WKU Environmental Health&Safety - Asbestos Management Request

ASBESTOS MANAGEMENT REQUEST

Maintenance/Renovation/Demolition Planning
~PRIOR TO DISTURBING SUSPECT ASBESTOS CONTAINING MATERIALS~

DEPARTMENTAL ASBESTOS COORDINATOR INFORMATION

Coordinator name:			E-mail:
Department:			Phone:

PROJECT INFORMATION

Building & Room number/area:
Specific location:		Project start date:

Planned project (Allow 10 days for survey results)

Emergency project (Emergency situation required)

Briefly describe work to be performed in the text box below. You must hit 'Enter' on your keyboard at the end of each line in the text box for the text to come through in its entirety. Include areas that may be impacted by utility connections, etc. If you have a floor plan, job specification or other attachment, please attach below as a text, Word or PDF file. The attached file size cannot exceed 4 MB.

Attach a file:

Type of Material		Quantity of Materials
	Floor tile and mastic	Estimated quantity:	Sq. Ft.
	Ceiling tile	Estimated quantity:	Sq. Ft.
	Pipe insulation	Estimated quantity:	Sq. Ft.
	Pipe joint/valve/fitting	Estimated quantity:	Sq. Ft.
	Tank insulation	Estimated quantity:	Sq. Ft.
	Trowel applied plaster	Estimated quantity:	Sq. Ft.
	Spray applied texture	Estimated quantity:	Sq. Ft.
	Gasket/gasket material	Estimated quantity:	Linear Ft.	Sq. Ft.
	Other:	Estimated quantity:	Linear Ft.	Sq. Ft.

Your name:		Date:

Please direct questions, concerns, or additional information pertaining to this Asbestos Management Request to laura.tomlin@wku.edu.

A copy of this Asbestos Management Request will be provided to the e-mail address you entered above when received into the Asbestos Management Program. Please allow 24 hours for your return confirmation.

Form created: July 10, 2006
Form revised: November 19, 2008

ASBESTOS MANAGEMENT REQUEST

Maintenance/Renovation/Demolition Planning ~PRIOR TO DISTURBING SUSPECT ASBESTOS CONTAINING MATERIALS~

DEPARTMENTAL ASBESTOS COORDINATOR INFORMATION

PROJECT INFORMATION

Maintenance/Renovation/Demolition Planning
~PRIOR TO DISTURBING SUSPECT ASBESTOS CONTAINING MATERIALS~