APPLICATIONPACKAGEFOR LICENSE

TO REMOVE/ENCAPSULATEASBESTOSINTHESTATEOFMARYLAND

[Thispackagecontainstheapplicationform,SchedulesI,IIandIII,COMAR26.11.21,ControlofAsbestosRegulations(asamendedAugust24,1998),NESHAP40CFRPart61,SubpartM,

AsbestosRegulations(asamendedNovember20,1990)],andMaryland-ApprovedAsbestosTrainingCourses.]

DECEMBER 2015

MARYLANDDEPARTMENTOFTHEENVIRONMENTAIRRADIATIONMANAGEMENTADMINISTRATION

MarylandDepartmentof the EnvironmentDivisionof Asbestos LicensingEnforcement1800 Washington Blvd.STE 725

Baltimore,Maryland21230--1720

410-537-3200FAX: 410-537-3924

This is not an official version of the regulations. The official version is published by the Division of State Documents inthe Code of Maryland Regulations (COMAR) and in the Maryland Register. NESHAP regulations are published in theCodeofFederalRegulations(CFR)andinthe Federal Register. This unofficial version is provided as a courtesy only.

ApplicationNotes

ImportantInformationConcerningMaryland'sAsbestosLicensing

  • Renewalapplicationsmustbesubmittednotsoonerthan90andnolaterthan30daysbeforecurrentlicenseexpires.ifexpired,submitas"laterenewal".
  • Businessentitiesmayberequiredtoprovideproofofthecurrentstatusoftheirfirm,corporation,businessconcern,etc.AndmustsupplydocumentationtoMDEuponrequest.
  • Ifyouareanout-of-statecompanybuthavealocalofficethatwilloverseethedailyoperationofMarylandprojects,pleasebesuretoprovidethataddressforthecomputerdatabase.Thiswillensurethatinformationisdisseminatedtoappropriateindividualsandoffices.

Pleaseprovideyourworkers’compensationpolicybindernumberoracopyofacertificateofcompliancewithMarylandWorkers’CompensationAct(EnvironmentArticle,§1-202).Withoutthis,wewillnotissuealicensetoremove/encapsulateasbestos.Ifyouhaveanyquestions,pleasecallWorkman’sCompensationCommissionat410-864-5100or800-492-0479.

  • Youmustanswerallquestionscompletelyontheapplicationform,includingschedulesI,IIandIII.Failuretoprovidealloftheinformationrequestedinthisapplicationwilldelaythereviewandapprovalprocess.Donotsubmityourcompany'sworkpracticesmanualinresponsetotheinformationrequestedinthisapplication.Itwillbediscardedandyourapplicationconsideredincomplete.
  • Youmustbefamiliarwith,andunderstand,bothCOMARandNESHAPregulations.[COMAR(codeofMarylandregulations26.11.21.ControlofasbestosandNESHAP(nationalemissionstandardsforhazardousairpollutants)40CFR61,subpartm,asbestosregulations].Youareresponsibleforapplyingthoseregulationsindailyasbestos-relatedactivities.
  • Applicationfeeisbasedonthenumberofworkersyouemployatthetimeofapplicationornumberusedduringthepreviouslicenseyear.Ifyouhavepaidlessthanthemaximumfeeanduseadditionalworkersanytimeduringthelicenseyear,applicablefeesmustbepaidtothedepartmentbeforethoseworkerscanperformasbestosworkinMaryland.
  • Besuretoencloseacompanycheck,certifiedcheck,cashier’scheckormoneyorder(nopersonalchecks,nocash,norcreditcards)withyourapplication.
  • YoumaynotconductasbestosremovalorencapsulationactivitiesinMarylandwithoutavalidandcurrentasbestoscontractor'slicense.
  • Mailcompletedform,schedulesI,IIandIII,andrequiredfeeto:DepartmentoftheEnvironment

P.O.Box2037

BaltimoreMD21203-2037

  • Nofaxtransmissionofanyasbestos-relateddocumentswillbeaccepted.[Thisincludestheapplicationform,attachments,and/oradditionstotheapplicationform,projectnotifications,wastemanifests(disposalreceipts),finalairresults,exemption(variance)requests,etc.]Faxeddocumentswillbediscarded.
  • Notifythisofficeinwritingofanyaddresschangeforyourcompanyatanytimeduringthelicenseyearforthecomputerdatabase.Revisedlicensescannotbeissuedforaddresschanges.Addresscorrectionsonthelicensecanonlybemadeatthetimearenewallicenseisissued.

