ASBESTOS REMOVAL

CERTIFICATION OF COMPLETION

____________________________________ hereby certifies that the asbestos removal work performed for the Iowa Department of Transportation as listed below, is complete and that all identified asbestos-containing materials have been properly removed in accordance with all local, state, and federal regulations.

COUNTY

PARCEL NUMBER(S)

PROJECT NUMBER

(Signature)	(Date)
(Title)

Contractor to forward completed form to project engineer along with the final project documentation.

Project engineer received
	(Date)	(Initials)

Project engineer to forward completed form to Office of Location and Environment after receiving contractor’s final documentation.