Form DAQA-025-18 "Asbestos Alternative Work Practice Request Form" - Utah

What Is Form DAQA-025-18?

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

Form Details:

  • Released on June 10, 2018;
  • The latest edition provided by the Utah 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 Form DAQA-025-18 by clicking the link below or browse more documents and templates provided by the Utah Department of Environmental Quality.

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Download Form DAQA-025-18 "Asbestos Alternative Work Practice Request Form" - Utah

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State of Utah
Utah DEQ/DAQ Date Received Stamp Only
Department of Environmental Quality
Division of Air Quality
ATLAS Section
th
195 North 1950 West, 4
Floor
P.O. Box 144820
Salt Lake City, Utah 84114-4820
Postmark Date: __________________ Initials: _______
Check #/Credit Card Amount: _____________________
asbestos@utah.gov
ASBESTOS ALTERNATIVE WORK PRACTICE REQUEST FORM
Please read the instructions on the last page of this form prior to completion. Please complete all
sections of the form or write n/a. Improperly completed forms may be rejected delaying your project!!
A. Type of Notification
Initial AWPR Form (Please check this box, complete, and submit the entire form)
Revision to Initial or Previously Revised AWPR Form (Please check this box, complete all areas of Section
B and any additional sections of this form which require amending, then submit the entire form)
AWPR Form Project Cancellation (Please check this box, complete all areas of Section B, then submit the
entire form)
B. AWPR Facility Location
Facility Name: _______________________________________________________________________________________________
For Residential Structures, put the owner’s last name followed by the word “Residence”/For Public or Commercial Structures, put the business name followed by the word “Building”
Facility Address: ______________________________________________________________________________________________
Street Address (Please, no P.O. Box)
City
State
Zip Code
Parts of the Facility Involved: ______________________________________________ Project Dates: __________________________
C. Asbestos Company Information
Company Name: _______________________________________________________ Company Certification #ASBC - ____________
Company Address: ____________________________________________________________________________________________
Street Address
City
State
Zip Code
Contact Person: __________________________ Telephone #: (_______) _______ - _________ Email: ________________________
D. What State/Federal rule will the AWPR replace?
(e.g. < 10D R307-801-11(1)(a), <10A R307-801-11(1)(c)(i), BF R307-801-11(1)(a). V R307-801-13(10))
Attach additional pages to complete this form, if necessary
E. Why is it not feasible to comply with the State/Federal Asbestos Rules/Regulations?
Attach additional pages to complete this form, if necessary
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State of Utah
Utah DEQ/DAQ Date Received Stamp Only
Department of Environmental Quality
Division of Air Quality
ATLAS Section
th
195 North 1950 West, 4
Floor
P.O. Box 144820
Salt Lake City, Utah 84114-4820
Postmark Date: __________________ Initials: _______
Check #/Credit Card Amount: _____________________
asbestos@utah.gov
ASBESTOS ALTERNATIVE WORK PRACTICE REQUEST FORM
Please read the instructions on the last page of this form prior to completion. Please complete all
sections of the form or write n/a. Improperly completed forms may be rejected delaying your project!!
A. Type of Notification
Initial AWPR Form (Please check this box, complete, and submit the entire form)
Revision to Initial or Previously Revised AWPR Form (Please check this box, complete all areas of Section
B and any additional sections of this form which require amending, then submit the entire form)
AWPR Form Project Cancellation (Please check this box, complete all areas of Section B, then submit the
entire form)
B. AWPR Facility Location
Facility Name: _______________________________________________________________________________________________
For Residential Structures, put the owner’s last name followed by the word “Residence”/For Public or Commercial Structures, put the business name followed by the word “Building”
Facility Address: ______________________________________________________________________________________________
Street Address (Please, no P.O. Box)
City
State
Zip Code
Parts of the Facility Involved: ______________________________________________ Project Dates: __________________________
C. Asbestos Company Information
Company Name: _______________________________________________________ Company Certification #ASBC - ____________
Company Address: ____________________________________________________________________________________________
Street Address
City
State
Zip Code
Contact Person: __________________________ Telephone #: (_______) _______ - _________ Email: ________________________
D. What State/Federal rule will the AWPR replace?
(e.g. < 10D R307-801-11(1)(a), <10A R307-801-11(1)(c)(i), BF R307-801-11(1)(a). V R307-801-13(10))
Attach additional pages to complete this form, if necessary
E. Why is it not feasible to comply with the State/Federal Asbestos Rules/Regulations?
Attach additional pages to complete this form, if necessary
1
F. What alternative and equivalent engineering controls will be used to control asbestos?
Attach additional pages to complete this form, if necessary
G. AWPR Design