Workman’sCompensationMarylandDepartmentoftheEnvironment1800WashingtonBlvd.,STE725

PolicyBinderNumber

BaltimoreMD21230-1720 410-537-3200,FAX–3924

APPLICATIONFOR LICENSETO REMOVE/ ENCAPSULATEASBESTOS INTHESTATEOFMARYLAND

TypeofApplicationNew□Renewal*□LateRenewal*□

APPLICATIONFORLICENSETOREMOVE/ENCAPSULATEASBESTOS–MarylandDepartmentoftheEnvironment

SCHEDULE I

Business entity or public unit nameApplication Date

List all employees on your payroll, at thetime of application, who will be involvedin any asbestos project.(Use additional sheets, if necessary).SEE "APPLICATION NOTES"CONCERNINGAPPLICABLEFEESFORADDITIONALWORKERSNOTINCLUDED IN THIS APPLICATION.
Training Institutions must be Maryland-approved.[See list of approved training institutions included inthis license application package. If you have questions
concerning training institutions not included on the approved list, call (410)537-3200].
Employee'sFull Name / Employee'sSocialSecurity Number / DateEmployee'sCertificationEXPIRES / NameLocationof TrainingInstitution(s)Attended / Check(I)Type*
Wrkr / Supv
* / O & M
1
2
3
4
5
6
7

*You must have at least one 40-hour AHERA trained supervisor on your staff.You must attach a copy of each supervisor's training certificate to this application.

APPLICATIONFORLICENSETOREMOVE/ENCAPSULATEASBESTOS–MarylandDepartmentoftheEnvironment

