Document z2jKV49OrZa4BdB3O0om9MEn
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:
Mailing Address:
City:
Houston
TDH License No.:
Project Supv.:
P. 0. Box 87667 State:
Job Site Andrew Paoli
Phone:: (713) 944-0610
Texas
Zip:
77287
Phone: ( 409 ) 945-7411, ext.
TDH License No.:
6140
2) Other Contractor:
n/a
Mailing Address:
Phone: ____i ..)
City:
State:
Zip:
3) Facility Owner: Mailing Address:
Union Carbide Corporation
P. 0. Box 471
Phone::
(409) 945-7411'
City: Texas City
State: Texas
Zip:
77592-0471
Principal Business::
Chemical Plant
4) Description of Facility
Name: Union Carbide Corporation
Address: 3301 5th Avenue South__
County:
Galveston
State:
City: Texas
Texas City
Zip:
77590
Size:
__ sq. ft.
Age: 2f yrs.
Prior Use: #2 SRC Reflux Drum
5) Demolition: _ Renovation: X Encapsulation: _ Non-Friable:
6) Notification Type: _ Planned
__ 10 Day
___ 20 Day
___ Renovation
X__ Emergency
___ Ordered
Ordered By:
7) Amount Asbestos: ___ linear feet (pipes) 412 sq. ft. (other) 8) Method of Removal: Negative Pressure Enclosure 9) Scheduled Start Date: 08/15/89 10) Scheduled Completion Date: 08/15/89
11) Disposal Site: Gulf Coast Waste Disposal Site
Add res s:
Campbell Bayou Road off Loop 197 _
County:
Galveston
State:
Texas
Phone: (409) 935-4783
TDH/TWC Permit No.:
City: Zip:
39036
Texas City_ 77590
Andrew F. Jackson Industrial Hygienist
APY:IW:AS081589
August 14, 1989 (Date)
(409) 943-5123__ (Telephone Number)
UCTC 18165
LJ
SUBJECT:
AS8EST0S
PAGE: 3 OF 3 LAST REVISED: 11/09/87
UNION CARBIOE CORPORATION TEXAS CITY PLANT
Plant Procedure Srl-5.6 Attachment # 1
NOTICE OF INTENTION TO DEMOLISH OR RENOVATE A STRUCTURE OR FACILITY CONTAINING ASBF ;S MATERIAL
1. Description of the facility: ^2. Sflc. rcflux
Estimate of approximate amount of friable asbestos materials present:
(Area In sq. ft. or linear ft.)
j ______________________________
Estimation technique used: TT b L___________:______________________________
Estimated age of asbestos material: Zl
Location of facility: f3i^
_________
Scheduled starting day: Scheduled completion day:
^
Nature of planned demolition or renovation: &me/jena| rP/iwaL- l/&xseI
devg-'o^e^ cl
and m
lo1<U 5prrc.j irvf/g r.orrosian
Method to be used (negative pressure enclosure, glove bag, etc.): __
-ajkaEipfe>s<^ negq4-iyg press^re encloiMVf Name of person that prepared the form: T)- R ScRoen________________
Location and telephone number:
S3*03
Date:
NOTE:
This form must be completed and delivered to the EP Department (Bldg. #1) at least 30 days ahead of the scheduled starting day of the planned demolition or renovation, or as soon as possible
following an emergency renovation operation.
1X
April 1985/Revised November 1987 #0184s
UCTC 18167