Please read the instructions on the last page prior to completing this section!!
Utah Certified Asbestos Project Designer: __________________________________________________________________________
First Name
Middle Initial
Last Name
Asbestos Project Designer Certification # ASB - _____________________________________________________________________
Utah Certified Asbestos Company: ____________________________________ Asbestos Company Certification # ASBC - _________
Company Name
H. Asbestos AWPR Fee
Please read the instructions on the last page prior to completing this section!!
AWPR Type
AWPR Fee
Total AWPR Fee
Training Providers and Single Family Owner Occupied
$110. 00
$110.00
Residential Structures
All Other Structures and Asbestos AWPRs NOT
$275.00
$275.00
Specifically Identified Above
I. Certification Statement
I hereby attest and affirm that the information included on this Asbestos AWPR Form, including any attachments, is true and accurate to
the best of my belief and knowledge. I acknowledge that I have read the instructions for this form found at the end of this document. I
further acknowledge that any approval authorized pursuant to this Asbestos AWPR will be subject to revocation if issuance was based
on incorrect or inadequate information that materially affected the decision to issue the Asbestos AWPR approval. I also attest and
affirm that I will follow all work practice standards required by Utah Administrative Code R307-801.
_________________________________________________________________________________________________________________________
Owner’s/Contractor’s Signature
Date Signed
_________________________________________________________________________________________________________________________
Owner’s/Contractor’s Title
Owner’s/Contractor’s Printed Name
Before sending this Utah DEQ/DAQ Asbestos AWPR Form, please check to make sure you have:
Filled out all sections of the Asbestos AWPR form and attached
Enclosed or paid by credit card the appropriate Asbestos
additional information as necessary?
AWPR form fees?
Signed and dated the Asbestos AWPR form?
Made a copy of this Asbestos AWPR form for your files?
Mail original completed Asbestos AWPR Form, supporting materials, and fees to:
Utah Department of Environmental Quality
Division of Air Quality
195 North 1950 West
P.O. Box 144820
Salt Lake City, UT 84114-4820
or
asbestos@utah.gov
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Official Use Only
PLEASE DO NOT WRITE IN THIS AREA
Official Use Only
Date AWPR Form Received _______________________ Date Additional Information Requested ___________________
Month/Day/Year
Initials
Month/Day/Year
Initials
Date/Amount Fee Received _______________________ Date Additional Information Received ____________________
Month/Day/Year
$ Amount
Initials
Month/Day/Year
Initials
Date AWPR Form Reviewed _______________________ Date AWPR Form Accepted/Rejected ___________________
Month/Day/Year
Initials
(circle one)
Month/Day/Year
Initials
Reason for Rejection:
Additional Information:
Revision 1.1 - 6/10/18
DAQA-025-18
General Instructions
This Alternative Work Plan Request (AWPR) form must be properly completed with the appropriate fee and returned to the
Utah Department of Environmental Quality/Division of Air Quality (UDEQ/DAQ) on traditional work days (Monday – Friday) and
hours (8:00 AM – 5:00 PM) and be at least seventy-two (72) hours before proposing to begin any regulated work activities
related to this AWPR. An AWPR is required when an entity believes it can not comply with the asbestos rules/regulations as written.
Typically the entity must assure equal protection to human health and the environment through alternative means. Please remember
that you cannot start any regulated work activities related to this AWPR until you have a signed approval letter from the UDEQ/DAQ.
The use of an AWPR form should be in rare cases when full compliance cannot be achieved with existing state administrative
rules and federal regulations. The use of the AWPR form should not be part of an individual’s or company’s standard
operating procedure. You can email this form to asbestos@utah.gov and pay with a credit card by calling 801-536-4000 or by logging
on to your UDEQ/DAQ Asbestos Lead-Based Paint (ALBoP) account. Please remember to complete this form in its entirety by writing
legibly (using blue or black ink only). If you use this form’s PDF fillable capability, please save it to your desktop before closing
the document or all information will be lost.
Section G. AWPR Design
A project design of the affected project portion must have sufficient diagrams, photographs, and description to define the AWPR scope
of work and demonstrate that the AWPR is designed to achieve the control of asbestos equivalent to the Utah Asbestos Administrative
Rules and Federal Asbestos Regulations, if appropriate. This AWPR must be designed by a Utah Certified Asbestos Project Designer
working for a Utah Certified Asbestos Company. The approval of the AWPR applies only to the Utah Administrative Rule(s) and Federal
Regulation(s) cited above and is specific to the project for which the request is submitted. All other regulatory requirements found in the
Utah Asbestos Administrative Rules and Federal Asbestos Regulations will apply to this project, if applicable.
Section H. Asbestos AWPR Fee
The UDEQ/DAQ has established an AWPR Fee of $110 for Training Providers and Owner Occupied Single Family Residential
structures. A fee of $275 is required for all other AWPRs not specifically identified above.
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