The URL can be used to link to this page

Home My WebLink AboutColumbus Ave. #19 - 6/29/1995$'t fnrlrszu>pAt7l�iSd�'assacriusetts '�-t sue' �"� `�~,�,�-� �( A!rAenW- HuMcation Fomit— ANF-001 4 v+ g) Asbestos Abalemenl Oescllpllon 1. Facility location: ......................... ..5.......................................... !a......... un bu `: eE�uer m...... aslRucnoiF MaeZ - 5� g 97 .. I. All seolaa of this .....�. . mq�)5.:.._?e.�cl..................fenta .. �J.y....�l�i..£ ...............�� .g..-..........a .'_............_63 Mm mWbcangktl GbAaa p Irudalocamp4'w1h R In Jrling..5,(..._........ ........_..................:_._.....___........__........_....._...._..._.________ MDepenmanlal_......._.................................... ... ..... Embarimmill NAYbryaoMArbala7 am,%+Mt nav, Protection ndnhalion 2. Is the Wilily occupled? Yes O No lovinalab of Alo CMR 7.15 Pol"000 3. Asbestos Contractor..{gyp l> ? ..............._.........._... ..:_1.. `..0........`./.ir..!....1...___sa_!._4C.�..._.....Sv�it p-okol: Val tv _ ...._ Adxw (farsrlmanl of Labor Mr. r� —2 p /�Q $gyp (�(� and Industrial TO.0 n � on 0 O- I (�Q V l7 (�00 — �/ `�,.1... no1N'ralbn lequaeneds ......................................_............. ............................................................. o1453CM16.12 (rm MOM s6yaplaratihalbnb ((��sa /-y Q "Mull o1ANY A C,./.O..V..,-...`................................................................................................................................................................. ....................................... amlm rra (emarveaee7 rMOarsA" tiara urrr.,r.i Aura lna lhr+r w SµareAM• 4. On -Stye Psop)eei Superrv!lso�rffoyre��mapn: 2. Ursk algeul Fam ............A...�Y.,1......C...U'(........K...y.............................. .IX, F..4...1.6.6.!-.t...._........_............_....................-----'-- le: aaam CaSsmnvol0 d pueaewpta 6. .Project Monitor. Asbest" Preens P.gJ.120e17 ...............___....._...-- .................................. 4...............................................................IX Iu1n,lAA/tilt• ltua oosl 6. Asbestos Analyllwl Lab: 3. Thblo,mmaybe used W MilYhg tiv 1........... ....... ................ .._............. .......... ......... ........ ........ ...__.___.__._.__.._ US.Enviarmerarl Abm - PlmecUonAgwcyAeplon to 7. ProjedcWd dale=TR Iq e<dale J I cHicwwkhours(Mon: Fd.) ^ (Sal.Sun.) I of »beslos demdlbN fenewdmepeulbm "MIo NESMS(4) S. What type of project Is this? (circle one): srawfol sae mows aw"µviaxl CFRS,bpat L0. 0. Describe the asbestos abatement procedures tobeused (circle): Ponaao «.Musa Aar«dnnd a"na wcawaar., maovavr onntwpux)� '% �pF 5�rnglC�.$ a" 10. Is the job being tend ❑Indoors outdoors If 11. ]Dist amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts Qlnearf.) ofoth4r ,2s,, als surfaces (Square It.) t-10 be removed, enclosed or encapsulated: llneadsquant bet .. bclkr, b"addna, ofµ wAx4ac'allnps..._l Awma( solOcaaptv lnnAekn...... comVWor hymlpyaploohsulelon.... _J lw,wngosnene.................. .._J 141 Anp"aodnp..................... _/ Yowevsagn'coallnps.............. _J t1olM, woaen kdks..................... _1 eemNe Mad. Iregbowd............. )� atlw(pksaadaalbs).................... _1�3LS1E51� r Mfg 12�5� 12. Describe the decontamination systam(s) to be used: U ....................... ............................................ ... ............................. ......... ......... ......... ............. ............................. ............................................. _.................. 13, Describe the conlalnedatlon/disposal methods to compkI Ith 310 CMR 7.15 and 453 CMR 6.14(2)(g): uK)._....... Gye..........kA.._...?�.1.._.._..l._c�bCB.f0.._......,kr.q ..............................................-.......... ................................. .............. _.......................... 14. For Emergency Asbestos Abatement Operations, the DEP and OLI officials who evalualed the emergency: ........................N...4../?.................................................................... .. ......................................... .................................................. ' wm,or.drc..r...o.aa.i.a ............ ................... ........ __....................... ......._....._............................... ... .............. _......�_�__ e,Y dAaaabakN ........ .....N... 1.0................................. .�w......................................................................................................--_...... _ _ yaanadouaadd ..._..................................................................:......:..................... .................................................:..................... .......................................... __..... _._.... tie dAw.waaan wi+"/ eb: Do prevailing wage rates apply as per M.O.L. c. 149,§26,27. or27A-Flo this project? OYeS No SW AV , Facility Description Note: Transfer Stations must comply wlh the Sold Waste Dfvlslon repine• flans 310 CMa 18.00 1. Cunenlor pdoruseol(acllity: Re'sti.ence_ 2. Is the facility owner-occupled reddential with / units or lecs7 'Ayes 0 No 3. rectify Owner. ......................................... .... ......... ... ....__`..._. r4ne _ ..................................... _..`a ............... _................. .... _.___._.._ GbAaxn__. ....... _.._._..__._..._..._........_._............................. &mda 4. Facility'$ Owner's On -Site Manager. ............................ ..........................n........................... .................. .................................................... _. ........ ......... . ................................... Name ....._.._._.._...__._.._.._._ '�.. .....____......_..__._�.--- GbAaen 6. General Contractor. ........ ............ NIB ....................................... xame .................................. . ............. ...................................................................................... ............ ly roes.............. GyAaxn colawfors Wodm camp. Maunr Fblryp 'an 6. What is the size of the facility?M (s9If) i V of Ibor$) Asbestos Transportation and Disposal 1. Transporter of asbestos -containing waste material from she to lemporery storage she (h necessary) to find disposal the: _.........:.N..S!'rJ:..................................................... .... 1�A�_.......5'an......5+!te1......a k..._36... Him IbLu n l fctn.......................................... 7..a-�. 0....:.......... .' .�.U..'_ �Q..`... GyAam locr* TOW" 2. - Transporter of asbeslos-containing waste material from IemovaDtemporary storage site to final disposal site: .. tea....._..s_�►_v..r.....s re'...._._--- ud� t�._ k,1, nG..................... ......... 0_ 640...................,y�103.".....'�2.."0667 3. Refuse hansler station and owner (h applicable): .................. .............,............ ............................ ............. ........._............,................... I .............. _-'—'.....__ A4mr CNAoeo 4. Final DI ................._...._....._.................._.-----.___ .................................................. r"siµaaa ryawa .........a..avr..n.................... s....:.::.:....... UxxnNm............. ........ ....._.___._.. /aalm Nola .... ... _..6-1............... .........__....._:........ ...._..................... _...... .............................. ..._............. .........._..... ......_._ War r� b. l-C`e� {� .......�,�I...�..1. .!/..1.• Jy� ' / 1 �........... .. ......... .... ........ ..- ...... ......... .rN...........,................................................. ............................... . MAM ID certification The undersigned hereby &late$, under the penalties of perjury, that he/she has read the Commonweahh of Massachusetts Regublions for the Removal, Containment or Encapsulation of Asbestos, 463 CMR 6.00 and 310 CMR 7.15, and (hat the Information wntalned In this notification Is true and correct to the best of hia/her knowledge and belief. ;Ilm Pale. 5�a��GS Nate: Contractor n /J ESrY! 5V0� muslOgn this i 4�.� �.4 ....................._...................._. ...... form la OLl rmaravnra h{rrxnrMe rpm nollfallon (.... n........... .......__..... Gblio n....._�un ............. 0_r°.�._../._0 .... Fee exempt (City, Town, distdcl, municipal housing authority, owner-occupled residential of lour units or less) 7 µi yes ❑ no Slicker / (from front of form): 79-7 30 -7 I ,