ࡱ> #` ybjbjmm .u.###8*$$.fN%,,,,--3A6UMWMWMWMWMWMWM$ROhQv{M:--::{M,, N@@@:^8,,UM@:UM@@IMK,% P# ;^J4K6N0fNK40Rg;80RhMK0RMKT7{8|@8d[9P777{M{M@^777fN::::...#...#...  Lead Project Notification 2008 RevisionState 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 L Page 1 of 2  Important Notice: The notification submitter must submit a complete written notification to the Department at least 5 working days prior to the start of the abatement project, including set-up or on-site preparation activities. This notification must be typewritten or easily legible. An incomplete notification is not acceptable & therefore not of record. 1. Project Code  FORMTEXT       (Assigned by notification submitter) Type of Notification  FORMCHECKBOX  Initial (Original)  FORMCHECKBOX  Courtesy (Z)  FORMCHECKBOX  Lead Smart Renovation (R) Containment Level (Check all that apply)  FORMCHECKBOX  Level 1 (1)  FORMCHECKBOX  Exterior Work Area Preparations (3)  FORMCHECKBOX  Level 2 (2)  FORMCHECKBOX  Window Preparation Levels (4)  FORMCHECKBOX  Standard Variance  FORMCHECKBOX  Non-Standard Variance Lead Abatement Contractor Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      Facility Owner Name  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      Facility Location (Where abatement is to take place) BLDG Name  FORMTEXT       Floor and/or Rm.#  FORMTEXT       Physical Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Facility Description Present Use  FORMTEXT       Prior Use  FORMTEXT       BLDG Size  FORMTEXT       No. Floors  FORMTEXT       BLDG Age  FORMTEXT      Scheduled Dates for Lead Abatement Project Project Start Date (mm/dd/yy)  FORMTEXT       Project Completion Date (mm/dd/yy)  FORMTEXT       Project Work Days Weekdays (Check all that apply)  FORMCHECKBOX  M  FORMCHECKBOX  T  FORMCHECKBOX  W  FORMCHECKBOX  T  FORMCHECKBOX  F Weekend (Check all that apply)  FORMCHECKBOX  Sat  FORMCHECKBOX  SunProject Work Hours  FORMTEXT       AM to  FORMTEXT       PM (Show actual hours)Operation (Check all that apply)  FORMCHECKBOX  Interior Paint Removal (B)  FORMCHECKBOX  Encapsulation (J)  FORMCHECKBOX  Water (P)  FORMCHECKBOX  Exterior Paint Removal (C)  FORMCHECKBOX  Enclosure (K)  FORMCHECKBOX  Soil (S)  FORMCHECKBOX  Interior Window Removal (F)  FORMCHECKBOX  Component Removal (H)  FORMCHECKBOX  Exterior Window Removal (G)  FORMCHECKBOX  Carpet Abatement (Q) Lead Project Type (Check all that apply)  FORMCHECKBOX  DHS Ordered (A)  FORMCHECKBOX  Rental (F)  FORMCHECKBOX  MSHA Grant (B)  FORMCHECKBOX  Commercial (C)  FORMCHECKBOX  Other HUD (G)  FORMCHECKBOX  Industrial (I)  FORMCHECKBOX  Daycare (D)  FORMCHECKBOX  Public (H)  FORMCHECKBOX  Private Residence (E)  FORMCHECKBOX  Steel Structure (J) ME DEP USE ONLY ______ Mailed ______ FAX ______ Hand Delivered Date Received ________________________ Lead Project Notification 2008 RevisionState 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 L Page 2 of 2Project Code  FORMTEXT       (As listed on page 1) 