Microsoft Word - Asbestos Notification Instruction Guide

Publication No. EF18-14025 revised 01/23/13

Department of State Health Services

DEMOLITION / RENOVATION NOTIFICATION FORM INSTRUCTION GUIDE

PO Box 149347

Austin, TX 78714-9347

www.dshs.state.tx.us/asbestos

The Department of State Health Services Demolition/Renovation Notification form combines the requirements of the National

Emission Standards for Hazardous Air Pollutants, 40 CFR, Subpart M (NESHAP) and the Texas Asbestos Health Protection

Rules (TAHPR). Both of these regulations require that written notification be submitted before beginning renovation projects

which include the disturbance of any asbestos-containing building material in a public building or the disturbance of the

NESHAP threshold amount of asbestos-containing material in a facility. A notification form is required before the demolition

of a building or facility, even when no asbestos is present. This form must be used to fulfill either of these requirements. Please

call either 512-834-6747 or 1-888-778-9440 (within Texas), or your local regional office for assistance in completing this form.

This form must be used whether you are notifying in accordance with NESHAP, TAHPR, or both. The notification form must

be postmarked at least 10 working days (not calendar days) prior to the project start date (except for emergencies or ordered

demolitions). Notifications that do not meet the 10-day requirement or are incomplete are considered to be "improper" and may

result in enforcement proceedings. If an item on the form is not applicable to the project in question, you must write "N.A." in

that space, which shows that you have considered the item, but it does not apply to your operation.

INSTRUCTIONS

I) The notification type must be checked. An original must be postmarked 10 working days (Mon. - Fri.) prior to the start

date. An amendment is required for any stop date, which changes by more than one working day for each week for

which the project has been scheduled. An amendment must be submitted for any changes from the original notification

and must be provided to DSHS no less than 24 hours prior to the change, including stop date changes. Please note

these changes by circling or highlighting them on the form. Attach a copy of the original notification or previous

amendment to the back of the amendment (Example: If you are sending in Amendment 2 attach a copy of Amendment

1 behind it. When marking which Amendment you are sending in, do not count the Original notification as

Amendment 1.The start date can be any day after the 10th working day and must be specified in Section IV. A

cancellation must be postmarked 24 hours or more prior to the scheduled start date. If asbestos abatement or demolition

will begin earlier than scheduled, an amendment must be postmarked at least 10 working days prior to the new start

date. If the start date is to be delayed, the amendment must be postmarked 24 hours prior to the scheduled original start

date. The appropriate DSHS Regional or Local Program inspector must be notified by phone of all start or stop

date changes.

The appropriate DSHS Regional or Local Program inspector should be contacted in the event of an emergency. All

information regarding an emergency must be provided. Emergency notifications must be postmarked no later than the

following working day after the emergency incident.

If the demolition is ordered, then all information in this section must be provided. The appropriate DSHS Regional or

Local Program inspector should be notified, by telephone or in person, prior to beginning the ordered demolition.

Notifications for ordered demolition must be postmarked as soon as practicable, but no later than the following working

day after the demolition. A copy of the demolition order must be submitted with the notification.

II) One type of work must be checked. An asbestos-related activity (asbestos abatement project) is marked as a renovation.

A project that includes the removal of load-bearing structural members is marked as a demolition. If the project

involves both a renovation and demolition portion check the one which will be occurring last as far as project dates are

concerned. An annual consolidated notification can be submitted for a calendar year of January 1 through December

31. The annual consolidated notification will predict all asbestos O&M operations and all small, separate abatement

projects that are less than 160 square feet, 260 linear feet or 35 cubic feet. The predicted, additive amount of asbestos

to be removed or stripped during the one-year period must be listed in the chart in Section V.

Publication No. EF18-14025 revised 01/23/13

A phased project classification can be added to the type of work; it cannot be marked alone. (The project may be a

phased renovation or a phased demolition - the phased box AND either the renovation box or demolition box must be

checked). A description of the phased project schedule must be sent to the appropriate DSHS or Local Program

inspector. The DSHS policy regarding phased projects must be strictly followed, if that box is checked. (A copy of the

phased project policy letter can be obtained by calling any DSHS inspector). The scheduled work time must be

checked. A description of the work schedule must be provided, if the schedule varies from that listed as the project

dates (Section 16 and/or Section 17). Example: If a project is scheduled to last one month, but the contractor will not

be working on the weekends, a statement should be included that say “Working Monday - Friday.” The statement must

be accurate; an inspection will be based upon the provided information.

