1201 N. Magnolia Ave (3).
t(Q)f?J1f
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
" 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
.i MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # LOS ANGELES CA 90074-5641
AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION #
COMPLETED BY JoAnn Chavez COMPANY Aman Environmental Construction PHONE 626-967-4287 I
DATE 4/8/2005 CHECK # 124343 FEE $ 1,000.00 PROJECT # 5-005
NOTIFICATION TYPE c..... ORIGINAL ~ REVISED DATES REVISED OTHER (highlighted) CANCELLATION
PROJECT TYPE C DEMOLITION ~DERED DEMOLITION RENOVATION (removal) EMERGENCY REMOVAL PLANNED RENO (annual)
SITE INFORMATION SITE NAME DELPHI BATTERY
SITE ADDRESS 1201 North Magnolia Avenue CROSS STREET W. La Palma Ave.
CITY Anaheim STATE CA ZIP 92801 COUNTY ORANGE
DESCRIBE WORK LOCATION FACILITY DEMOLITION
BUILDING SIZE (SQ FT) 280,000 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 45+ NUMBER OF DWELLING UNITS N/A
SLOG PRIQRlPRESENT USE (lCOMMERCtAL )OSPITAL INDUSTRIAL Other OFFICE PUBLIC SLDG.. HOUSE SCHOOL SHIP UNIV/COLLEGE
SITE OWNER Delphi Automotive Systems ADDRESS 5725 Delphi Drive
CITY Troy STATE MI ZIP 48098 CONTACT Tim Renner PHONE 317-579-3875
REQUIRED BUILDING ASBESTOS @NO ASBESTOS eNO ASBESTOS GNO BUILDING TO BE @NO
I MATION PRESENT? SURVEY? REMOVED? DEMOLISHED
PROJECT DATES START 4122/005 END 7/22/2005 WORK SHIFT 7:00 - 4:00 PM
ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL REMOVED (add row)
REMOVED (in square feet) 0
ASBESTOSREMoveOFROM SURFACES PIPES COMPONENTS
ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC
AMOUNT OF EACH TYPE OF
ASBESTOS (In square feet)
FLOOR TILES (VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER
(describe)
CONTRACTOR INFORMATION CSLB LICENSE # 671303 OSHA REG # AQMD ID # 74407
NAME Aman EnVironmental Construction ADDRESS 614 East Edna Place
CITY Cavlna STATE CA ZIP 91723 SITE SUPERVISOR Doug Cool PHONE 626-967-4287
WASTE TRANSPORTER #1 LANDFILL Azusa Land Reclamation
ADDRESS ADDRESS 765 S. Ayon Ave.
CITY STATE ZIP CITY Azusa STATE CA ZIP 91702
.
.. Not required far demolition notifications * Asbestos survey are required prior to Demolition and Renovation
Form, instructions, and the Rule 1403 can be obtained from AQMD web site http://www.aqm~.gov
PMA 1 of2
Form REV 2D04D623
WASTE TRANSPORTER #2 WASTE STORAGE SITE
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Prooedure # 1, 2, 3, 4, 5 or Other.
For asbestos removals circle the combination of Rule 1403 procedures used. Procedures 4 and 5 submit plans for AQMD prior approval
ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING:
Bulk sampling, InspectIon, Survey. PLM. PCM, TEM, Assumed as Asbestos, Describe Other:
Bulk sUlVey analysis of affected materials. Analysis using PLM procedures.
FOR DEMOLITIONS GIVE THE COMPANY NAME AND THE DATES OF THE ASBESTOS REMOVAL: ISPECIAllZED ENVIRONMENTAL 662-698-9222'
FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME:
AUTHORIZED PERSON: TITLE:
DATE OF ORDER: DATE 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 SUDDEN, UNEXPECTED EVENT:
EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN:
CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOL.1.0INED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MArERIA\. BECOME DISTURBED, CRUMBLED,
PULVERIZED, OR REDUCED 10 POVVDER ISOLATE AREA, USE HEPA FilTERS, WET METHODS
TRAINING CERTIFICATION: I Certify that an Individual trained In the provisions of regulation ACMO Rule 1403 and NESHAP wiil be on site during the removal an
evidence that the required training has been accomplished by this person will be available for Inspection during normal business hours.
Aman Environmental Ron Spencer ~ Vice President 41812006
-
Company Name Print name of owner/operator Signatu 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.
Aman Environmental Ron Spencer ~ Vice President 41812005
COmpany Name Print name of owner/operator Signature of bwner/operator Title of owner/operator DATE
Notifications can be not accepted without the required fee (AQMD Rule 301), Asbestos removals of less than 100 square feet are exempt from notification and fees.
Please make checks 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 OR REMOVAL PROCEDURE 4 OR 5 PLAN SERVICE CHARGE
1,000 or less $ 36.90 $ 450.91 Special Handling Fee $ 36.90
1,001 to 5,000- $ 112.80 $ 526.81 rev\slon to Notification $ 36.90
5,{)ol to 10,000- $ 264.03 $ 678.04 Return Check Fee $ 29.28
10,001 to 50,000- $ 414.01 $ 828.02 Planned Renovation $ 408.38
50,001 to 100,000-' $ 600.00 --- $ 1,014.01
100,0010rmore-- $ 1,000.00 -- - $ 1,414.01
. 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 S09-3SS.2336. For your convenience please mail the form and fee and do not hand carry to AQMD.
