Notice of Intent to Remove Asbestos Application  Notice Help? 

Stop! Javascript and Cookies must be enabled to process your Online Notice. Please review the entire web page for content you may need before beginning the application. Online application requires a credit card - no cash is accepted. In addition to the SWCAA asbestos fee, other fees are payable on our Fee Payment page at https://www.swcleanair.gov/fees/fees.asp Our payment acceptance company assesses a small transaction fee.

Use this form to submit the details of your Asbestos Removal Project.
If you need to amend an existing project use our Asbestos Amendment Online Form.

PROJECT SCOPE

Quantity to be removed: square feet and/or linear feet Click Notice Help? button for fee structure  
* Optional field  
 
The removal will be performed by an Certified Asbestos Contractor
I am the Owner and Occupant of the property, and I will be removing the asbestos material myself
 
Emergency (call SWCAA at 360-574-3058 immediately for notification period waiver)
NO
YES  Reason for Emergency:
 
 
Facility Type:
Present Use:
Previous Use:
 
Project Starting Date:   Completion date: Workshift Days: Su M T W Th F Sa
Site Name: Workshift Hours:
Site Address:   
Site Extra Address:   *
Site Parcel Number:   *
Site City:   State:    Zip:    County:
Location of Asbestos:
Demolition of Structure? Yes No    
Remodel/Repair? Yes  No

MATERIAL DESCRIPTION

Material to be Removed: (Check all that apply)
Fireproofing Popcorn Ceiling CAB Sheet Vinyl Boiler Insulation
Duct Tape Duct Paper Mag Pipe Insulation Air Cell CA Pipe
VAT Other Required if Other is checked
Control Methods: (Check all that apply)
N.P. Enclosure Glove Bag Mini Enclosure Wrap & Cut Water
HEPA Vac Other  Required if Other is checked

OWNER/INSPECTOR/CONTRACTOR/DISPOSAL

Property Owner Name:    Phone #:
Mailing Address:
City:   State:     Zip:

Asbestos Inspection Conducted or Samples Taken?
YES - Include Ahera Inspection Summary or Samples Results and other documents, or check the NO button and supply a reason for no samples/inspection:











NO - Provide reason:

AHERA Inspector:
     If Owner Occupant category, not required or select Owner Occupant from this list

Asbestos Contractor:
     If Owner Occupant category, not required or select Owner Occupant from this list

Supervisor/Contact Name:    Phone #:

Asbestos Disposal Site / Landfill Address:


PAYMENT

Amount to Pay NOTE: you will be charged a payment service fee which will range from $2 to $32 USD based on the transaction amount.

 Pay by Debit Card, Visa, Mastercard, American Express, or Discover
 Pay by Electronic Check

Card Number:  16 digits only - no spaces or dashes MM/YY Expiration Date:   CVV:
 
  Name and Address is the same as Property Owner
Name on Card: Company Name or Cardholder Name as it appears on the card
Billing Address: Extra Address:  *
City:    State:    Zip: 
Cardholder Phone: Cardholder Email:

CERTIFICATION

I DO HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS NOTIFICATION IS, TO THE BEST OF MY KNOWLEDGE, ACCURATE AND COMPLETE.

Your Name:   Dated: 4/28/2024 2:09:20 AM

Title:  *  Representing:

Your Email Address:

Your Phone Number:

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this completed page for your records before clicking SUBMIT.