Asbestos Abatement Documentation
Contractor Information
Company Name
*
Contact’s Name
*
First Name
Last Name
Contact’s Email (or whoever should receive a copy of this completed form)
*
example@example.com
Contact’s Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Ohio EPA Asbestos Contractor License No.
*
Name of BGSU contact contractor is working with/for
*
Abatement Information
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Building or Structure Name
*
Room number or area if not inside a room
*
Location within room or area (i.e. northwest corner)
*
Asbestos building material(s) removed
*
i.e. 9x9 floor tile, pipe Insulation, fireproofing, etc.
System, if applicable (If not applicable, please put NA)
*
i.e. domestic cold/hot water lines, steam lines, etc.
Approximate quantity removed
*
Unit
*
LF, SF, fittings, etc.
Attach maps if necessary
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Documentation
Name of asbestos air monitoring firm if applicable (If not applicable, please put NA)
*
Attach Report(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Corresponding waste manifest number
*
Regulator visits?
*
i.e. OEPA, OSHA, etc. - attach reports
Attach Reports
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Other
Any issues or concerns encountered during the project? (If not applicable, please put NA)
*
Is there anything else worth mentioning about this project? (If not applicable, please put NA)
*
Submit
Should be Empty: