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2. Asbestos Compliance Statement

4. Project Name:
6. Project Address:
8. Pursuant to Senate Bill 509 of the 77th Legislature of the State of Texas

   1. I certify
   2. I do NOT certify

   I hereby certify that the above referenced building is in compliance with all aspects of the National Emissions Standards for Hazardous Air Pollutants and the Texas Asbestos Health Protection Act.

10. Signature:

    Typing your name here is the same as a signature and certifies this document.

12. Date:
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

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