CITY OF CAPE CANAVERAL ASBESTOS NOTIFICATION STATEMENT

Transcription

1 CITY OF CAPE CANAVERAL 100 POLK AVENUE CAPE CANAVERAL, FL (321) phone (321) fax CITY OF CAPE CANAVERAL ASBESTOS NOTIFICATION STATEMENT [You may download this authorization: You may fax to: (321) ] Date: As required by Florida Statute , please complete this form indicating compliance with the asbestos notification requirements of the State of Florida. Site : Scope of work (check one): Fire Damage Demolition Renovation of existing building Name (Print): Owner/Agent/Contractor Signature: Owner/Agent/Contractor Date: State of Florida County of Brevard Subscribed and sworn to before me this day of,, personally appeared who is personally known to me or produced as identification, and who did/did not take an oath. Notary Public Signature Seal FORM DATE: 4/11/2018 PAGE 1 of 1 FORM: Asbestos

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3 Florida Department of Environmental Protection Division of Air Resource Management NOTICE OF DEMOLITION OR ASBESTOS RENOVATION TYPE OF NOTICE (CHECK ONE ONLY): ORIGINAL REVISION CANCELLATION COURTESY TYPE OF PROJECT (CHECK ONE ONLY): DEMOLITION RENOVATION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? IS IT A PLANNED RENOVATION OPERATION? I. Facility Name YES YES YES NO NO NO City State Zip County Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years Prior Use: Present Use: School/College/University Residence Small Business Other School/College/University Residence Small Business Other II. Facility Owner Phone ( ) City State Zip III. Contractor's Name City State Zip Phone ( ) Is the contractor exempt from licensure under section (4), F.S.? YES NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) DEP Form (1) Effective Page 1 of 2 Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That Apply): OTHER Strip and Removal Glove Bag Bulldozer Wrecking Ball Wet Method Dry Method Explode Burn Down VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter: Name City State Zip Phone ( ) VIII. Waste Disposal Site: Name Class City State Zip IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM. Amount of RACM or ACM* square feet surfacing material linear feet pipe cubic feet of RACM off facility components square feet cementitious material square feet resilient flooring square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: X. Fee Invoice Will Be Sent to in Block Below: (Print or Type) Name City State/Zip I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on-site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. (Print Name of Owner/Operator) (Date) (Signature of Owner/Operator (Date) DEP USE ONLY Postmark/Date Received ID#

4 DEP Form (1) Effective Page 2 of 2 Instructions The state asbestos removal program requirements of s , F.S., and the renovation or demolition notice requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule , F.A.C., are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by law). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and the date ordered to begin. A copy of the order must also be attached to the notification. If you checked renovation, is it an emergency renovation operation? If so, in addition to the information required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. I. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" is defined in Rule , F.A.C.; small business, as defined in s (1), F.S.; or other. If "other" is checked, identify the use. Please follow the same instructions for "present use." II. III. Complete the facility owner information. Complete the contractor information. IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated by reference in Rule , F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with 40 CFR section (3)(c)(i).) VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos material becomes crumbled, pulverized, or reduced to powder after start of the project. VII. Complete the asbestos waste transporter information. VIII. Complete the waste disposal site information. IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable. X. Provide the address where the Department is to send the invoice for any fee due. Do not send a fee with the notification. The fee will be calculated by the Department pursuant to Rule , F.A.C. Sign the form and mail the original to the district or local air program having jurisdiction in the county where the project is scheduled (DO NOT FAX). The correct address can be obtained by contacting the State Asbestos Coordinator at: Department of Environmental Protection, Division of Air Resources Management, 2600 Blair Stone Road, Tallahassee, FL

