State of New Jersey

NOTIFICATION OF ASBESTOS ABATEMENT

(Pursuant to NJAC 8:60 and 5:16)

Date of Notification (1)	Name of Building Owner/Operator (2)

/	/
Agencies Notified

EPA

DOLWD

DOH

DCA

(NJAC 5:23-8)	Type Notification

Initial

Amended

Amendment #

Emergency (including justification)

Cancellation	Street Address

City, State, Zip Code

Name of Contact

Telephone Number

FACILITY INFORMATION
Name of Facility Where Abatement is Taking Place (3)

Type of Facility (4)

School (K‑12)

Subchapter 8 (Other than K‑12)

Other (i.e., private and commercial buildings,

homes, etc.)
Street Address

City (5)

Square Feet

# of Floors

Bldg. Age

County (6)

County Code (7)(STATE USE ONLY)	Current Use (Prior if being demolished)

Name of Monitoring Firm Hired by Building Owner (8)

ASCM No.

Name of Abatement Contractor (9)

Street Address

Street Address

City, State, Zip Code

City, State, Zip Code

Project Manager for Monitoring Firm

Telephone No.

Telephone No.

License No.

Start Date (10)	Scheduled Completion Date (11)	Name of OSHA Monitor

/	/
/	/
Occupancy Status During Abatement (Check only one)

Facility Closed/Vacated During Entire Period of Abatement

Abatement Performed Outside of Normal Facility Hours - Describe Time of Abatement: AM- PM/ PM- AM	Street Address

City, State, Zip Code

Scope of Work (Check all that apply)

Full Containment with Negative Pressure

>3 sf or >3 lf	Renovation	Mini‑Enclosure

>160 sf or >260 lf	Demolition	Glovebag Procedure

Non-Exempted (*) and Non-Friable Procedure
Location of

Asbestos-Containing Material (ACM)

TO BE ABATED

IN Facility

(13)	Is Location

Normally

Used Solely by Maintenance/

Custodial Staff?

(12)	Description of

Asbestos Containing Material (ACM)

(i.e., thermal systems insulation, surfacing, VAT, or

other miscellaneous)	Amount

(Specify

SF or LF)	Abatement Type
Removal	Repair	Encapsulate	Enclosure
Yes	No	N/A
Name of Registered Waste Hauler

NJDEP Waste

Hauler ID No.

Cubic Yards of Waste

Name of Registered Landfill

City, State

Disposal Date

City, State

Completed By (Print or Type)

Title

Signature	Date
ASB-41

JAN 13	* Do not use this form for asbestos licensure exempted activities.

ASB-41, Notification of Asbestos Abatement

ASB-41, notification of asbestos abatement 10-day notice, asbestos, abatement,

EWhite

2007-06-04

NJDOH