Form 7077 R03 PDF Details

The IRS has released a new Form 7077, for employers to use when reporting employee travel and business entertainment expenses. This form is intended to help both taxpayers and the IRS in verifying that these expenses have been correctly reported. It is important to understand how this form works, and the various requirements that apply when using it. This article will provide an overview of the new Form 7077 R03, and explain some of the key things employers need to know about it.

QuestionAnswer
Form NameForm 7077 R03
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform aac 2 printable, form aac 2 print, louisiana notification demolition printable, louisiana aac 2 form

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ASBESTOS NOTIFICATION OF DEMOLITION AND RENOVATION FORM AAC-2

 

 

 

 

 

Louisiana Department of Environmental Quality

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OES – Public Participation and Permit Support Division, Notifications and Accreditations Section

 

 

 

 

 

 

 

PO Box 4313, Baton Rouge, LA 70821-4313

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone (225) 219-3244 Fax (225) 219-3310

 

 

 

 

 

 

 

 

Boxed Area for LDEQ Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AI No.

 

 

 

Note: Please type and complete all appropriate information

 

 

 

 

No. of ADVFs Requested:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ck/Voucher

 

 

 

Emergency

 

Revision - ADVF no(s) to be Revised ___________

Canceled - ADVF no _________

 

 

 

 

 

 

Elec Transfer No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I. Type of Notification: (check only one box)

 

 

 

 

Check if AAC-2 is for Nonscheduled Operations for repair or

 

 

Amt Received:

 

 

 

*Original

Additional-Latest ADVF no issued_____

 

 

maintenance less than 1 cubic yard of RACM per operation

 

 

 

 

 

 

 

 

 

 

Annual (Maintenance) Note Total Vol. Sec V as bin size

 

 

Postmark Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disposal Only (work performed in _____

year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADVF No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. Type of Operation: (check only one box)

 

 

 

 

 

Check being demolished under an order of a state or

 

 

 

 

 

 

DEMO (RACM or *if structure contains no RACM)

RENO

 

 

 

local government agency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check/Voucher Date

 

 

 

RENO & DEMO (RACM removal & subsequent demo)

 

 

 

 

Government Ordered

(Complete Sec. XIV)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III. FACILITY DESCRIPTION *

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Facility Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Project Designer La. Accred. No (schools &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

state bldgs only).

 

 

 

 

 

Physical Address:

 

 

 

 

 

City:

 

State:

 

 

Zip Code:

 

 

 

Parish:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Site Location: (Building no., Name, Floor, Room No. Etc.)

 

 

 

 

 

Telephone No. (

)

 

 

 

 

Building Size:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No. of Floors:

 

 

Age in Years:

 

 

 

 

 

 

 

Present Use:

 

 

 

 

 

 

Prior Use:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV. IS ASBESTOS PRESENT: *

 

YES

NO

 

 

 

Inspection Date: (MM/DD/YY)

 

 

 

 

 

Known or Assumed Asbestos

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inspector’s Name:

 

 

 

 

 

 

 

 

 

Inspector’s Accreditation No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Procedure including analytical method, if appropriate, used to detect the presence of asbestos material:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V. APPROXIMATE AMOUNT OF ASBESTOS INCLUDING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REMOVAL TIMES:

 

 

 

 

RACM/ CATEGORY I & II

 

 

 

 

 

 

 

*NONREGULATED ACM NOT

 

 

 

(Check Applicable Times)

 

 

 

 

 

 

 

TO BE REMOVED

 

 

 

 

 

 

 

TO BE REMOVED PRIOR TO

 

 

 

Business Hours

After Hours

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEMOLITION * (if applicable)

 

 

 

Weekends

 

Holidays

 

 

RACM

 

 

 

 

 

 

 

CAT I/CAT II

 

 

 

 

 

 

 

 

CATEGORY I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(packings, gaskets, resilient/vinyl/asphalt)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE MATERIAL TO BE

 

TSI

 

 

Ceiling

 

VAT

Transite

Piping

 

Type of Non-Regulated Asbestos

 

 

 

 

 

 

 

 

 

 

 

REMOVED

 

 

 

Fireproofing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VAT

 

Asphalt Roofing

 

 

 

 

 

 

 

Other______________

 

Other_____________

 

 

 

 

Other_________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RACM - UNIT OF MEASUREMENT

 

Linear Ft.

 

Square Ft.

 

Total Volume of all RACM

 

Amount of Non-Regulated Asbestos

 

 

 

(Type in Amount)

 

 

 

 

 

 

 

 

 

 

 

 

 

_____________ Cubic Yards (mandatory)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VI. FACILITY INFORMATION *

Owner Name:

Contact Name:

Telephone No.

