Asbestos Abatement Project Form
 

Notice of Asbestos Abatement Project

Online version of f413-025-000

Printable instructions for how to use this form (PDF).

This notice must be received no later than 10 calendar days prior to the start date. Complete all applicable boxes. Incomplete notices will not be accepted.

To load a form you've already submitted, enter the form ID here:

Notice Date:
11/23/2009

Start Date:

Completion Date:

Initial

On Hold

Emergency

Site Work Hours

From:

(ex. 8:00 a.m.)

To:

(ex. 5:00 p.m.)

Su
Mo
Tu
We
Th
Fr
Sa

 
Project Dates and Work Hours must be Exact

Contractor

If you are the owner of the facility to be abated, choose "In House Work."

**NOTE: If your company is not listed, please contact L&I's Asbestos Program (360-902-5435; greb235@LNI.WA.GOV). You must be a active, registered Asbestos Abatement Contractor to use this form.

Job Site C.A.S.:

Your e-mail address: (example: myname@myisp.com)
(NOTE: Enter your e-mail address if you would like a copy of this form data.)

Your phone number:

Property Owner

Name:

Company:

Owner's Agent:

Address:

City:

State:

Zip+4:

Phone:
(ex.: 123-456-7890)

Job Site

Address:

Building Name:

Room:

City:

Zip + 4:

County:

Facility

Type:

Year of Construction :

Size:

Remodel

Repair

Demolition

Maintenance

 

Quantity of Asbestos to Be:

Removed Encapsulated

Quantity: (square feet)

Indoors Outdoors
Fireproofing Boiler insulation

Control Measures

Popcorn ceiling Duct paper Neg. pres. enclosure Wrap & cut
CAB VAT Glove bag Wet methods
Sheet vinyl Roofing Mini enclosure HEPA vacuum
Asbestos paper Other:
 Critical barriers Manual methods

Quantity: (linear feet)

Other:
Other:
Mag. pipe insulation Cement asbestos pipe

Respiratory Protection

Air cell pipe insulation Mudded pipe ins. 1/2 mask APR Type C continuous flow
Ducting/duct insulation Duct tape Full face APR Type C pressure demand
Other:
Other:
PAPR Other:

 

Any additional information? Provide it here:


Visit AccessWA, the WA State Gov Portal
© Washington State Dept. of Labor and Industries. Use of this site is subject to the laws of the state of Washington. Access Agreement | Privacy and security statement | Intended use/external content policy | Staff only link