ࡱ> npm'` ,]bjbj 2`0000000 !!!!\"| 7""%"%"%"%"%<^'L(6666666$7h':660`-"%"%`-`-6600"%"%6333`-0"%0"%63`-633:x4,004"%" 3!h/4 4,60 74 :X1\:4:04,R)p*3<++R)R)R)66663 R)R)R) 7`-`-`-`-$!!D$h000000  Asbestos Project Variance Request  FORMTEXT       Project Code 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 V Page 1 of 2 2009 Standard Variance(s) Requested by Maine Certified Asbestos Design Consultant Check all that apply. Written Department approval is not required prior to implementation. Standard variances submitted during or before the project due to unforeseeable conditions shall not be implemented until 5 days after the variance is received by the Department unless otherwise approved by the Department. 1. Wetting ACM (during removal phase only) is not required when:  FORMCHECKBOX  Temperature inside regulated area below 320F & heating not feasible nor practical  FORMCHECKBOX  Electrical conditions exist that would create shock/electrocution hazard  FORMCHECKBOX  Operational high-pressure steam lines are being abated/repaired 2. Exhausting to Ambient Air is not feasible when:  FORMCHECKBOX  Distance too great  FORMCHECKBOX  Health & Safety concerns (limited egress) 3. Aggressive Air Clearances in dirt crawl spaces only are not required when:  FORMCHECKBOX  Dirty or dusty conditions exist not related to asbestos activities exist inside or outside the regulated area and will likely result in count overloads (Static Air Samples are required) 4. Containment and air clearances not necessary when:  FORMCHECKBOX  Enclosure activities do not impact ACM  FORMCHECKBOX  Removal of TSI components that utilize wrap & cut methods, provided that an Asbestos Inspector has determined the components to be in good condition & not likely to release fibers during removal, & has recorded this determination in the project design. By signing below, the Design Consultant attests that an Inspector has determined the TSI is in good condition.  FORMCHECKBOX  Removal or repair of ACM using multiple non-contiguous glovebags that are no larger than 60 inches by 60 inches  FORMCHECKBOX  Removal or repair, using contiguous glovebags, that involve a total of no more than 30 l/ft of ACM on a single pipeline, or any amount of ACM that can be removed within 10 glovebags for pipelines running parallel to each other 5. Remote decontamination unit is needed:  FORMCHECKBOX  Explain:  FORMTEXT   6. Smaller than standard decontamination unit needed in residential structure:  FORMCHECKBOX  A variance to the requirements for minimum decontamination unit size is allowed in residential structures where construction of a decontamination unit meeting minimum size requirements is not possible due to room size and configuration, HVAC system component locations, or restriction of safe egress for residents. Note: A detailed floor plan showing the work area, decontamination unit n and room dimensions must be submitted with the requested variance.  Design Consultant Sign-off for Standard Variance(s) _______________________________________________  FORMTEXT       Signature Print Name Date  FORMTEXT       Company  FORMTEXT       ME Certification Number DC- FORMTEXT       Address  FORMTEXT       Certification Expiration Date  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT       Asbestos 2009 Notification Form V.doc  Asbestos Project Variance Request  FORMTEXT       Project Code 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 V Page 2 of 2 2009 Non-Standard Variance(s) Requested by Maine Certified Asbestos Design Consultant Provide written justification that presents clear & convincing evidence that the asbestos project is distinctive in some way & the proposed alternative(s) to required work practices will comply with the intent of State law & rules. Written Department approval is required prior to implementation of non-standard variance(s).  