ࡱ> GIF#` ,.bjbjmm .8Z ^^^^jjjj,<(Z8888T,$hN 'Q'^^88x)))^888)))U8 {j!-}0A 1 (U U(Zq@)4,'' ^^^^^^  Asbestos Project Annual Facility Variance Request 2008State of Maine Department of Environmental Protection Lead & Asbestos Hazard Prevention Program 17 State House Station, Augusta, ME 04333 TEL (207) 287-2651 FAX (207) 287-6220FORM AV Page 1 of 1 Reporting Calendar Year 2008 Facility Code  FORMTEXT       Important Notice A facility that files an annual facility notification with the Department of any asbestos abatement projects that: (1) involve less than 160 square feet or 260 linear feet of asbestos-containing material; and (2) are necessitated by the need to repair or perform maintenance on facility equipment may submit this application once during any calendar year for standard and non-standard variances commonly used or anticipated in the facility provided the facility has a contractual agreement with an Asbestos Abatement Design Consultant to perform services for the calendar year in which the annual facility variance is requested. The facility representative must be aware of and approve of the requested variances by signing below. Instructions Complete and submit to the Department (at the time of submittal of form A- Asbestos Project Annual Facility Notification) the following: Form AV (Asbestos Project Annual Facility Variance Request) with appropriate signatures. Form V (Asbestos Project Variance Request) with Design Consultant sign-off. Record Keeping Requirements You must still notify the Department of each asbestos abatement project conducted at the facility using the Departments Asbestos Project Notification Form N. You may apply for a project specific variance at the time you submit Form N. A copy of the Asbestos Project Annual Facility Variance Notification Form AV and Asbestos Project Variance Request Form V must be available at the facility for review by the Department. When utilizing variances approved under the Annual Facility Variance procedure, write Approved Annual Variance in Item 4 (Variances) on Form N. Design Consultant Sign-off for Requested Variance(s) Name  FORMTEXT       Company  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT       _______________________________________  FORMTEXT       Signature DateFacility Representative Sign-off for Requested Variance(s) Name  FORMTEXT       Company  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT     3478   " & e f p q   2 4 QR̶̐łxjhi@UCJU h@`5CJ h@`>*CJ h@`5>*jhi@U5UmHnHujhi@Uh=5Ujhi@U5U hi@U5 h@`5CJ h@`5 h@`5CJ4 h@`5CJ0 h@`5CJ hi@UCJ h@`CJhi@Uh@` h@`CJ -349Ho $Ifgdi@U $$Ifa$gdi@U $Ifgdi@U $Ifgdi@U $$Ifa$$If$If$If&.*.     2 4 yypjyyyjdd$If$If $$Ifa$$Ifkd$$IflF~ #+ !b0    4 la 45QR?yss$If\kd$$Ifl4+m+04 laf4 $$Ifa$  & F$If$If  & F$If$If    "68:DFhj~  ",.:<Pɹɩəɉyjhi@Uh=CJUjnhi@Uh=CJUjhi@Uh=CJUjhi@Uh=CJUjhi@Uh=CJU hi@UCJ h@`CJjhi@UCJUmHnHujhi@UCJUjhi@Uh=CJU*H0:f(p(r(() $Ifgdi@U dh$Ifgdi@U$If dh$IfPRT^`rt&8: >@TɹɩɠɃsj(hi@Uhi@UCJUjhi@Uhi@UCJU h@`CJ h@`5CJhi@Uh@`CJ j>hi@Uh=CJUjhi@Uh=CJU hi@UCJ h@`CJjhi@UCJUmHnHujhi@UCJUjVhi@Uh=CJU)TVXbdpr(((((&(((*(4(6(H(J(^(`(b(l(n(p(r((((Ͽϯϟ՝ύ}w h@`CJjhi@Uhi@UCJUjlhi@Uhi@UCJUUjhi@Uhi@UCJUjhi@Uhi@UCJUjhi@Uhi@UCJU hi@UCJjhi@UCJUmHnHujhi@UCJUjhi@Uhi@UCJU.  