Illinois Form Apc 430 PDF Details

Do you need to fill out the Illinois Form APC 430? This form can be overwhelming, especially if you haven’t completed one before. Filling out this specific type of form accurately and efficiently is critical for managing your tax filing obligations in the state of Illinois. In this blog post, we'll discuss what Form APC 430 is and explore helpful tips on how to properly complete it. We'll also cover some common mistakes people make when filling it out and provide resources for getting assistance with filing these forms should you need additional help understanding their contents or completing them correctly. With a little guidance, you can confidently submit your forms with peace of mind that all necessary information has been stated correctly!

QuestionAnswer
Form NameIllinois Form Apc 430
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesresource3_DemoR eno form iepa form apc430

Form Preview Example

REC. NO. NOTIFICATION OF DEMOLITION AND RENOVATION

IL 532 1296 APC 430

Illinois Environmental Protection Agency

P.O. Box 19276, Springfield, IL 62794-9276

Rev.06/03

THIS INFORMATION IS REQUIRED; NESHAP-40CFR-SUBPART M-61.145, Rev. Nov. 20, 1990

ALL SECTIONS MUST BE COMPLETED TO AVOID NOTICE VIOLATION

1.TYPE OF NOTIFICATION (O-Original/R-Revised/C-Canceled):

2.TYPE OF OPERATION (R-Renovation/D-Demo/A-Annual/O-Ordered Demo/E-Emergency Renovation):

3.FACILITY DESCRIPTION (Building Name):

Address:

City:

 

County:

 

 

State:

 

ZIP:

 

 

 

 

 

 

 

Location of Asbestos Containing Material (ACM) in structure:

 

 

 

 

 

 

 

 

 

 

 

 

Bldg. Size:

 

# of Flrs.

 

Age:

Present Use:

 

 

 

 

 

 

 

 

 

 

Prior Use:

 

Future Use (Demo):

 

 

 

 

 

 

 

 

 

 

4. IS ASBESTOS PRESENT?

Y N

5. WORK HOURS:*

a.m.

 

p.m.

 

 

 

 

 

6. SCHEDULED DATE DEMOLITION:

 

Start:

Complete:

 

 

 

 

7. SCHEDULED DATE ASBESTOS REMOVAL:

Start:

Complete:

 

 

 

 

 

8. REGULATED ASBESTOS

 

NONFRIABLE ASBESTOS NOT

NONFRIABLE ASBESTOS TO BE

 

TO BE REMOVED (Demolition):

REMOVED:

 

 

CONTAINING MATERIAL TO BE

 

 

 

 

 

 

 

 

REMOVED (RACM):

 

CATEGORY I

 

CATEGORY II

CATEGORY I

 

CATEGORY II

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pipes (Ln. Ft.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surface Area (Sq. Ft.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Volume (Cu. Ft.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. ASBESTOS REMOVAL CONTRACTOR:

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

State, Zip:

 

Contact:

 

 

Phone:

 

 

 

 

 

 

 

 

 

10. DEMOLITION CONTRACTOR:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

State, Zip:

 

Contact:

 

 

Phone:

 

 

 

 

 

 

 

 

 

 

11. OWNER NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

State, Zip:

 

Contact:

 

 

Phone:

 

 

 

 

 

 

 

 

 

 

12. WASTE TRANSPORTER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

State, Zip:

 

Contact:

 

 

Phone:

 

 

 

 

 

 

 

 

 

 

13. WASTE DISPOSAL SITE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

City:

 

 

 

 

 

 

 

 

State, Zip:

 

Landfill Permit #:

Phone:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-AGENCY USE ONLY-

 

 

 

Date Received:

Input to ACTS:

 

To Region 1 2 3

 

 

 

 

 

 

 

 

Post Mark Date:

To Cook/City:

 

Champaign:

 

LaSalle:

 

 

 

 

 

 

 

Springfield:

Rockford:

 

 

Moline:

 

Marion:

 

 

 

 

 

 

 

 

 

14.PROCEDURE, INCLUDING ANALYTICAL METHOD, USED TO DETECT THE PRESENCE OF ASBESTOS.

ILLINOIS LICENSE NUMBER OF INSPECTOR: NAME OF ANALYTICAL TESTING LABORATORY:

15.DESCRIPTION OF PLANNED DEMOLITION OR RENOVATION WORK:

METHODS TO BE EMPLOYED INCLUDING DEMOLITION OR RENOVATION TECHNIQUES.

16.DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO PREVENT EMISSIONS AT THE DEMOLITION OR RENOVATION SITE:

17. IS DEMOLITION ORDERED BY A GOVERNMENTAL AGENCY?

Y N (If Yes, a signed copy of Order must be attached.)

 

 

Governmental representative ordering the activity:

 

 

 

 

Title:

Date of Order:

Ordered Demolition Date:

18.FOR EMERGENCY RENOVATIONS: Date and Hour of Emergency:

Description of the Sudden, Unexpected Event (e.g. structure in danger of eminent collapse):

19.DESCRIPTION OF PROCEDURES TO BE FOLLOWED IN THE EVENT THAT UNEXPECTED ASBESTOS IS FOUND OR PREVIOUSLY NONFRIABLE ASBESTOS MATERIAL BECOMES CRUMBLED, PULVERIZED, OR REDUCED TO POWDER.

20.I CERTIFY THAT AT LEAST ONE REPRESENTATIVE, TRAINED IN THE PROVISIONS OF 40 CFR PART 61, SUBPART M, SHALL BE ON-SITE DURING DEMOLITION OR RENOVATION, HAVING IN HIS OR HER POSSESSION, FOR INSPECTION, EVIDENCE THAT THE REQUISITE TRAINING HAS BEEN ACCOMPLISHED.

I CERTIFY THE ABOVE INFORMATION IS CORRECT.

Signature of Owner/Operator Date

(Original Signature Only, Photocopy Not Valid)

A FILING FEE OF $150 MUST BE PAID WITH EACH INITIAL 10-WORKING DAY NOTIFICATION REQUIRED BY THE ASBESTOS NESHAP. MAKE CHECKS PAYABLE TO ILLINOIS EPA AND MAKE NOTATION THAT IT IS FOR THE 10-WORKING DAY NOTIFICATION FEE. CASH AND CREDIT CARDS ARE NOT ACCEPTABLE. IF THE FEE IS NOT SUBMITTED WITH THE NOTIFICATION, THE NOTIFICATION WILL BE DEEMED IMPROPERLY FILED.

*Not required under NESHAPS.

Mail this form to: IL Environmental Protection Agency, Attn: Asbestos Unit, P.O. Box 19276, Springfield, IL 62794-9276

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