13. Occupant Location  FORMCHECKBOX  Inside building but outside work area  FORMCHECKBOX  Outside building but returning at day s end  FORMCHECKBOX  Outside building until all work is completed (relocated)Design Consultant (complete as applicable) Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      Lead Inspection (ME licensed Lead Inspector) Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  *        ` ƿӧӠӖpӠjhybCJUmHnHuj*hybhV3CJU hybCJjhybCJU hV35CJ hV35CJ hybhV35CJ hV3>*CJ hV35CJ4 hV35CJ0 h'}CJ hV3CJh/hyb5h/hV35 hV3CJ hV35CJ hV3 hV3CJ '*9`$If$If $$Ifa$ $$Ifa$$If$If$Ifwyy yyy$Ifkd$$IflF$ n$+ Jb0    4 la  ^ `  ; < e f $If & F$If$If\kd$$Ifl4+<,04 laf4      ; < N d e f g u v w ٻ١ߡӊ߄߄tٻijhV3UjnhybhV3CJU hrCJjhybhV3CJU hV35CJ hV35CJhV3jhV3UhybjhybUjhybhV3CJU hybCJ hV3CJ hV3CJjhybCJUjhybhV3CJU'f + , } ~  pf] dh$If & F$Ifkd$$Ifl4Fpd+ l0    4 laf4$If$If + , - ; < = T U c d e } ~     "68:DF`bʿʴʮqaqjhybhV3CJUjhybCJUmHnHujdhybhV3CJU hybCJjhybCJU hV35CJ hV3CJ hV3CJ j@h MUjh MUh/jh/Uh/h/CJ aJ jVhV3UhybjhybUhV3hr&H8 TD&(ylkd $$Ifl0+804 la & F$If$If dh$Ifbvxz&(*46NPdfhrtztm hV35CJ hV3CJ j hybhV3CJUj hybhV3CJUjhybhV3CJUj4hybhV3CJUjhybhV3CJU hV3CJjhybCJUmHnHujhybCJUjLhybhV3CJU hybCJ*,.BDFPRln246@BZ\tjR hybhV3CJUj hybhV3CJUjf hybhV3CJUj hybhV3CJUjz hybhV3CJUjhybCJUmHnHuj hybhV3CJU hybCJjhybCJU hV3CJ hV3CJ -\prt~&(DFZ\^hj "68:ʭ}mjhybhV3CJUj2hybhV3CJUjhybhV3CJUjFhybhV3CJU hV35CJ hV3CJ j> hybhV3CJU hV3CJjhybCJUmHnHujhybCJUj hybhV3CJU hybCJ*(l 2~ PRplkdX$$Ifl0.+04 la dh$If & F$If$If dh$If :DF\^rtv   "$.02VXlnpz|~ںഭږ{mjhybUmHnHujhV3UhybjhybUhV3j hybhV3CJU hV35CJ hV35CJ hV3CJ jhybhV3CJUjhybhV3CJU hybCJ hV3CJjhybCJUjhybCJUmHnHu' (*>@BLNPR@V\^rtvɹɩϛɅuϕj`hybhV3CJUjhybhV3CJU hV3CJ hV35CJ hV35CJ jhybhV3CJUjlhybhV3CJU hybCJ hV3CJjhybCJUmHnHujhybCJUjhybhV3CJU.Rprtqkd $$Ifl40+j`04 laf4 dh$If$If & F$If   8:<@HJfhjnvx,.04BD`bٓ|ljhybhV3CJUj$hybhV3CJU hV35CJ hV3CJ jhybhV3CJUj8hybhV3CJUjhybhV3CJUjLhybhV3CJU hV3CJjhybhV3CJU hybCJjhybCJU*bdhnpr&(*,@lnprKLZ[\hiuj&hybhV3CJUjhybhV3CJUj:hybhV3CJUj#hybhV3CJUjhybCJUmHnHujhybhV3CJU hV35CJ hV35CJ hV3CJ hV3CJ hybCJjhybCJU.r(*,nphi}ttt dh$Ifqkd$$Ifl40+j 04 laf4$If & F$If ijxyz   '()`aopq "#ٓsٓojo hV35hV3j`hybhV3CJUjhybhV3CJU hV3CJ jthybhV3CJUjhybhV3CJUjhybhV3CJUjhybhV3CJU hV3CJjhybhV3CJU hybCJjhybCJU)#$lmOP`a $$Ifa$ dh$If  & F$If\kd$$Ifl4+<,04 laf4$If#$%345pq  JKYZ[lmn|}~ԮԄtdj"hrhV3CJUj!hrhV3CJUjhrCJUj0!hybhV3CJUj hybhV3CJU hrCJjD hybhV3CJUjhybhV3CJU hV3CJjXhybhV3CJU hybCJjhybCJU hV3CJ '~()789OP`arzs hV35CJ hV35CJ4 hV35CJ0 h'}CJh/h'}5h/hV35 hV3CJ hV35CJ hV35hV3 hV3CJ j~#hrhV3CJUj#hrhV3CJUj"hrhV3CJU hrCJjhrCJU hV3CJ-ap|~|vv$Ifqkd#$$Ifl4T 0 +V! 04 laf4$If dh$If Gr$If$If$If $$Ifa$ $$Ifa$$If  : < j l ^!`!yyyyyyyyssss$If$Ifkd$$$IflF$ #* ^b0    4 la   < h j l n !!^!`!b!~!!!!"L"N"P"d"f"z"|"~""""""ɼ¼{j'h'}hV3CJUj&hV3Uj2&hV3UhV3j%hV3Uh'}jh'}U hV3CJ hV35CJ hV3CJjh'}CJUmHnHujF%h'}hV3CJU h'}CJjh'}CJU*`!!N"P"""z##,$.$$[kd*$$Ifl44Fp* 0    4 laf4 dh$If$If & F$If$If """"""""""####0#2#4#>#@#R#T#h#j#l#v#x###############$$$ɹɩəɉyj)h'}hV3CJUjl)h'}hV3CJUj(h'}hV3CJUj(h'}hV3CJUj (h'}hV3CJU h'}CJ hV3CJjh'}CJUmHnHujh'}CJUj'h'}hV3CJU*$$$($*$,$.