative Yressure Enclosure - S~;et ;:ethocs 8. Will this be a complete demolition? Yes: X No: 13. Days of week and hours of day to be worked: If yes, give demolition start date: 6-9-97 17iesday - L^.iursday 9. Describe type and percentage of asbesfos material and 8:OOam - 4:30p~n where it is loCated in facility: G:6 ChrYOSlite Tile &~SasLic 14. Oregon Certitied Supervisor on this project: 25~' Ciirysolite Fittings Jim Kcenig Ore. Certified Supervisor number: 5-07780 I 15. Asbestos disposal site: Sroorn Island I 70. Quantity of asbestos material to be removed or 1 6. Waste Hauler. Precision Industrial Constn:c`,,crs, Inc• I encapsulated: I I.inearfeet: 50 Square fee[: 3,600 Phone: 360-225-7955 t 7. Name of owner, ope tor, or abatement contracior: Precision Industrial Constructors, Ine. ~ _ I ignature: ~~ ~4~ti ~~~ Date: 6-9-97 _ Phone: 366-225--7955 ~ ~ Sign this form and send with [he appropriate fee ro: DEQ Business Office, ~~ 811 SW Sixth Avenue, Portland, OR 97204. Make checks payable to "DEQ". '~,. IRevised 5/98) I