Scheduled Dates for Asbestos Removal or Activities that may disturb Asbestos Material in a Demolition, Renovation, Response Action, or ACDA Start Date (mm/dd/yy) Completion Date (mm/dd/yy) Scheduled Demolition Dates Start Date Completion Date (mm/dd/yy) (mm/dd/yy) Solid Waste Transporter to Landfill for RACM/ACD Transporter Name Contact Name LDEQ SW Transporter T- Contact No. Mailing Contact Phone ( ) Address City State Zip Solid Waste Transporter Only if Taken to Offsite Premises and Stored Prior to Disposal (RACM/ACD) Physical Transporter Name Location LDEQ SW Transporter of Drop Off T- City State Zip No. Area Mailing Contact Name Address City State Zip Contact Email Contact Phone ( ) Recognized Asbestos Landfill (RAL) for RACM/ACD Disposal Site for RACM Name Contact Name Physical Address Contact Phone ( ) Mailing City State Zip Address City Zip Governmental Agency Ordered Demolition (Complete only if you checked in Section II) “Yes” Gov’t Agency Representative Name Government Agency Representative’s Title Date Issued (mm/dd/yy) Date Ordered to (mm/dd/yy) Attach a copy of the Demolition Order from the governmental agency identified (above). NOTE: The will not be Notification of Demolition and Renovation and Asbestos Contaminated Debris Activity Form AAC-2(a) processed without this attachment. Emergency Renovations Involving RACM (Complete only for emergency event indicated by checked box on page 1) “Emergency” Date of Emergency (mm/dd/yy) Time of Emergency Describe the sudden, unexpected requiring immediate attention
Scheduled Dates for Asbestos Removal or Activities that may disturb Asbestos Material in a Demolition, Renovation, Response Action, or ACDA Start Date (mm/dd/yy) Completion Date (mm/dd/yy) Scheduled Demolition Dates Start Date (mm/dd/yy) Completion Date (mm/dd/yy) Solid Waste Transporter to Landfill for RACM/ACD Transporter Name Contact Name LDEQ SW Transporter No. T- Contact Mailing Address Contact Phone ( ) City State Zip Solid Waste Transporter Only if Taken to Offsite Premises and Stored Prior to Disposal (RACM/ACD) Transporter Name Physical Location of Drop Off Area LDEQ SW Transporter No. T- City State Zip Mailing Address Contact Name City State Zip Contact Email Contact Phone ( ) Recognized Asbestos Landfill (RAL) for RACM/ACD Disposal Site for RACM Name Contact Name Physical Address Contact Phone ( ) City State Zip Mailing Address City Zip Governmental Agency Ordered Demolition (Complete only if you checked “Yes” in Section II) Gov’t Agency Representative Name Government Agency Representative’s Title Date Issued (mm/dd/yy) Date Ordered to (mm/dd/yy) Attach a copy of the Demolition Order from the governmental agency identified (above). NOTE: The Notification of Demolition and Renovation and Asbestos Contaminated Debris Activity Form AAC-2(a) will not be processed without this attachment. Emergency Renovations Involving RACM (Complete only for emergency event indicated by checked “Emergency” box on page 1) Date of Emergency (mm/dd/yy) Time of Emergency Describe the sudden, unexpected requiring immediate attention