421 Asbestos Documents Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
100237616
Asbestos Project#
Project Revision
Project Cancellation
111.”01wW,.i purssixa C.Asbestos Transportation&Disposal:(coot)
3.Name and address of temporary storage location/transfer nation for the asbestos containing waste
matenab
NA NA
Tenpraay Save tocabon Name
NA
Address
MA 00000
City/Town
0000000000
Stele Zjf Gale Tekphare
4.Name and location of final disposal site(asbestos landfill):
MMEIWABBER'RBE esrser AENTE PRff
Final Disposal this Slams Final Deposal Silo Owner Name
9000 MNERVA RD
Address
NNVNESBURG Qi 44eae
CMy/rawn
D. Certification
"I cetity that I have personalty
examined the foregoing and am
familiar with the information
contained in this document and
all afactmerS and that,based
on my inquiry of those
individuals immediately
responsible for dbtainmg the
information,I believe that the
infmmation is true,accurate,and
complete I am aware that there
are significant penalties for
submitting false information,
including possible fines and
Imprisonment. The undersigned
hereby states that 1 have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shag not be deemed meld
unless payment of the
applicable fee is made."
]3096&4435
Sate Decode Telephae
GREGORY FpPDING GREGORY FORDING
fbn Autitoazed Signature
OMER 211902016
Poseow a Dete(MttDOtYYY)
G7t3759634 PERO TEC
Telephone Representing
tea FtCE A\£ NCRT BOROUGH
Address GtyRwm
me 01632
SOO al Code
Revised: 11/13/2013
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CilCommonwealth of Massachusetts
Asbestos Notification Form ANF-001
1037616
Asbestos Project#
e Project Revision
e Project Cancellation
Rote:Temporary
storage or Aebeaba
containing waste
material Is only
allowed at the place
of business of a OLS
licensed Aebats
contractor or transfer
steam that is
pen-Trifled by
MaMOEP and
operated in
compliance wih$ollp
Waste Regulations
31 0 m1R 19000
B. Facility Description
1.Current or prior use of facility: NDILOMG
2.Is the facility owner-occupied residential with 4 units or less?
3.VAMC 421 N MAN ST
Fumy Owner Naha
NOR716pR0
e Yes
b No
Address
148 01502
4136844040
CiylTown
A.NA
Slate Zlp Code Telephone
NA
Name of Fairy Owens On-611e Manager Address
NA MA 00000
0000000000
City/Town Stale by Code Telephone
5,AERO MC 1E3 RICE AVE
Name of General Cataeter
NORTneORCtel
Address
IAA 01532
9783759534
Clty/Town State cep Code Telephone
ACE
LAMBdors Workers Compensation insurer
668206 5/1712016
Polo/a EWbation Dom(MMV (IYYYY)
6. What is the six of this facility?
35000 3
6quamFeel
C. Asbestos Transportation & Disposal
*of Flows
I. Transporter of asbestos-containing waste material from site of generation:
c Directly to Landfill or b To Temporary Storage Location/Transfer Station
AF3m1EC@NRONMENTAL 163 RICE AVE
Name or Transporter Address
NCRSBOIma1 MA 01532
9783759534
CByacren State Zip Code Telephone
2. If a temporary storage location/trmufer station is used,list name of transporter of asbestos containing
waste material from temporary storage location/transfer station to final disposal site:
RTL 173 FiCKERNG ST
None of Transporter Address
PCR11M4D CT 06490 8603420648
City/Term Stale Al Code Telephone
No Cofactor n
son cola soon Tor OtS Revised: 11/13,2013 Page 3 of
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C31Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
100231618
Asbestos Project#
• Project Revision
• Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
• Glove Bag a Encapsulation a Enclosure b Disposal Only Cleanup a Full Containment
• Other-Please Specify:
13.Job is being conducted: b Indoors a Outdoors
14.Total amount of each type of asbestos Containing materials(ACM)le be removed,enclosed,or
encapsulated:
Linear Feel flu FL) Spare Feet(Sq FL)
Boiler,Breathing,Duct. Tramite Pipe
Tank Surface Coatings urr.Ft. Sq.Ft. Lin.FL Sq.Ft.