SCHEDULE II

Business entity or public unit nameApplication Date

Your answersMUSTspecifically address August 24, 1998 COMAR and November 20, 1990 NESHAP regulations.DO NOT SUBMIT YOUR COMPANY'S WORK PRACTICESMANUAL. DIRECT QUOTATIONS OF COMAR AND/OR NESHAP REGULATIONS ARENOTACCEPTABLE. We requirethat youdemonstrate your understanding of bothFederaland Marylandregulations.
1.WORKER PROTECTIONREQUIREMENTS (Reference COMAR 26.11.21.05) - Enter worker training information in Schedule I.
Brand name of protective clothing used:
RESPIRATORINFORMATION:[YOUMUSTHAVEATLEAST PAPR PROTECTION FOR YOUR WORKERS.]
HALF-FACE / BRANDNAME / MODELNUMBER / NIOSH TC NUMBER* of the Filter Cartridge
FULL-FACE
PAPR**
TYPEC
*NIOSH(NationalInstituteofOccupationalSafetyandHealth)TCNumber(TrainingandCertificationNumber)**PoweredAirPurifyingRespirator
2.NOTIFICATION(ReferenceCOMAR26.11.21.03)-Onaseparatepage,brieflydescribethenotificationrequiredforNESHAPandnon-NESHAPrenovationprojects,ALLdemolitionprojects,andallencapsulationprojectsinMaryland.IncludetherequirementsforrevisionofaNESHAPnotificationasoutlinedin40CFR,61.145(b).
3.CONTROLOFEMISSIONS(ReferenceCOMAR26.11.21.06and.07)-Onaseparatepage,statetheproceduresyouwillusetomeetpostingrequirementsforDangerandProjectNotificationsigns.Notethatworksite/projectareareferstotheBUILDINGfortheProjectNotificationSigns.DescribeyourCompany'sremovalandencapsulationprocedures.YOURCOMPANY'SWORKPRACTICESMANUALISNOTACCEPTABLE.Besuretomakereferenceto6milpoly,amendedwater,criticalbarriers,theconstructionoffullcontainment,negativepressure,andthree-stagedecontaminationproceduresinyourdescription. Exemptions:RefertoCOMAR26.11.21.06B(1);notethatwrittenrequestsfortheuseofglovebagsorotheralternativeproceduresonNESHAP-sizedjobsMUSTbereceivedandapprovedbyMDEpriortoinitiatingtheseprocedures.
4.CLEAN-UP,AIRMONITORINGFINALAIRSAMPLE(ReferenceCOMAR26.11.21.06and.07-Onaseparatepage,describeyourCompany'sclean-upandairmonitoringprocedures.AlsorefertoCOMAR26.11.21.06B(3)andnotethatfinalairsampleresultsforallNESHAPrenovationsmustbesubmittedwithin24hoursofreceipt.Onaseparatepage,describeclean-upproceduresyouintendtofollowifyourfinalairsampleresultISEQUALTO0.01fiberspercubiccentimeterorgreater.BesuretoincludewetwipingwithamendedwaterandHEPAvacuuminginyourdescription.
5.WASTEDISPOSALLABELING(ReferenceCOMAR26.11.21.08)-Onaseparatepage,explaintheasbestoswastehandlingpractices,includingtransportanddisposal,yourCompanywilluse.Includeastatementofyourunderstandingthat:(1)WastefromNESHAPjobsinMarylandrequirefourlabels(WasteGeneratorandSiteLocation[Reference40CFRPart61.150]ANDMarylandcontractorlicensenumberandsealdate[ReferenceCOMAR26.11.21.08A(2);and(2)AcopyofallwastemanifestsmustbesubmittedtoMDEWITHIN10DAYSofdisposal.
6.Mail,DONOTFAX,projectnotifications,wastemanifests,finalairsampleresultsandrequestsforalternativeproceduresto:MarylandDepartmentoftheEnvironment
AirRadiationManagementAdministration
Attention:DivisionofAsbestosLicensing
1800WashingtonBlvd.,STE725,BaltimoreMD21230-1720

APPLICATIONFORLICENSETOREMOVE/ENCAPSULATEASBESTOS–MarylandDepartmentoftheEnvironment

SCHEDULE III

Business entity or public unit nameApplication Date

ProvidealistofasbestosprojectsyourCompanyhasCONDUCTEDINMARYLANDinthepast12months.(Useadditionalsheets,ifnecessary)ICheckhereifyourCompanyhasNEVERperformedasbestosworkinMarylandandDONOTcontinuewithScheduleIII
Project Site / StartDate / End Date / Total Amount ACM Removed(insquare/linearfeet) / Number of AsbestosWorkers on Project

THISPAGE RESERVED FOR CODE

OFMARYLANDREGULATIONS(COMAR)

26.11.21CONTROLOFASBESTOS…

TO OBTAIN A COPY OF COMAR CONTACT:

Division of Asbestos Licensing & Enforcement Maryland Department of the Environment 1800 Washington Blvd.

Baltimore MD 21230-1720

Telephone:410-537-3200

OR of State Documents)

THISPAGE RESERVED FOR NESHAPSREGULATIONS40 CFR61, SUBPART M

(AMENDEDNOVEMBER20,1990)

TO OBTAIN A COPY OF THE NESHAPS CONTACT:

Division of Asbestos Licensing & Enforcement Maryland Department of the Environment 1800 Washington Blvd., Suite 725

Baltimore MD 21230-1720

Telephone: 410-537-3200

Email:

OR

THISPAGERESERVEDFORLIST OFMARYLAND-APPROVEDTRAININGPPROVIDERS

TO OBTAIN A COPY OF THE NESHAPS CONTACT:

Division of Asbestos Licensing & Enforcement Maryland Department of the Environment 1800 Washington Blvd., Suite 725

Baltimore MD 21230-1720

Telephone: 410-537-3200

Email:

OR