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HomeMy WebLinkAboutHall St. #67 - 11/20/2006:. ;;111 iihtlalbilllH ININ ININtUilih'I :htt: Commonwoolth of Musochutsotts 100047018 Asbestos Notification Form ANF401 WINNU~ a„ t A. Asbestos Abatement Descrlption corms on ss 1. a. to this facility fee camptAec use nY • Kernpt - city, town, district, municipal housing authority, wvnKoccupied o" the M key residence of four unit or Was? W Yes ❑ No to mew your cursor - do M b. Provkte blanket decal number If applicable: FWartkx OWN tetars»r we the return key. 2. Facility Location' LINDA TNOMAB 07''HALL iT Inc a MANSFIELD MA OY048 BOr1 �IN7M c. CWTom d. Stft e. idp Coda r.'fee ismlo� INSTRUCTIONS 3. Workslie Location: 1."eealon.orthis SAME L� cam must be 0. Bulk" NsmNaull ft Location b. awe tp t c. V" d. Floor 0. Room mmplsted In order 0 aOmply With 4. DEP w9taodon fWRIMarsa of 310 cNR T.15 5. and the OWlslon orOwupatia„ I aslsty (DOS) nott!"tlon Mulrstnants of 463 CMR 6.12 8. 7. 8. 9. Is the facility occupied? 0 Yes ❑ No Asbestos Contractor: 10. a. What type of prof act Is Ihls7 ❑ DerRolklon ❑ Renovation 0 Repair ❑ Other, please specify: 11, a. Check abatement procedures: Glove bag a Encapsulation Enclosure Disposal only Cleanup © Other, specify: 0 Full containment 61 ENDICOTT ST BLDG 112 iel7esaa�e a, Ta1a{Mwrs ►sxnr»r g. Contract Type: ❑ WOW ❑ verbal It. Describe FLOOR BEaRIs b. D"Oft 12. Is the Job being conducted: 0 indoors? ❑ Outdoors? 0 WOD1sP.doa. 1=2 NOV 2 0 2006 M mtos NatikYsan Form • Peps 1 of 3 Commonwealth of Massachusetts ` Asbestos Notification Form ANF-001 947918_ 1g9M DOWN A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or ancilip Ltl LW--: _ �S real issuud'acea square -PrRaM�j 45o pipee�or uc Ii q. Boller, breaching, dud, tank �,_J 40 d. Insulating Daman __ Li; surface coatings �Liinnh. —_{ Lin S9 n.._...-_., e. Corrugated or layered paper L,wI "n •.1 f. Tmwei/Sprayer coatings pipe insulation Lin, fl. tl.�� nLl IL f— - Cam_ l ..-_ h. Transits board, wall board —q g. Spray -on Fireproofing ' un—ft sq. ft. Linfr-- _ i. Cloths, waven fabrics Other, please specify: 1• es. �-7 g k. Thermal, solid core pipe FLR DEBRIS . I. specify Insulation Lin. It. §q- 14. Describe the decontamination system(s) to be used: 3CHAMBER 15. Describe the containerization/disposal methods to comply with 310 CMR 7,15 and 453 CMR Ie MIL POLY LABELLED DOUBLE BAGS 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? [] Yes © No B. Facility Description 1. Current or prior use of facility: RESIDENTIAL _ 2. Is the facility owner -occupied residential with 4 units 3. 4, ■ onfoglap.doc• 7W02 ,- — Asbestos Notification Form - P e 2 of 3 —M J Note: Transfer Stations must comply with the Solid Waste Dvlslon Regulations 310 CMR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 B. Facility Description (cont.) a. Name O1 Generel Contiia I(c_'c�lry'rl'oyn d. 2lo Code f Contractors Worker's Compinauret 6. What is the Size of this facility? a. 100047910 Decal Number C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): rre. Nemg of Tr nsp_orar c, CltylTown d. Zip Code e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: 3. 4. D. Certification The undersigned hereby states, under the penalt188 of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7,15, and (hat the Information contained In this notification la true and correct to the best of his/her knowledge and belief. anf001apArrc • 10102 f NOV 2 0 2ON 02062 I. Sip Code Asbestos NotlflCa110n Form • Page 3 of 3