DEQ Form 100-960 "Notification of Demolition and Renovation" - Oklahoma

What Is DEQ Form 100-960?

This is a legal form that was released by the Oklahoma Department of Environmental Quality - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 7, 2018;
  • The latest edition provided by the Oklahoma Department of Environmental Quality;
  • 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 DEQ Form 100-960 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 100-960 "Notification of Demolition and Renovation" - Oklahoma

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NOTIFICATION OF DEMOLITION AND RENOVATION
Date Received
I. Type of Notification (O=Original R=Revised C=Canceled)
II. FACILITY INFORMATION (Identify owner, removal contractor, and other operator)
Owner Name:
Address:
City:
State:
Zip:
Contact:
Tel:
Removal Contractor:
Address:
City:
State:
Zip:
Contact:
Tel:
Other Operator:
Address:
City:
State:
Zip:
Contact:
Tel:
III. TYPE OF OPERATION (D=Demo O= Ordered Demo R=Renovation E=Emer. Renovation)
IV. IS ASBESTOS PRESENT? (Yes/No)
V. FACILITY DESCRIPTION (Include building name, number and floor or room number)
Bldg. Name:
Address:
City:
State:
County:
Site Location:
Building Size:
# of Floors:
Age (in years):
Present Use:
Prior Use:
VI. PROCEDURE, INCLUDING ANALYTICAL METHOD, IF APPROPRIATE, USED TO DETECT THE PRESENCE OF ASBESTOS MATERIAL:
VII. NAME OF ACCREDITED INSPECTOR WHO PERFORMED INSPECTION AND SAMPLING, OKLAHOMA DOL LICENSE NUMBER:
VIII. APPROXIMATE AMOUNT OF
Non-friable Asbestos Material To Be
Indicate Unit of
ASBESTOS INCLUDING:
RACM
Removed
Measurement Below
To Be
1. Regulated ACM to be Removed
Removed
2. Category I ACM Not Removed
Category I
Category II
UNIT
3. Category II ACM Not Removed
Pipes
LnFt:
Ln M:
Surface Area
SqFt:
Sq M:
Vol. RACM Off Facility Component
CuFt:
Cu M:
IX. SCHEDULED DATES ASBESTOS REMOVAL (MM/DD/YY) Start:
Complete:
X. SCHEDULED DATES DEMO/RENOVATION (MM/DD/YY) Start:
Complete:
DEQ Form #100-960
Page - 1 -
Revision Date 7/2/18
NOTIFICATION OF DEMOLITION AND RENOVATION
Date Received
I. Type of Notification (O=Original R=Revised C=Canceled)
II. FACILITY INFORMATION (Identify owner, removal contractor, and other operator)
Owner Name:
Address:
City:
State:
Zip:
Contact:
Tel:
Removal Contractor:
Address:
City:
State:
Zip:
Contact:
Tel:
Other Operator:
Address:
City:
State:
Zip:
Contact:
Tel:
III. TYPE OF OPERATION (D=Demo O= Ordered Demo R=Renovation E=Emer. Renovation)
IV. IS ASBESTOS PRESENT? (Yes/No)
V. FACILITY DESCRIPTION (Include building name, number and floor or room number)
Bldg. Name:
Address:
City:
State:
County:
Site Location:
Building Size:
# of Floors:
Age (in years):
Present Use:
Prior Use:
VI. PROCEDURE, INCLUDING ANALYTICAL METHOD, IF APPROPRIATE, USED TO DETECT THE PRESENCE OF ASBESTOS MATERIAL:
VII. NAME OF ACCREDITED INSPECTOR WHO PERFORMED INSPECTION AND SAMPLING, OKLAHOMA DOL LICENSE NUMBER:
VIII. APPROXIMATE AMOUNT OF
Non-friable Asbestos Material To Be
Indicate Unit of
ASBESTOS INCLUDING:
RACM
Removed
Measurement Below
To Be
1. Regulated ACM to be Removed
Removed
2. Category I ACM Not Removed
Category I
Category II
UNIT
3. Category II ACM Not Removed
Pipes
LnFt:
Ln M:
Surface Area
SqFt:
Sq M:
Vol. RACM Off Facility Component
CuFt:
Cu M:
IX. SCHEDULED DATES ASBESTOS REMOVAL (MM/DD/YY) Start:
Complete:
X. SCHEDULED DATES DEMO/RENOVATION (MM/DD/YY) Start:
Complete:
DEQ Form #100-960
Page - 1 -
Revision Date 7/2/18
XI. DESCRIPTION OF PLANNED DEMOLITION OR RENOVATION WORK, AND METHOD(S) TO BE USED:
XII. DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO PREVENT EMISSIONS OF ASBESTOS AT THE
DEMOLITION OR RENOVATION SITE:
XIII. WASTE TRANSPORTER #1
Name:
Address:
City:
State:
Zip:
Contact
Person:
Tel:
WASTE TRANSPORTER #2
Name:
Address:
City:
State:
Zip:
Contact Person:
Tel:
XIV. WASTE DISPOSAL SITE
Name:
Address:
City:
State:
Zip:
Tel:
XV. IF DEMOLITION ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY BELOW:
Name:
Title:
Authority:
Date of Order (MM/DD/YYYY):
Date Ordered to Begin (MM/DD/YYYY):
XVI. FOR EMERGENCY RENOVATIONS:
Date and Hour of Emergency (MM/DD/YY):
Description of the sudden unexpected event:
Explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden:
XVII. DESCRIPTION OF PROCEDURES TO BE FOLLOWED IN THE EVENT THAT UNEXPECTED ASBESTOS IS FOUND OR PREVIOUSLY
NONFRIABLE ASTESTOS MATERIAL BECOMES CRUMBLED, PULVERIZED, OR REDUCED TO POWDER:
XVIII. I CERTIFY THAT AN INDIVIDUAL TRAINED IN THE PROVISIONS OF THIS REGULATION (40 CFR PART 61, SUBPART M) WILL BE ONSITE
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.
(Signature of Owner/Operator)
(Print Name)
(Date)
XIX. I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT:
(Signature of Owner/Operator)
(Print Name)
(Date)
DEQ Form #100-960
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Revision Date 7/2/18
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