Notice of Intent to Remove Asbestos Help? 

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PROJECT CATEGORY

Project Type:
Choose one category below: Advance Notification Period SWCAA Fee
Residential (Any amount-owner occupant performed) Prior Notification $31.00
Less than 10 linear feet, less than 48 square feet Prior Notification $0.00
10-259 linear feet, 48 to 159 square feet 10 days $124.00
260-999 linear feet, 160 to 4999 square feet 10 days $310.00
1000 linear feet, 5000 cubic feet or more 10 days $620.00

Emergency (call SWCAA at 360-574-3058 immediately for notification period waiver - Fees Double!)
NO
YES  Reason for Emergency:

PROJECT SCOPE

Quantity to be removed: square feet or linear feet Workshift days: M T W Th F Sa Su
Project starting date:  Completion date: Workshift Hours:
Site address:    City: Zip:     County:
Location of asbestos:
Demolition of structure? Yes No If yes, Notification of Demolition application is required

MATERIAL DESCRIPTION

Material to be Removed: (Check all that apply)
Fireproofing  Popcorn Ceiling   CAB  Sheet Vinyl   Boiler Insulation  Duct Tape  
Duct Paper  Mag Pipe Insulation   Air Cell  CA Pipe   VAT  Other
Control Methods: (Check all that apply)
N.P. Enclosure  Glove Bag   Mini Enclosure  Wrap & Cut   Water
HEPA Vac  Other  

INSPECTOR/CONTRACTOR/OWNER/DISPOSAL

Asbestos Inspection Conducted?
YES - Include results summary page:
NO - Provide reason:

AHERA Inspector Name:    Certification #:

Asbestos Contractor:    Asbestos Certification #:

Mailing Address (CSZ):
Owner/CEO Name:   Phone:
Onsite Supervisor Name:    Certificate #:   Phone:

Property Owner Name:    Phone #:

Mailing Address:
City:   State:    Zip:

Asbestos disposal site and landfill address: (Site Name, address, city state zip)


CERTIFICATION

I DO HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS NOTIFICATION IS, TO THE BEST OF MY KNOWLEDGE, ACCURATE AND COMPLETE.

Your Name:   Dated: 5/31/2020 9:00:05 AM

Title:    Representing:

Your Email Address:

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