5 CHAPTER ASBESTOS PROGRAM Purpose and Scope. (Effective 2/9/99) Definitions. (Effective 2/9/99) Applicability. (Repealed) Notification Procedure and Fee. (Effective 10/12/08) National Emission Standard for Asbestos. (Repealed) Fee Schedule. (Effective 2/9/99) Enforcement. (Repealed) Form. (Effective 10/12/08) Purpose and Scope. (1) This chapter implements Section , F.S., by establishing a fee schedule for asbestos removal projects. (2) The purpose of the Department s asbestos removal program is to prevent the release of significant amounts of asbestos fibers to the outside air during demolition or renovation activities. Asbestos fibers in the outside air present a risk to human health. (3) The purpose of the fee is to fund the implementation of the Department s asbestos removal program as prescribed in this chapter and in 40 CFR Part 61, Subpart M National Emission Standards for Hazardous Air Pollutants (NESHAP) for Asbestos, adopted and incorporated by reference in Rule , F.A.C. (4) This chapter requires prior notification to the Department in accordance with 40 CFR Part 61, Subpart M. Specific Authority , FS. Law Implemented , FS. History New , Formerly , Amended , , Definitions. (1) Asbestos means the asbestiform varieties of serpentinite (chrysotile), riebeckite (crocidolite), cummingtonite-grunerite, anthophyllite, and actinolite-tremolite and includes trade acronyms products such as amosite. (2) Asbestos-containing materials, ACM, means any materials which contain more than one percent asbestos as determined by Polarized Light Microscopy. (3) Asbestos removal project means a renovation or demolition operation in a facility that involves the removal of a threshold amount of regulated asbestos-containing material. (4) Category I Nonfriable Asbestos-Containing Material (ACM) means asbestos-containing packings, gaskets, resilient floor covering, and asphalt roofing products containing more than 1 percent asbestos as determined using the method specified in Appendix A, Subpart F, 40 CFR Part 763, Section 1, Polarized Light Microscopy. (5) Category II Nonfriable ACM means any material, excluding Category I Nonfriable ACM, containing more than 1 percent asbestos as determined using the methods specified in Appendix A, Subpart F, 40 CFR Part 763, Section 1, Polarized Light Microscopy, that, when dry, cannot be crumbled, pulverized, or reduced to powder by hand pressure. (6) Department means the Florida Department of Environmental Protection. (7) Demolition means the wrecking or taking out of any load-supporting structural member of a facility together with any related handling operations or the intentional burning of any facility. (8) Emergency renovation operation means a renovation operation that was not planned but results from a sudden, unexpected event that, if not immediately attended to, presents a safety or public health hazard, is necessary to protect equipment from damage, or is necessary to avoid imposing an unreasonable financial burden. This term includes operations necessitated by nonroutine failures of equipment. (9) Facility is as defined in 40 CFR , adopted and incorporated by reference in Rule , F.A.C. (10) Friable Asbestos Material means any material containing more than 1 percent asbestos as determined using the method specified in Appendix A, Subpart F, 40 CFR Part 763 Section 1, Polarized Light Microscopy that, when dry, can be crumbled, pulverized, or reduced to powder by hand pressure. If the asbestos content is less than 10 percent as determined by a method other than point counting by Polarized Light Microscopy (PLM), verify the asbestos content by point counting using PLM. (11) Local Air Program, for purposes of Chapter , F.A.C., only, means a county air pollution control program which meets the criteria of Section (1), F.S. (12) Nonscheduled renovation operation means a renovation operation necessitated by the routine failure of equipment, which is expected to occur within a given period based on past operating experience, but for which an 1

6 exact date cannot be predicted. (13) Ordered demolition means a demolition under an order of a State or local government agency, issued because the facility is structurally unsound and in danger of imminent collapse. (14) Owner or operator means any person or entity who owns, leases, operates, controls, or supervises either the renovation or demolition operation or the site of the renovation or demolition operation. (15) Planned renovation operation means a renovation operation, or a number of such operations, in which regulated asbestos-containing material will be removed or stripped within a given period of time and that can be predicted. Individual nonscheduled operations are included if a number of such operations can be predicted to occur during a given period of time based on operating experience. (16) Renovation means the alteration in any way of a facility or of one or more facility components. Operations in which load-supporting structural members are wrecked or taken out are demolitions. (17) Regulated Asbestos-Containing Material (RACM) means: (a) Friable asbestos material; (b) Category I nonfriable ACM that has become friable; (c) Category I nonfriable ACM that will be or has been subjected to sanding, grinding, cutting, or abrading; or (d) Category II nonfriable ACM that has become crumbled, pulverized, or reduced to powder or has a high probability of becoming crumbled, pulverized, or reduced to powder by the forces expected to act on the material in the course of demolition or renovation operations regulated by 40 CFR Part 61, Subpart M, as adopted in this chapter. (18) Residential dwelling means any structure or building intended to house a single family, or a residential building having no more than four dwelling units. This term is not intended to include any institutional, commercial, public, or industrial structure, installation or building, any structure or building being demolished as part of a public project, regardless of its previous use, function or ownership, or any building, structure or installation being used partly for residential purposes and partly for commercial, public or industrial use. (19) State Asbestos Coordinator means the person designated by the Director of the Department s Division of Air Resources Management to serve as the statewide coordinator for the asbestos program. (20) Threshold amount of regulated asbestos-containing material means at least 260 linear feet on pipes, or at least 160 square feet on other facility components, or at least 35 cubic feet off facility components where the length or area could not be measured previously. (21) Working day means Monday through Friday and includes holidays that fall on any of the days Monday through Friday. Specific Authority , FS. Law Implemented , FS. History New , Formerly , Amended , Applicability. (Repealed) Specific Authority , FS. Law Implemented , FS. History-New , Formerly , Amended , Repealed Notification Procedure and Fee. (1) The notice requirements of Chapter , F.A.C., Asbestos Program, apply to each owner or operator of a renovation of a facility involving the removal of a threshold amount of regulated ACM or any demolition of a facility regardless of whether or not asbestos is present and to each owner or operator of the site for a renovation of a facility involving the removal of a threshold amount of regulated ACM or any demolition of a facility regardless of whether or not asbestos is present. (2) If a notice is required per subsection (1), F.A.C., the timely submittal of a completed Notice of Demolition or Asbestos Renovation form, as promulgated under subsection (1), F.A.C., or an electronically generated facsimile thereof, is required. (a) The notice will be complete when the owner or operator legibly provides all the information requested on the Department s form, and, if applicable, the additional information required by 40 CFR (b), adopted and incorporated by reference in Rule , F.A.C., for ordered demolitions or emergency renovation operations. (b) The notice will be timely when the owner or operator mails it or delivers it to the Local Air Program or, where there is no Local Air Program, to the Department's District Office having jurisdiction over the site of the renovation or demolition operation, so that it is postmarked or received: 1. At least 10 working days prior to the start of the renovation or demolition operation; or 2. No later than the following working day after an emergency renovation operation or ordered demolition; or 2

