Fillable Analytical test results are required for the following (Metro)

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Analytical test results are required for the following (Metro)

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oregonmetro.gov

To protect the health and safety of our employees and customers, all loads of construction,

remodeling and demolition waste brought to Metro Central or Metro South transfer stations are

screened before, during and after unloading for materials that may contain asbestos. This form is

required for all such loads of waste that contain construction and demolition waste.

Analytical test results are required for the following products commonly known to

contain asbestos:

• Interior walls and ceilings: acoustical tiles, glue dots, plaster, and textured surfaces

• Exterior walls: cement siding, stucco

• Flooring: vinyl tiles, sheet vinyl, some mastic adhesives

• Insulation/fireproofing: block, boiler, spray-applied, vermiculite, monokote, sink

undercoating, thermal system insulation (fiberglass, cellulose, and mineral wool are

exempt)

• Gaskets: furnace, mechanical, boiler, wood stove (automotive gaskets are exempt)

• Heating: white paper or seam tape on ducts, air-duct cement and insulation

• Roofing materials: tar paper, felt, silver/white roofing paint, Nicolite paper

• Fire doors, fire/kiln brick and fireproofing

• Various compounds: window glazing, adhesives, caulks, patching, mastics, vapor barrier

products (plastic or synthetic materials such as Tyvek are exempt)

• Electrical: switch gear, circuit boxes and fuse panels; wiring with cloth insulation (Romex

wiring is exempt)

PLEASE NOTE: Flat/built-up roofing is not accepted, even if customers present negative

analytical test results.

INSTRUCTIONS

• This form is required for all loads containing construction, remodeling or demolition

debris.

• This form should be completed by the person responsible for and knowledgeable about

the contents of the load.

• For multiple-load projects, copies of this form will be accepted, but the contents of the

load must match the description of the waste materials on the form.

All parties involved (generator, contractor and hauler) may be held responsible for the

abatement of positive (greater than one percent asbestos by weight) asbestos-containing

materials unloaded at Metro's transfer stations, including but not limited to the costs for

testing, a licensed abatement contractor, fines and administration.

Revised October 2018

Construction and demolition waste acceptance form

Revised October 2018

Did waste materials originate from a structure or RV constructed after January 1, 2004, or

were the materials manufactured after January 1, 2004?

 Yes (if yes, skip to #4)  No

Was an asbestos survey conducted?



Yes (if yes, attach survey)



No (if no, skip to #4)

If any asbestos-containing materials were identified in the survey, submittal of this form is

my statement that those materials were handled properly and are not present in this load.

Signature: ____________________________________________________________________________________________

Address of work site ________________________________________________________________________________

City _____________________________________________ State _____________________ Zip _____________________

Property owner _____________________________________________________________________________________

Phone ________________________________________________________________________________________________

Mailing address (if different) _______________________________________________________________________

City ____________________________________________ State ____________________ Zip ______________________

Hauled by: (if self, skip to #6)

 Building Contractor

 Waste Hauler

Name of hauling company or contractor: _________________________________________________________

Company contact: ___________________________________________________________________________________

Phone number: ______________________________________________________________________________________

Description of waste:

Certification: I certify that the above information is true and correct to the best of my

knowledge, and that the documentation presented represents the materials delivered to the

transfer station. I also attest that the waste materials in this load do not contain asbestos.

Name (Print): ________________________________________________________________________________________

Signature: ____________________________________________________________________________________________

Please print this document, sign and bring to a Metro transfer station with any required analytical test results.

FACILITY USE ONLY

Date _____________________ Time ________________ AM/PM Facility:



MCS



MSS

ACCEPTED:  Y  N Comments: ________________________________________________________________________

Approver: _____________________________________ TRACKING NUMBER: _____________________________________

Fillable Analytical test results are required for the following (Metro)

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