ࡱ> '` wzbjbj 7!-BBBB4 :::8:<4;Hf\<6====q>I??DGGGGGGG$IhbLpGQWBm>q>WBWBGBB==NH/D/D/DWBB8==G/DWBG/D/Dz/D=P< D@:B/DDLdH0H/DL[CvL/DL/D\@v@T/D@DA8@@@GGC^@@@HWBWBWBWB|/D |/T60BBBBBB  JOHN ELIAS BALDACCI GOVERNOR David P. Littell COMMISSIONER STATE OF MAINE DEPARTMENT OF ENVIRONMENTAL PROTECTION NEW APPLICATION FOR LICENSING AS AN ASBESTOS ANALYTICAL LABORATORY 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 laboratory in another state?Yes FORMCHECKBOX No FORMCHECKBOX If Yes, where: FORMTEXT  License or Registration Number: FORMTEXT  2. Laboratory Categories: (Note: if applying for both Air & Bulk, fee is $400.00 only)A) FORMCHECKBOX Air AnalysisB) FORMCHECKBOX Bulk AnalysisC) FORMCHECKBOX Limited Air Analysis (In-House*)D) FORMCHECKBOX Limited Bulk Analyst (In-House*)*NoteLimited to asbestos analytical activities conducted in-house solely for internal company use and not for a third party (individual, business or public entity) 3. APPLICATION REQUIREMENTS: An applicant for an Asbestos Analytical Laboratory license must meet all the application requirements set forth below and submit attesting documentation: A. A statement (and copy of two party sign-off form) attesting that the business or public entity trains all employees about related standard operating procedures prior to job placement; B. A list of all asbestos associated citations and notices of violation received in the United States during the last two years including the name of the issuing agency or department, the final disposition of such citation or notice, and, if the applicant's principal owner or operator or officer has received an asbestos associated citation or notice while owning or operating another company in the previous two years, a list of those violations; C. A list of states in which the applicant holds a license, certification, accreditation, or any other approval for asbestos associated activity; D. A copy of the applicant's standard operating procedures which prevent contamination or recontamination of a facility and the environment and which protect the public and employee health from the hazards of exposure to asbestos; include satellite labs; E. A copy of the relevant aspects of its QA/QC program for ensuring accuracy of analysis of air and bulk samples, including a description of its annual QA/QC training for all air and bulk analysts. F. Proof of access to a licensed asbestos disposal site; G. Proof that the applicant's employees are certified pursuant to the requirements of this Chapter; H. A list of the names of the applicant's owner(s) or operator(s), principal(s), and officer(s); I. A list of all other entities, performing asbestos activities or asbestos associated activities, of which the applicant, owner or operator(s), principal(s), or officer(s) is an owner or operator, principal or officer; J. A list of all names (or acronyms) by which the applicant's firm is known or under which it does business; K. Any information requested by the Department for purposes of determining the proficiency and adequacy of the applicant's standard operating procedures; L. Proof that the Asbestos Analytical Laboratory works under the supervisory control of an Asbestos Air Analyst or Asbestos Bulk Analyst as applicable; and M. Number of satellite laboratories that the firm will operate. [Note: satellite (field) labs do not require separate licensure.] 4. RECORDKEEPING REQUIREMENTS: A. An Asbestos Analytical Laboratory is subject to the recordkeeping requirements outlined below to the extent applicable to sample analysis and must make the following available to the Department within 24 hours of request: * Sample chain of custody procedures, including but not limited to handling, storage, and disposal procedures; * Analytical quality assurance program(s); * Equipment calibration and standardization procedures; * Results of the last four PAT or round robin tests including individual analyst results; * Laboratory standards procedures for asbestos analysis; * An up to date asbestos analytical equipment inventory; * Documents related to laboratory personnel training; * The DEP certificate of the laboratory owner, operator or supervisor; * A copy of their quality assurance program ensuring proficiency of all analysts; * Copies of state certificates and dates of employment for past and present employees performing analyses; and * Copies of records of analyses performed, indicating sample identification number, analysis method utilized, analytical results, and certified employee performing the analysis. B. A laboratory applying to the Department for an Asbestos Analytical Laboratory license must provide proof of proficiency, as determined by NVLAP or AIHA, to the Department along with its application. New laboratories shall have 1 year to submit proof of proficiency to the Department. C. If applicable, the applicant must submit statements affirming the following: * That the Asbestos Analytical Laboratory whose license encompasses air analysis uses phase contrast microscopy for the analysis of air samples for enumeration of fibers including asbestos unless NVLAP (National Voluntary Laboratory Accreditation Program) approved for the use of electron microscopy. Analytical procedures shall be in accordance with the NIOSH (National Institute for Occupational Safety and Health) Methods 7400 or the OSHA Reference Methods Asbestos Standard for General Industry, 29 CFR 1910.1001 Appendix A, (effective date July 20, 1986). * That an Asbestos Analytical Laboratory submits to the Department adequate proof that it is approved by NVLAP to provide electron microscopy services. NIOSH method 7402 shall be used for TEM analysis. * That the Asbestos Analytical Laboratory whose license encompasses bulk analysis uses polarized light microscopy procedures in accordance with US EPA specifications defined in US EPA Regulations Governing Asbestos Abatement Projects, 40 CFR Part 763, Appendix A, as amended (effective May 27, 1982). 5. IN-HOUSE ASBESTOS ANALYTICAL LABORATORIES: In-House Asbestos Analytical Laboratories are exempt from NVLAP or AIHA accreditation as long as each analyst is rated proficient by AIHA's Asbestos Analytical Registry or by an independent active participating laboratory rated proficient by AIHA or NVLAP. Analysts must be annually rated proficient as part of their individual AIHA certification. In-House Asbestos Analytical Laboratories are subject to all other laboratory requirements. 6. FEE: The application must include a non-refundable cashiers, certified or company check in the amount of $400 dollars made payable to the Maine Environmental Protection Fund. 7. SIGNATURE: I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED THE INFORMATION SUBMITTED IN THIS DOCUMENT AND ALL ATTACHMENTS THERETO AND THAT, BASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING THE INFORMATION,0=>MN[\ijtu ŷųnaQaCah/mhlb6OJQJ^Jh/mhlb5CJOJQJ^Jh/mhlbOJQJ^J#h,-hlb5CJ OJQJ^JaJ h,-5CJ OJQJ^JaJ hQ@B*CJphhQ@B*CJphhQ@B*CJphhQhQB*CJOJQJphhQB*CJ OJQJphhQB*CJOJQJphhQOJQJmHnHu"jhQOJQJUmHnHu0=>Mtu{{{{{$ h8(a$gdlb$da &#$+Daa$$dh$q} &#$+D.H/Ha$$dh<q`&#$+De.H/Ha$$dh<q`&#$+De.H/H^a$ }&/gd,- Gztzvz yikd/$$Ifl$$ t0$44 laytQ $IfgdQgdlb h8(gdlb  H J ^ ` b h j x z ײƠ׌ƠxƠdƠ'j>4h/mhlbOJQJU^J'j^3h/mhlbOJQJU^J'j1h/mhlbOJQJU^J#h/mhlbOJQJ^JmHnHu'jH0h/mhlbOJQJU^J!jh/mhlbOJQJU^Jh/mhlbOJQJ^Jh,-hlbOJQJ^Jh,-hlb5OJQJ^J! 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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. 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