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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