ࡱ> #` cbjbjmm 7l3BBBB,0,0,08d0D0v>f1~&3&3&3&342755\=======$?hDBp=E84488=BB&3&30>Y:Y:Y:8pB8&3&3=Y:8=Y:Y:zY:&31 psq,08Y::$F>0v>Y:B9vBY:BY:HG6v6TY:7DU78G6G6G6==9^G6G6G6v>8888# #4"BBBBBB  JOHN ELIAS BALDACCI GOVERNOR David P. Littell COMMISSIONER STATE OF MAINE DEPARTMENT OF ENVIRONMENTAL PROTECTION RENEWAL APPLICATION FOR LICENSING AS AN ASBESTOS ABATEMENT CONTRACTOR OR IN-HOUSE ASBESTOS ABATEMENT UNIT Complete all sections of the application either by hand printing in ink or typing in the gray areas. Print out and sign the completed application and mail to Maine DEP with the appropriate application fee. Attach additional sheets as necessary. 1. Applicant:Company Name FORMTEXT  Company Address FORMTEXT  City FORMTEXT  State FORMTEXT  Zip FORMTEXT      Company Phone Number FORMTEXT  e-mail address FORMTEXT  Previous License Number (if applicable): FORMTEXT  Responsible Person: FORMTEXT  Title FORMTEXT      Is the applicant licensed or certified an asbestos contractor in another state?Yes FORMCHECKBOX No FORMCHECKBOX If Yes, where: FORMTEXT  License or Registration Number: FORMTEXT  2. Contractor Categories: check only oneA)FULL FORMCHECKBOX Includes all abatement activities with no restrictionsB)LIMITED FORMCHECKBOX  Roofing FORMCHECKBOX  Siding FORMCHECKBOX  Demolition by Large EquipmentC)IN HOUSE ASBESTOS ABATEMENT UNIT FORMCHECKBOX  To conduct asbestos abatement activities on owner properties only 3. RENEWAL REQUIREMENTS: A renewal application for an Asbestos Abatement Contractor or In-House Asbestos Abatement Unit license must meet the application requirements set forth below and submit attesting documentation: A.  FORMCHECKBOX  By signing this renewal application, the applicant hereby confirms that the information, submitted in our original application is currently in effect and unchanged. or  FORMCHECKBOX  Included with this renewal application are any changes to the information in our original application including standard operating procedures. B.  FORMCHECKBOX  Included with this renewal application is a list of current employees including expiration of state certification and training certificates. 4. ENFORCEMENT ACTIONS: Have there been any enforcement actions taken against the company with respect to asbestos abatement activities during the past year? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If YES, provide detailed information on the enforcement action(s) and copies of all correspondence relating to the enforcement action. (Note: Notices of violation are considered enforcement actions.) 5. FEE: The application must include a non-refundable cashier's, certified, or company check in the amount of $250 dollars made payable to the Maine Environmental Protection Fund. 6. SIGNATURE: I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED THE INFORMATION SUBMITTE0=>MN[\ijt ŷųrbrTrBr#hOhO5CJOJQJ^JaJhOhO6OJQJ^JhOhO5CJOJQJ^JhOhOOJQJ^JhOhO5CJ$OJQJ^Jhi@B*CJphhi@B*CJphhi@B*CJphhihiB*CJOJQJphhiB*CJ OJQJphhiB*CJOJQJphhiOJQJmHnHu"jhiOJQJUmHnHu0=>Mt~~~~~$ h8(a$gdO$da &#$+Daa$$dh$q} &#$+D.H/Ha$$dh<q`&#$+De.H/Ha$$dh<q`&#$+De.H/H^a$ &/ bcc yikd/$$Ifl$$ t044 layti $IfgdigdO h8(gdO 7 $Ifgdi $Ifgdiikd/$$Ifl$$ t044 layti   5 6 J K U V W   k'j4hOhOOJQJU^J'j>4hOhOOJQJU^J'j^3hOhOOJQJU^J'j1hOhOOJQJU^J#hOhOOJQJ^JmHnHu'jH0hOhOOJQJU^JhOhOOJQJ^J!jhOhOOJQJU^J 7 8 9 z $Ifgdi|kd"1$$Ifl0$( t044 layti9 : J $Ifgdi $Ifgdiikd1$$Ifl$$ t044 layti z $Ifgdi|kd2$$Ifl0$6  t044 layti   $Ifgdi $Ifgdiikd3$$Ifl$$ t044 layti > @ T V X  d f z | ~ `bpr˷إˑإ}إiإ'j:hOhOOJQJU^J'jp8hOhOOJQJU^J'j6hOhOOJQJU^J#hOhOOJQJ^JmHnHu'j:6hOhOOJQJU^JhOhOOJQJ^J!jhOhOOJQJU^J,jhOhOOJQJU^JmHnHu!   