$N$$$$$$$$$$$$$$$$$$%%.%0%2%<%>%T%V%j%l%n%ýϽ}m]j,h=hk"CJUjl,h=hk"CJUj+h=hk"CJUjh=CJUmHnHuj+h=hk"CJU h=CJjh=CJU hV3CJ hV35CJ hV35 hV3CJ jh'}CJUmHnHujh'}CJUjX*h'}hV3CJU$$$$%%%ffffffggNgPgxgzg & F$If dh$If$Ifn%x%z%%%%%%%%%%%%%%%&fffff f*f,f>f@fTfVfXfbfdffffffffffffgggںڨژ摊tj0/h=hk"CJU hV3CJ hV35CJ hV35CJ j.h=hk"CJUjD.h=hk"CJUUj-h=hk"CJUjX-h=hk"CJU h=CJ hV3CJjh=CJUjh=CJUmHnHu-  FORMTEXT       FAX  FORMTEXT      Project Clearance Visual assessment by: (Lead Inspector)  FORMTEXT       Dust Testing by: (Lead Inspector)  FORMTEXT       Waste Transporter Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      Disposal Site Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      19. Important Notice to Lead Abatement Contractors Concerning this Notification A weekly updated schedule for each lead abatement project shall be faxed to the Department each Monday morning until the lead abatement project is complete. Lead Abatement Contractors are expected to be on-site for all work days for the dates set forth in this notification. The contractor must notify the Department no later than 24 hours prior to any change in schedule. Whenever there is a lapse in abatement activity at a project site of more than 10 days, a new project notification must be submitted to the Department. A single project notification may be submitted for multi-unit projects provided there is not a lapse of abatement activity of more than 10 days between units and the Department is sent a weekly work schedule. Certification (Notification Submitted by) I certify that to the best of my knowledge, the information contained in this notification is true and accurate, and that the lead abatement contractor will be/has been contracted to implement work practices as required by Maine DEP Chapter 424, Lead Management Regulations. _________________________________________________  FORMTEXT       Signature Print Name Date  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT             FILENAME \p H:\BRWM\Solid Waste Division\Lead & Asbestos\FORMS\Lead Applications\Lead Applications 2007\Lead Notification Form L.dot g*gNgPgRgfghgjgtgvgxgzg|gggggggggggghh hhh0h2hFhHhJhThVhlhnhhhhhhhhܠܐ܀pj2h=h=CJUj1h=h=CJUj.1h=h=CJUj0h=h=CJU hV35 hV35CJ jh=CJUmHnHuj/h=hk"CJU h=CJjh=CJU hV3CJ hV3CJ hV35CJ,zg|gggghhi~iiiij}qqqqh}qq $Ifgd= dh$Ifgd=$If & F$Ifqkd0$$Ifl4O0*04 laf4 hhhhhhhhhhhiii i4i6i8iBiDiViXilinipizi|i~iiiiiiiiiiiijjjj|lj4h=h=CJUjh4h=h=CJU hV3CJ hV35CJ hV35CJ j3h=h=CJUj|3h=h=CJUj3h=h=CJUjh=CJUmHnHujh=CJUj2h=h=CJU h=CJ*jj*j,j@jBjDjNjPjfjhj|j~jjjjjjjjjjjjjjjjjkkk.k0k2kkPkRkfkhkjktkvkzky hV3CJ j7h=h=CJUj,7h=h=CJUj6h=h=CJUj@6h=h=CJUj5h=h=CJUjh=CJUmHnHujT5h=h=CJU h=CJjh=CJU,jjkxkzkllXmZm oo>p@pxrrhrhrhr & F$If$Ifqkd8$$Ifl40*04 laf4 $Ifgd= dh$Ifgd= zklllXmZm oo>p@pqqq:r@> Heading 1$$@&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>*CJDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List <B@< Body Text$a$5CJ6P@6 Body Text 2CJ@Q@@ Body Text 3$a$5CJ4@"4 Header  !4 @24 Footer  !HBH 1L Balloon TextCJOJQJ^JaJ*9`bcduv ;<ef+,}~/M5S67YZ  ' E F G h i   : ; ? @ !