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Acoustic Ceiling 650 Linoleum <br />Ducting 0 Dry Wall <br />Mastic (Non friable) 0 Floor Tiles (Non -friable) <br />Stucco 0 Plaster <br />Mastic (Friable) 0 Floor Tile (Friable) <br />Transite (Damaged) 0 <br />Asbestos Amount to be Removed in Sq.Ft <br />FRIABLE <br />720 <br />CLASS I <br />300 <br />CLASS lI <br />0 <br />Total <br />1020 <br />Asbestos Removal From Surfaces <br />Asbestos Detection Procedure(s) Survey <br />Survey Information <br />Certified Asbestos Inspector Name MICHAEL S CUSHNER <br />Survey Plan Date 10/25/2021 12:00.00 AM <br />Email mcushner@ninyoandmoore.com <br />0 <br />Insulation <br />0 <br />Fire Proofing 0 <br />70 <br />NEPA Vacuum & wet wipe <br />0 <br />Porous Personal Possessions 0 <br />300 <br />TransEte <br />0 <br />Roofing 0 <br />0 <br />Other (Friable) <br />0 <br />Coal Tar Wrap 0 <br />0 <br />other (Non -friable) <br />0 <br />Contaminated Soil 0 <br />Control Procedures 1,3 <br />Certification Expiration Date 7/20/2022 12:00:00 AM <br />Phone Number (949)753-7070 <br />Emergency <br />Sudden Unexpected Event(s) Vandalism <br />Name of Person/Declaring DAVID RAMIREZ Phone (714)647-5641 <br />Authorizing the Emergency <br />Date of Emergency 2/3/2022 <br />Waste Information <br />Waste Transporter <br />BDC SPECIAL WASTE SERVICES <br />Address <br />1211 WEST GLADSTONE AVENUE <br />City <br />AZUSA <br />State <br />CA <br />Zip <br />91702 <br />Landfill <br />Azusa Land Reclamation <br />Address <br />1211 W Gladstone 5t <br />City <br />Azusa <br />State <br />CA <br />Zip <br />91702 <br />Fee Payment <br />Total Amount of Asbestos to be Removed in sq.ft 1020 <br />Tracking Number 3949415 <br />Project Size Fee 208.19 <br />Additional Fee 68.07 <br />Total Fee $ 276.25 <br />Payment Made $ 276.25 <br />Balance Due $ 0 <br />By clicking the Sign & Submit button, I certify that an individual trained in the provisions of SCAQMD Rule 1403 and the Asbestos NESHAP (CFR Title <br />40, Part 61, Subpart M) will be onsite during the demolition or renovation and evidence that the required training has been accomplished by this <br />person will be available for inspection during normal business hours. In addition, I certify that all of the information contained herein and information <br />submitted with this Notification is true and correct. <br />