HomeMy WebLinkAboutBristol St. #? - 10/3/1990✓/re %oveonoosaa�ll�C► of,T�irdeucise�id-
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NOTIFICATION OF ASBESTOS WORK
(in accordance with the provisions of N.O.L, c. 149, §6-6F and 453 CMR 6.12)
All sections of this form oust be completed in order to comply with
the notification requirements of 453 CMR 6.12
TEN DAY PRIOR NOTIFICATION IS REQUIRED OF ANY ABATEMENT PRA7ECT
ORBATER THAN THREs (3) LINEAR OR SQUARE FEET
DLr FILE NUMBER
Contractor performing project Mat.inna. Abatwmt Se7vioes. Inc. License# AC 000060
Do prevailing rates of wages apply to this project es required
under M.O.L C. 149, §26, 27 or 27F? (circle one) YES NO
Address of -project
Building Name (if any) NET
Street. Address Bristol StYset
city %nsfield Zip 02048
Project type (circle one): DEMOLITION RENOVATION REPAIR OTHER
If *Other' selected, please explain
Asbestos Activity: (circle one): ENCAPSULATION ASSOCIATED PROJECT
ENCLOSURE REMOVAL
Indicate amount of: asbestos surface on pipes or ducts 50 LINEAR FEET
OR
asbestos surface on structures other than pipes or ducts
to be removed, enclosed or encapsulated 60 _ _SQUARE FEET
Start date Oct. 1, 1990 am- 8� pm 5;00 weekends? No
Completion Date 0--t. 3, 19M
Project supervisor Name ftr Johnson Certificate k SF C4734
Asbestos Analytical Lab Name Nub Testing Certificate #
Name s Address of disposal site(s) Roe Creek Develowent Inc.. P.O. Box 655. Cattlesburg,
Kentucky
• s
0049412
Is asbestos contract written or verbal? ••Wry o
Contractor's Workers Compensation Insurer_ Travelers Insurance Company
Policy Number 6-UB-477J633-6-89
Facility owner New Fnglarxl Teleptbne
Address 245 State St.
City Boston State MA Zip
Descriptioq of work practices to be followed: Full contaiml'_nt &opt Wrap
Description of decontamination system(s) to be used Full Contaiwwt - 3 stage tieom - neg. air -
criticais.'
methodsDescription of handling1disposal
Name and address of transporter(s) if other than the asbestos contractor:
EMS, 8 Hayward Street, Attleboro, MA
The undersigned hereby states, under the penalties of perjury, that he/she has
read and understood the Commonwealth of Massachusetts Regulations for the
Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00, and that the
Information contained in this notification is true and correct to the best of
his/her knowledge and belief.
Date_ Sept. 4, 1990 Signed:y��� \ (fGeam
Title: President ��
Company: National Abatement Services, Inc.
Please return this form to:
Asbestos Control Technical Services
Department of Labor and Industries
Division of rndustrial Safety
100 Cambridge Street, Room 1102
Poston, MA 02202
0049al2
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UNITED STATES ENVIRDNMENTAL PADTECTION ADENCY
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I. please provide the folloWhir inforaatton 66 required in Title 40 CPft
$Is Subpart N, Seotion 6.1.146 of the HESHkP's Asbestos Standard,*
(I) NATURE OF VDAK (oheatc Ono I ( ) D1NOI.ITION (x ) RENOVATION
(9) NANR OF ONNAR OR OP"AT0111 NatiDnal Abate'ectlServl6es. tnc,
ADDRESS 6 OV11AR OR OPERATORS J =mot ce rushlod'�4lev
OITV$ STATE,*
18) DESCRIPTION OF FACILITY,* SIBEi U'kr'Own ApE,* eve ryrs. old
PRIOR USLI Cantral Office
(4) ANOUNr OF FAIABLE ASBESTOS,* ,, _ 50 _•LIVEMi FA6T 6 SQUARE rFeT
For depDlition of a Faailitq with LBSS•than SOD square feet or 260
linear feet, desoribe teohniques wed for estimation:
(6) ADDRESS OF FACHATY! uriswi
CITY2 MansfiUd
(S) SCHEDULED DATES OF PROJECT,*
(7)
(B)
FROM 110/l�90 TO 10/3/90
PR0011011RES TO VR
NANE OF HASTE DISPOSAL SITE1 Roe Creek Development Inc
ADDRESS OF WASTE DISPOSAL SIT62 P 0 Box 655
CITY,* Catlettsburg STATE; Kenlltcklc
(9) 14MMO TITL», AND AUTHORITY OF AOENOT ORDERING 11110LITION1
(For proJetts 00400t to 61slMo) onli)
II. Additions) Requested InforAb"on (Not required';
(1) NAHS OF Ob7iRR OF Or"" t'entiArve
ADDRESSI 6--tum
CITY:
(2) LOCATION IN FACILITY VHERE ADATEUENI VJLL DE 1'1.'RFOAHED,*
(3) 440M
OF 11A8LBR OF ASBESTOS VAfiTn• ENS
ADDRESS CITYt Attlpfinro STATEI MA
DEMO/REND CLERK-2311-U.S. E.P.A. - Region 1 - J.F.K. Building, Boston, MA 02203-2211