Fax No.

Mailing Address:

City:

State:

Zip Code:

Email:

VII. ASBESTOS REMOVAL CONTRACTOR INFORMATION FOR RACM

Asbestos Removal Contractor Name:

 

LA Contractor’s License

On-Site Supervisor Name:

On-Site Supervisor Accreditation No.

 

 

 

No.

 

 

 

 

 

Mailing Address:

 

Fax No.

Contact:

Supervisor Exp. Date:

 

 

 

(

)

 

 

 

 

City:

 

State:

 

 

Zip Code:

Telephone No.

Email:

 

 

 

 

 

 

(

)

 

VIII. OTHER OPERATOR/DEMOLITION CONTRACTOR: *

Contact:

Telephone No. (

)

Mailing Address:

City:

State:

Zip Code:

Email:

IX. SCHEDULED DATES ASBESTOS REMOVAL (MM/DD/YY)

Start:

Complete:

X. SCHEDULED DEMO/RENOVATION DATES (MM/DD/YY)*

Start:

Complete:

Form_7077_r03 9/15/11

NOTIFICATION OF DEMOLITION AND RENOVATION FORM – AAC-2 (page 2-continued)

XI. SOLID WASTE TRANSPORTER TO LANDFILL FOR RACM

 

Name:

 

DEQ SW Transporter No.

Contact:

 

Telephone No.

 

 

 

 

 

 

(

)

 

 

 

Address:

 

City:

State:

Zip Code:

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

XII. SOLID WASTE TRANSPORTER ONLY IF TAKEN TO OFFSITE PREMISES AND STORED PRIOR TO DISPOSAL (RACM ONLY)

 

Name:

DEQ SW Transporter No.

Contact:

 

Telephone No.

 

 

 

 

 

 

(

)

 

 

 

Address:

 

 

City:

 

State:

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

Physical Location of Drop Off Area:

City:

State:

XIII. ASBESTOS WASTE DISPOSAL SITE FOR RACM:

 

Name:

Contact:

Telephone No.

 

 

 

(

)

 

 

 

Physical Location:

City:

State:

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

XIV. IF DEMOLITION ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY REPRESENATIVE:

 

Name:

Title:

Authority:

 

 

 

 

 

 

Date of Order: (MM/DD/YY)

Date Ordered To Begin: (MM/DD/YY)

Note: Copy of Order must be attached to this

 

 

 

Notification.

 

 

 

 

 

XV. EMERGENCY RENOVATIONS INVOLVING RACM:

Date

and

Hour

of

Emergency:

Description of the Sudden, Unexpected Event that must immediately be attended to:

(MM/DD/YY)

 

 

 

 

 

 

 

 

 

 

Section 5151.F.2.d.xv – Explain how the event caused an unsafe condition (or health hazard) or would cause equipment damage, or poses an unreasonable financial burden:

Section 5151.F.2.d.xv -- Description of procedures to be followed in the event unexpected RACM is found or Cat II nonfriable becomes crumbled, pulverized, or reduced to powder:

XVI. Description of planned non-RACM Demolition or RACM Renovation work and Methods to be used: *

XVII. I certify that the above information is correct and that personnel performing asbestos Demolition or Renovation activities are trained and accredited in accordance with LAC 33:III.5151; and that the evidence of the required training will be available on the project site for inspection by LDEQ personnel. (Sign Sec. XVII only if RACM is present)

____________________

__________________________________________

______________________

(Date)

(Signature of Owner or Operator/Contractor)

(Printed Name)

XVIII. * Certify in this Section For Demolitions Only if the Structure Contains No Regulated Asbestos Containing Material (RACM) I certify that the above information is correct and that during Demolition No Regulated Asbestos Containing Material is present.

____________________

__________________________________________

______________________

 

 

 

(Date)

 

(Signature of Owner or Operator/Contractor)

(Printed Name)

 

 

 

 

 

 

 

 

 

ADVF Fees:

$66

(Minimum of 10 working days notification given)

 

 

 

 

 

$99

for Emergencies (less than 10 working days notification given) No Voucher’s Will Be Accepted for Emergencies

 

 

 

*No Fee for Notification of Demo containing No RACM (Negative Declaration) may be faxed – Fax # 225-219-3310.

 

REMIT TO: LDEQ / OES – Permit Support Services Division, Notif & Accred Section, P. O. BOX 4313, BATON ROUGE, LA 70821-4313

Pursuant to La. R.S. 40.1574 A&B, be advised that no construction or renovation can begin until the plans and specifications are reviewed by the Office of the State Fire Marshall or it is determined by that Office that plans are not required to be submitted.

Form_7077_r03 6/09/10

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