Asbestos Project Information Sheet

Complete and submit this form to Environment, Health & Safety (EH&S) at least 1 week before starting an asbestos abatement project.

Submission of this form is required before the project begins to ensure proper data tracking and timely manifest approval. PLEASE NOTE: Delay of asbestos waste pick up may result if this form is not initially sent to EH&S.

This information enables EH&S to maintain an accurate database of asbestos-containing materials (ACM) at UCSD, and comply with San Diego County Air Pollution Control District and Cal/OSHA regulatory requirements.

Project Title:
Project/W.O. Number:
Project Manager: Department:
E-mail (required):
Cell Phone:
Building:
Size of Abatement Area: (sq ft. or lin. ft.)
Project Start Date:
Completion Date:

Room:
Type of ACM:
Abatement:
Remove or Encapsulate

Space Usage:

Project Summary:


CONTRACTOR / CONSULTANT INFORMATION

Contractor:
Consultant:
Contact:
Contact:
Contractor Phone:
Consultant Phone:

WHO IS SUBMITTING THIS FORM?
Your Name:
Your phone extension:

IMPORTANT: Only EH&S personnel are authorized to sign hazardous waste manifests for removal or disposal of asbestos-containing materials from UC San Diego facilities. Contact EH&S at (858) 534-2753 to have the manifest for asbestos-containing waste disposal signed. Please have a copy of this form available.

Please print a copy of this form for your records before submitting.

       


Environment, Health & Safety UCSD logo University of California, San Diego

Questions about this form? Contact UCSD Environment, Health & Safety, (858) 534-1075 or 822-1743.

Last revised 9/11/2009