Document emZLE1v8dbgZMEk5emzOvvM59
^ .* *' i
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:
/
INVESTIGATION DATE:
//
INVESTIGATOR STAFFCODE:
INVESTIGATOR JURISCODE:
INVESTIGATION TYPE:
NOV SENT DATE:
//
COMPLAINT:
//
PSDB INV NO:
COMPLIANCE STATUS (C.N.U): __________
REVIEWER:
/
1) Removal Contractor: _All State Erectors, Inc.
Mailing Address:
P. O. Box 87667_______
Phone: (713) 944-9610
City:
Houston_______
State:
Texas
Zip:
77287
TDH License No.: __ _________ Job Site Phone: ( 409 ) 945-7411, ext. 6140
Project Supv.:
Andrew Paol iTDH 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) 945-741 1
City: Texas City_______ State: Texas____ Zip:
77592-0471
Principal Business: __ _________ Chemical Plant______________________________ _________
4) Description of Facility
Name: Union Carbide Corporation
Address: 3301 5th Avenue SouthCity: ____Texas City
County: _____ Gal veston_______ State:
Texas_______ Zip: __ 77590
Size:sq. ft.
Age: 40_ yrs.
Prior Use: Remove roof on work bench Bldg. 47.
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) 302 sq. ft. (other)
8) Method of Removal: Glove bag and plastic wrapping
9) Scheduled Start Date: 07/17/89
10) Scheduled Completion Date: 07/21/89
11) Disposal Site: Gulf Coast Waste Disposal Site
Address: __ Campbell Bayou Road off Loop 197_____ City: ___ Texas__CJ_ty _
County:
Galveston
State:
Texas
Zip:
77590__
Phone: (409)~ 935-4783
TDH/TWC Permit No.:
39036
O-'We.C.C >-Q ^
Andrew F. Ja Industrial Hygienist
_____
June 22, 1989 (Date)
l|40F _948-J1 ? 3 _. _
(Telephone Number)
APY:IW:AS0717 89
I
UCTC 18162
UC-4392
SUBJECT:
AS8EST0S
PAGE: 3 OF 3 LAST REVISEO: 11/09/87
UNION CARBIDE CORPORATION TEXAS CITY PLANT
Plant Procedure SH-5.6 Attachment #1
NOTICE OF INTENTION TO OEHOLISH OR RENOVATE A STRUCTURE OR FACILITY CONTAINING ASBESTOS MATERIAL
1. Description of the facility:
<_S
Estimate of approximate amour,' of friable asbestos materials present
3 Q'^~(Area In sq. ft. or linear ft.)
Estimation technique used:
3. Estimated age of asbestos material:
4. Location of facility:
5. ScheJuled starting day:
S..c.h.e.d.u.le.d...c.o.m.p..le.t.io.n..day:
fZf _
* 7./pfX?
Nature of planned demolltIon or renovation:
r*IMS
Method to be used (negative pressure enclosure, glove bag, etc.):
r-
Name of person that prepared the form: Location and telephone number:
^
Date:
/
NOTE:
This form must be completed and delivered to the EP Depart" t (Bldg. #1) at least 30 days ahead of the sche'iled starting day of the planned denolltlon or renovation, or as soon as possible following an emergency renovation operation.
April 1985/Revised November 1987 #0184s
UCTC 18164