Appendix E– CERTIFICATION LETTER FOR ASBESTOS CONTAINING MATERIALS

General

Prior to sampling by the DOT, submit a letter of certification for ACM to the District Materials Engineer. The letter should be signed by an authorized representative from the RAS Supplier.

(SAMPLE ACM CERTIFICATION LETTER)

DATE:       _______________________

TO:          _______________________(District Materials Engineer)

FROM:      _______________________(Supplier’s authorized representative)

SUBJECT:      Certification of ACM

The recycled asphalt shingles in pile number ________ located at _______________________________ (source) have been certified asbestos free. The ACM testing protocol outlined in the ________________ (Supplier name) quality control plan was followed and records are available upon request.

Signed,

________________________________(Authorized Representative’s Name)

________________________________(Authorized Representative’s Signature)