Form Daqa 424 12 PDF Details

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.

QuestionAnswer
Form NameForm Daqa 424 12
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnotdemo utah division of air quality 10 working day notification form

Form Preview Example

See fee calculator at www.deq.utah.gov/eqair/haps/asbestos/index.htm

UTAH DIVISION OF AIR QUALITY

Postmark Date:

195 North 1950 West, 4th Floor

Initials:

P.O. Box 144820

Fee Received:

Salt Lake City, UT 84114-4820

Check Number:

10 WORKING-DAY NOTIFICATION OF DEMOLITION - no asbestos removed, no intentional burning

1 Fee

$75 +$50 for each 5,000 sq. ft. of floor space above 5,000 sq. ft.

$

2Facility Name

Address

City

 

 

County

 

 

Zip Code

 

Part of Facility Involved,( e.g. floor #, room #, area etc.)

 

 

 

 

Age of Facility

Size

 

 

# of Floors

 

 

 

 

 

 

 

 

Present use

 

Prior Use

 

 

 

 

 

 

 

 

 

 

 

 

3

Facility Owner/Operator Name

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

City

 

State

 

Zip Code

 

 

Contact Person

 

 

 

 

 

Phone Number

 

 

 

4

Demolition Contractor Name

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

City

 

State

 

Zip Code

 

 

Contact Person

 

 

 

 

 

Phone

 

 

 

 

5

Dates of Demolition

 

 

Start Date

 

 

 

Ending Date

6

Asbestos Inspection Information

 

 

 

 

 

 

 

Date of Inspection

 

 

 

 

Name of Utah Certified Inspector

 

 

 

 

 

 

 

ID Number

 

 

Name of Utah Certified Asbestos Company

 

 

 

 

ID Number

 

Analytical Method used for asbestos analysis

 

 

 

 

 

 

 

 

Is asbestos present?

 

 

 

 

Was it sampled or assumed?

 

 

 

 

 

 

 

 

7

Asbestos Containing Material to be left in the facility during demolition, (list types and amounts).

 

roofing

 

 

flooring

 

 

other

 

 

 

 

8Description of procedures to be followed in the event that unexpected RACM is found or generated during the project.

9

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

 

Date Rejected

 

Acts #:

 

Reviewers Initials

Rejection Comments:

 

 

 

 

 

 

DAQA-424-12

Revision 7/1/12