ࡱ> RTQ#` 4bjbjmm .@, Yhhh|````T4|8!F::::C{ } } } } } } $!hV$x Qhm" ::3 MMM8:h:{ M{ MMPh: p`|!08!$$$h,Z@M=4q, =8!||| `|||`|||  Asbestos Project Notification Revision State of Maine Department of Environmental Protection Lead & Asbestos Hazard Prevention Program 17 State House Station, Augusta, ME 04333 TEL (207) 287-2651 FAX (207) 287-6220 FORM R Page 1 of 1 2008 Revision1. Project Code  FORMTEXT       (assigned by original notification submitter) Revision #  FORMTEXT      Revision Information Submitted by Name  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      Asbestos Contractor (As listed in original notification) Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT       Facility Location (Where removal is to take place) BLDG Name  FORMTEXT       Floor and/or Rm.#  FORMTEXT       Physical Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       6. Notification Revisions (Check all that apply)  FORMCHECKBOX  Change Start Date from  FORMTEXT       to  FORMTEXT        FORMCHECKBOX  Change End Date from  FORMTEXT       to  FORMTEXT        FORMCHECKBOX  Change in Work Hours  FORMTEXT        FORMCHECKBOX  Cancellation of Project Date  F()    ! l     * , P R ʚzjh:~hTkCJUjh:~hTkCJU hTkCJjh:~CJUmHnHujh:~hTkCJUjh:~CJU hTk5CJh:~ hTk5CJ4 hTk5CJ0 h:~CJ hTkCJ hTk5CJ hTk hTkCJ 0 ()8_ $$Ifa$gd:~$If $Ifgd:~ $Ifgd:~ $$Ifa$$If$If44     j l yyyyyoyyoy & F$If$Ifkd$$IflF$ #* ^b0    4 la . x , h R T ~0|v$If & F$Ifokd2$$Ifl40$ * !04 laf4 dh$If R f h j t v      ( * @ B V X Z d f ~ zjHh:~hTkCJUjh:~hTkCJUj`h:~hTkCJUjh:~hTkCJUjxh:~hTkCJU hTkCJjh:~CJUmHnHujh:~CJUjh:~hTkCJU h:~CJ+  R T h j ~  468BDVXlnpz弬弜弌|ljh:~hTkCJUj,h:~hTkCJUjh:~hTkCJUj@h:~hTkCJUjh:~hTkCJU h:~CJ hTkCJ hTk5CJ hTkCJ jh:~CJUmHnHujh:~CJUjh:~hTkCJU*z|  ",.0V   "$.0VXl|j h:~hTkCJUjz h:~hTkCJU hTk5CJ hTkCJ j h:~hTkCJUjh:~hTkCJUjh:~CJUmHnHujh:~hTkCJU h:~CJ hTkCJjh:~CJU+02~246V vokd> $$Ifl40<*04 laf4 dh$If$If & F$If lnpz|   "$.0268nɹɩəϓ{{tdj h:~hTkCJU hTk5CJ hTk5CJ!jhTk5CJUmHnHu hTkCJ j h:~hTkCJUjR h:~hTkCJUj h:~hTkCJU h:~CJ hTkCJjh:~CJUmHnHujh:~CJUjf h:~hTkCJU' ".0DFHRTVXtvx  *,.hj~ɹɩəɉyijh:~hTkCJUjh:~hTkCJUjh:~hTkCJUjh:~hTkCJUj(h:~hTkCJUj h:~hTkCJU h:~CJ hTkCJjh:~CJUmHnHujh:~CJUj< h:~hTkCJU),,,,, ,,,.,B,D,F,P,R,T,V,r,t,v,,,,,,,,,,,,,---wjh:~hTkCJUjFh:~hTkCJUjh:~hTkCJUj\h:~hTkCJUjh:~CJUmHnHujh:~hTkCJUUjrh:~hTkCJU h:~CJ hTkCJjh:~CJU*ORMTEXT       to  FORMTEXT        FORMCHECKBOX  Change in Contractor to  FORMTEXT        FORMCHECKBOX  Change in amount of ACM being removed (Show increase or decrease)  FORMTEXT        FORMCHECKBOX  Change in Waste Transporter to  FORMTEXT        FORMCHECKBOX  Change in Disposal Site to  FORMTEXT        FORMCHECKBOX  Variance Request not previously submitted (Non-Standard Variance Request requires Department written approval)  FORMCHECKBOX  Change in abatement methods  FORMTEXT        FORMCHECKBOX  Other  FORMTEXT       _________________________________________________  FORMTEXT       Signature Print Name Date  FORMTEXT       Important Note: This form may be faxed to the Department. Remember to keep a record of all notifications sent to the Department.  Asbestos Notification Form R.dot ME DEP USE ONLY Postmark/ FAX/ Hand delivered Date Received _____________________ T,,-J../p00001~222222222233 $$Ifa$ $Ifgd:~$If dh$If----------".$.8.:.<.F.H.J.L.h.j.l.............///00H0J0^0ɹɩəɉyijh:~hTkCJUjzh:~hTkCJUjh:~hTkCJUjh:~hTkCJUjh:~hTkCJUjh:~hTkCJU h:~CJ hTkCJjh:~CJUmHnHujh:~CJUj0h:~hTkCJU)^0`0b0l0n0p0r000000000000`1b1v1x1z1111222222222ɹɩϢ}l\XhTkj<h:~hTkCJU!jh:~5CJUmHnHu"jh:~hTk5CJU h:~5CJjh:~5CJU hTk5CJjPh:~hTkCJUjh:~hTkCJU h:~CJ hTkCJjh:~CJUmHnHujh:~CJUjdh:~hTkCJU"2222333 4 44444464r4t4444hTk h:~CJ hTkCJ hTkCJ hTk5 hTk5>* h:~5CJ hTk5CJ33344464r4t44444dh\kd$$Ifl4*P+04 laf4 ,/R / =!"# $ % $$If!vh5 5^5b#v #v^#vb:V l05 5^5b4tDText1tDText2tDText3tDText4tDText5tDText6tDText7tDText8tDText9vDText10$$If!vh5 5!#v #v!:V l405 5!4f4vDText11vDText12vDText13vDText14vDText15vDText16vDText17vDText18vDText19vDText20vDText21vDText22vDText23vDText24$$If!vh55#v:V l4054f4tDeCheck1vDText36vDText37tDeCheck2vDText34vDText35tDeCheck3vDText33tDeCheck4vDText31vDText32tDeCheck5vDText30tDeCheck6vDText29tDeCheck7vDText28tDeCheck8vDText27tDeCheck9vDeCheck10vDText26vDeCheck11vDText25vDText38vDText39$$If!vh5P+#vP+:V l405P+4f4<@< NormalCJ_HmH sH tH >@> Heading 1$$@&a$CJ>@> Heading 2$$@&a$CJ <@< Heading 3$@&5CJ <@< Heading 4$@&5CJB@B Heading 5$$@&a$5CJ>@> Heading 6$$@&a$5DAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List X X[ @ ()8_)WXcdx8Va;aMLGZa b ~   , < = [ \ 00000000000000000000000 000 00000000 0000000 0000000D0000000000000000000000000000 0 00H000000R zl-^024  034 4 !'dpv$06BNTams}%1=CMY_kw} '39MY_my ,29EKM]{+18DJL\| 3?EGWz"FRXZjwj v | FFFFFFFFFFFFFFFFFFFFFFFFG FFG FFG FG FFG FG FG FG FG G FG FFF8@(  P   " B S  ? p<)t2Text1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12Text13Text14Text15Text16Text17Text18Text19Text20Text21Text22Text23Text24Check1Text36Text37Check2Text34Text35Check3Text33Check4Text31Text32Check5Text30Check6Text29Check7Text28Check8Text27Check9Check10Text26Check11Text25Text38Text39e$Ca}1Mk(Nm :M{8L}4G{GZxj   !"#$%&'()*+,-./01(w7Ut&D`~:`3L^2K] FX#Yk} g8\h8?}i8$ j8*urn:schemas-microsoft-com:office:smarttags PostalCode 0J, , (dw$7BUat}&1DM`k~':M`m 39LM^{28KL]| 3FGXz#FYZkwj } ( ( + ,  W qEhh^h`5o(. 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