HomeMy WebLinkAboutPleasant St. #64 - 3/22/1999Ewmrerws MbjMIAass-achusetts
ka,% rrs fietificatfon Form — At
1. Facility location:
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__.._.. -
G7Awm _ _ lip at4 TOO" .
iG."�n..1._l.(J.....I_.=.'.A.....A...1....................................... ...............
...._....._
HnYll M KYbAI balmt e-04�1j,P%n.
2. Is the facility occupied? s(, Yes O No
3. Asbestos Conlract0a
Neu7�n�.1-anc(.__serf« ._ .. r n....._i-..-P_...._.._.g_'.. �WShirc�r�l Sfre2
Wm Addrav
Gnn�
( `�......................... ............ ..................................... ....... I ....................
A_c._oco...................._...�
4, On-Slla Prolecl SUpervis0i'Foreman: ��
.C.!� ....._QCJ f kS......................................................... _............................................................._.._.—
t .. OIICwlekaem/
S. . Projecl 6� nitoc
4i �'Q_Oa t .... .._.........._.... ---
6. Asbestos A Mlcal uao: ON
�A1ro..._ u............V..........._�..� --
N._..... ^�
..__ .. IXlGmatlM/ �7P V"
7. ProsciclarldaleJ 2 enddaO' X197 pecNicworkhoure(Mon.-Fri) .—J--(Sat. Sun.)
8. ?fiat type of project Is this? (circle one): amm/n, rwra ypwsm oNtimrra)
9. Describe the asbestos abatement procedures to be used (circle): Plea aro -A-w r�rPa''''""M d.W
wnavi ew �ros/evy DOWILOW
10. Is the lob being conducted Indoors [) outdoor$? r9
11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear N.)�yd orolher
surfaces (square It.) LO to be removed. enclosed or eneapsulaled:
linmr/square lest
Doila, MeaoUrq. r4Sf taNsuhce swfinpt..._J� dinm,l, tolNmeOW DulA,lbn..........
reap,adah7aedpar>s'pMlmalllfon...�-� hmWhp arnmf.................. _J
sMy-onargwoa6np..................... _l aaveusp,coalrMs.............. _l
Plats. wowl6Drin ....................._J k,rsrb board, wan bond.............
Paw (poise d.-U).............:.....
12. Describe the decontamination syslem(s) to be used: '
.................. _.................... ........... ........... .......... ........ ..... ........... ....
...............................
13. Describe the containeritallon/disposal methods to comply
with
wi�10 _CMR 7.15 and 45_3._C_M..D 6.14(2)(9):
_I?'�1�wi_�tbztd
............................................................._.........__....
... ..............-.......--........._........_:S—_
14. For Emergency Asbestos Abatement Operations, the DEP end DU officials who evaluated the emergency:
.... .................. .._..... I ..... .......
_.._.__.
..................
imr. aa,oeee
[tla elNRAwaakw
--
NmdttlIXltlN
........................ ............................ ................................... .....................................
_._.
lAk W.WM'DfM ,,jj ,
451 Do prevailing wage tales apply Asper M.G.L. c. 149,5 26, 27, or 27A- F to this project? ❑ Yee No
v,. sac
Nola: Transfer
siaoons must
«rr & With the
Sorld Waste
Misioortgula-
Hons 31 o cMR
18.00
u FacllilyDescriptlon
1. Current or prior use of facility: /Qp.S t CiiQ✓1GQ,
2. Is the facility owner-occupled residential with 4 units orkss7 g1Yes ❑ No
3. Facility Owner.- I /,,
____..._._-_._.._......_.._........_...i................._..._.__._........_:............_._.._..._._..__..__.__
MO. Nma raise.
4. Facility's Owner's On -She Ma. art per,
)..{.....................
Non
__.—__.._....._..._..._......_..___-...._.._............. _.___—.._._ .__......._______...._._
Garton 10n fa'4aaaar
S. General Conlraclor. j
__...... ..... ..... ...... ......... _!...1t..........................................._......._._.._......._.........................._....._......_.___.__.._
Name Aeenaa
—_.__—__.._.___.__.........._....._.................. ... ._._.............. ...................._._..._...._.....................
._...........
.......
_._______
aa/rom zb soJt nwpeon
caeuacterx Wwbn C.P. Went Poary/ W.Dtn
S. What It the size of the facII47)7"loz loci It) L (I of floors)
Asbestos Transportation and Disposal
1. Transporter of asbestos -containing waste material from she to temporary, storage she (H necessary) to final disposal she:
- - - ..._N...Es_n'1....1.._ _ P.................._ ...... ..._.w.._.as�Ay)q c>.�..... t t
4m Adhu
We'46100.'.11.........._ 1P9............._Q;2., 9 1V...-._337..-.'A
Cn/rtan Adobe r✓wbx
2. • Transporter of asbestos-conlalning waste material from removal/ temporary storage silo to final disposal site:
USFI�WCLsi-
Nan
...... .Po.Cl'l_erne/..._......_�-T............_0_6.`i._9U..............._ �-0.-._3, Hx..."CJ66-7
UhAoo AC 0.b< rNeplatt
3. Refuse transfer station and owner (H applicable):
Nan
cM/raa
Fkuf Moonset Site:
r✓a+we
S
rV
CMrton 7{l Oxrl ra'gbe
V Certilicatfoll '
The undersigned hereby rates, underthe penalties of perjury, that he/she has read the Commonweahh of Massachusetts Regulaliont
for the Removal, Containment or Encapculallon of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and [hat the Information contained In
this no00n0on Is true and correct to the best of his/her knowledge b hit.
I._Ll_........ ..........._ .......... .. _.......... !f_......... _... .. .......... _ -
IffeNun A pnxsre s rA1
Note: Contractor ^'r �i 2
must sign this r (' s, 1�5�'') 1 p �' J3 ^D.) 1 -7
formfor DLl rs-`=-y'-._..................... _.......... .__._..___7.__._ _..._-_• .x _...___�I
notr adkw
�5�0 _UJQ h i n f y1_S _. ei ._..._due._ ""--..�`....
putpcsts ('�
Adam Gyrtwm ..'• ryaW
Fee exempt (City, Town, disirkl,municipal housing autharlly, owner -occupied residential of four units or less) 7yes ❑ no
-
Slicker I (from front of form): 32-5inJ 3