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J� ':L� i�` . � , � � 1 �,_ ... , �° � u g Sutg�it f�rm fq; '�O�" �pCp �� � ��� � �� � 1 � � !'�� �I � ' ���1 � � PermitCoordinato�. hw : ,• ��;: . +(� '�,, � � � �� �xp ��a �� � �� ���� � � � � � Coforado Dept. of Public Health �' q. ;.: ��Z��:'y�t ��.� and Envlronmenl [� ; � �, , APCO-SS-Qt , �. r� �r. �� * � F'�� NIUST �CC�MPAIVY �HIS FORM . 4300CherryCreek l7rive South � �_� � � �% INCOMPL�T� /�PPI..IGAT101VS WIL.I. BE f�iEl'UF2N�D . �enver, eoaozas-�s3o � � f$7.� �' � {Permit will be mailed to abalement contractor uniess s eclfled otharwise Phone: 3a3-69?_-314d p � Fax; 303-7a2-0278 F�errnit °fy�e 34p��y �O�D�y �o�e=Y+��r Plotic� �r�iy �°r�r►sfer � Gourt�sy Notice � _._ . . ._ — _ _._ ... _ . . _. ----__ .. _ � __.. .. , . _.---- ___ �. ... , __ Sinyle-Family Residontial Uwefling ONLY � hjp ��@ > 50 LF or 32 SF or a 55-yaf, drum, bu4 �a�� ��7� ���� . �J� : ��� 5 264 LF or 160 SF or a 55-gal. drum Okay to Fax -----..._.__.._. . _ � -- - _. . . . _._ ..____ _ .� � ------.. .. .._..-- --I-��. .._. ---- ---- - ----- --- ----- - .. Pu61ic & Commerciaf, School, end Singie• �q ��@ Family f�esidantial �well�ng Building ;� ��7� ���Q ���� ' ��� �Q'� 6kay 4o Fax >260 l � or 160 SF or a 55-c�al, drum � Company Name Buflding Name � IIudspetti & Associat�s, Inc. Itesidetttia ( Home � —___ . _._ . T—..._._ _ _ ------�—._ _ ._�— _._ ___.__. . _._ � StreSt � Speo(fy IqCaUon In the bullding where work will take place (6.g. OoOr, room, Wing, efc.) � 14 Invez�aess �r. E. Ste. l� i24 � Izlterias• Walls and cei(ings _._ _ __.__ __.. ..._ --- � Ciry _ . . - _ . --..^� � State _ . Zip Oode � StreeY � En�Iewaod CO I 80112 � � � 327 S � rearnside Ca. .rc �. e � __.._ ....�_�-- _ .J_^...__ . . . • � Telephona With Area Gode Colarada GAC PJumber � City �� � � , State County 7ip Codo � 3Q3 79I - 5562 84- 1488347 � ! V�il ( �O �:a�le �—_ � Project Supervisor �Goloraclo Cert. Number t 6ufiding Contaet ielephona with �rea Coria Building ConiaC4 PBPSOn � I Ricarclo C:havez ! 023 ' 970�4% 1 -2919 .�e4'f Peteraon Landfill Name Owner's Nam� � Denver Arap�hoe Dispost�) Situ _T _ �° � Jeif' I'eterson _ ---- -- � � ... .... _.. _._..- ----______._. .. _..._. ._..--�_.-- . _.._ ..-- � � Street � � 5treet °°° I 350Q S. Gi�n Club RT7. � � 3033 �ast 15t �ve. Suite 4 l5 � ---.-- ... __. i Stafe ----- °Zip Code _ ` � � City __ . . ... . __._._ ._ ___._ Siaie ZiP Code City .. __ . _. . . . __ __ C N � Aurora � C� 8001 �-41 U2 "� � Denver CU � 8U2UC .—._... _ __ -- - -- -----. _ . ..._.. . .. . . .. --- .._. . --1----�- - �y � Telephone With Area Cods � � 7slephone With Area Cade : 303-690-4303 974-Lb71 -2919 Colorado ProjeCt ManagePs Name Start Dale End Dale � 4/24/Q6 5/ 10/OG �° --- . _. ..- - --------. .. .. _._— ._. -- -- - -�--- --- -. d Telephone With Area Gode � Calo. Proj, Dsgr. Cert Number Start Time weekends End Time weekends � � � � � o�ao �t� 1 foo �� '� v._... ------_ ___ _ . _ _. —_ _._ � __.. - - -- --.. . ._._� ColorAdo ProJec4 t7esigner's Name � Q � ' Amount of Asbestos --- --. .... — - - --------- �° � 7eff ICnight � ; Linear Feek: 5quare Feet: 55 ga! Drums: � . �.__ ..... .... .- -- — --._...... ._ �. . _ ___ ___.__ � � Telephone VVith Area Gode Colo. Proj, Dspr. Cert. Number � � � ��gQ � __. .. . , _.._..... _ -- - - . � 303-791 -5562 � __�_ __oaysoao eration -- Gheckallttiat. apply: .