DEP Form 62-257.900(1) "Notice of Demolition or Asbestos Renovation" - Florida

What Is DEP Form 62-257.900(1)?

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

Form Details:

  • Released on October 12, 2008;
  • The latest edition provided by the Florida Department of Environmental Protection;
  • 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 DEP Form 62-257.900(1) by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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DEP Form 62-257.900(1)
Florida Department of
Effective 10-12-08
Environmental Protection
Page 1 of 2
Division of Air Resource Management
NOTICE OF DEMOLITION OR ASBESTOS RENOVATION
TYPE OF NOTICE (
):
ORIGINAL
REVISED
CANCELLATION
COURTESY
CHECK ONE ONLY
TYPE OF PROJECT (
):
DEMOLITION
RENOVATION
CHECK ONE ONLY
IF DEMOLITION, IS IT AN ORDERED DEMOLITION?
YES
NO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION?
YES
NO
IS IT A PLANNED RENOVATION OPERATION?
YES
NO
I.
Facility Name ___________________________________________________________________________________________________________
Address
City
State _______ Zip __________County __________________________________
Site
Consultant Inspecting Site
Building Size
(Square Feet) # of Floors _______ Building Age in Years ______
Prior Use:
School/College/University
Residence
Small Business
Other __________________________________________________
Present Use:
School/College/University
Residence
Small Business
Other ________________________________________________
II.
Facility Owner
Phone (_____)
Email Address ______________________
Address ________________________________________________________________________________________________________________________
City
State__________________ Zip _________________
III.
Contractor's Name ______________________________________Phone (_____)
Email Address ________________
Address _____________________________________________________________________________________________________________________
City _____________________________________________ State _________ Zip
Is the contractor exempt from licensure under section 469.002(4), F.S.?
YES
NO
IV.
Scheduled Dates: (Notice must be postmarked 10 working days before the project start date)
Asbestos Removal (mm/dd/yy) Start: _________ Finish: _______ Demo/Renovation (mm/dd/yy) Start: __________Finish: _____________
V.
Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be
used and description of affected facility components.
Procedures to be Used (Check All That Apply):
Strip and Removal
Glove Bag
Bulldozer
Wrecking Ball
Wet Method
Dry Method*
Explode
Burn Down
OTHER
*MUST OBTAIN PRIOR DEP APPROVAL BEFORE USING A DRY METHOD
VI.
Procedures for Unexpected RACM:
VII.
Asbestos Waste Transporter: Name
Phone (_____)
Address
City ________________________________________________________________ State
Zip ______________
VIII. Waste Disposal Site: Name
Class
Address
City State
Zip
IX.
RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM.
_____________________________________________________________________________________________________________________________________
X. Fee Invoice Will Be Sent to Address in Block Below: (Print or Type)
Amount of RACM or ACM*
RACM ACM
Name:
______ ______
square feet surfacing material
Address:
______ ______
linear feet pipe
City:
State/Zip:
______ ______
cubic feet of RACM off facility components
*
Identify and describe surfacing material and other materials as applicable: ______
______ ______
square feet cementitious material
square feet resilient flooring
_____________________________________________________________________
I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on-site 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.
______________________________________________________________ ______________________________________________
(Print Name of Owner/Operator)
(Date)
______________________________________________________________ ______________________________________________
(Signature of Owner/Operator)
(Date)
DEP Form 62-257.900(1)
Florida Department of
Effective 10-12-08
Environmental Protection
Page 1 of 2
Division of Air Resource Management
NOTICE OF DEMOLITION OR ASBESTOS RENOVATION
TYPE OF NOTICE (
):
ORIGINAL
REVISED
CANCELLATION
COURTESY
CHECK ONE ONLY
TYPE OF PROJECT (
):
DEMOLITION
RENOVATION
CHECK ONE ONLY
IF DEMOLITION, IS IT AN ORDERED DEMOLITION?
YES
NO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION?
YES
NO
IS IT A PLANNED RENOVATION OPERATION?
YES
NO
I.
Facility Name ___________________________________________________________________________________________________________
Address
City
State _______ Zip __________County __________________________________
Site
Consultant Inspecting Site
Building Size
(Square Feet) # of Floors _______ Building Age in Years ______
Prior Use:
School/College/University
Residence
Small Business
Other __________________________________________________
Present Use:
School/College/University
Residence
Small Business
Other ________________________________________________
II.
Facility Owner
Phone (_____)
Email Address ______________________
Address ________________________________________________________________________________________________________________________
City
State__________________ Zip _________________
III.
Contractor's Name ______________________________________Phone (_____)
Email Address ________________
