DAQ-2024-008712

State of Utah
Department of Environmental
Quality Division of Air Quality
ATLAS Section195 North 1950 West, 4th Floor
P.O. Box 144820
Salt Lake City, Utah 84114-4820
[e-mail]
For Official Use Only
Postmark Date: __________________ Initials: _______
Check #/Credit Card Amount: _____________________
Notification ID: ____________________________
DEMOLITION NOTIFICATION FORM
A.Type of Notification (choose one)
Demolition or Moving a Building Notification Form
Intentional Burning Notification Form
Ordered Demolition Notification Form
Moving of a School Portable Classroom
Does this notification require an emergency form or alternative work practice request?
Document Types (Choose one)
CancellationInitial Filing Revision
Person Contacted at DAQ Date Phoned
Other:
B. Demolition Activity Location
Residential Structure Public/Commercial Building School
Structure Name
Structure Address
Part of Facility Involved (All or part, describe the part)
Year Built Total Facility Size # of Floors Total Demo. Size
Prior Facility Use Present Use Future Use
C.Facility Owner/Contact Person
Facility Owner Name
Facility Owner Address
Contact Person, Phone & Email
D.Demolition Contractor Information
Name
Mailing Address
Contact Person, Phone & Email
ASB #
ASBC #
F.Asbestos Inspection Report Information Utah *ACM is asbestos containing material
Certified Asbestos Inspector
Utah Certified Asbestos Company
Date of Inspection
Asbestos Analytical Method Used
Was ACM Present at the Time of Inspection Y/N
Was Regulated ACM (RACM) Present Y/N
Was the ACM Sampled or Assumed:
Date of Removal for Regulated ACM
G.Asbestos Containing Material to be Left in the Facility During Demolition
Roofing ft2 Flooring ft2 Other ft2 Other ft3
Materials that have asbestos coating or contain asbestos must not be recycled. This includes concrete that
has asbestos flooring and/or mastic.
Are you recycling concrete or other materials? Y/N Was the asbestos removed? Y/N
H.Procedures to be followed in the event that RACM is found or generated during demolition:
I.Comments
General Contractor Name, if applicable
Mailing Address
Contact Person, Phone & Email
E. Demolition Dates Start Date:End Date: Work Days: M T W Th Fr Sat Sun
General Instructions
This Form must be completely filled out with the appropriate fee and returned to the DAQ at least ten working days
before starting demolition activities. Start counting the ten working days after the day that the notification was of
submitted. This form can be emailed to [e-mail] and the fee paid by credit card at the DAQ Marketplace, click
on Step 3 or the form can be filled out and paid online once you receive a login at https://asbestos-lead.utah.gov. Request
access here: Atlas login request
If you use this form’s PDF fillable capability, please remember to save it to your desktop before closing or all
information will be lost.
The definition of “demolition” in UAC R307-801 Utah Asbestos Rule means, “…the wrecking, salvage, or removal of any
load supporting structural member of a regulated facility together with any related handling operations or the intentional
burning of any regulated facility. This includes the moving of an entire building, but excludes the moving of structures,
vehicles, or equipment with permanently attached axles, such as trailers, motor homes, and mobile homes that are
specifically designed to be moved.” Utah law requires you have a copy of the asbestos inspection report produced by a
Utah Certified Asbestos Inspector working for a Utah Certified Asbestos Company on-site and available at all times
when demolition activities are being performed.
A. Type of Notification•Intentional burning requires the removal of all asbestos containing material prior to demolition.
•Ordered demolition requires a signed letter on government letterhead saying the structure is unsound or in
danger of imminent collapse (from state, county, or city engineer) or a health hazard (from State Health Official
or Local Health Department Health Officer).
•Moving a school portable classroom specifically designed to be moved and has no asbestos containing material.
There is no fee.
•Revisions require section B, C, D and any additional section to be filled out. If the revision is sent before the
previously accepted start date, a phone call is not required. A phone call is only required when the date is
changed on the accepted start date.
B.Demolition Activity
Type of structure and facility use is important because different rules apply depending on the type and use. Include the
total facility size and the demolition size if the whole building is not being demolished. The fee is based on the actual size
of the demolished structures.
J. Demolition Notification Fee: Base Fee + Square Footage Fee
K. Certification Statement
I hereby attest and affirm that the information included on this Demolition Notification Form, including any
attachments, is true and accurate to the best of my belief and knowledge. I acknowledge that any approval authorized
pursuant to this notification will be subject to revocation if issuance was based on incorrect or inadequate information
that materially affected the decision to issue the demolition project approval. I also attest and affirm that I will follow all
work practice standards required by Utah Administrative Code (UAC) R307-801.
_______________________________________________________________________________________________
Applicant’s Signature Date Signed
_____________________________________________________________________________________________
Applicant’s Printed Name Applicant’s Title
Total Fee ______
$
Structure Type
Regulated Structure
Moving School Portable Classroom
Base Fee + Each 5,000 ft2 (or fraction thereof) Fee
$31.63 + (_____ x $63.25)=
$0 $0
J. Demolition Notification Fee
The fee is calculated by adding the base fee and a per unit fee of the total structure square footage. For structures
with multiple levels or floors, be sure to include the area of all levels (including subsurface levels) when
determining the total fee. The per unit fees are in blocks of 5,000 square feet or any fraction thereof. For example
a building that is 6,000 square feet would be calculated as follows: $31.63 + (2 x $63.25) = $158.13. The fee for a
building under 5,000 square feet is $94.88.
B.School definition: All public and non-profit private elementary and secondary schools must inspect all buildings that
they lease, own, or otherwise use as a school building. A school building includes any structure suitable for a classroom
or other school facility (i.e., laboratory, food prep/dining areas, athletic facilities, student housing, research, portico,
covered exterior hallway or walkway and any maintenance, storage, or utility facilities essential to the operation of any of
the school buildings listed above.
For a detailed definition, please refer to: 40 CFR § 763 Subpart E—Asbestos-Containing Materials in Schools
D.Demolition Contractor Information
If there is a general and a subcontractor, list both.
E.Demolition Dates
Specify the dates when you will actually begin and end the demolition activities. These are the days that you will start and
end the demolition (including the removal of all demolition debris) and it is NOT a window of opportunity when you
MAY be demolishing the structure. If necessary, estimate the end date using your best professional judgment and revise
the notification form, if necessary. Revisions can be made without charge. Include all days you will be working on the
project.
For revisions, if the new start date and work times are later than the original start date and work times, then notice by
phone, or electronic means shall be given as soon as possible before the start date and a revised notification form shall be
submitted in accordance with R307-801-12(10) as soon as possible before, but no later than, the original start date. If the
written notification form is received by the director no later than the day before the original start date and work times,
no notice by phone is required.
F.Asbestos Inspection Report.
If you have questions about filling out this portion, contact your asbestos inspector.
G.Asbestos Containing Material to be Left in the Facility During Demolition
If non-friable asbestos will be left in place, enter in the amounts. Any material that has asbestos coating or
contains asbestos must not be recycled.