III) Provide the name of the building or an identifying description. Example: vacant warehouse. A physical address must

be provided (not a post office box) and a sufficient description must be provided to locate the site in the event that the

address alone is inadequate. The ZIP CODE for the building MUST be provided. The name of a contact person at the

facility MUST be provided for inspection purposes, even if the building or facility is vacant. If the building does not

have a phone, list the contact person’s phone number.

The type of building/facility must be checked. Only one box may be checked. An example of a NESHAP-Only

Facility would be a house that was being demolished as part of a Texas Department of Transportation right-of-way

project, or a ship.

Detailed information must be provided in all spaces, including the age and size of the building or facility. Check

whether the building/facility is occupied. If the building/facility is vacant during the time of the renovation, but will

later be re-occupied (not demolished), then indicate that the building/facility is occupied.

An asbestos survey/inspection must be performed prior to any renovation or demolition. A DSHS licensed inspector

must perform the inspection if the project is in a public building. Provide the DSHS Inspector License Number, if

required. If the survey/inspection was performed in a public building prior to January 1993, or if the project is not in a

public building, "N.A." should be placed in the space for the DSHS License Number. The date that the survey was

performed must be provided. The analytical method used to detect the presence of asbestos must be checked. TAHPR

requires that a DSHS licensed laboratory perform the analysis of samples from public buildings. Provide the DSHS

Laboratory Number if the samples are collected from a public building. The assumption of asbestos-containing

building material (for renovations) in a public building must be made by a DSHS licensed inspector. The date that the

survey (assessment) was performed would be provided, the DSHS Inspector License Number would be provided, and

the “assumed” analytical method box would be checked on the notification form, for an assumption of any asbestos-

containing materials that would be abated during a renovation project. When an assumption of asbestos-containing

material is done in a non-public building, all of the above must be completed except for the DSHS Inspector and

Laboratory License Numbers (not required). If there was no suspect material discovered, such as a garage, built of

concrete and steel only, indicate that no suspect material was found.

IV) If ACBM is to be removed before a building is to be demolished or renovated, enter the removal dates (start and

completion) in this section. Asbestos abatement work includes any activity which will disturb ACBM. The asbestos

abatement start date is the date that asbestos will be disturbed. The asbestos abatement activity stop date is the date

upon which air monitoring clearance has been achieved. In no event shall an abatement start or be completed on a

date other than the dates entered in this section (see Section 295.61(f)). Refer to Section I for information on

notifying of any change in the start and completion dates.

Enter the scheduled dates for the start and completion of the building demolition. In no event shall a demolition start

or be completed on a date other than the dates entered in this section. Refer to Section I for information on

notifying of any changes in the start or completion dates. When the building will not be demolished, but an abatement

will be performed, the dates of the total renovation (remodeling) project can be provided in this section. The

notification will remain active, if the renovation dates are provided.

V) If asbestos is present, the chart must be completed. If no asbestos is present (as revealed by the survey), check the box

provided. Category I non-friable ACBM includes floor tile, when removed intact, floor tile mastic, gaskets, and roofing

material. Category II non-friable ACBM includes transite siding. Use the appropriate row to designate whether the

“Category I or Category II non-friable ACBM removed” is located on the interior or exterior of the building. If

Category I or II materials are to be sanded, ground, abraded, crumbled, pulverized, reduced to powder, or have the

Publication No. EF18-14025 revised 01/23/13

potential to become friable because of the abatement procedures, then list them with RACM. “ Category I and II left in

place during demolition” would be listed for demolitions or for enclosure or encapsulation. (Transite does not remain

Category II during demolition and must be removed prior to demolition). “RACM left in place during demolition”

would be listed for enclosure or encapsulation or in the event of a demolition under very specific conditions (such as the

demolition of a structurally unsound building). RACM Off-Facility Component (material that is not attached to the

facility) shall only be measured in cubic feet or cubic meters. All other material must be measured in linear feet or

meters (pipes) or in square feet or meters (surface material). If an abatement will be performed in a portico, or a HVAC

system that conditions the inside of a public building, list the amount as “Interior Category I non-friable removed,

Interior Category II non-friable removed, or RACM to be removed”, depending on the type of ACBM that will be

removed. The amounts listed should always reflect the TOTAL amount removed during the project.

