1833 & 1841 State College Blvd.
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
COpy
MAIL FORM AND FEE TO SCMMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES, CA. 90074-5641
AQMD USE ONLY SCREEN BY RECEIVED . POSTMARK ENTERED BY NOTIFICATION #
COMPLETED BY Lourdes Reynoso COMPANY American Wrecking, Inc. PHONE (626) 350-8303
DATE 11/22/05 CHECK# 2246 FEE $ $438.85 PROJECT# A05-118L
NOTIFICATION TYPE ( T O~IGINAL)) REVISION DATES . REVISION OTHER(hightight) CANCELLATION
PROJECT TYPE DEMOLITION) ORDERED DEMOLITION RENOVATION{removal) EMERGENCY REMOVAL PLANNED RENO(annual)
SITE INFORMATION SITE NAME A-Town Metro - Demolition
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SITE ADDRESS \..!8:!.3.~ 184\~ta!,,_College Blvd. > CROSS STREET E. Katella Ave.
CITY Anaheim STATE CA ZIP 92805 COUNTY Orange
DESCRIBE WORK LOCATION Demolition of Structures and Site Clearing
BUILDING SIZE{SQ FT) 31.015 NUMBER OF FLOORS 1&2 BUILDING AGE (YEARS; 25+ NUMBER OF DWELLING UNITS
BLDG PRIOR I PRESENT USE K:. COMMERCIAL>) HOSPITAL INDUSTR1AL OTHER OFFICE PUBLIC BLDG. HOUSe: SCHOOL SHIP UNIV/COlLEGE
SITE OWNER Lennar Corporation ADDRESS 25 Enterprise
CITY Aliso Viejo STATE CA ZIP 92656 . CONTACT Lisa Galloway PHONE (949) 349-8220
REQUIRED BUILDING ASBESTO@ ASBEST~~NO ASBEST~O BUILDING TO BE ~\:YO
INFORMATION PRESENT? SURVEY? REMOVED? DEMOLISHED?
PROJECT DATES START 12/06/05 END 03/24/05 WORK SHIFT(day, swing, night) 7am to 4 pm
'ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL REMOVED (add row)
REMOVED (in square feet)
'ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS
'AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING OUCTING STUCCO MASTIC
ASBESTOS (in square feet)
FLOOR TILES (VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER
(describe)
CONTRACTOR INFORMATION CSBL LICENSE # 685192 OSHA REG # AQMD ID# 97316
NAME American Wrecking, Inc. ADDRESS 2459 Lee Avenue
CITY Soulh EI Monte STATE CA ZIP 91733 SITE SUPVR Jerry Galaviz PHONE (626) 350-8303
WASTE TRANSPORTER #1 LANDFILL Olinda Aipha Landfill
ADDRESS ADDRESS 1942 N. Valencia Ave.
CITY STATE ZIP CITY Brea STATE CA ZIP 92621
'Not required for demolition notifications asbestos surveys are required prior to Demolition and Renovation.
Forms, instructions, and the Rule 1403 can be obtained from AQMD we site http://www.aqmd. gOY Page 1 of 2 Form REV 20040623
. '''''' '" ',C sCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
~g1' q oeRIGINAL TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE #55641, LOS ANGELES CA 90074.5641
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WASTE TRANSPORTER #2 WASTE STORAGE SITE
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ADDRESS ADDRESS ,
CITY STATE ZIP CITY
STATE ZIP
'CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED ATTHE RENOVATION AND DEMOliTION SITE. Procedure #1, 2, 3, 4, 5, or Other.
For asbestos removals circle the combination of Rule 1403 procedures used, Procedure 4 and 5 submit plans for AQMD prior approval.
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'ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES ANO ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING:
Bulk Sampling, Inspection, Survey, PLM, PCM, TEM, Assumed as Asbestos, Describe Other:
.'. ,. .
FOR DEMOLITONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL, , ", Date
FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AN GIVE THE AGENCY NAME & PHONE #
AUTHORIZING PERSON: TITLE:
DATE OF ORDER: IDA TE ORDERED TO BEGIN:
,
'FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY, DATE AND HOUR OF
EMERGENCY AND DESCRIBE THE SUDEN. UNEXPECTED EVENT:
.
EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN:
CONTINGENCY PLAN: DESCRIBE ACTIONS AND PROCEDURES TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING, DEMOLITION OR NONFRIABLE
ASBESTOS MATERIAL BECOME CRUMBLED, PULVERIZED, OR REDUCED TO POWDER STOP DEMOLITION WORK IMMEDIATELY AND NOTIFY AQMD.
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jrTRAINING CERTIFICATION: 1 Certify that an individual trained in the provisions of regulation AOMD Rule 1403 and NESHAP will be ensile during the removal and
evidence that the required training has been accomplished by this person will be available for inspection during normal business hours.
Comoanv Name Print name of owner/ooerator Sianature of owner/operator Title of owner/operator DATE
INFORMATION CERTIFICATION: I certify that the above information is correct and I have enclosed any required attachments.
American Wrecking, Inc. Lourdes Reynoso Project Coordinator 11f22105
Company Name Print name of owner/onerator Sianalureolowner/oDeralor Tille of owner/ooerator DATE
Notifications can not be accepted without the required fee ( Rule 301l. Asbestos removals of less tha 100 square feet are exempt from notification and fees.
Please make check payable to "SCAQMD". Fees are per notification, not refundable, and vary according to the project size. Fees are as follows:
, , ,
PROJECT SIZE in ft DEMOLITION OF REMOVAL SERVICE CHARGE
1,000 or Ie" ......... $39.11 -........-..........- Special Handling Fee --- $39.11
1.00115,000- $119,57.-.-...--....... Revision 10 Notification -- $39.11
5,001 to 10.000 -.... $279.87 --.....-.-.......-- Returned Check Fee -- $31.97
10.001 to 50,000..... $438.65 -....----.....-.- Planned Renovation - $438.85
50,00110100,000 - $636,00 ...............-......-..-,-.- Procedure 4 or 5 Plan - $438.85
100.001 or more..- $1.060.00-....--..-.....--
ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a
demolition permit. For questions call 909-396-2336. Please mail the form and fee to AQMD. Mailing saves time, money and reduces traffic and air pollution.
MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641
TELEPHONE: (909) 396.2336 FAX: (909) 396.3342
FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTIP:/fWWW.AQMD.GOV
SCAQMD is localed at 21865 E, Copley Drive. Diamond Bar. CA 91765-4182 (909) 396.2000
Page2of2
Form REV 20030627