HomeMy WebLinkAboutPratt St. #90 - 9/8/1989DEpAR-h!EA'T OF PUS —'IC HEALTHIDEPART,��LAIT OF LABOR 6 INDJSTF,IES
NOTIFICATION O. DELEADINC,POR1:
All sections of this form must be completed in order to comply with
the notification requirements of H.C.L. C. 111 §197
FILE NUMBER
ED REPLACEMENT Certification N DC 000003
Contractor performing project ADVANC
ENVIRONMENTAL LEAD DETECTDate of Inspection 06/28/89
Lead Paint Inspector_
Address of Project
Building Name (if any) Floor
Strzet Address_
90 Fratt.at. Apt. xo.
City Mansfield, MA zip 0?050
Deleading Method: DRY SCRAPING SEAT GUN ENCAPSULATION DEMOLITION
(circle all that apply)
POnTR SANDING CAUSTICS REPLACEh.E'NT OTHER
If "p,he^` selected, please erplain
Ch eCY. one dwelling is Hult::-_emily single family
Start date Sept 7,1989 Completion Date but R JQR9
{,yhenwill work be done: am x pm x weekends?
?roject Supervisor.l✓ame RnhQrj 13a�nld,, Ce ificate n
➢S 000005
Property Owner James
132 Willow,;Street
aric Tess
Telephone
Mansfield.
339-9135
In case of emergency contact:
Phone: day
508-823-8730
State
NIA
JOHN E, EASTMAN
evening SAME
zip 02050
rev 216189
0034BI5
i
.7n accordance w"th Chanter 773 of the Acts of 1987, Kassachuse is Gene a' Laws
C. )11 >197, 454 CA1R 22.00 and 105 CPR 460.600, notice of the date aac method's) of
removal or covering of paint, plaster soil or other accessible material containing
dangerous levels of lead, is to be provided to the following persons at leas- five
days prior to the begin:inq of deleading.
1. Occupants of the dwelling unit
2. All other occupants_of_the residential premises, if any
3. Director, Childhood Lead Poisoning Prevention Program
Department of Public Health, 305 South Street, Jamaica Plain, MA 02130:
4. Lead Removal Program, Bureau of Technical Services -
Department of Labor and Industries, 'Division of.Industrial Safety
- 100Cambrigge Street,.xoorr,_1101,._'acstrn,.._N.:. __.0.:202,__. _
5. Local Board of Realth/Code Enforcement Agency
6: Massachusetts Eistorical Commission
(if premises is listed on the State Register of Eistoric'Places)
undersic",u�_
nej hereby states, under* the pbna_1ce r==ju-y, the..
and understood nhe Commonwealth of Massachusetts Deleadino Regulations, 454 CYR
22.00, and Lead ?oisoring prevention and Control Regulations, 105 C22 460.00, and
chat the information contained in this notification is. true abd cor.rec.. to the best
of his/her Ynowledge and belief.
Date August; 29.1989
Late Signed: ---'
Title: OWNER
Company: ADVANCED REPLACEMENT SYSIP��
Office Use 0nlu
00348/6 rev 216189