HomeMy WebLinkAboutEast St. #240 - 1/16/2002j',v',7i51Y TwM'a.{`k Ottdamchusetts
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W Asbestos Abatemen( Description -- <LLa�t�l ■
1
1. Fauldy location:
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2. Isthefacilityoccupied? `Yes❑No
3. Asbestos Contractor:
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5. . Project Monitor.
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_.__.
t� IXlGdadM /
6. Asbestos Analytical Lab:
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Maw arGdeva,/
7. Project start dales-L—Wend data —IA p specificworkhours(Mon: FrL)(sat.Sun.)
8. What type of project Is this? (circle one): dmMam _ nwr nee arer4¢eam)
9. Describe the asbestos abatement procedures to be used (circle): pbw w rx7osaa_ fdaraaa d.4
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10. Is tha job being conducted t;A(ndoors 0 outdoors ?
11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear N.) or other
surfaces (square ft.), 1000 to be ran aved, enclosed or encapsulated: ,
Anaadsquare teat
bohet. brmch1w. dxL Wsa/aa coahm... I Mornal, solM crapga1%dadoo..... ._/
ttvrvpareda p/eradpapa'Oipe lruulifoo....J ivuhthp coned .................. _l
sMY-04&yraa6rp..................... _ I eaenVWi)w coatings..............
dohs, woven W3..................... _ . f 00 earella board. wall board .............
&w (a4ase desorbe)....................
12. Describe the decontamination systems) to be used:
..._�de�,tirdl
13. Describe the containeriralion/disposal methods to campy with 310 CMR 7A5 and 453 CMR 6A,1(2)(g):
................... ........................... _._._.............. ........................... _.................... ._.-_..........
14. For Emergency Asbestos Abatement Operations, the DEP end OLI officials who evalualed the emergency:
.......................................................................................................................
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me d.wmuem Wa'wr/
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45: Do prevailing wage rates apply as per M.G.L. c. 149, § 26, 27. or 27A - F to this project? KY.-
O No
Ytn S2
Facility Description
1. Current or prior use of faclliry:
2. Is the facility owner-occupled residential with 4 units or kss7 ❑ Yes bl!& -
3. Facility Owner.
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Nura .�
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4. Facility's Owner's On -Site Manager.
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6. General Contractor. -
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Nma � Addnu
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Gry/roen &' ar
.... .... ..._........ .__..........._._...__—.—_
TAM. ,
conlxlah wohrn C.P. tar., Porrye
6.. What Is the the facility7' i It) of floors)
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Asbestos Transportation and Disposal
1. Transporter of asbestos -containing waste material from site to temporary storage she
('it necessary) to final disposal she:
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ad
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maa+ne
• 2.Transporter of asbeslos-contafning waste material from removall temporary storage site to final disposal site:
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................. __ (_"C76 ].
Nate: Transfer
VNIM
Stations must
comply with the
3. Refuse transfer station and owner (8 applicable):
Solid West#
D&WOR regula-
bons 3 f0 CMR
f8.00
GryAwn Nm4
rNrparR '
4. Final Disposal Site:
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Certification
The undersigned hereby slates, under the penahies of perjury, that he/she has read The Commonweahh of Massachusetts Regulations
for the Removal. Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15. and that the Information contained In
this notification Is true and correct to the best of his/her knowledge an be 4.
Oak
Nob: Contractor
must sign this
form for OCl_--.___.______._.......__.._._.=_......._...—.—.........__..._.._...__. ...._.._._....__.�--�
rmnnvnrr amr>anea r rgaawm
notifications G �^1 ' 1 ����1 `` ,�ry l L ' ' 1 ���1 ,y�� sL� /')
purposes —' 1 f 111�j :t 'J.._�. Gry` .—_W ��I!!Q_ t r ).. ._.l_...._V l rJ I
Fee exempt (City. Town, district, municipal housing authority, owner -occupied residential of four units or lass) 7 yes O no
Slicker/(from front of form):`
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