Form CEOH-2 "Notification of Non-friable Vinyl Asbestos Tile Work Activities" - New Jersey

What Is Form CEOH-2?

This is a legal form that was released by the New Jersey Department of Health - 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 September 1, 2019;
  • The latest edition provided by the New Jersey Department of Health;
  • 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 CEOH-2 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form CEOH-2 "Notification of Non-friable Vinyl Asbestos Tile Work Activities" - New Jersey

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New Jersey Department of Health
Consumer, Environmental and Occupational Health Service
PO Box 369, Trenton, NJ 08625-0369
Telephone: 609-826-4950
Fax: 609-826-4975
NOTIFICATION OF NON-FRIABLE VINYL ASBESTOS TILE WORK ACTIVITIES
Must be submitted 10 days prior to the beginning of work. Please type or print legibly.
I. NOTIFICATION INFORMATION
Date of Notification:
Type of Work:
Demolition
Renovation
Initial
Amended
Cancellation
Emergency (must include justification)
II. BUILDING OWNER INFORMATION
first / middle / last
Name of Building Owner/Operator:
This is an Adobe® Acrobat® Interactive PDF form with
Street Address:
City:
State:
Zip:
first / middle / last
dynamic functionality and will perform as intended in
Name of Contact:
Telephone No.:
Adobe® Reader® 6.0 and higher. Interactive elements
may not function in non-Adobe PDF applications. If you
III. FACILITY INFORMATION
are seeing this message, you must download this docu-
Name of Facility Where Work Activity is to Take Place:
ment and open using Adobe® Reader® 6.0 and higher.
Describe Facility Use:
Street Address:
City:
State:
Zip:
County Name:
County Code (State Use Only):
Instructions on how to download pdf files can be found here:
Individually list all areas, days and hours of work being performed (be as specific as possible, include floor number, room
http://www.nj.gov/health/forms/oas-f2.pdf
number, etc.). This information must accurately reflect when work will be performed; if days change, an amended notification
must be submitted; failure to indicate dates correctly may result in a penalty action and/or the revocation of the
contractor’s DOH approval to perform exempted VAT work. You may use additional sheets if necessary:
Building/Area
Floor
Room
Date(s) work will be Performed
Work Hours
(i.e. 8a-4p)
Number
CEOH-2
Page 1 of 2
SEPTEMBER 19
New Jersey Department of Health
Consumer, Environmental and Occupational Health Service
PO Box 369, Trenton, NJ 08625-0369
Telephone: 609-826-4950
Fax: 609-826-4975
NOTIFICATION OF NON-FRIABLE VINYL ASBESTOS TILE WORK ACTIVITIES
Must be submitted 10 days prior to the beginning of work. Please type or print legibly.
I. NOTIFICATION INFORMATION
Date of Notification:
Type of Work:
Demolition
Renovation
Initial
Amended
Cancellation
Emergency (must include justification)
II. BUILDING OWNER INFORMATION
first / middle / last
Name of Building Owner/Operator:
This is an Adobe® Acrobat® Interactive PDF form with
Street Address:
City:
State:
Zip:
first / middle / last
dynamic functionality and will perform as intended in
Name of Contact:
Telephone No.:
Adobe® Reader® 6.0 and higher. Interactive elements
may not function in non-Adobe PDF applications. If you
III. FACILITY INFORMATION
are seeing this message, you must download this docu-
Name of Facility Where Work Activity is to Take Place:
ment and open using Adobe® Reader® 6.0 and higher.
Describe Facility Use:
Street Address:
City:
State:
Zip:
County Name:
County Code (State Use Only):
Instructions on how to download pdf files can be found here:
Individually list all areas, days and hours of work being performed (be as specific as possible, include floor number, room
http://www.nj.gov/health/forms/oas-f2.pdf
number, etc.). This information must accurately reflect when work will be performed; if days change, an amended notification
must be submitted; failure to indicate dates correctly may result in a penalty action and/or the revocation of the
contractor’s DOH approval to perform exempted VAT work. You may use additional sheets if necessary:
Building/Area
Floor
Room
Date(s) work will be Performed
Work Hours
(i.e. 8a-4p)
Number
CEOH-2
Page 1 of 2
SEPTEMBER 19
III. FACILITY INFORMATION (CONTINUED)
Building/Area
Floor
Room
Date(s) work will be Performed
Work Hours
(i.e. 8a-4p)
Number
Occupancy Status During Activity (check only one):
Facility Closed/Vacated During Entire Activity
Activity Performed Outside Normal Facility Hours—Describe:
Other—Describe:
Type and Amounts of Material (complete all applicable information):
%
Floor Tile
Square Footage:
Percentage Asbestos:
%
Mastic
Square Footage:
Percentage Asbestos:
IV. CONTRACTOR INFORMATION
Company Name:
Telephone No.:
Street Address:
City:
State:
Zip:
New Jersey Asbestos Abatement License Number (if applicable):
Monitoring Firm (if applicable):
Telephone No.:
V. SIGNATURE
Completed By
(type or print legibly):
Title:
Signature:
Date:
CEOH-2
Page 2 of 2
SEPTEMBER 19
Page of 2