Form ASB-41 "Notification of Asbestos Abatement" - New Jersey

What Is Form ASB-41?

This is a legal form that was released by the New Jersey Department of Labor & Workforce Development - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2008;
  • The latest edition provided by the New Jersey Department of Labor & Workforce Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ASB-41 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Labor & Workforce Development.

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Download Form ASB-41 "Notification of Asbestos Abatement" - New Jersey

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Print Form
State of New Jersey
NOTIFICATION OF ASBESTOS ABATEMENT
(Pursuant to NJAC 8:60 and 12:120)
Date of Notification (1)
Name of Building Owner/Operator (2)
Agencies Notified
Type Notification
Street Address
EPA
Initial
City, State, Zip Code
DEP
Amended
DOL
Amendment #
Emergency (including
Name of Contact
Telephone Number
DOH
justification)
DCA
Cancellation
FACILITY INFORMATION
Name of Facility Where Abatement is Taking Place (3)
Type of Facility (4)
School (K-12)
Street Address
Subchapter 8 (Other than K-12)
Other (i.e. private & commercial buildings, homes,
etc.)
City (5)
Square Feet
# of Floors
Bldg. Age
County (6)
County Code (7)
Current Use (Prior if being demolished)
(STATE USE ONLY)
Name of Monitoring Firm Hired by Building Owner (8)
ASCM No
Name of Abatement Contractor (9)
.
Street Address
Street Address
City, State, Zip Code
City, State, Zip Code
Project Manager for Monitoring Firm
Telephone No.
Telephone No.
License No.
Start Date (10)
Scheduled Completion Date (11)
Name of OSHA Monitor
Occupancy Status During Abatement (Check Only One)
Street Address
Facility Closed/Vacated During Entire Period of Abatement
Abatement Performed Outside of Normal Facility Hours
City, State, Zip Code
Other – Describe:
Scope of Work (Check All That Apply)
≥3 sf or ≥3 lf
Renovation
Full Containment with Negative Pressure
≥160 sf or ≥260 lf
Demolition
Mini-Enclosure
Glovebag Procedure
Non-Exempted (*) and Non-Friable Procedure
Abatement
Is Location
Type
Normally
Location of
Description of
Used Solely by
Asbestos-Containing Material (ACM)
Asbestos Containing Material (ACM)
Amount
Maintenance/
TO BE ABATED
(i.e. thermal systems insulation,
(Specify
Custodial Staff?
In Facility
surfacing, VAT, or
SF or LF)
(12)
(13)
other miscellaneous)
Yes
No
N/A
Name of Registered Waste Hauler
NJDEP Waste
Cubic Yards
Name of Registered Landfill
Hauler ID No.
of Waste
City, State
Disposal Date
City, State
Completed by
Title
Signature
Date
* Do not use this form for asbestos licensure exempted activities.
ASB-41 (R-06-08)
Print Form
State of New Jersey
NOTIFICATION OF ASBESTOS ABATEMENT
(Pursuant to NJAC 8:60 and 12:120)
Date of Notification (1)
Name of Building Owner/Operator (2)
Agencies Notified
Type Notification
Street Address
EPA
Initial
City, State, Zip Code
DEP
Amended
DOL
Amendment #
Emergency (including
Name of Contact
Telephone Number
DOH
justification)
DCA
Cancellation
FACILITY INFORMATION
Name of Facility Where Abatement is Taking Place (3)
Type of Facility (4)
School (K-12)
Street Address
Subchapter 8 (Other than K-12)
Other (i.e. private & commercial buildings, homes,
etc.)
City (5)
Square Feet
# of Floors
Bldg. Age
County (6)
County Code (7)
Current Use (Prior if being demolished)
(STATE USE ONLY)
Name of Monitoring Firm Hired by Building Owner (8)
ASCM No
Name of Abatement Contractor (9)
.
Street Address
Street Address
City, State, Zip Code
City, State, Zip Code
Project Manager for Monitoring Firm
Telephone No.
Telephone No.
License No.
Start Date (10)
Scheduled Completion Date (11)
Name of OSHA Monitor
Occupancy Status During Abatement (Check Only One)
Street Address
Facility Closed/Vacated During Entire Period of Abatement
Abatement Performed Outside of Normal Facility Hours
City, State, Zip Code
Other – Describe:
Scope of Work (Check All That Apply)
≥3 sf or ≥3 lf
Renovation
Full Containment with Negative Pressure
≥160 sf or ≥260 lf
Demolition
Mini-Enclosure
Glovebag Procedure
Non-Exempted (*) and Non-Friable Procedure
Abatement
Is Location
Type
Normally
Location of
Description of
Used Solely by
Asbestos-Containing Material (ACM)
Asbestos Containing Material (ACM)
Amount
Maintenance/
TO BE ABATED
(i.e. thermal systems insulation,
(Specify
Custodial Staff?
In Facility
surfacing, VAT, or
SF or LF)
(12)
(13)
other miscellaneous)
Yes
No
N/A
Name of Registered Waste Hauler
NJDEP Waste
Cubic Yards
Name of Registered Landfill
Hauler ID No.
of Waste
City, State
Disposal Date
City, State
Completed by
Title
Signature
Date
* Do not use this form for asbestos licensure exempted activities.
ASB-41 (R-06-08)