Asbestos NESHAP Notification Instructions
This page last reviewed July 6, 2016
The Asbestos NESHAP Notification Form should be typewritten and postmarked or delivered no later than ten working days prior to the beginning of the asbestos removal activity and/or demolition.
For specific information regarding California's Non-Delegated Air Districts, please view the Counties in Non-Delegated Districts table.
|Mail Original To:||Please send a copy of the Asbestos Notification Form using one of the following options:|
Mr. Kingsley Adeduro
Email (preferred): email@example.com
California Air Resources Board,
Fax: (916) 229-0645
Enter "O" if the notification is a first time or original notification, "R" if the notification is a revision of a prior notification, or "C" if the activity has been canceled.
Enter the names, addresses, contact persons and telephone numbers of the following:
If known, the name of the site supervisor should be entered as the contact person for the notification. If additional parties share responsibility for this site, demolition activity, renovations or ACM removal, include complete information (including name, address, contact person and telephone number) on additional sheets submitted with the form.
Enter "D" for facility demolition, "R" for facility renovation, "O" for ordered demolitions, or "E" for emergency renovations.
Answer "Yes" or "No" regardless of the amount or type of asbestos.
|5.|| Facility Description:
Provide detailed information on the areas being renovated or demolished. If applicable, provide the floor numbers and room numbers where renovations are to be conducted.
Describe methods and procedures used to determine whether ACM is present at the site, including a description of the analytical methods employed.
Amount of Asbestos Including:
ACM to be removed (including nonfriable ACM to be sanded, ground or
abraded); (2) Category 1 ACM not removed; and (3) Category II ACM not
Dates of Asbestos Removal (MM/DD/YY):
Enter scheduled dates (month/day/year) for asbestos removal work. Asbestos removal work includes any activity, including site preparation, which may break up, dislodge or disturb asbestos material.
Dates of Demo/Renovation (MM/DD/YY):
scheduled dates (month/day/year) for beginning and ending the planned
demolition or renovation.
Planned Demolition or Renovation Work, and Method(s) to be Used:
Include in this description the demolition and renovation techniques to be used and a description of the areas and types of facility components which will be affected by this work.
of Engineering Controls and Work Practices to be Used to Control
Emissions of Asbestos at the Demolition and Renovation Site:
Describe the work practices and engineering controls selected to ensure compliance with the requirements of the regulations, including both asbestos removal and waste-handling emission control procedures.
Enter the names, addresses, contact persons and telephone numbers of the persons or companies responsible for transporting ACM from the removal site to the waste disposal site. If the removal contractor or owner is the waste transporter, state "same as owner" or "same as removal contractor." If additional parties are responsible, include complete information on an additional sheet submitted with the form.
Identify the waste disposal site, including the complete name, location and telephone number of the facility. If ACM is to be disposed of at more than one site, provide complete information on an additional sheet submitted with the form.
is Ordered by a Government Agency, Please Identify the Agency Below:
Provide the name of the responsible official, title and agency, authority under which the order was issued, the dates of the order and the dates of the ordered demolition.
Provide the date and time of the emergency, a description of the event and a description of unsafe conditions, equipment damage or financial burden resulting from the event. The information should be detailed enough to evaluate whether a renovation falls within the emergency exception.
of Procedures to be Followed in the Event that Unexpected Asbestos is
Found or Previously Nonfriable Asbestos Material Becomes Crumbled,
Pulverized or Reduced to Power:
Provide adequate information to demonstrate that appropriate actions have been considered and can be implemented to control asbestos emissions adequately, including at a minimum, conformance with applicable work practice standards.
of Presence of Trained Supervisor:
One year after promulgation of the applicable regulation, the notifier must certify that a person trained in asbestos-removal procedures will supervise the demolition or renovation. The supervisor is responsible for the activity on-site. Evidence that the training has been completed by the supervisor must be available for inspection during normal business hours.
Please certify the accuracy and completeness of the information provided by signing and dating the notification form.
There are no fees required to submit the notification.