Address _____________________________________________________________________________________________________________________
City _____________________________________________ State _________ Zip
Is the contractor exempt from licensure under section 469.002(4), F.S.?
YES
NO
IV.
Scheduled Dates: (Notice must be postmarked 10 working days before the project start date)
Asbestos Removal (mm/dd/yy) Start: _________ Finish: _______ Demo/Renovation (mm/dd/yy) Start: __________Finish: _____________
V.
Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be
used and description of affected facility components.
Procedures to be Used (Check All That Apply):
Strip and Removal
Glove Bag
Bulldozer
Wrecking Ball
Wet Method
Dry Method*
Explode
Burn Down
OTHER
*MUST OBTAIN PRIOR DEP APPROVAL BEFORE USING A DRY METHOD
VI.
Procedures for Unexpected RACM:
VII.
Asbestos Waste Transporter: Name
Phone (_____)
Address
City ________________________________________________________________ State
Zip ______________
VIII. Waste Disposal Site: Name
Class
Address
City State
Zip
IX.
RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM.
_____________________________________________________________________________________________________________________________________
X. Fee Invoice Will Be Sent to Address in Block Below: (Print or Type)
Amount of RACM or ACM*
RACM ACM
Name:
______ ______
square feet surfacing material
Address:
______ ______
linear feet pipe
City:
State/Zip:
______ ______
cubic feet of RACM off facility components
*
Identify and describe surfacing material and other materials as applicable: ______
______ ______
square feet cementitious material
square feet resilient flooring
_____________________________________________________________________
I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on-site 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.
______________________________________________________________ ______________________________________________
(Print Name of Owner/Operator)
(Date)
______________________________________________________________ ______________________________________________
(Signature of Owner/Operator)
(Date)
DEP USE ONLY
Postmark/Date Received
ID#
DEP Form 62-257.900(1)
Effective 10-12-08
Page 2 of 2
Instructions
The state asbestos removal program requirements of s. 376.60, F.S., and the renovation or demolition notice requirements of
the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule 62-257,
F.A.C., are included on this form.
Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by law). If
the notice is a revision, please indicate which entries have been changed or added.
Check to indicate whether the project is a demolition or a renovation.
If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the
information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title
of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and
the date ordered to begin. A copy of the order must also be attached to the notification.
If you checked renovation, is it an emergency renovation operation? If so, in addition to the information required on
the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden,
unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an
unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice
is effective for a period not to exceed a calendar year of January 1 through December 31.
I.
Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This
address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm
that conducted the asbestos site survey/inspection. For “prior use” check the appropriate box to indicate whether the
prior use of the facility is that of a school, college, or university; residence, as “residential dwelling” is defined in Rule 62-
257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If “other” is checked, identify the use. Please
follow the same instructions for “present use.”
II.
Complete the facility owner information.
III.
Complete the contractor information.
IV.
List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project
and the renovation or demolition portion of the project.
V.
Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description
of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated by reference in
Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with
40 CFR section 61.145(3)(c)(i).)
VI.
Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos material
becomes crumbled, pulverized, or reduced to powder after start of the project.
VII. Complete the asbestos waste transporter information.
VIII. Complete the waste disposal site information.
IX.
List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off
facility components is only permissible if the length or area could not be measured previously.) Identify and describe the
listed surfacing material and other listed materials as applicable.
X.
Provide the address where the Department is to send the invoice for any fee due. Do not send a fee with the notification.
The fee will be calculated by the Department pursuant to Rule 62-257.400, F.A.C.
Sign the form and mail the original to the district or local air program having jurisdiction in the county where the project is
scheduled (DO NOT FAX). The correct address can be obtained by contacting the State Asbestos Coordinator at: Department
of Environmental Protection, Division of Air Resources Management, 2600 Blair Stone Road, Tallahassee, FL 32399-2400.
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