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ASBESTOS AIR MONITORING NOTIFICATION
This notice and the accompanying permit fee must be received by the Asbestos/Lead Compliance Unit at least 5 calendar
days before the beginning of the project. This includes all air monitoring required by the rules including background
sampling to establish an alternative indoor air standard.
Type of Notification: □ Original □ Amended □ Cancellation
Project Permit # (required)
Air Monitoring Contractor
Building Owner
License Number
Name
Name
Contact Person
Address
Phone Number(s)
City, State, Zip
Contact Person
Building Information
Building Name
Abatement Contractor
License Number
Name
Address/Location
City, State, Zip
County
Phone Number
Air Monitoring Activity Dates
Start
End
Work shifts, days and times (e.g. Mon-Fri 7AM - 3PM)
Permit Fee
Air Monitoring Costs for Project $
1% Permit Fee $
For all air monitoring projects, residential and nonresidential, with more than 260 linear, 160 square or 35 cubic feet of
asbestos material a fee of 1% of the total air monitoring costs is required. For all residential projects with less than 260
linear, 160 square, 35 cubic feet but more than 10 linear, 6 square or 1 cubic feet of asbestos material, the $35 fee must
be paid by the abatement contractor.
□ 1% permit fee included with this notification.
□ Fee included with abatement contractor’s notification.
If no fee included, notification may be faxed to 651-201-4606.
If there is a change in costs, you must submit a final accounting to the department within 30 calendar days of submission
of the final invoice to the contracting entity.
I certify that the above information is correct and I am a bona fide representative of the asbestos air monitoring contractor
and have authority to enter into agreements for my employer.
Signature
Date
Mail to: Minnesota Department of Health, Asbestos/Lead Compliance Unit, PO Box 64497, St. Paul, MN 55164-0975.
Questions? Call 651-201-4620 or visit our website at http://www.health.state.mn.us/asbestos.