In the complexity of managing environmental concerns during construction and demolition activities, the role of regulatory compliance becomes paramount, as evident in the utilization of the Daqa 424 12 form. This document, integral to operations within the state of Utah, serves as a pivotal notification tool for entities engaging in demolition projects that do not involve asbestos removal or intentional burning. It mandates a working-day notification alongside a detailed fee structure, which escalates based on the square footage of the facility beyond an initial threshold. The form outlines specific requirements, including the facility's name, address, and detailed information about the structure's age, size, and use. Critical too is the identification of the facility owner/operator and demolition contractor, each required to provide comprehensive contact information. Dates framing the demolition project, alongside asbestos inspection details, including the presence or absence of asbestos, form a crucial part of the submission. Furthermore, the form anticipates scenarios where unexpected regulated asbestos-containing material (RACM) might be encountered, asking for detailed procedural outlines in such events. Importantly, the form serves not only as a notification but as a declaration of truthfulness and accuracy from the submitting party, underscored by a signature of assurance. The Utah Division of Air Quality, through this form, enforces a structured approach to demolition, emphasizing environmental safety and regulatory compliance, while also providing resources like a fee calculator to streamline the submission process.
Question | Answer |
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Form Name | Form Daqa 424 12 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | notdemo utah division of air quality 10 working day notification form |
UTAH DIVISION OF AIR QUALITY |
Postmark Date: |
195 North 1950 West, 4th Floor |
Initials: |
P.O. Box 144820 |
Fee Received: |
Salt Lake City, UT |
Check Number: |
10
1 Fee |
$75 +$50 for each 5,000 sq. ft. of floor space above 5,000 sq. ft. |
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2Facility Name
Address
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Part of Facility Involved,( e.g. floor #, room #, area etc.) |
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Age of Facility |
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# of Floors |
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Present use |
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Prior Use |
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Facility Owner/Operator Name |
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Demolition Contractor Name |
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Dates of Demolition |
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Start Date |
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Ending Date |
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Asbestos Inspection Information |
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Date of Inspection |
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Name of Utah Certified Inspector |
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ID Number |
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Name of Utah Certified Asbestos Company |
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ID Number |
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Analytical Method used for asbestos analysis |
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Is asbestos present? |
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Was it sampled or assumed? |
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Asbestos Containing Material to be left in the facility during demolition, (list types and amounts). |
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roofing |
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flooring |
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other |
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8Description of procedures to be followed in the event that unexpected RACM is found or generated during the project.
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attach additional sheets as necessary
I certify that the all the information in this notification is true and correct.
Signature of Owner/OperatorDate Print name and title of Owner/Operator
OFFICIAL USE ONLY!
Date Accepted |
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Date Rejected |
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Acts #: |
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Reviewers Initials |
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Rejection Comments: |
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Revision 7/1/12 |