Pipe Insulation Transite Shingles
tit Ft Sq.Ft U:.FL Sq,FL
Splay-On Fireproorwg 7`ansite Panels
Lln.Ft Sq.Ft In Ft Sq.Ft.
Cloths,Woven Fabrics Other-Please Specify:
un.Ft.
64 FL
Insulating Cement GASKET 1
in.Ft Sq.Ft
15.Describe the decontamination system(s)to be used:
2 fAWABER WASH BUCKET
Lit Ft Sq.Ft
16.Describe the containerisation/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
e MILL DOUBLE BAG
17.For Emergency Asbestos Operations,the MnsaDEP and DLS officials who evaluated the emergency:
Name of MeasDEP Oleos Tate of MaeDEP Office
Data of A W auvaice(MPIRJDIVnm Waiver*
Name at DLS Oaan TIIIe mots OItCid
Date ot?of Authatzalion(aee/DD1fYYY) Waiver*
18.Do prevailing wage rates as per M.G.L c. 149,§26,27 or 27A—F apply to this b Yea
project?
No
Revised: 11/13/2013
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pc., Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
500237616
Asbestos Project M
c Project Revision
o Project Cancellation
Instructions 1.AA
ceaons of the faro
mutt to cantplemdn
*Marto comply Mir
MssaCCP naafabon
reauteMents of 310
COR7.15 and
Department M Labor
mandarb(DLS7
rouirene
requirements of 453
W612
MesSDEP Use Only
Date Revived
2.Fan To: Original
Form To:
Cemmonvaamr or 6. Asbestos Contractor.
Massachusetts AEROTEC ENJRCNN4EWAL
P.O.Box 4062
Bohn,MA 82211
A. Asbestos Abatement Description
L Facility Location:
VANIC
421 N MAN Sr
Name MFad➢y StreeIMdress
M.]RTIYYMIW4 MA 01602 4135644040
CityfTown San ZIp Code Telephone
MIMALMP1321EZ FACt1IY EN(MVD2E
Fealty Carded Person Name Fe:My Dana Perot Tice
Worksite Location: SARONG 09
2. Is the facility occupied?
b Yes a Nc
fading Name,Wit Floor.Room,et.
3. Is this a fee exempt notification (city, town, district,municipal housing authority, stale facility, or
owner-occupied residential property of four units or less)? b Yes e Yo
4.Blanket Permit Project Approval,if applicabk:
Approval IDB
5.Non-Traditional Asbestos Abatement Work Practice Approval,
if applicable: Approval C*
Name
ND21}60ROUGH
Cdyfrown
AC000558
l®PoCEAVEN.E
Ad a ms
MA 01532
arm-aw34
Stets Z4 Cade Telephone
Contract Type: b Written c Verbal
OLS Lingo
?.-GREGORY W.HMDNO AS000278
Name af Contactors On-Site 9 ,erMorlroremen
2. JAMES SLCNEI.L
Name of Project Monitor
9, ATC GROUP 9FFACE8 INC
Nan*of Antenna Mayteal Lab
10. 33.20016
P?n$d Start Date(MMrDDrtVYY)
SAM TPM
wok 4idee-MdMay mraurn Ftidry
11.What type of project is ibis?
b Demolition e Renovation
CLS cemmcatbn s
AMOT3784
DLSCegt rnn8
Aad000M
DLSCerakabon8
31712016
Ertl Data(AN11DO frrN
BAMiPM
York Han-smarmy&Sunday
Repair c Other-Please Specify:
Revised 11/13/2013
Z a5rd
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FAX
Ae
nvramnwn.�
PO BOX 929
NORTHBORO,MA 01532
greg®aerotecasbestosremoval.com
PHONE: 978-375-9534 FAX: 508-393-3365
ATT : BOH
Fax : 413-587-1221
FROM: Greg Harding
DATE: 3/3/2016
PAGES: a
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