MAil FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FilE # 66641, LOS ANGELES CA S{)074-S641
TELEPHONE, (900) 300-2336 FAX: (909) 396-3342 . Form REV 200610
FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP:/WWW.AQMD.GOV
SCAQMD Is located at21865 E. Copley Drive, diamond Bar, CA 91765-4182 (909) 396-2000
.
PaQe 2 of 2
Form REV 20040623
RENOVATION NOTIFICATION
ASBESTOS REMOVAL
Date:
4/01/05
Job Number:
Address:
Cal OSHA
2100 E. Katella Avenue, Room 140
Anaheim, CA 92806
Phone Number:
Fax Number:
Daternme Faxed:
SA05-044
(714) 939-0145
(714) 939-0815
4/01/05 @
Contractor:
Specialized Environmental, Inc.
12115 Rivera Road
Whittier, Ca 90606
Phone Number:
DOSH #:
Contractors License #;
(562) 698-9222
621
712428
Owners Name:
Address:
Delphi Automotive Systems
5725 Delphi Drive
Troy Ca
48098
Phone Number:
Contact Name:
Job Site Name:
Address:
,
~nat-ItnU..t.~
'p""-N,.~Alo!!l""IiA,.Av,e_
Anaheim Ca
92803
Phone Number:
Contact Name:
Nearest Intersection:
County:
45
Orange County
Age:
Prior Use:
Commercial
Work Area:
various
Site Supervisor:
317/579-3875
Tim Renner
626/967-4287
Brian Laurin
Size:
J. Hernandez, J. Cisneros, J. Moreno, G. Valdez, P. Rangel, M. Ponce, J. Carrillo, W. Reyes, S. Ramos
Work Description:
Remove and dispose of ACM
Type of Asbestos:
VAT & mastic, transite, window putty, TSI, Drywall, roofing, gaskets,
Friable:
LF. 115,622 SQ. FT.
Non-Friable:
Start Date:
Completion Date:
5/27/05
4/18/05
LF. 162,882 SQ. FT.
Work Hours: 7a-3:30p
Method of Removal: All asbestos shall be removed wet, In small sections and cleaned up promptly.
Use of local exhaust ventilation and coliection system designed and opera tad to capture the particulate
asbestos material produced by stripping. Asbestos containing materials will be placed in double 6-mil
poly bags or wrapped in double 6-mil poly sheeting and properly labeled. Project personnel will
be provided with the required protective clothing, rubber gloves and respirators with HEPA filters
attached.
EVALUATION OF POTENTIAL FOR EXPOSURE:
ESTIMATED NO. OF EMPLOYEES ON THIS JOB:
NONE
16
NOTE: ANY CHANGE IN THE INFORMATION PROVIDED THE DIVISION BY THE WRiTTEN NOTICE SHALL BE
REPORTED TO THE DIVISION AT OR BEFORE THE TIME OF THE CHANGE.
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396.2000
MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074.5641
Page 1 of 2
DATE
4/01/05
CHECK #
FEE $
1000.00
PROJECT #
SA05-044
NOTIFICATION TYPE
REVISION DATES
REVISION OTHER (HIGHLIGHT)
CANGELLA TION
PROJECT TYPE
DEMOLITION ORDERED DEMO
RENOVATION (R OVAL)
EMERGENCY REMOVAL PLANNED RENO (ANNUAL)
SITE INFORMATION
SITE NAME Delphi, Anaheim
SITE ADDRESS
1201 N. Magnolia Ave.
CROSS STREET
o
CITY
Anaheim
STATE Ca
ZIP
92803
COUNTY
Orange County
DESCRIBE WORK LOCATION
various
BUILDING SIZE (SO FT)
NUMBER OF FLOORS
BUILDING AGE (YEARS}
45
NUMBER OF DWElliNG UNITS
BLDG PRIOR / PRESENT US
INDUSTRIAL OTHER OFFICE PUBLIC SLDG HOUSE SCHOOL SHIP UNIV/COLlEGE
SITE OWNER
Delphi Automotive Systems
ADDRESS
5725 Delphi Drive
CITY
Troy
STATE
Ca
ZIP
48098
CONTACT Tim Renner
PHONE 317/579-3875
REQUIRED BUILDING
INPORMATION
PROJECT DATES
7a-3:30p
4/18/05
ASBESTOS YE
. REMOVED?
5/27/05
BUILDING TO BE YE
DEMOLISHED?
