HomeMy WebLinkAboutUnion St. #106 apts.1&2 - 3/8/1991NOTIFICATION OF DELEADING-WORK
All sections of this form must be completed in order to comply with
the notification requirements of M.G.L.C. 111 197
FILE NUMBER
Contractor performing project Action Deleading, Inc. Certificationl�DL000006
Address of project
Bullding:Name (if any)..
' ', Floor —
Street
,/A�ddress %l%� l ���a �/f�2 e- R Apt. No.
City/>i"c�JC i io/� yGl Zip 9
Deleading Method: RY SCRAPING HEAT GUN,:... ENCAPSULATION. DEMOLITION .
(circle all that apply) OTHER
POWER SANDING CAUSTICS. REPLAC_ EMEND.
If "OTHER" selected, please explain
Check one: dwelling is Multi-family--iz single family
Start Date Completion Date_ lgYJ'
When will work be_,done: am_ 1 pm Zweekends? .
Supervisors: David Smith DS000244
John Hammond Jr. DS000243
Bruce Hammond. DS000009
-_ Gary Greene DS000232
Timothy Washington DS000250
Property Owner - ( t� �Q/' �nrl ✓t
Address .. Of J to `, iL<<J-
City ��-34A�u State _ .. Zip
Telephone
In case of emergency" contact: Claude Limo es
Phone: day(508) 941-0284 evening (508) 823-9594
(OVER)
0034B/5
In accordance with Chapter 773 of the acts of 1987, Massachusetts General
Laws C.111 197, 454 CMR 22.00 and 105 CMR 460.000, notice of the date and
method(s) of removal -or -covering of'paiut,-plaster soil qr other accessible
material containing dangerous -levels -of - lead, is tobe"prRvided to the
following persons prior to the; beginning of deleading.
1. Occupants of the dwelling unit ,r_
2. All other occupants of thefresidential premises, if any
Director, Childhood Lead.Poisoning Prevention Program
<` Department ofoPiiblic Health_305''South:Street, Jamaica�'Plain; MAM130t» !J:.
l4 Lead__ Removal Program,_ Bureau of Technical_ Services ___-__ is A
Department of Labor and Industries, Division of Industrial Safety
100 Cambridge_StreeY. Room__1101;-Boston,__MA_._02202___-_-__..____.---..- '
5. ' Local( Board of<-Health%Code Enforcement Agency tb,: '•
r
6. Massachusetts.Historical Commission -
(if premises listed on the State Register of Historical Places)
The undersigned hereby states, under the penalties of perjury, that he/she
has read and_, understood, the=Commonwealth of Massachusetts_Deleading-J� L'-
Regulations, 454 CMR 22.00, and Lead Poisoning Prevention and Control
9A Regulations,_ 105—CMR A60.00s---and that._the_information-contained'in this--
-,. notification is true and; correct to the best of his/her knowledge and
belief.
Date o2 / �l° t Signed:Qe A t
Title:
office Use Only
Inspector -Name
0034B/6
Company;, Action Deleading ._._ In
- Date of.Inspection
W, c.v. - -
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