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South Coast Air Quality Management District <br />Rule 1403 Procedure 5 <br />Content/Property Release/Waiver <br />This release/waiver applies to non -building materials (building contents, personal property, etc.) that have been deemed <br />"asbestos contaminated" by a Certified Asbestos Consultant (CAC) in a Procedure 5 Clean -Up Plan submitted to the <br />SCAQMD for Review and Approval. This release/waiver is required to be signed by the property owner if the CAC <br />identifies asbestos -contaminated non -building materials, and the Procedure 5 Clean -Up Plan will not be approved if it is not <br />signed by the contents/property owner and included. <br />Asbestos is a naturally occurring mineral fiber that has properties of tensile strength and fire resistance. Asbestos has been <br />a useful product in building materials. Some amounts of asbestos fibers are present virtually everywhere in local outdoor <br />environments. Use of asbestos was never banned in the manufacturing building materials and products in the United States. <br />Asbestos fibers that were used in the building materials of your structure were disturbed. Your personal property has been <br />exposed to asbestos, and has been deemed contaminated as a result. <br />Specialized cleaning may reduce the levels of asbestos on/in your contents/possessions. Even after specialized cleaning is <br />performed and scientific testing indicates that levels of asbestos are reduced or are low, your contents/personal property <br />are not guaranteed to be 100% free of asbestos fibers. <br />Exposure to asbestos can present an increased risk for lung disease, asbestosis, lung cancer, and Mesothelioma. Health <br />effects from the exposure to asbestos may not surface for as many as 30 to 40 years. <br />The Procedure 5 Clean -Up Plan for this project will not be approved unless the owner of asbestos -contaminated personal <br />property initials all of the items below that apply, and signs the waiver/release. <br />I understand that my personal property has been contaminated with asbestos and cannot be 100% <br />decontaminated, and wish to have these asbestos -contaminated items disposed properly. <br />Even though my personal property cannot be 100% decontaminated, I understand the information presented <br />above and I wish to accept my personal property and contents after specialized cleaning by a Licensed <br />Asbestos Contractor that is registered with DOSH is performed and scientific testing by a State Certified <br />Asbestos Consultant has been completed and met the clearance criteria. <br />I understand that my personal property have been deemed asbestos -contaminated, and I wish to accept my <br />personal property and contents as is. <br />By signing below, the owner of the personal property and/or contents (as defined in the Procedure 5 Clean -Up Plan) hereby <br />releases the abatement contractor and its employees, the Certified Asbestos Consultant company and their employees, and <br />the South Coast Air Quality Management District, its executive officers and employees, from any and all claims, suits, <br />liability and future liabilities involved with and related to asbestos as it applies to the personal belongings and contents. <br />Signature: <br />Kristine Ridge, City Manager <br />Printed Name: <br />20 Civic Center Plaza, Santa Ana, CA <br />Address: <br />Date: Yl17&z� <br />