HomeMy WebLinkAboutCDPHE 3352 Youngfield St Unit 28-202100824 PermitASBESTOS ABATEMENT NOTIFICATION and PERMIT APPLICATION FORM
FEE MUST ACCOMPANY THIS FORM. INCOMPLETE APPLICATIONS WILL BE RETURNED.
OF COtO
C4'P Submit form to:
r o Single Family Residential Dwelling (SFRD)
> 50 LF or 32 SF or a 55 -gal. drum, but <_ 260 LF or 160 SF or a 55 -gallon drum
Permit
Public and Commercial Building, School, and Single -Family Colorado Dept. of Public Health
Residential Dwelling: > 260 LF or 160 SF or a 55 -gallon drum and Environment
code 200 1❑ $0 Courtesy Notice
code 100 JEI 1 $0
APCD-IE-B1
Courtesy Notice 4300 Cherry Creek Drive South
❑ $60 Non -Public Access Notice (Opt Out)code
105 ❑ $80
Non -Public ANoDenver, CO 80246-1530
on- Access tice
code 205
Colorado Department $60 Notice
Phone: 303-692-3100
code 210 10
" lu LJ
Fax: 303-782-0278
of Public Health 230 ❑ $180 30 -Day Permit
code 130/232 ] ❑ $400
30 -Day P&C/SFRD Permit
code 1
asbestos@state.co.us
and Environment [ code 290 ] ❑ $300 90 -Day Permit
[ code 1 izy
a ermit
[ code 265 ] ❑ $420 365 -Day Permit
[ code 165/267❑] $1200
365 -Day P&C/SFRD Permit
Abatement fi(W
bateme
t S de "
Phase Permit # uildi ig Owner
Company Name
Building Name
Owner Name
Region 8 Enviro, LLC
Applewood Village Unit 28
Regency Centers
Street Address
Specify location in the building where work will take place (e.g. floor, room, wing, etc.)
Contact
6531 Washington St
Throughout the entire space
Tom Metzger
City
State
Zip code
Street Address
Street Address
Denver
CO
80229
3352 Youngfield St
One Independent Drive Suite 114
Telephone #
Fax #
City
County
Zip code
City
State
Zip code
303 424-4887
303 424-9193
Wheatrid e
Jefferson
80033
Jacksonville
FI
32202
Project Supervisor
CO. Cert #
Building Contact
Cell Phone #
Telephone #
Fax #
AnthonyMilam
3970
Tom Metzger
303 300-5335
303 300-5335
303 424-9193
Project Personnel
Project Information
Disposal Site
CO Project Mgr. Name
Start Date
End Date
Landfill Name
04/28/21
05/10/21
Denver Arapahoe Disposal Site
Cell Phone #
CO Project Designer #
Start Time
End Time
Street Address
()
700 AM N/A PM
N/A AM 5:30 PM
3500 South Gun Club Road
CO Project Designer Name
Check the day(s) of operation: Su M Tu W Th F Sa
City State Zip code
❑ ® ® ® ® ❑ ❑
Aurora CO 80018
Cell Phone # CO Project Designer #
Emergency? Type of ACM: TSI, Texture, VAT, etc.
CDPHE Use Only
Postmark or D RECEIVED aPaFovEo
ConsultingFirm Name
9�
Registration #
Linear Feet / Type
YP
Square Feet / Type
q YP
55 al. Drums
9
APEX
17163
By Cody Archuleta af1:25 pm, Apr 13, 2021
A.M.S. Name
Form of Pay
PM req'd.
Robert Lon mire
Remove 1650Sq ft of
166476844 / $400
Permit #
Y N w
Cell Phone #
CO A.M.S. Cert #
Date Issued:
(720) 288-8499
12856
residual mastic
Please describe below the work Dractices and procedures to
be emoloved in conducting the ahatPmPnt of achPctnc RF SPFr]Fl
Inriirato tvnalcl of Of RSA +n ho ahs+cri �o n ���T
ceiling tile, TSI, etc.). Use another page if necessary. I
Region 8 employees will establish a full containment per Colorado Regulation 8. Full containment will require the installation of a three stage Decontamination station and two stage loadout which will be located
outside the front door of the building. Region 8 will first remove non -ACM Ceramic tiles.Then remove approximately 1650 sq ft of ACM mastic. Abatement will be completed using a mechanical buffer. During
abatement amended water will be sprayed through a airless sprayer to control fiber release. Waste will be placed in a primary asbestos labeled bag, goose necked and taped prior to being placed in a second
labeled bag with a generator label and taped. aAll areas inside the containment will then be HEPA vacuumed and wet wiped.
Form: AANPA08
APPROVED
By Cody Archuleta at 1:25 pm, Apr 13, 2021