7. $IfgdikdB5$$Iflֈ*46c $W-- t044 layti  > $Ifgdiikd5$$Ifl$$ t044 layti   ]T $Ifgdikd7$$Ifl\ l$ b$ t044 layti  d $Ifgdiikd$8$$Ifl$$ t044 layti zqzq $Ifgdi $Ifgdi|kd,9$$Ifl0$ t044 layti dp]TKTK $Ifgdi $Ifgdikd9$$Ifl\~ $ &  t044 laytiFHdfhprBCMNOںںںںںں~lںںXlں'jz?hOhOOJQJU^J#hOhOOJQJ^JmHnHu'j=hOhOOJQJU^J'j<hOhOOJQJU^J'j&<hOhOOJQJU^JhOhOOJQJ^J$jhOhOU^JmHnHu!jhOhOOJQJU^J'j:hOhOOJQJU^J]T $IfgdikdL;$$Ifl\~ $ &  t044 layti>Fjp $Ifgdiikd;$$Ifl$$ t044 laytiJA $Ifgdikd=$$Iflr!$~v t044 layti $Ifgdiikd=$$Ifl$$ t044 layti !z $Ifgdi|kd>$$Ifl0$t t044 layti!"B $Ifgdiikd.?$$Ifl$$ t044 laytiz $Ifgdi|kdV@$$Ifl0 $" t044 layti$ikdA$$Ifl$$ t044 layti $Ifgdiikd@$$Ifl$$ t044 layti !",-;<=FGUVWòÞòÊòvòbQ!jhOhg0OJQJU^J'jChOhOOJQJU^J'jChOhOOJQJU^J'jBhOhOOJQJU^J'jAhOhOOJQJU^J!jhOhOOJQJU^JhOhOOJQJ^JhOhO>*OJQJ\^JhOhOOJQJ\^J"hOhO5CJOJQJ\^J $IfgdiikdPA$$Ifl$$ t044 layti ,Fw]TTTTT $IfgdikdB$$Ifl\b$.. t044 laytiwx{JAAA $IfgdikdC$$Iflr H$.H t044 layti9:HIJo[G'jvFhOhOOJQJU^J'jFhOhOOJQJU^J'jEhOhOOJQJU^J!jhOhOOJQJU^JhOhOCJOJQJ^JhOhO5OJQJ^JhOhO5CJOJQJ^JhOhOOJQJ^J!jhOhg0OJQJU^J'jDhOhg0OJQJU^JhOhg0OJQJ^JpggXA h8(0^`0gdO h8(gdO .gdOkdE$$IflF $.  t0    44 layti45wxr h8(0^`0gdO h8(0^`0gdO$ h8(8^8`a$gdO h8(8^8`gdO h8(0^`0gdO h8(h^h`gdO JXc6:x ,./0>```bbbbbȹ~tr^'jGhOhOOJQJU^JUhOOJQJ^J'jbGhOhOOJQJU^J!jhOhOOJQJU^J+jFhOhOCJOJQJU^JhOhOCJOJQJ^J%jhOhOCJOJQJU^JhWOJQJ^JhOhO5OJQJ^JhOhOOJQJ^J#.0>?aaaaabbb%b $Ifgdi h8(`^``gdO h8(h^h`gdO h8(0^`0gdOD IN THIS DOCUMENT AND ALL ATTACHMENTS THERETO AND THAT, BASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING THE INFORMATION, I BELIEVE THE INFORMATION IS TRUE, ACCURATE, AND COMPLETE. I AM AWARE THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT. I AM ALSO AWARE THAT ALL ASPECTS OF ASBESTOS ABATEMENT ACTIVITIES ARE SUBJECT TO INSPECTION AT ANY TIME BY THE MAINE DEPARTMENT OF ENVIRONMENTAL PROTECTION. SIGNED:  DATE: FORMTEXT   PRINTED:  RETURN TO: Lead & Asbestos Hazard Prevention Program Department of Environmental Protection (BRWM) 17 State House Station Augusta, Maine 04333-0017 (207) 287-2651     Renewal Asbestos Contractor 12/4/07 b#b$b4bbbbbbbbbbbbccccccchihg0hOh+Gjh+GU#hOhiOJQJ^JmHnHuhOhOCJOJQJ^JhOhO5OJQJ^JhOhOOJQJ^J!jhOhOOJQJU^J#hOhOOJQJ^JmHnHu%b&b'b0b1b2b[RRRR $IfgdikdjH$$Ifl\w,"9 t0644 layti2b3b4b5b6blbbbb|bbbbbb$ h8(0^`0a$gdOgdO}kdH$$Ifl0,"9_ t0644 laytibbbbbbbbbbbbbccccccgdO h8(0^`0gdO$ h8(0^`0a$gdO50&P:pO/ =!"#$%h /Dd5 T  0Ab/A+ne\Hp}V_c.Dn.A+ne\Hp}V_cPNG  IHDR2ZsRGB@}0PLTE9O pHYsYYNV.4IDATxI#9Q\ԕH E UVdFG AڿߖC}_hE~6[{F,CSum9γ anҔgt 4(i11a|hB%MИ`ӌfOјv#h^lM>  4r_, =iKN!03s4;u ՌChhmM5#:N3[&& Ml8HO4jl# ui,J44Od,$iJF66ndh4,ΐQ ǕbRی s1M4Ni0'xQӻ!8iiTJ^٢)MFЙFUѷ rJ#,V,$DoK8!g6*'iz9繩K@iǓ@J41; k?0MRkF{,|^? d;hb G."J^i ䷧yvu(#4*Ѥ&T#b}XtXVhړ1kr#|iڲOGV]V)s+7Ѥ NytMՓ0=?k=JQ]iG=Y!$v13A=6>RRUM'_4T \?*5nԴibeh_9O~otzj-!V-jicwnOs+Ќ0޴e;9qݨnzFlps9 %6ϾWbsyhw#h|PʱM4;Uc-Հ|l|Ϡ&yfO9O֝;Jє3 _Fe#wEbaS H-cѨhybu3DZI߸]y(g#v:zc ׏~4e'gˤϲHѯhco&f4fAEewbaѭjߌ&Ai4zSGccf^Stp},3ςfܒh|Xh~nGq ߏf|")`}̈$NH7asv=:h0mxnb۽|8x&Y6 i瓖6m=]''4M}ezl)ͦ<h+j#i jD<44d4=0ȧ+B}O66h& ߐnt_g=Ǜ@3,hiO(n4cG<:64wSl&4Ïy~1KwL ?NtML{u%Ɇ"4>]D8U7?͔G$lԝHGJdZ&LA[uY6%s1/u5 MEl@ӕ `sY! 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