�__ .. . . ._.._ _ --_._ _ .. Air Monitodng SpecialisYs Name � ,e� �„ Sun. Mon. 7ue. Wed, 7hu. Fri. S�t. �, r�m sco�,k �° � x � � , � � Telephone W7th Area Gode --. ' � Colo. AMS. Cert. Numher _� � . __... . . . . __ �..... . . - —...._ . �' 303-882-5271 4757 �mer�ency Pro�ect7 Yes 1 No 1°NI� �DX�,� FdR �1�$�6�� USE ONLY: Project Manager Raquired? Y N W F'ermit #: Postmark ar Hand Dellvery t�a4�: Check #: Issued: Pi�ase describe below the work practices and procedures no be smp(ayed in conducting th� abatemenY of asbestos. �� ����IFIC . Indicats t�pe(s} o� ACEiM to be abated (e .g . �A't', ceiling tilu, T51 , etc. }, Use anaftier page if �ecsssary. 'T'his }�roject involves �tae remov�l c�f 30�(� sc�uare feet o#' asbestos cantairaing drywall texh.ire and spray applied zcoustical caverin�;s in one nebativc; pre�gure Ful( containment. 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It is onl.� f�r th� �SUa�aa� 4f a.11owt.ng aGl,e�t�s alaatcenerr.C. ,hI)ilZ'�'�C�1�i�.I� ff'�.$tMI'I' Fkt.�4�,��0�'� : 1�y ���z•�'oz�m.u7g work und�� tJzis p�rmi� thc �i��t�m��,t eonha.�tor agr�as thflt th� Di.u�s�on .�n.ay r��okc or su��acnd t1.�is persx�it s�t�uld tfa� D.'tvisio.n find that tla� �ontr��ar: � [�c�s� v.ioP�ct�ci or has �ided �nd ab�ti�d in thc vic,f�ti.Qn �af 25-7-�01 or 25,7�501. et �eq-, � ,T�. S . 47' RC�i��Ataon No. $ , oa� ar� ard�r af tl�e Division o.r �t�msnissat��3, � has fax.led to rn�e� aa�y perrnit ar�d Ri.�ti.�catiars rcqi►ircm�ett ar fail.�d tQ ��xr��C �ny viol.a�ions �ited by tlae T7.ivwsi�n de�ri».g �t�y I11Sp�CCtO1t VI+ ItIliit a reakpna.j?I� �?�k'I.pd. O'CT;].Ct.1E, �s may '�c �eter�n.tx�.�cl l�y t�hc T�ivisi�n, � has us�r� misreprescnt�tic�n or �'raud i.�� obtaining this pe.t°m.it, or, � has cot��n7itted an.y ac# or amissian w.hicii daes �aot m.ect ��me.r�lly flc�cp��d st�r�d��-ds v.f tla� �ar�ctie� �f �sbestas r�t�rat�tr�cnt. I�s a �anl�ractot�, Y�u itiay bc subj�Gt to othcr licenscs and pe,��i.ts; d�pez�cl.ing an chc rcc�u�r�rn�nts of th. .e cr�unty and. xnun.ic.ipal 'sty 1t5 VR+�iIC,I1 iI1L W�3X(c, z� �14'1ZAg �i �l'�OLTI1�tI. T�}l� CDIOYaCJ.4 DC}��Cfit�T1.� 4� �CII9jAC I'��al$h fLtl(� �fl.V].C{182Yf1�'t]4:, �tir Ft+ llu.ti.an C�nntx•o� �7ivision strongly suggests tlta4 yau c�iecic with cotmty and rnunie�paJ, aut.�.orzti.es .iz� ord�r to determi.n� any other loeal buileiing/p�rmatting rcc�t�i.tct��ent� tbat za�ust be mct. '�T��+ ���Z�.�.� �� I'T 11��'�'� �:E Ft.� �'�'��1 �� ���'� 1�.T �I��, "T�1��� e I111I7PL�R'Ift�'L�I� 92�fl,�� �'h �+ �IlRil OJ�j]P'PJ�Ci� ,i:itOl���L'RlPO)tS /J� �C�� �f8lli%Y�IJ�1� �rhr>v�� r�r' e�t�srael �trr�dr�,�,� abov�) R�t#f tfRe �,v,�ro,�1�'#al� cor�n.ty A�er�l�h nfept�r�a�aexa� hy frrx. P�Dfeet �aorl�CnPi�a�,s �n�dude cfarrrage,s ��z the ,�cope o�' t�ork ar t1s� sefi�rlt�f�d wark cl�rt�.o�, er�. This asbc�to� al�atenie�t �aerzr� i� zs v��i � k�e�izuain� 4l20/�00� tl�rau�l� 1 � : 59 PM a.n 51191�4{�6 . . T11� �� tual sched�.����. wor� da,�cs ar� f�°om 4/�0J2006 t�7rtru�l� SII. Q/24�C� . A.pprc�val iseu.ecl on: Q-/12/�U06 ,�,znc�unt pa.id: �275 .04 P�e�orc� tiu�b�r: � 1. 025 Ci�.�c�c z�um.�er: US�kSt} �fl�F�' 4' �i$ A�Ct�)�.'1°a ���i��d� ��l� �roject Su�aervisor: Va�.i�t�Ge: Norae iticlr�do �h ��+e�; �onzm�nks: Pdr�z�� �eri���.t�oz� f� v , : 1�23 Far thc location spcclfi�d �eiav,+ ; �'xoj �ct .A,�l� : ��SId��A#��1 IE�Ck#�WC ,�a �ae� �> �ti4ut ��t���c��° 4���X$ ��d ��z1ir��s ���7 S#me�tx�� id� � A�°, �e.rif��ation 1�10.: 4fi57 `���� 1?rojeet �Vlar�t���r: ��t�[� �aign�y This perrrtit has be�ri issuerl to ; i-� ut�� �efh � �t��a���s�g�s , X�� --- -- --. . . _ ., ..._. .... _ .. _..,,,.. __..... �, � T�e�ea°.�a���� ��°, �e S�ak�� k"X2� �Ii���i�6P�F90�y �� ��� �� �S�L1�G�. �� a ��1,� _ .. .... .. . . .. ... ..-- �