Document 4adOozdMe2yYkVDvz59p8QbbV
Texas Air Control Board ASBESTOS DEMOLITION/RENOVATION NOTIFICATION FORM
(THIS SECTION FOR TACB USE ONLY)
ADO
CHANGE DELETE
* ASTERISKED ITEMS TO BE FILLED IN BY TECHNICAL SERVICES
DISTRIBUTION
Blue - Region/Local Green - Region/Local Canary - Data Entry Pink - Dept, of Health
CNTY: *
SOURCE: *
PTNO: *
APST- *
TACB ACCOUNT:
--
FEDERAL FACILITY:
(Y/N)
CMST: *
NOTIFICATION RECEIVED DATE (MMDDYY): / /
POSTMARK: / ~7
INVESTIGATION DATE: / /________
INVESTIGATOR STAFFCODE:
INVESTIGATOR JURISCODE:
_
INVESTIGATION TYPE:
NOV SENT DATE: / /
COMPLAINT: / /
PSD8 INV NO:
COMPLIANCE STATUS (C,N,"U): _________
REVIEWER:
1) Removal Contractor: Catalytic Industrial Maintenance Company
Mailing Address: P. 0. Box 35Phone:
(409) 948 -5723
City: La Mat que________
State:
Texas
Zip: __ 77568
TDH License No.: __ ______ Job Site Phone: ( 409 ) 948-5723
Project Supv.:
C. L. Snell_______
TDH License No.: _"
2) Other Contractor: _n/a
Mailing Address: _ Phone:
~( )
City: _State:____________________________________________________ Zip: ____
3) Facility Owner: ______Union Carbide Corporation
Mailing Address:
P. 0. Box 471Phone:
(409) 945-7411
City: __ Texas_C[ty State:
Texas
Zip:
77592-0471
Principal Business: __________ Chemical Plant_____________________________
4) Description of Facility
Name:__ Union Carbide Corporation_________________________ ________ ________
Address: 3301 5th Avenue SouthCity:
_ Texas City___
Co; `y:___ GalvestonState:
Texas ___ Zip:
77590_ _
Size:sq. ft.
Age: ____ 30___ yrs.
Prior Use: Transite roofing on Building 248 Machine Shop
5) Demolition: _ Renovation: X Encapsulation: _ Non-Friable:
6) Notification Type: _ Planned
X_ 10 Day
___ 20 Day
__X_ Renovation
___ Emergency
___ Ordered
Ordered By:
7) Amount Asbestos: ___ linear feet (pipes) 1_000_ sq. ft. (other)
8) Method of Removal : wetted and wrapped in plastic
9) Scheduled S ;rt Date: October 1, 1989
10) Scheduled Completion Date: October 6, 1989
11) Disposal Site: Gulf_Coast_Waste DisposaJ_Svte
Address: Campbell Bayou Road off Loop j97____ City:___ Texas CUy
County:
Galveston
State:
Texas
Zip:
77590
^Phone: (403}__ 9~35~:47S3
TDH/TWC Permit No.":
39036 __
isL' /.
A. Perivan Yalcinkaya /
Industrial Hygiene Director
September 19,_1989 _____(409) 948-5123
(Date)
(Telephone Number)
APY:IW:AS 100189
UCTC18159