WORK SHIFT (AM/PM)
NO
ASBESTOS AMOUNT TO BE
REMOVED (in square feet)
ASBESTOS REMOVAL FROM
CLASS"
TOTAL AMOUNT (add row)
278,504
COMPONENTS
AMOUNT OF EACH TYPE OF
.. ACOUSTIC CEILING
FIRE PROOFING
MASTIC
6470
SCAQMD ID#
106250
NAME
Specialized Environmental, Inc,
ADDRESS
12115 Rivera Road
CITY
Whittier
STATE:
CA
ZIP: 90606
SITE SUPVR
PHONE
(562) 698-9222
J. Hernandez, J. Cisneros,J. Moreno, G. Valdez, P. Rangel, M. Ponce, J.Carrillo, W. Reyes, S. Ramo
WASTE TRANSPORTER #1 BDC Special Waste Services
LANDFILL
AZUSA LAND RECLAMATION
ADDRESS:
766 S. Ayon. Ave.
ADDRESS
1201 W. Gladstone Street
CITY:
Azusa
STATE: CA ZIP: 91702
CITY.
Azusa
STATE CA ZIP
91702
. Asbestos surveys are required prior to Demolition and Renovation
Forms, instructions, and the Rule 1403 can be obtained from AQMD web site http://www.aqrnd.gov Page 1 of 2 Form REV 200610
SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
MAIL ORIGINAL TO SCAOMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641
Page 2 of 2
SA05-044
WASTE TRANSPORTER #2 WASTE STORAGE SITE
--
Delpl1a
ADDRESS ADDRESS
1201 N. Magnolia Ave.
CITY STATE ZIP CITY SrATE C ZIP 9
Anaheim Ca 92803
CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED ATTHE RENOVATION AND DEMOLITION SITE. Procedure ~,5 or other
1&3 For asbestos removals circle the combination of Rule 1403 prcedufes used. Procedure 4 and 5 submit plans for AQMD prior approval.
ASBESTOS DETEC~EDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING:
Bulk Sampling, lnspectio ,Survey, M, PCM, TEM, Assumed as Asbestos, Describe Olher:
.
FOR DEMOLITION GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL:
FOR ORDERED DEMOLITlON SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME:
AUTHORIZING PERSON: TITLE:
DATE OF ORDER: DATE ORDERED TO BEGIN:
FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARINGJAUTHORIZING THE EMERGENCY, DATE
AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN. 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.
ISOLATE WORK AREA, INSTITUTE FIBER CONTROL MEASURES,
NOTIFY BUILDING OWNER, PROCEED AS DIRECTED INCLUDING REVISED NOTIFICATIONS.
TRAINING CERTIFICATION; I CERTIFY THAT AN INDIVIDUAL TRAINED IN THE PROVISIONS OF REGULATION SCAQMD RULE 1403 AND NESHAP WILL BE ON-SITE DURING
THE REMOVAL AND EVIDENCE THAT THE REQUIRED TRAINING HAS BEEN ACCOMPLISHED BY THIS PERSON WILL BE AVAILABLE FOR INSPECTION DURING NORMAL
BUSINESS HOURS. ~"O~L(;
Specialized Environmental. Inc. Carlos Reyes President 4101/05
Company Name Print name of owner/operator Signature of owner/operator Title of owner/operator Date
INFORMATION CERTIFICATION: I CERTIFY THAT THE ~ATION IS CORRECT AND I HAVE ENCLOSED ANY REQUIRED ATTACHMENTS.
Specialized Environmental. Inc. Carlos Reyes n...- ~(t.- President 4/01/05
Company Name Print name of owner/operator Signature of owner/operato Title of owner/operator Date
Notifications can not be accepted without the required fee (AQMO Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees.
Please make checks payable to 'SCAQMO". Fees are per notification. not refundable. and vary according to the project size. Fees are as Follows.
PRQJECT SZ IN FT. DEMO! ACM PROCEDURE 4 OR 5 PLAN PLANNED RENOVATION $ 408.38
100 TO ., ,000 SQUARE FEET $36.90 , 450.91 SPECIAL HANDLING FEE $ 36.90
1,001 TO 5,000 SQUARE FEET $112.80 , 526.81 REVISION OF NOTIFICATION $ 36.90
5,001 TO 10,000 SQUARE FEET $264.03 $ 678.04 RETURNED CHECK CHARGE $ 29.28
10,001 TO 50,000 SQUARE FEET $414.01 s 828.02 CANCELLATION OF NOTIFICATION $ 0.00
50,001 TO 100.00 SQUARE FEET ~ ") $ 1,014.01 RESIDENTIAL ASBESTOS REMOVAL' $ 29.52
100,001 OR MORE 1,000.00 s 1414.01 * owner-occupied. single-unit dwelling
ATTENTION: Keep a copy of your nO(lTIcation. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a
demolition pemlt. For questions call 909-396-2336. For YOUT convenience please man and do not hand carry to AQMD.
MAIL FORM AND FEE TO: SCAQMD,ASBESTOS NOTIFICATION, FILE # 55641, LOS ANGELES CA 90074-5641
TELEPHONE: (909) 396.2336 FAX: (909) 396.3342 Form REV 06152001
FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP://WWW.AQMD.GOV
SCAOMD is located at 21865 E. Coolev Drive. Diamond Bar. CA 91765.4182 (909) 39&-2000