List proposed work practice alternatives  FORMTEXT        Reasons for Non-Standard Variance(s) (Explain in detail. You may add an attachment when necessary)  FORMTEXT        Design Consultant Sign-off for Non-Standard Variance(s) _______________________________________________ HJL`bdnpr            g h % & M N O ] ~ h{CJH*jhXph{CJU h{5CJ h{5h> h{5CJ4 h{5CJ0 h{5CJ h{CJ jhXpCJUmHnHujhXph{CJU hXpCJjhXpCJU h{CJh{ h{CJ,&HJrN       $$Ifa$gdXp $IfgdXp $$Ifa$gdXp $IfgdXp $IfgdXp $$Ifa$ $$Ifa$$If$If,]   g h ysymy$If$If$Ifkdt$$IflF #* b0    4 la M N $If\kd$$Ifl4*P+04 laf4 ] ^ _ 4 5 6 D E F d e s t u  ߼ٵӥӕ߼ߵ|ߵ߼xh{jhXph{CJUh{5>*CJjhXph{CJUj|hXph{CJU h{5CJ h{5CJ jhXph{CJU hXpCJ h{CJ h{CJjhXpCJUjhXph{CJU+ 4 5 ?\kdd$$Ifl4*P+04 laf4$If\kd$$Ifl4*P+04 laf4 45;<2th$If^h`gdXph$If^h`gdXp$If\kdZ$$Ifl4*P+04 laf4$If   456DEF{|H;<=KLM234_`aopq}~Ѿ;峣͘Ѿّ͆Ѿ{rѾk h{5CJ hXpmHnHujh{Uj0h{U h{5CJj8h{UjhXph{CJU hXpCJ h{>*h{jPh{UhXpjhXpU h{CJ h{CJjhXpCJUjhXph{CJU*234_`$If$If\kd$$Ifl4*P+04 laf4$Ifbch$If^h`gdXp$If$If_kd $$Ifl4*>+04 laf4#$%bcg(pq{|  ,.0:<RThع҅o_҅jhXpCJUmHnHujt hXph{CJU hXpCJjhXpCJU!jhXp5CJUmHnHu"j hXph{5CJU hXp5CJjhXp5CJU h{CJ h{5CJ h{CJ h{5CJj h{UhXpjhXpUh{ h{CJ !()>@v.0 dh$If$If$If\kd~ $$Ifl4*P+04 laf4hjlvx,.0:<ƹwgWj hXph{CJUjD hXph{CJUj hXph{CJU hXpCJ$jhXphXpCJUmHnHuj\ hXph{CJUhXphXpCJjhXphXpCJUhXph{CJ h{CJjhXpCJUmHnHujhXpCJUj hXph{CJU",.0:<NPdfhrt.246|~up hXp5jhXp5U h{CJh{ h{5 h{CJ h>CJjhXph{CJUjhXph{CJUjhXph{CJUjhXpCJUmHnHuj,hXph{CJU hXpCJjhXpCJU h{CJ&026Z|~. $$Ifa$ $$Ifa$$If$If\kd$$Ifl4*P+04 laf4 ,-01234   ¼ȵ¡œȒ|lȒjhXpCJUmHnHuj&hXph{CJU hXpCJjhXpCJU h{5 h>CJ h{5CJ4 h{5CJ0 h{5CJ hXpCJ h{CJ h{CJ h{ hXp5jhXp5UmHnHujhXp5UjhXph{5U' ,-234XR$Ifkd$$IflF #* b0    4 la $IfgdXp $$Ifa$gdXp $IfgdXp $IfgdXp4$If\kd$$Ifl4*P+04 laf4$If$If  $If$If^kd$$Ifl4*P+04 laf4  LLL,L.L0L:LLFMHM\M^M`MjMlMMMMü~tn^tNt~tnjhXpCJUmHnHujhXph{CJU hXpCJjhXpCJU h{CJ!jhXp5CJUmHnHu"jhXph{5CJU hXp5CJjhXp5CJUU h{5CJ h{CJ h{CJ h{CJjhXpCJUmHnHujhXpCJUj"hXph{CJU>L4M6MnMpM4NNOPP dh$If$If$If\kd$$Ifl4*P+04 laf4  FORMTEXT       Signature Print Name Date  FORMTEXT       Company  FORMTEXT       ME Certification Number DC- FORMTEXT       Address  FORMTEXT       Certification Expiration Date  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT        MEDEP Action on Non-Standard Work Practices Variance(s) Requested  FORMCHECKBOX  APPROVED  FORMCHECKBOX  DISAPPROVED (by) ______________________________ (date) __________________________ ______________________________MMMMMN NN"N$N&N0N2N4NFNHN\N^N`NjNlNNNNNNNN O O O"O$O.O0OƹwgWjhXph{CJUjhhXph{CJUjhXph{CJU hXpCJ$jhXphXpCJUmHnHuj|hXph{CJUhXphXpCJjhXphXpCJUhXph{CJ h{CJjhXpCJUmHnHujhXpCJUjhXph{CJU"0ODOFOZO\O^OhOjO|O~OOOOOOOOOOOOOOOPPPPPPPPPPPPPPP Qzhz"jhXph{5CJU hXp5CJjhXp5CJU h{5CJ h{CJ jhXph{CJUj@hXph{CJUjhXph{CJUjhXpCJUmHnHujThXph{CJU hXpCJjhXpCJU h{CJ'PPPPPQO\\)]*] dh$If$If$If\kd,$$Ifl4*P+04 laf4 Q QQ4Q+#v>+:V l405>+4f4vDeCheck12$$If!vh5P+#vP+:V l405P+4f4tDText3tDText4tDText5tDText6tDText7tDText8tDText9vDText10vDText11vDText12vDText13$$If!vh5P+#vP+:V l405P+4f4vDText14$$If!vh5 55b#v #v#vb:V l05 55b4$$If!vh5P+#vP+:V l405P+4f4vDText15$$If!vh5P+#vP+:V l405P+4f4vDText16$$If!vh5P+#vP+:V l405P+4f4vDText17vDText18vDText19vDText20vDText21vDText22vDText23vDText24vDText25vDText26vDText27$$If!vh5P+#vP+:V l405P+4f4vDeCheck13vDeCheck14$$If!vh5P+#vP+:V l405P+4f4<@< NormalCJ_HmH sH tH >@> Heading 1$$@&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 6P@6 Body Text 2CJ6B6 Body Text>*CJPC@P Body Text Indent0^`0CJTR@"T Body Text Indent 20^`0CJ`  $%9FGV}ghMN4545;<2 3 4 _ `   b c ( )    8n>iIJKLuv@A45O_90*v:. . . ^. v:. v:. 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AndersonKaren M. Anderson  Oh+'0( DP p |  Asbestos Project Karen M. Anderson$Asbestos Notification Form V.dotKaren M. Anderson1Microsoft Office Word@F#@ G'8@3@\Q3aH՜.+,0 hp   Environmental Protection, Maine) ' Asbestos Project Title  !"#$%&'()*+,-./023456789:;<=>@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\^_`abcdfghijkloRoot Entry F1#3qData 11Table?:WordDocument2`SummaryInformation(]DocumentSummaryInformation8eCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q