TEL  FORMTEXT       FAX  FORMTEXT       _______________________________________  FORMTEXT       Signature Date  MEDEP Action on Annual Facility Variance Request ( APPROVED ( DISAPPROVED (by)_______________________________________ (date)_________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ __________________________________________________________________________________________  Asbestos 2008 Annual Notification Form AVMEDEP USE ONLY Postmark/ FAX/ Hand Delivered __________________________________ Date Received ____________________ ((((()))))x)z)|))))f*j*D+,,,,,,,, -6-T-".$.&.*.,.y hi@UCJ h@`CJh@`5CJ mHnHuh@` h@`5 joh@`5CJ h@`CJh@`5>*CJ h@`5CJ h@`CJ h@`5CJ hi@U5CJ hi@UCJjhi@UCJUmHnHujhi@UCJUjT hi@Uhi@UCJU")))x)z)j*D+,,,t $dh$Ifa$ dh$If$Ifokd $$Ifl40J+04 laf4 ,,,,,,,6-T---". dh$If dh$If$If\kdb $$Ifl4+m+04 laf4 ".$.&.(.*.,.okd $$Ifl40+@-04 laf4,/R / =!"# $ % $$If!vh5 5!5b#v #v!#vb:V l05 5!5b4tDText1$$If!vh5m+#vm+:V l405m+4f4tDText2tDText3tDText4tDText5tDText6tDText7tDText8tDText9vDText11tDText2tDText3tDText4tDText5tDText6tDText7tDText8tDText9vDText11$$If!vh55#v#v:V l40554f4$$If!vh5m+#vm+:V l405m+4f4$$If!vh5@5-#v@#v-:V l405@5-4f4<@< NormalCJ_HmH sH tH >@> Heading 1$$@&a$CJ>@> Heading 2$$@&a$CJ <@< Heading 3$@&5CJ <@< Heading 4$@&5CJB@B Heading 5$$@&a$5CJ>@> Heading 6$$@&a$5D@D Heading 7$$@&a$ 5>*CJDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List <B@< Body Text$a$5CJ@Q@@ Body Text 3$a$5CJ6P@6 Body Text 2CJH"H lE Balloon TextCJOJQJ^JaJ] ] 8349HoyzhivwZk45Nk  Q d J    | V  2 X Y Z [ ^ 00000000000000000000000000 0 0000 0 0000OpOO0000000000 00000000@00 0 00000000 0 000000 0000 0 0y000 ^ 00Z 0  00 0  00PT(,.  ),".,. *. eqw:FLWci{  = I O   ' - 6 B H O [ a k w } ] FFFFFFFFFFFFFFFFFFF8@0( 7 7  B S  ?] Text1Text2Text3Text4Text5Text6Text7Text8Text9Text11e;X| > ^  xMj P ^ Q,Q<Q,QQQBB^ GG^ 9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace8*urn:schemas-microsoft-com:office:smarttagsCity>*urn:schemas-microsoft-com:office:smarttags PostalCode l,Z ^ Z ^ 78"&ex:MWj{  < P Z c  Y ^ Z ^  W qEmq .- %l# 2kB BJ 0 W hh^h`5o(.hh^h`.hh^h`. hh^h`OJQJo(hh^h`o(.hh^h`o(.hh^h`o(. W BJmq%l#.-0 W2kB=lEi@U@`9d X Y ^ @rw,rrJLrrGG G ] `@` `@```(UnknownGz Times New Roman5Symbol3& z Arial;Wingdings5& zaTahoma"h4Æ4ÆK&\ \ r4dT T 2QHX(?lE*-Asbestos Project Annual Facility NotificationCarole CifrinoOIT(       Oh+'0L Xd    0Asbestos Project Annual Facility NotificationCarole Cifrino0Asbestos 2008 Annual Notification Form AV.dotOIT3Microsoft Office Word@@P@dj@'\ ՜.+,00 hp   Environmental Protection, MaineT ' .Asbestos Project Annual Facility Notification Title  !"#$&'()*+,-./012345789:;<=?@ABCDEHRoot Entry FU~JData 1Table%!WordDocument.8SummaryInformation(6DocumentSummaryInformation8>CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q