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Home My WebLink AboutGilbert St. #200 - 6/7/1995nimucnoMs 1. At sections slats farmmsuWtarpMed IoadulocompNwsh is Dopsdmenl of Embedment$[ protection Mulkdlon requ2enuls o1210 emll 7.15 (W ew kv car pWaoW Mis liquidolsnyat "" po}W:udt+ 0padment at Labor .A ln4uddn notlballonrequYenaea 01153CM1 U (W da)spiarmUOalbab raquSedolANY ataYmMp'oAWaaNW squwe bat. 2. S,dnt Ulo„alEam lo: eo6mewal6 of Wesehwrlh Ihbeilw Pletam RO.3.120087 Iuloa, MA 02112- coal o. Thblammly A used W ncilyN 14 US.Envaomwaal Proledlon AI7uwY 0eglon I al uhnno demdt10l m apualbm MkIed W NESIIAPS 00 CNt Subpart M), W9r sx yg74 As dsrrLfilglficallonFan►►—ANF-001 I. Facllitylocallont n i ., s"T— < ...1-,rt.T.a.nn.........................___. ,wsao M4 !S. r..r.w...................................................... .....0--w H.fr............... Gy/laxn _.._.....i.:s a,eamnm. /. aha Mv, roan 2, Is the facll9y occupled7 Clyde ONO 3. Asbestos Contractor. ............... .._........2Q_......_._._.._.._.._..__..._.__. ._.....N...5'n...._. 9'......... �.8.0.........: Tatj nkon coca ...... ..6...Q$.-3�o...' .................................... � GD/!am A C (7QC.�q. ..........................cuabd ...................... .......... rYWlertYMva+q ................................................... IXllYma/ • 4, On-Sl a Project Supervisorffolemant • S r 1166 3 .................. 0. .......... ...........................................___.__._ Wne 5. , project Monitor ...................................................................................... 6. Asbestos Analytical Lab: p................._.............................................................__..__._.._..__�- •.t..%.N......................:.............................................IXI GdIr1W / Nano dale��PecHlcworkhours(Mon: Fd.) k (Sa1.SunJ — 7.- Projecltladdale-J�snd maa as+r(mpuN1 np Y B. Whai type of project Is this? (circle onow e): w be us d 0ii"$[asap 9. Describe the asbestos abatement procedures toed used (circl wn�ac Q�2 ww"AM Wrp+da4Y vmr(nybnl 10. Is the job being conducted-ifidome Oeutdoon4 or oth4r 1t. Total amount of each type of Asbestos Containing Malarial' (ACM) to be handled on pipes or ducts (linear ll.) l surfaces (square It) ,._____—.---to be removed, enclosed or encepeulaled: fln"t1squm feet talky, breaching. cud. bntsahacoallnps..._J�0 Ywmal, .... _J7. �'C sol5lcaepla Wslubn......_J carupaWablaedpspWploakwhilon._J hwWhprem............... apray-on fireproofing ..................... agnalkb d, wHb .............. _1 dolls,wme76614s..................... _� tuslkbaud, waataard............. sow(gWsel ltal.................... —J 12. Describe the decontamination system(&) to be used: , no.e„ an a rl 3.._C k,1+f.(3.L'.!L._..:�L,_.1'LLn__5fi•"'—�nt{'^-� a Describe the with 3 t0 CMA .................... _... . .......................................... . 14. For Emergency Ash a'los .. . .. Abatement .0110milons, the DEP and IILI Officials who evaluated the emergan . ........ .......................... .............. ......................... .............................. I ......... ............ Ahnv WaalOIkIY ..................................................... ........._.._.........................._.__ 'lwwr/ WYWAW/a4'a'LN ..................................................................................... ........ .... .... wa+Wouasdd .......................................... .............................. :................ ....... ..... MY WAWAweYM 45: Do prevailing wage rails apply as per M.G.L. c. 149, § 26, 27, or 27A - Fla this plolect7 O Yea f}t\No MW WIL, U Facility Description 1. Current or prior use of facility: ........... tA..gs_nitO.:!......... ........... __........ _... ...... ... _............. ... ... _______ 2. Is the laclihy owner-omupled reaidenllai whh 4 units or kssi O Yes KNo 3• Facility Owner. :7Sf.K..........._........ ................... .............. ......... ..............................................................:........................................_........ . _. tons, 6. General Contractor. ............. ................................................................_.........._...._..._.. ....✓..tl..?.i�..................................................................... ................................... Nona Mli111 ............_.....•..........................................................................._............. . ........................................................................................ n, roll ...................hapiorx GyAoxn ' r Cooaeclore WotlVrn Cenp• Inrunr Polryp rxp•Oalr I�000 6. What b the size of the IacIINyT• I (sq It) —/ (I of floors) (�K /t2P4-$ 13 Asbestos Transportation and Disposal 1. Transporter of asbestos -containing wale material Irom she to temporary storage she IN necessary) to Dnal disposal she: ..:1.............. ............................ ...............I� uyrt'SC,.yr1................................................:......9..&..'U..'_o.!q.. 2.' Transporter of asbestos-conIAning waste material from removaDtemporary storage alle to final disposal site: Ca._ k►.,a .....................GT...............0_�., 9.................... 0.3........' a•-o667 Note:Transfer •Gn/Iaa A"°tr rrmma Siallons must - 3. Refuse transfer station and owner (N applicable): comply with the Solld Waste ................._...... ...._.......................,.._ ......... I ........ __:.�_:._..__ Dlvhlon repula• Rae aaa.0 Ilona $10 CMR ' 18.00................I......................... _. r� ........... _...................... _._....___.7— G7/Ia n........................................................................................AP 4. Fire! Disposal Site: F'� - iI e.11ll. ....._k,Si.cl.:.....► 1.fit.l.'............... .... ............._._...:......_._.......... ...... _....... ....._.__..__... _....._ ........... ............ ...._..._................. ......:............................. .......... .................._._.......... _......._._..._.._........_._. Arian .Ml.'.!-„.kr....L....l....1.........1.......... {.......... .......................................... `Y..............................................:............. r certification The undersigned hereby states, under the penaNles of perjury, that he/she has read the Commonweallh of Maseachusetls Regoiatlons for the llsmwd, Containment or Encapsulallon of Asbestos, 453 CMR 6.00 and 3t0 CMR 7 15, and that the Information contalned in this nollllcaalli'(onn Is true and correct to the beat of his/her knowledge and bellef. v'^a....lrt....................................... ........................................................... ...�.:........._.. • hhfprmr A retpwur @e ac(e:Confractor n F_,,, / must sign this Pus,['[........„�•1 .. ,• _ SY"T') 5M formfor DLl itivai%oii" . ... .... _.......... _.........................._..............................._..................__. i✓W.r,i..................---.____..__ nolhlcallon pumoses_.._1..1.Q..._.►.7....t'.p.n........_sfr:.."..........._...:...........`rG.un�l-t�✓->.......................O.a _ .0.._..._. AcWur GyAoen roroa Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of lour units or less) 70 yea 0 no Slicker /(Irom front of form): S5077G0