HomeMy WebLinkAboutSchool St. #315 & 321 - 2/28/2011FEB-15-2011 11:29 FROM:
TO:15082617343 P.2
Massachusetts Department of Environmental Protection 1100120707
Bureau of Waste Prevention - Air Quality
' Duval Number
1013-
Project Revision Notification _
For Asbestos Notification ANF-001 and AQ OB bri
OW
N When nning out A. Facility Location
When
formson the MANSFIELD COMMERCIAL INVSTMNT$ 41.0
onllyy t computer, use aL
pthe fah key 1. Name of Faclllry
to move your 316 & 321 SCHOOL ST
ouraor-do not2. Street Ad resa
uae the retum --^-
key. IMAN5FIELD MA
3. 4. ome a-Di)Code
"' 81T'5041058
94 6. Telephone Number
r.m
IN$TRUCTIONS B. Project Cancelled
1. This form In
only available for J Check here if this project islwas cancelled,
online n6no or
project date
ravlalona.
2. al ter number. C. Project Dates
decal number.
th 3. Validate that 1
the project 0212512011 OW2812011
location is wrrect t. onoinal Start Date jmmlddlyyYy)
nor the entered
4. En j, iateat Revtoed (
Start Date mmldd
4, Enter your new ) 4. Latest Revleed End Data (mmlddlyyyy)
project dates.
5, Codry your
noblicetion, D. Revised Project Dates
submit date
chanyea. 0212412011
1. eviaed tart Date (mmlddhrm) 2- Reneed End ate Date (mmldaryyyy)
E. other Project Revisions
F.
r.
anY06pdm,dw - rev. 215/04
FEB-15-2011 11:29 FROM: TO:15082617343 P.3
Commonweafth of Msssachusatts
i061120707
L Asbestos Notification Form ANF-001 "°W""nb°'
yw,e . t
A. Asbestos Abatement Description
ame to tho
r.. use computet
1. a. Is this facility fee exempt • city, town, district, municipal housing authority, owner -occupied
onlyy
� tBb
residence of four units or less? ❑ Yes Q No
Tear
de not
um the tetum
um the
b. Provide I>far W decal number if applicable:
Srerurot Oeml camber
key-
_ I
2. Facility Location:
,MANSFIELD COMMERCIAL IWVSr LLC 1
15 dh 321 SCHOOL ST
,KM
1(617) 504-ION
MANS IELO
'4"
t Ckdt'own d. SWe
e.2lp Cale kl'ilfphorq l�7rir• .
INSTRUCTIONS 3, Wbrlcilte Location:
1. Ae mdonsaf tNs SAME J
Tarn must be d. OkWAnM r1u11elBUIft LoQWM b. &ddaa 0 d V ft d. NOW e. Ream
coml9eled fin cedar
totmnprywia 4,
DEP naWkn ion
rewhaw errwo
CMR 7.15 $.
am bw Division
n=
teeuin rents of 453
CMR 5.12
G.
7.
8.
9.
Is the facility occupied' ❑ Yes ❑ No
Asbestos Contractor
10, a. What type of project is this?
d Demolition
❑ Renovation
L� Repair
❑ Other, please specify:
11. a. Chack abatement procedures:
OEncloosum
8
Disposal Only
Cleanup
[3 Other, spout.
p FIAI containment
61 ENDICOTT SMEETT
b. AddIM
7017823300
I. Telephone NINOW '
g. Contract'I'ype: 0 Wlitten f] Vefbal
b. oesalhe .
b, Desame
12, Is the job being conducted: r❑ Ind*=? ❑ Outdoors?
01 an1001ep.doc-IQ Y
Asbodw NOMMon Fam • PsWl of 3
FE8-15-2011 11:30 FROM: TO:15082617343 P.4
Commonwealth of Massachusetts _ ■
I E
' Asbestos Notification Form ANF-001 Dacia to.WFMW
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
3 IBM
*.Total PI„ Ta, . �....`. ,.vim«*, m U
C, SOW Urfa" Caiatl!rfN � �
�i'1L^'�
f-td. trig nmant
a.
plpelatlee r oe paper
L ,I
Un. IL
�q�
Rt.—...._J I.TMwetlSpraYorwaww
M SpaYwn flu"MUNN
IL Themes bowd. well hoard
i. Clods, woven hbrim
K ihpmld, amid cav PkW
I. (YOWL prom spodk-
IVAT R MASTIC r
Un, iL
I..
14, Describe the decontamination systems) to be used:
,3 CHAMBER OECON
IS- Describe the 0ontakwh2dan/disimal medm& to comply with 310 CMR 7.15 and 453 CMR
16. For Emergency Asbestos Operations, the DEP and DOS otfraals who evaluated the emergency:
17, Do prevailing wage rates as per MAL c.140. § 26,27 or 27A-F a" to this project? "I 1 Yes JZ No
B. Facility Description
1. Current or prior use of facility: RF.SIDEHTIAL .
2. Isthe facility awneaoeeupied residential with 4 units or lass? M Yes
&]I
U
No
410
■ arAoolap.doc•1tU0t - Alhbsfos teotlnrauon Form• PUL2 ar3■.
FEB-15-2011 11:30 FROM: TO:15082617343 P.5
C0mm0nw*alth of Mommchu"ft
100120707
Asbestos Notification Pone ANC-001 °w''"'"""
NOW Tnmsfar
Stanona nest
Salt waste
OWlalsn
Rsyslsiiuna 310
Cse219.006
B. Facilily Description (cont.)
5. �' 7=== = I b. Address
own
d. ft Cotls e. T Number eroa amn and e 1
f. Cormrsrtafe--duns Cdrq. treuer aVaser NaMer a c,.. n.r. i..,....«.._..
s. What is the sire of this %drW
ko. Asnesms r rantsporMon and Disposal
1. Transporter of ashe9tos-canfaining material from site to temporary storage site (lf necessary).
AMOAM
d. Ty) Cade
2, Transporter of as6estost»ntaining waste material fi
4.
MA
—w�.
0210
e. Stata r. zip Cads
D. certification
The u ICIAMigned hereby:dalas, under that
Penalties of perjury, that he/she has road the
CanmomxalN of Maasachusetls regaladans
for the Removal, contal6mertt or
F.ncapeuleson u1A*beeto% 463 CMR e.00 and
310 CMR 7.16, and that the inf wmnftn
contained in this notifimilan is true and correct
0a the best of his/her knnedge and belief
■ O n OImp.doc. IQW
b. Address
e. Tepptgns NmWar
22062
L xtp Cale
Asbealos NWksear Farm. page 3 013 0