VI) Provide adequate information to demonstrate that appropriate actions have been considered and can be implemented to

control asbestos emissions adequately, including conformance with applicable work practice standards. This section

must be completed, even if no asbestos was discovered in the survey. Example: stop work; contact owner/consultant

and DSHS; demarcate area; secure critical barriers.

Include in this section 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. The specific type of asbestos-containing building material

that will be abated must be listed. Example: Vinyl asbestos-containing floor tiles to be removed by wet methods

recommended by the Resilient Floor Covering Institute.

Describe the work practices and engineering controls selected to ensure compliance with the requirements of the

regulations, including both the asbestos removal and waste-handling emission control techniques. Example: describe a

glove-bag procedure, including the use of a HEPA vacuum. Work practices that vary from the provisions of TAHPR,

§295.60 must be clearly described in this section.

VII) A. Provide information on the legal owner of the facility. The invoice for the notification fee will be sent to the

owner of the building, and the billing address for the invoice will be obtained from the information that is

provided in this section. The company's name should be written on the first line. A specific person's name

should be written following "Attention..." on the third line. This person will be receiving the notification fee

information.

B. The Department of State Health Services (DSHS) Contractor License Number is required if the project falls

under TAHPR. The contractor's name, address, and office phone number must be provided. The contractor’s

address must match that which was submitted on the DSHS license application, if the company has more than

one office.

C. In the event that two asbestos abatement contractors are used, provide all information for the second contractor

in the space provided. For a demolition in which the building does not contain asbestos, or in which the non-

friable asbestos will not be removed prior to demolition, write "N.A." in the spaces provided for the abatement

contractor information.

D. The site supervisor must be stated and the DSHS Supervisor License Number is only required for public

building projects as defined in TAHPR. Two site supervisors may be listed, if there are two work shifts, etc

E. The trained on-site NESHAP individual and the certification date must be stated for NESHAP projects. The

site supervisor and the trained on-site NESHAP individual may be the same person, if qualified. List the

individual’s name in both spaces. Since the DSHS License satisfies the requirements for NESHAP training,

provide the supervisor’s name and DSHS License Number and write "N.A." in the spaces for the NESHAP

individual and certification date.

F. The demolition contractor's name, address, and office phone number must be provided for all demolition

projects.

G. A DSHS licensed asbestos project consultant is required to design all asbestos response actions in public

buildings. A DSHS licensed asbestos project consultant is also required to design all asbestos abatement

projects which involve non-friable asbestos-containing building materials in quantities greater than 160 square

feet, 260 linear feet, or 35 cubic feet, in accordance with TAHPR. Provide all other information. The

Publication No. EF18-14025 revised 01/23/13

consultant’s address must match that which was submitted on the DSHS license application, if the company

has more than one office. If the project is not in a public building, the general contractor, or any other person

who controls the project site, may be listed as the "operator.”

H. Provide all information for the waste transporter. The TAHPR requires that a DSHS Licensed Transporter

transport ACBM from the public building removal site to the waste disposal site. Provide the license number if

the project is a public building. If you are performing a demolition without ACBM you still need to list who

will be transporting the waste from the project site. If two waste transporters are utilized, one to transport to a

holding site and one to transport from the holding site to the waste disposal site, list the first transporter on the

notification. However, the waste manifest must contain information for both transporters.

I. Provide all information for the waste disposal site. State regulations require that all waste disposal sites be

permitted by the Texas Commission on Environmental Quality (TCEQ), including disposal sites located at

industrial facilities. Provide the permit number.

An amendment must be submitted if any of these items are changed.

VIII) The notification for the abatement in a public building shall only be signed by the legal owner, his designated legal

representative, the DSHS licensed abatement contractor, or the DSHS licensed consultant. The TAHPR allows for

this task to be delegated to the DSHS licensed contractor or the DSHS licensed consultant IN WRITING; however, the

responsibility continues to be shared with the owner. For a NESHAP abatement or demolition, the notification form

may be signed by the legal owner or the operator of the site. The name must also be printed, and the date and telephone

number must be provided. The signature must be an original; a copied signature will not be accepted. Please Sign in

blue or red ink to avoid confusion.

MAIL TO: ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP

DEPARTMENT OF STATE HEALTH SERVICES

PO BOX 143538

AUSTIN, TEXAS 78714-3538

An invoice for the notification fee will be sent to the facility owner (c/o the person identified in Section VII, A) after the

project has been completed. DO NOT submit the fee with the notification. Revised 1/23/2013