159 Asbestos Notification Form 1999 Note: Transits
Stations must
comply with the
Solid Waste
Division regula-
tions 310 CMR
18.00
Nate:Contractor
must sign this
form for DPI
notification
purposes
Telephone
5 General Contractor:
Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow Rd .
Name Address
MA . 01360 413 498-0201
Northfield - ieiepnone
ciynown Zoe code
Granite State Ins . Co. WC 3515762 00 Faooale�l ����
Contractor's Workers Comp.Insurer Polity/
6 What is the size of the tacility2 410(sci ft) e2 (#of floors)
Asbestos Transportation and Disposal
1 Transporter of asbestos-containing waste material from site to temporary storage site (if necessary)to final disposal site:
Shearer & Snide Inc. dba/Ace Asbestos 716 Pine Meadow Rd .
Nan+e Address
Northfield MA 01360 413 498-0201
nd a le Teiephune
GryNpwn
2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site
same as above __. .
Name
Ciro/Tnw;
3 Refuse transfer station and owner(if applicable).
N/A
Name
Wormy
4 Final Disposal Site:
Valley Landfill Waste Management/ Logano Trucki
LO-appn Nane GMers Name
Pleasant Valley Rd .
r;;acre
Address
rebphom
wale le TNermu it
D
Address
Irwin
PA
15642 724 744-7446
_.m.- .nhnme
Certification
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Reg
fm the Removal,Containment or Encapsulation of Asbccta3.453 CMR 6.00 and 310 CMR 7.15.and that the information cool
this notification is true and correct to the best of his/her knowledge and belief.
L'Laak.d d7 Shearer
Run!Name
k(C&S ;PEr z
PusilionTde
11/15/94
AumomM Signature
Shearer & Snide Inc. dba/
Ace Asbestos Removal
716 Pine Meadow Rd .
413 498
Representing tAeWane
Northfield , MA . 01360
mem. Gry/rpml
Fee exempt(City.Town.district.municipal housing authority,owner-occupied residential of four units or less)?XI ye!
Sticker l(from front of form)'. /3 / ,"34!
Axle
odium
ion nmiliwtan
cents o1310 CMR
n working days
of any abatement
and he
nerd al Labor
unifies
m requirements
NA 6.12 (ten
r no(iliwloo?is
oIANY
It project ryearer
?linear or
or,omai Fern
waalth of
use Its
Program
'0067
AA 02112-
n may De
[lying me
nmental
19ency Region
sdendlmn/
ipetalmns
.SNAP„(40
I.M).
2. Is the facility occupied? T4 Yes DO No
3. Asbestos Contractor:
Shearer & Snide Inc dba/Ace
Name
Northfield
Asbestos 716 Pine Meadow Rd .
Address
01360
Cory/1-own 00 rose
AC000006
Ott license/
4. On-Site Project Supervisor/Foreman.
Ed Shearer/Tom Shearer
Navu
5. Project Monitor:
None
6. Asbestos Analytical Lab.
7.
Leers,'tie lwnhe(evenW)
4 ) 3 498-0201
ielepnone
AS70245 , AS70066
Duaemr rmi/
IXl Cenn!weevil/
NOV 18 1999
Cc , t_L
6002c�iniu.0rt?c S4r/P0A)6- & /74600/32-? 372A)� Du eennlmlmn/ (,?/
Project start date/a/ 6/ 77enddate/a/ '7/Hspecdic work hours(Mon.-Fri.) p Cs (Sal Sun ) VLt
![.Ea Cft )5E update
8. What type of project is this? (woe one): rxmonnou mdwr renoealrom] omaa,M,an�� `-eat
9. Describe the asbestos abatement procedures to be used (circle): glove ha/ emiosure
enrysehtem
dlggsy ow, ogler lmpinnl
10. Is the job being conducted 0 indoors C outdoors?
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) r-20 or Cher
surfaces (square ft.) 36 to be removed, enclosed or encapsulated:
linear/square feet
boiler,breaching,duce,tank surface coatings. r_3L Inermal,so»d cue pipe it uiaion _/
coitugaled Of layered paper pipe insulation Q/ insulating cement _/
spray-on Greprooing... / toweVspiayercoalings.. r
cloths.wean lab= _/ Parade board,wall board.
other(please describe) _. _/
syS tee
set—up variable air pressure,
poly work area , HEPA vac, HEPA
filter respirator , wet asbestos
12. Describe the decontamination system(s)to be used 3 c ham her
shower, tyveko suits ,HEPA vac for clean—up.
decon unit 'w/'.:arm water
13. Describe the containerizat ion/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g).
Rewet asbestos & pack in labeled double sealed poly bags
removal from site .
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency.
of
Mime oral/onzm
Dale awrnmvaJon
Nave a a(,UIYAI
Odle ol&Mut alms
fire
Na rti/
line
We per/
15. Do prevailing wage rates apply as per M.G.L.c 149, §26, 27.or 27A-F to this project? C Yes No