HomeMy WebLinkAboutCentral St. #108 - 8/1/2001Hiv1;MWAMYA1 a Atdass-nhusetls
Ao&estlxx HuNficatlon Form _ ANF-001
Asbestos Abatement Description
1. Facility location:
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2. Is the facility occupied? ayes O No
3, Asbestos Contractor.
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4. On- 'a Project SUDe,visor/Foreman:
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S. . Project Monitit`or.
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6. Asbestos Analytical Lab:
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7. Project sUrtdatdO/��1(anddaley)�p(specHieworkhours(Mon.-Fd.)—S�--
6. What type of project Is this? (circle one): eea»am mx maw oesr(syrh)
9. Describe the asbestos abatement procedures to be used (circle): ahnmd - wYamv NrepeYmna .damp
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10. Is lha job being conducted .indoors O outdoors? //^^��
11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes orducts(Ilnear OJ 2-1 �-grolher
surfaces (square R.)
to be removed, enclosed or encapsulated: ,
linear/square leer
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12. Describe the decontaminatlon syslem(s) to be used:
13, Describe the cOm ainerlration/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.
14. For Emergency Asbestos Abatement Operations, the DEP and DLI offloads who evalualed the emergency.
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e5: Do prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A - F to this projec17 ❑ Yes #,No
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Note; Transfer
Stations must
campty wrlh the
Sofid Waste
Division reguie.
bons 310 CMR
18.00
Halt: Contractor
mustsign this
tam tar 01.1
nodricanon
purposes
U Facility Description
1. Current or prior use of fachily:
2. Is the facility owner -occupied residential with 4 units or less? vI Yes O No
3. Facit'ny Owner, �/J (�`
Mkea
ChA. � Ip aW IYp1v.e
4. Facility's Owners On -She Maruger.
.
UgrTwn 7baae 7Ytabe
S. General Conlraclar. .
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OyRowr lb rode 177.4pe"
Casrrctora Warba amW Naunr. _.. �Yr rxplke
G. What Is the s¢e of the f;ug1 72SC sq h) L(I of Mors)
13 Asbestos Transportation and Disposal
1. Transparta ofabestmcontaining waste material from she to temporary starage site necessary) to final disposal site:
WSM , LLP
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2.' Tmnsparter of asbestos•coniainui wage material from removalltemporaf storage site to final disposal site:
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111
3. Refuse transfer station and owner (If applicable):
Xaw
4. Foul Disposal site:
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e CerHficatlan y
Tht undersigned hereby slates, undtrthe peruMies of perjury, that he/she has read th.,CCpppmmomvealth of MusachuuNt Regub&ns
for the Ramwal, Containment or Encapsulation of Asbtstos, 453 CMR 6.00 and 31rM9 7.15. and that the Information contained In
this notification Is We and coned to the best of hiuhar knowledge an baW
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Fee exempt (City, Town, district, municipal housing authority, ownar-occupied residenital of four units or less) p,(1 yes O no
Sticker / ffram iron(of form): `I C:5