5 Asbestos Notification Form 1999 LI • Fatuity Description
1. Current or pilot use ul lacllily:
Reeidentiai
2. Is the Iacilily ownm-uccupled residential wilh 4 nulls or loss? n Yes CI No
3. facility Ownol:
Marcus Barrows 5 5th Avenue
Thine A,✓,es
Nor thamptoni_ Ma 01060
C0%lmu,
4. Iacilay's Owner's(51-Site Manner:
Marcus Barrows
VSne
apwoim
r. General Gonbaclur
N/A
Name
413-584-96
lelr;Nwr,e
Same as above
A✓✓,es,
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✓✓,u
(Ur/loon Ip code
Reliance NaLlya91 NWA1795179-00
contractor's n'o,aen Camp.humus' Pony/
G. What Is the see ul lire lacllily? (se II) (r ul flows)
Asbesfus TranspultalPon and Disposal
ieep,on,
11/04/99
lip Vale
I. 1mnspmler of asheslus-conlaIuley waste material hum sire to tempulmy&lunge sire(II necessary)to final ills
Accu'rech Insulation & Contract lug, Inc. Uumut_Street, Delta 1'
Nate Amen
Chicopee, MA
4'lry/loan
01013 (413) 592-5326
/6 nee Imµies
2. Transporter of asheslus-coi dalniny waste material hum renewal/temperer),stooge silo to final disposal slier
Lozano Trucking Company, Inc. 25 Silver Street
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Note:lousier
Stations must
comply with Ilia
Solid Waste
Division regula-
tions'310 GAIR
‚Lou
Fiala;CWJIracfor
must sign This
form for ULI
notiUcallon
purposes
Wane
Portland_CT
Wow
3. Rehm Daimler station and owner(II applicable):
N/JRN.
na..
Mann
06480
bp rude
Bp wilt
(860) 342-0667
ItIrp'PIne
... lelr�+nvn...
Won
Southern A
71e ha ill USA W a sSe Servis esi?nc
q. Final site:
rwnnn+ e WPM
B43 Miller P1 kid
AJd,est
Davidsville,?A
cw,lonn
_ 15928.-
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Idep'n+n
►j' ccrtificaUmr
aeathat lhassaci lion
the undersigned hereby slates,under the penalties of Vei)wy,that helshe has read the Cuuunmiweallh of Massachusetts
lidslnoWlcation Is Containment or
Encapsulation ul Asbestos,493 Cf4110PU
to the best of his/her knowledge and belie!J 31U c
/. IOL ._
Analia St. Gear e
Arnim e
Administrative Assistant
(WWII. 010 I�
Delta Park Chicopee, t1A 2010
Depot Street, CI Porn -
feeep g y 0 11ci.occupied i esidenital vi lout units ut less)1
f ea exempt(Cllri iuwn,JIs01c1,municipal housing aulhmil ,
Slicker I ilium Bout ul lours)'.
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Contractin
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