HomeMy WebLinkAboutChauncy St. #140 - 7/15/1993Commonwealth of Massu setts
6
Asbestos DO ANF-001
AWSIDS Abalem;int
1. Facility location
No C-84wrvCfi-Y
.... ... ....
WN
1. AN 5411M. 01 It"s
bm INS! N t'IffIolino
!ems IYYex.e
Valloarini
1100,114,41 .1 ......... .... .
Protection wilca!hm 2, k the Many, occupied7.1kyes 0 No
IIiIiiiiannerhoI310CMR
110 immA.P&), 3. Asbastol contractor
......... .. .
................................ . . ..........
............ Lo
0 a paM.1 or to Dot "it Ind.suis �0 I
vc? 1 ?6 rle-k-
Some kdo 4, or,411, Pro)ed 5up4muorfForainkri:
2, SbM(AqrWFffm
To. )bw
Cowenosswoolla of
Pripjact Menthol:
.... . .. . ... ...
Ratio, MA 0:11111. Yee
1097 '
6. AWolo4 Arwilylical Ub.
ew. . ......... . ....... . ..... . . ......... .. . .. ...
so Id" in
'am
sion 607 Sal SOL.
I or imbigo, carriolticin' 7. Nord
W&AM�A�
Shies Is W-qtkq (401, yyhal (droll(Ini IN")
Cm slew 14
nYaaroy 9. Drai the Alibigi Abatement Procedure" be used (C"C"): o` no
erg a fKwv
Dart A Wit conducted C)f-Kod, Q outdoors ?
11, Toudmousi of each trips ofiubalcdeoftui Mx1olieth (ACM)to W handled on pip" of data (fineast ft.)
suallatess (spume ft.) be mrsioyed, amlosed or any;Kpaularied:
firmearlssimare foot
bou,&OSOWV,
oft smemen leva .. ..... . ...
12. Doesuraft the decontamination systorti to be ould:
..........
I& Dwdboth, contlinirlubotidispotgmithodstocompy AM 31DCMR7.15&nd 453CMB 6.14(2)(0)
. . .......
.. . ... ....
14. For Emespewy, Ahowto Ablarporri Dpontions, the DEP end DO officials who W&JUAtId the tMeloenty;
I NMI/Wid9w rw
. . . ...... ..
trlrwaYwYn
.. . ....................................................
..... ......
IL Do prqv&Ihq wrigi tiles &;i as per M.G.L. c. 149,126.27. or 27A - F to this Poled! Yes
0
An 6m , .
14,
r
Lai facility Descrlpcfon
1. Cmten or pnOr use Oita 11 .
s,r�.�' .' _......_
2, Is Inc lactlily ownu•Occuged t aidentul wdh a unn. OF In$? Y a O NO
3. Facility owner
Sri
................................................................ _...
/. Futi ly s wnst's on•Sde Marativ:
^11A-
xnx
y.mx txapmr
............ A ............... ..........
..._...........
..............................................................
Anwl
GMo«,
6. 0enaul Contrator
Csnwar, w~ Camp. Yount Pao/ Ev Oak
6. What le the eiu of the t IRY?(��F ••7��//,,..''(eY t? (11d11011)
Asbestos Transporiailan and Disposal
1. Transporter of Ybeslos<omalnNp mud maleieltrom am to tsmput it ratio site (if MenBLfL) te final disposal "C
..
eesa
do271f-U Ovd'—t�lS
.. .. hocia fxWe
quaw^
Z. Twspcne dnhsalM CarNlnlna"do material film nmwau temporary gorapo silo to final disposal/hat
LOCyRNU /G{LFnb tv /l $ __ _.
............./._�._._.__.__....._lam_._._.._.......... �.
......rr2_.5,......5_[..........P...............a..,.._.............._..._........... _.
• ow", ✓CJn T Lf�-N.Q . �.:....._G) b�. rxrrw.
ado: Trantfor
sfaiwo must a. Ulf" twolor eWion and 0"I(a appikauls):
eompN with IN
"west, ..............
e..
Nona dlO;se.? .. .._........... ......... .....................
..........,...._................... ... ......_..............................__......... IeMov
11.W........................................._....... lima
aev7o,.
/. FYW 01epoeel She:
y / .......LA^OF,«...............................................................................................................
............................. pwnbY
soma
,�,� yammer
a CadillCaDan
1M undesipnod Muhy grin, under the peM6les at perfory, that Woe has rnd the Commonweallh of MaauChunits RepulalioM
Im the Romwal, Comainmonl OF, Enaps,didu n d hsGosms, 453 CMR li and 310 CMR 7.15. end that the informuon contained in
,his nolifKation Is true and COlret to the but at hufiet tnowledpe And belief.
-�OWN
._... _.._-a ...........................
Note: Contractor.......Ap.nn._� �•Y Px-ko 70
must this ... .....
....... .
form for on DiLl MiM,M
jaytificeli
Purposes/ ..................
Amu,.( ............... ..
Fee exempt (Cm, Timm, district , munici t lauetnp Who*, miner•occupied residential of lwf units 01 less)? yiyn 0 no,1-1sucyn/(from from ofform):
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