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Home My WebLink AboutWilliams St. #333 - 3/24/1995VISMUC21aNt 1. Ad Mons cloth foun"bacowle d In orb to canpvwlh to OspulmeM of Emhodmanlsl proleellm notification raviana33 01310 Will ?.IS (fmuwkk d'Ys pW nopMban k mpukddsnysbdenart ploJwr: erd eo gapedment at Labor end Industries noNkdlon IegUYamM3 oNSI CMO6.12 Iwr, do)3priwnaowtonk aeuiel MANY eldamanwawawer Owigaeelk ar nwe lad, 2. Submit Qipiot Fmm lo: Cammeewul0 d ' NausoLuspU Asbeeles Program P.e.1.12 0111 totes, MA 02112- coal 3. Thk Immmlybe used W notifying do U.S.fnviomnar2sl PlottedlonArgRegion 1 of ssbwm domolklonr onevatim operations wbioula NE51UPS(4o Cf3Sbpal Ill. CbmimigmadoAVIA'asnChusatls AmL-iftr iffutlllcaticn Fvm — ANF-001 Q Asbeslos AbolenleNt DOSC P11017 4 f=? 1. Facility location: N on mansFi'�i�.d.................. ............... ..U.a S?_N.B......................$..."...3.°.... .."19..7 Gb/lwn Nmde f✓w'�^^s CQIIS.16&.......... ............. ..... ......... ................. ....................... .:.........:_._............._................ _.... ._..... .._ WWI, Ire WWI kmeo? a AVA''N", I. sav, AWroxn 2. Is The facility occupied? ❑ Yea POO 6.. project Monitor. .... N .u.9 ..............arudedrAN/ 6. Asbestos Analytical Lab: .................................... _ N.... to........ .............. ............ ....'..: cam _ ....... 7. 6. What type of project Is thb? (circle one): drMlm _(SaLSun.) two "WPM od'dr(ap/rk 75 P,'Cl-lip 9. Describe the asbestos abatement procedures to be used (circle): at" bid Noun aamda'e"ar doW Koduddko drpwa'ody wrµgsrnp to. Is the job being conducted 0Indoor$ Xoutdoore If 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes orduels (linearft.) oroth4r surfaces (square ft.) N GO to be removed, enclosed or encapsulated: I Ilosadsquare, last lobo', Nmwlnv. dw( W*sabcec'WIV..._/ ewmal, Solid wepjo Wdsfkn..... cormprtdwkywediuvorpoelauwlon.... . kwwE,00en................... spnWan Areryaolnp..:.................. _J ka ol1waye•codlnpr.........•.... . cloths, worm hbliY....................._J aam@Doard, tnilload.............—J aew(pkue duwibe).................... _/Jf6Z .usbes+05 6h��1eS 12. Describe the decontamination systems) to be used: N4.A.........................................................._......................_.............................................._...__.....__...... ..................................................................................................................................................................................................................................... 13, Describe the containedrallonfdisposai methods to comps wills 310 CMR 7.15 and 453 CMR 6.14(2)(9): .............................................. T i........_1c!`.Q.E.................._K?A.1...........1._c1b.C.1.le.M............bn'C.5.._........_._: .................................................................................................................................................................................................................................... 14. For Emergency Asbestos Abatement operations, the DEP and DO orficids who evaluated the emergency: .................................... .................................................. ..._......_✓l.S..(�e C if7..................... Non dae/oldd as ............... .1._z3.q..,S.............................__..................1Pi..'.............. ........................ _.I .......... __-._... tired,wmwrni NYNrI .......... ..... ..... .................. .....................___.._....._-- tiiaadaraawr •...._.......................................................................:.............................................................._..............., ................................................................. Wrier/ INedAWAaltdbe 46: Do prevailing wage rates apply as per M.G.L. c. 149. § 26.21, or 27A - F to lhis project? ❑ Yes kNo IPne tgtpl Facility Description 1. Current or poor use of facility: Ru,60 eoc-Q, ........ .............. ..,...._... _..................... ..._"""....._ 2. ._._................................. _........................................... ............... _........................ _... ._.............. .._ Is the facility owner -occupied residential with 4 unlit or less? A Yes ❑ No 3. Facility Owner .��......................................................................... ............................ .............. ..... Wmr..............................n7_ri..(..!...'..�S.,,i...................... .....:._........_............................................._....................................._.............:.........................................._._:.......""" CIU(Mn.................._._. Ipori rNrplav 4. Facility's Owners On-Slte Manager. F ,............................................................................................................... ..............................................I.V........4 ............................... ....I., AJPW um GbAo+n.... ....... ._............... _........... _.... _................................ _.._ ..... --_...._...._..__.... ... ....... __ .rN .....I ...._ ........... _..... ...._.�.�_. 6. General Contractor. ..................................................................................................................._....._..._... .......................................1............................................. eons Aedms .............................................................................................................._............_..........._.. ........................................................................................ rysros Gb/Iaxn rrapeod ' emcniclor's Wenlso Cane. Imunr Poky/ [Apollo 6, Vital is the size of the facllily'19 C)w(sg Ill Z (/ of flours) Asbestos Transportation and Disposal 1. Transporter of asbestos -containing waste material from she to temporary storage she (h necessary) to Nutt disposal she: ��.. Cti:.............................................. 1..i_d........ .,C. 2..... § r t....... u' AG.....3........ N+m A'eisa 'Sou nlvrl........................................................:.............8..'��U..'.�o_!`�.. GyAam rhwdr brol" • 2, • Transporter of asbestos -containing waste material from temovalf temporary storage site to final disposal ills: m .h sacAno...._ Tc_K !.. ......_.....s.! ►. v..c'...._ S, krc e-... c.sa.►._.a...o_g .............. ...... C.......... ........ ........... ........._a-O_.......-......+a.-0667 Note: Transfer •GbAoee noc,w rNaeaN Slarlons must comply with the 3. Refuse transfer station and owner (h applicable): Solid Waste -' Olv&ion repula- 'A4mr Aasw Ilons $10 CMR to.00 GbAaan....................................................................................... ��................. ............ .............. ..... .r.............................. ........_................__ 4. Final Disposal Site: IGe 11114 Run. l-c+mfit l—......_......................................_......:........._........................................_.............. ..ou..:1...._.._...►..........................._...._....:..................................................................................................................._.........._. Addsn F.�. ao) � C h.............t.19.................�. .....................................................:...............................................:............ Gb?am ro. e CeptUlcaflen r The undersigned hereby states, under the penalties of penury, that he/she has read the Commonwealth of Massachusetts Regulations for tho Removal, Containment or Encapsulation of Asbestos, 463 CMR 6.00 and 310 CMR 7.15, and that the information contained In this notification is true and correct to the best of deliver knowledge and belief. ..... .........`�............. Ge_,.................._ .................................., a�a.l.q........._ RhlNam Aunaer w she Note: Contractor .[7n F_,,' , / must sign rhlr..............................................._._............AY..S►.(:'.'1...................__.5G8.."..._�,8O_.'G�GI�� {, ` _.._..._.1-...Y.a..:T_d...!....1 rormlor DLl lauamu notification nwruesv tNmnw 11 (� �pp� purports_..._.l...Q �s aU/7T(/r� OX p� ..............k...._.........-..+..1....'...:.:1r.................................................................._..............................................................._.__. Amrta GHAow ryaw Fee exempt (City. Town, district, municipal housing authority, owner -occupied residential of four units or less) 7Wye1 O no Slicker/(from front of form):-'c��•��