HomeMy WebLinkAboutSo. Main St. #370 - 8/7/2007Massachusetts Department of Environmental Protection
Bureau of Waste Prevention— Air Quality
Project Revision Notification
-- For Asbestos Notification ANF-001 and AG 06
Important:
when filling out
forms.on the
computer. lua
only.tne lab.kay
to move your
ftn w -daft
use the y6wro
Rag.
vlo
�VVVVVV® A
INSTRUCTION&.
t. Thie fomf to
only available for
onLne filing of
project date
reviaiong.
2. Enter project
decal number.
I Validate mat
the project
location N correct
Tor the entarad
dendt.
k_ Enter your now
koct dates.
S. Certify. your
hotiflcatlun.
Subrmt date
changes;
A= Facility LocatlOf
ANN MARE CONWAY
s. TeloWtons
B. Project Cancelled
[] Check here if this protect is/was cancelled.
C. Project Dates.-
712012007�
t. Or Inet3W+"
ero7raoor
Latest v a
D. Revised F , I
0810a/a0o7 , 1�(�
4. Rev6sed Start Data
aniospdm.doc.my. ZMI04
lo0059333
Decal Number
t 'i
T4., fete- 5. Zip Code
to7
end onto immWdtuxvl
9
food End: Date.(mWildfyyyy)i
... neviaa End Dale Pate (mmRrdW")
Commonwealth of Massachusetts Li
10005®333 T
w rx�a umber
Asbestos Notification Form ANF-041
impeMnt:
A. Asbestos Abatement Description
When Aliino out
forma on9w
1, a is thin facilityfeeexempt.--01, ,town, district, . municipal housing authority, owner �uPi
-
computst, use
residence of four units or less? Yes ® No
lffJJ
�y thetebk"
to move your
Cursor-do not
.
b. Provide blanket decal numberit applicable:
Blanket pecst Numt»r
use the return
key,
2. Facility LOPAU rtt
r
---"—'—�
CONWAY
370 souTN MAIN ST
MA
",kWyrrr0~
tY1Q4@ {6tt9 Dias 763 F
Nunlvw
GA
d. $iota
a, ip CodeTeleptione.
3'$AbME tta LbOn
INfiYRUCTONS,�����
e: Repm
a.. Bulb r p Namelaulldlnp Locatbn h aUlidinp p a n4 �• Floor
1. AA sedlone of thil.
fwm must be
oomoted In order
to oomek with
DEP notif0flOn.
reeuitei 1111 of 310
CMR 7.15
and the Division
srtery (o su btlso�t
noyAcaOse
retiulremeriteef{83
CMR 6.12
A. is the facility oc<:upied? ® Yea ❑ No
6. Asbestos Gontrad0t:
10. a. Wrist type of project is this?
0 Demultion 0 Renovation
® Repair 0 Other, please specify:
11. e. Check abatement procedures:
61 ENDICOTT ST OLDG 32
aQ1.7sa 3380
a_Telep�'Number
A. Contract Type: (Z] Written [I Verbal
b. Deaoribo
®® Glove beg Encapsulation
t } Enclosure Disposal only
C Cleanup Q Other. speeft
Q Full containment b. soeee
12. Is the job being conducted; Indoors? ❑ Outdoors?
® snf00lap.doc- 10102 Asbestos NoAAOallon Perm - Pape 1 of 3
Commonwealth of Massachueetta
100068333
Asbestos Notification Form ANF-001 useel Rumver
A. Asbestos Abatement Description (cunt.)
13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
1110 Ir�
a parse or uc a (meet �Fd" cFSIFir
110u ease cquens r
a. Roller, breaching, dual, tank_
surfacecaalln®s
e. Competed or layered paper
pipe insulation
p, Spray -on Mraprooang
I. Cloths, woven-febrim
it. Them+ot, solid oars 00
Insulation
14. Describe the decontamination system(s) to be used:
3CHAMBER M ON
d. Imulet ry aement
f. Trowel/Sprayer coatinpa Lin. e.
h.Transit* bxeard,wall board .:;=
j<Qlhar,. plaaa4.&P" .
16. Describe the oontainerization/disposal methods to cornply with 310 CMR 7.16 and 453 CMR
6.14(2) (a):
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency
17, Do. prevailing. wage rates as per U1,0 .. c. 149, § 26, 27 or 27/-F apply to this project? L] Yes 0 No
B. Facility Description
1, Cunentor prior use of facility: RESIDENTIAL.
2. is the facility owner -occupied residential with 4 units or less? ® Yes ONO
Gas
Z
E and ap.dec-idld2
Mbeelas NWIRcatian Form • p
Commonwealth of Massachusetts 1005e333
LLt�
Asbestos Notification Form. ANF-001
a e. Gltty n®scriation (font.)
Note! Transfer
station must
comply with the
acRdMora
otVistan'
Ra9u19110ns 3,10
CMR i9.000
[1
8. What is the size of this facility?
C. Asbestos Transportattionsnd Disposal
1, Transporter of asbestos -Containing materiel from site to temportsry storage ells (it ntsoeefstyj:.
AIRSAFE Add
--
a.
�.-----+1 dd. ZIp Crude .a. Yete
a CiyRavn phuna Number
site Po final disposal ait8:
2. Transporter of asbeatos�containing waste material hr ^ nmr,.ratttwrnoarery
3.
4.
s.
D. Certification
�3a
f. Zip bode
The undereigned hereby states, under the
penalties of perjury, that he/she has reed the
Commonwealth of Massachusetts regulations
for the Remove!. Contalnmant.Or
Encapsulation of Asbestos. 453 CMR 6.00 and
310 CMR 7.15, and that the information
contained in this nc Ocation Is true and correct
to the best of Mather knowledge and belle .
02082
l Zip cods
® aftmolep.doc - low Asbestos NOWCaUonForm -Pa" 3Of3M