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86 Asbestos Notification Form 1999 Facility Db_.ription 1. Current or prior use of facility.2,£.5/11 2. is the facility owner-occupied residential with 4 units or less? hhA,Yes = No 3 Facility Owner'. fin c; kin55 n &G arson St, Name Address tJcler-tFiHU'TDni MA _ D/060 4/3 5re- 57/t ,�'�rONf /m mIe Telephone 4 Facility's Owner s On-Site Manager: ry/4 relmlroim General Contractor: Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow Rd . Name Northfield M.A . 01360 413 498-0201 Ciry/rcAre NacoCe.... .. relepaone Granite State Ins . Co. wC 3515762 00 9///Q'2000 contrzcmrs WCrkeu Comp.Insurer PoAry/ fspDale 6. What is the size of the facility?as,Ye(sg N)_NO of floors) © Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material from site to temporary storage site (if necessary)to final disposal sit, Shearer & Snide Inc. dba/Ace Asbestos 716 Pine Meadow Rd . Name Address Northfield MA 01360 r h/Towr roan 413 998-0201 Telephone 2 Transposer of asbestos-containing waste material from removal/temporary storage site to final disposal site. same as above Note:Transfer e aee releonnne Commonwealth of Massachusetts Asbestos Notification Form — ANF-001 CIAsbestos Abatement Description 1. Facility location: /11 A/Cif7DAb ef_ Ir� .NcLS a ha r','.o%l.. LSjtrezt. Address ucrtgtu Nune 0 0 JJoRSH�9voti M l+ /oGo ... 5 .. ._ DRS completed ZylN]e d0ry� R �(� 1� comply art Clry/lown 't r. L5 G ltl _ nerd al NRW is Use awtrdeI ahare toldligl¢rle./.wmg.llow from enlal onotmcation 2. Is the facility occupied? Yes P No Its 01310 OMR wodmg days 3. Asbestos Contractor: Cation rs _. /any abatement Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow the We Address stries Northfield MA . 01360 nlenuile(ten raaa r al:onona.. IF 6.12 pen Cory/Torn] no noliecrirm MANY A0000006 1polect ry®ler al License areas or °0 4. On-Site Project Supervisor/Foreman'. AS70245 , AS70066 giginal Flom Ed Shearer/Tom Shearer Dar culenlwir/ Nine nnllh of husstts 5. Project Monitor: s Program 200117 MA02112. Name 6. Asbestos Analytical Lab'. am may ee !U/ n neurone gte Nane A pL2eNAOiiun/ ammecal /daa ,[oe nAgency Region d i (Sat Sun not nmdeations 7. Project start date l end date 9/ap �lspeciticworkhours(Mon:Fri.) 4� �aoRwSu)t face n operations —/3eJ/c£/L - Dot -LW E,y cv'AL o NEsHAPS(am n circle one . demwnal, WWII rewnlion '� m ,luomnl heat m B. What type of project is this? ( 1 s :stem SEP 2 7 1999 verbal- -emtryem ;onIft bat akArMe eeeaovl Clr 6eNL®lime/ Stations must oomph,with the Solid Waste Division regula- tions 310 CMR 1800 Note:Contractor must sign this form for DLL notification Purposes 3. Refuse transfer station and owner Of applicable): N/A Name Aeaess Cift/rowu bv4xle Rhphooe 4 Final Disposal Site: Valley Landfill Waste Management/ Logano Truc I valron Kane Pleasant Valley Rd . Ada Ss Irwin PA (Mmrs Name 15642 729 744-7946 role/One/ D Certification The undersigned hereby states,under the penalties of perjury.that he/she has read the Commonwealth of Massachusetts F for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information GI this not ication is true and correct to the best of Iveler knowledge and belief 4.6uACD %?. Sf%iPeek PnlNane Posllion/rine Aumo eyed Slpnaule Dare Shearer & Snide Inc. dba/ Ace Asbestos Removal 09/73/9 716 Pine Meadow Rd . 413 99 Repmssnlinn Telephone Northfield , MA. 01360 AnWee CIO///owe no role Fee exempt(City,Town.district,municipal housing authority, owner-occupied residential of four units or less)7 y / 7 Sticker!(from 1 ront of form). 73 / r ) 413 9. Describe the asbestos abatement procedures to oe used (circleCgrr re^ enclosure lull coe'an:re^ oevup set—up variable air pressure , efmmlarJon olsreslo, oererterplaml poly work area , HEPA vac ,HEPA filter respirator , Net asbestos 10. Is the job being conducted iX indoors D3 outdoors? 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) /7L` warier -I ho i7,,,5urtaces(square N.) .3 to be removed.enclosed or encapsulated: 'F*� (^ Iinear/Square feet T �(,ebox rem&aaL a� thermal,solid rare pipe insulation �_ to, bleaching.redp lank surface coal:ngs. / r cormganlie layered paper pipe insulation / insulating cement spray-on Gppm°Ong r oatings cloths.*awn tabus _J Parade board,rd.wall board one/(please describe) 12. Describe the decontamination system(s)to be used. 3 Chamber decon unit w/warm water shower ,tyvek- suits,HEPA vac for clean—up. 13. Describe the containertzat ion/disposal methods to comply with 310 CMR 7.15 and 453 CMR 614(2)(g). Rewet asbestos & pack in labeled double sealed poly bans before removal from site. 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency: TM ORSZt3K Haim aa/otnl ?- a3-99 (PIe WAutoonYalnn (GARY GASP/9IL Marne d al arvl 9—as-99 99- 337 — N5 Narer/ Title S M1JS r'£cent Z Nape/ Tale _LA)S PE crro 2 Gale olAullrwvalrulr 15. Da prevailing wage rates apply as per M.G.L.c. 149.§26,27,or 27A-F to this project? = Yes 72 0