7 3. At least 10 working days prior to the end of the calendar year preceding the year for which a planned renovation operation notice is being given. (3) The owner or operator who submits a single planned renovation operation notification involving small individual nonscheduled operations shall indicate on the notice form the total amount of regulated asbestoscontaining material predicted to be removed during the calendar year based on operating experience. (4) If after the start of the project it is determined that at least 20 percent more regulated asbestos-containing material than originally reported to the Department is to be removed, the owner or operator shall submit a revised notification according to Rule , F.A.C. (5) This notification form, when complete and timely submitted, will satisfy the notification requirements of the EPA s National Emission Standards for Asbestos, 40 CFR (b). (6) Except in the following situations, the owner or operator of an asbestos removal project shall pay a fee calculated pursuant to Rule , F.A.C., Fee Schedule. (a) The Department s fee requirements are not applicable to schools, colleges, universities, or to a residential dwelling as defined in Rule , F.A.C. (b) The Department s fee requirements are not applicable to those persons otherwise exempted from licensure under Section (4), F.S. (c) The Department s fee requirements are not applicable if the county in which the asbestos removal project is located collects a fee for providing asbestos notification and inspection services according to 40 CFR 61, Subpart M, adopted and incorporated by reference in Rule , F.A.C. (d) The fee to be paid by a small business, as small business is defined in Section (1), F.S., shall not exceed $300. Specific Authority , FS. Law Implemented , FS. History New , Formerly , Amended , , , National Emission Standard for Asbestos. (Repealed) Specific Authority , FS. Law Implemented , , , , FS. History-New , Repealed Fee Schedule. Except as noted in subsection (6), F.A.C., each asbestos removal project fee shall be calculated in accordance with the following fee schedule; however, no fee shall exceed $1,000 for the total of square, linear, and cubic feet of regulated asbestos-containing material to be removed: REGULATED ASBESTOS-CONTAINING MATERIAL TO BE REMOVED FEE square feet $ linear feet $ square feet $ linear feet $ 100 but if, square plus linear feet totals 421 or greater, then pay: 421-2,000 $ 200 2,001-3,000 $ 300 3,001-4,000 $ 400 4,001-5,000 $ 500 5,001-6,000 $ 600 6,001-7,000 $ 700 7,001-8,000 $ 800 8,001-9,000 $ 900 Greater than 9,000 $1000 and for total cubic feet, if applicable, pay: 0-34 $ $ $ $ $ 800 Greater than 74 $1000 Specific Authority FS. Law Implemented FS. History New , Formerly , Amended

8 94, Enforcement. (Repealed) Specific Authority , , FS. Law Implemented , , FS. History - New , Formerly , Repealed Form. The form with instructions used by the Department in the asbestos air regulatory program is adopted and incorporated herein by reference. Copies of the form and instructions may be obtained by writing to the State Asbestos Coordinator, Division of Air Resource Management, 2600 Blair Stone Road, Tallahassee, Florida The form is also available on the internet at or at the Department s District Offices or at Local Air Program offices. Notice of Demolition or Asbestos Renovation, DEP Form Number (1), effective Specific Authority , FS. Law Implemented , FS. History New , Formerly , Amended , ,