-DESlmot|#NOTYZfgtuv23@^]{*+?@ASTrBPQo?@/0  tuv/rstuwxz{}~    000000 000000 00000 0000 000000  00000000  00000000 0 0000000  0000000 0 0000000  000000 0l 00000  0000000 0 000  0 0 0 00000000 0 0 000000000 00000000 0000000 000000 0000 0000000 0000000  0000000 0 0000000  0000000000 0 0000000  0000000 000 00 00 00 00 0 0000000000000 000A00A00A00A0@000 0mTmT  b\:bi#~"$n%ghjzkvwy !#$&()-/02=?@BDF f (Rra`!$zgj@pZvyy"%'*+,.1>ACEGyvfv ,<Td '-9EKXdjt!-3?KQ^jpz".4AMS_kqz #/5EQW' 7 > N U e l |   & , i y  * e u  ! ; K ! 1 @ P .ov3C",8>JV\iu{!-9?IU[gsy+7=^jp{$.:@[gmx!+7=  '-:FL^jpFG G G G G G G G G FFFFFFFFFFFFFFFFFFFFFFFFFFFFFG G G G G G G FFG G G G G G G G G G G G G G G G G G G G FG G G FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 8@0(  B S  ?bText1Check1Check2Check3Check4Check6Check5Check7Check38Check39Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12Text13Text14Text15Text16Text17Text18Text19Text20Text21Text22Text23Text24Text25Text26Text27Text28Text29Text30Check10Check11Check12Check13Check14Check8Check9Text31Text32Check15Check16Check17Check18Check19Check20Check21Check22Check23Check24Check25Check26Check27Check28Check29Check30Check31Check32Check33Check34Text33Check35Check36Check37Text34Text35Text36Text37Text38Text39Text40Text41Text42Text43Text44Text45Text46Text47Text48Text49Text50Text51Text52Text53Text54Text55Text56Text57Text58Text59vf-U9Xt!@^z#A_z$F' > U l  i  e  ; ! @ ov3,Jj-Jh,:^  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`aw =e.Lk4Rq5Tr6X8 O f }  - z + v " L 2 Q /D#?]|"@\z>.Mq +o,d-.z/<012x34t5y6t33   88""   9 *urn:schemas-microsoft-com:office:smarttagsplace9 *urn:schemas-microsoft-com:office:smarttagsState8 *urn:schemas-microsoft-com:office:smarttagsCity>*urn:schemas-microsoft-com:office:smarttags PostalCode 4  uuwwxxz{}~  uuwwxxz{}~  vfw *|.9LXkt!4?R^qz"5AT_rz#6EX' 8 > O U f l }   - i z  + e v  " ; L ! 2 @ Q /oIMv3D#,?J]i|"-@I\gz+>TAQ>.:M^qtuuwwxxz{}~ uuwwxxz{}~  <[ ` ]I(u^ W qE=< 0 m22  V7 sDB QvDLNBJ u#K chzU XX P` 3{g M}p 9RvzCBk {q<{ y| #;}K}Xf]hh^h`o(.hh^h`o(.hh^h`5o(.hh^h`5o(.hh^h`o(.hh^h`o(.hh^h`5o(. hh^h`OJQJo(hh^h`o(.hh^h`o(hh^h`o(. hh^h`o(.hh^h`o(.hh^h`o(.hh^h`o(.hh^h`o(.hh^h`o(.>^`>o(()hh^h`o(()hh^h`o(.hh^h`o(.hh^h`5o(.hh^h`5o(.9Rv`XXk {K}QvD W m2]I#;}u#K<[chzU<{BJsDB3{g=<P`0M}p V7y|r=k"Hz/V31Lybr/rp^'} MZs S*cd<~YZ E F G lmoOfg@AB?@uvstuwz} @ TeqTTT p@p p@pppppp4@p p"p$pfUnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma"1h4Æ4Æ]f?63?63q4dgg2HX ?yb*Asbestos Steve ZayszlyKaren M. Andersonh                  Oh+'0 , L X d p| AsbestosSteve Zayszly forml.dotKaren M. Anderson2Microsoft Office Word@F#@s@ڶu@ڶu?6՜.+,0  hp   Environmental Protection, Maine3g'  Asbestos Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHJKLMNOPQRSTUVWXYZ[\]^_`abcdefgijklmnopqrstuvwxyz{|}~Root Entry F@3Data I=1TablehRWordDocument.SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q