When it comes to conducting demolition or renovation projects that may involve disturbing asbestos-containing materials, the importance of thorough planning and regulatory compliance cannot be overstated. This is where the APCD 272 form plays a vital role, specifically within the Louisville-Jefferson County Metro Government jurisdiction. It's designed to ensure that any such projects are carried out safely, minimizing the release of asbestos fibers into the environment. The form requires detailed information, starting from a basic notification at least ten working days before the commencement of work, to specifics about the facility, the abatement contractor, and the waste disposal plan. By submitting this form, facility owners or operators, along with contractors, affirm their commitment to adhering to safety standards and regulations, including the National Emission Standards for Hazardous Air Pollutants (NESHAP) guidelines and local ordinances. The document covers everything from the type of project—be it demolition, renovation, or emergency work— to the presence of asbestos, detailed descriptions of the abatement procedures to be used, and contingency plans for unforeseen circumstances. It acts not just as a permit application but as a blueprint for conducting environmentally responsible asbestos abatement.
| Question | Answer |
|---|---|
| Form Name | Apcd Form 272 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names |
AIR POLLUTION CONTROL DISTRICT
850 Barret Avenue, Suite 205, Louisville, KY
(502) |
Fax: (502) |
ASBESTOS DEMOLITION & RENOVATION NOTIFICATION FORM
This form is to be filled out and filed with the District at least ten (10) working days before starting the asbestos removal or other work which would disturb the
Type of Notification: NESHAP, GLOVEBAG, or CATEGORY I/II
Notification per 40 CFR 61.145(a)(2) (less than reportable quantity)
Check one: Initial Notice |
Revision - |
Revision # ___ (Circle changes on form) Permit No. |
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Office Use Only: |
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Date Notification |
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1. FACILITY OWNER or OPERATOR: |
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2.LOCATION of PROJECT: Name of Site/Building:
Address:
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State: KY |
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Abatement location (building, room, roof, etc.) |
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Year Built: |
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Size: |
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Number of Floors: |
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Present use: |
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Prior use: |
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3. ABATEMENT CONTRACTOR Name: |
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Kentucky Certification No: |
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Expiration Date: |
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/ / |
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4. RESPONSIBLE FOR PERMIT (billing): Name: |
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Page 1 of 3
APCD Form 272, Revised 09/08/1993. 02/15/2001, 07/01/2001, 03/18/2003, 06/20/2011
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7. TYPE of PROJECT: |
Planned Renovation |
Long Term |
Blanket |
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Emergency Renovation (attach a description of the applicable event)
Demolition (no asbestos) Demolition (asbestos) |
Ordered Demolition (attach order) |
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8. Scheduled start date: |
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8A. Scheduled completion date: |
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9. Asbestos present? |
Yes No |
Survey conducted? Yes |
No |
Performed by: |
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(circle one) |
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(circle one) |
Attach a copy of the survey. |
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10. Amount and type of material to be removed: |
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Amount In |
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Friable: All |
Category I/II |
Type of Material |
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Linear feet |
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Square Feet |
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Cubic Feet |
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11.Disposal amounts from project in cubic yards of waste:
12.Disposal schedule:
13.Asbestos type & percent (i.e. 10% Chrysotile, etc.):
14.Detailed description of the planned project:
Page 2 of 3
APCD Form 272, Revised 09/08/1993. 02/15/2001, 07/01/2001, 03/18/2003, 06/20/2011
15. Abatement procedures used to comply with Regulations 5.04 & 5.13:
(Check all that apply and include details below)
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Asbestos Removal |
Containment |
Remove Intact |
Wet Methods |
Rotating Blade Cutter |
Strip and Removal |
Mechanical Chipping |
Glove Bag |
Component Removal |
Other (Explain below)
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Demolition |
Negative Pressure |
Bulldozer/Loader |
Full Containment |
Wrecking ball |
Mini Containment |
Implode |
Dry removal * |
Live Burn Training * |
* Must obtain prior approval from District before using this method
16. Contingency plan to address any additional ACM discovered during demolition/renovation:
17. Name(s) of Trained Supervisory Person(s) in attendance during abatement:
18.I certify that at least one trained person listed on contractor's Kentucky issued certificate will supervise the abatement work described herein.
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Signature |
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Representing |
19. Notification information submitted and certified by:
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Signature |
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Date |
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Phone No. |
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Name (Person, typed or printed) |
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Title |
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Representing |
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Information supplied in this Notification shall serve as an application for a District permit to perform an asbestos abatement project at an affected facility.
Attach additional sheets if necessary.
Page 3 of 3
APCD Form 272, Revised 09/08/1993. 02/15/2001, 07/01/2001, 03/18/2003, 06/20/2011