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59 Asbestos Notification Form 2001 Note: Transfer Stations must Facility Dest.e.ption 1. Current or prior us.. 2. Is the facility owner 3 FacilityOwner: UArl'A-013 Name of facility: Es.A.DerNCD -occupied residential with 4 units or less? Yes 0 No --SCESP3 11—a Eve- Y+A-MP'latit NA rnna.,, 4. Facility's Owner's On-Site Manager Nnnr 5 Genera!Contractor: Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow Rd . Aire Apm m ACaress Iv,ear. Ada,. ye sale 59 Coo Lai9e, Aft 0/060 9{/3- 581 -7801- Northfield MA. 01360 c,y/MAn Zip cone Granite State Ins . Co. w08540584 ' .00nrnnn.r Workerz Camp.Insurer porty/ EXP.pan 413 498-0201 /e/epnone 09/01/01 6. What is the size of the facility? , (sg ft) a (S of floors) ElAsbestos Transportation and Disposal 7. 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 . Name Northfield cannot,, Addrgs MA 01360 413 498-0201 Ln care lerenAmx•2 Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site' Logano Trucking-Waste Mgmt 209 Pickering Street Name AONOS Portland CT 06480 ay/luvm an le 860-342-0667 re/eiNmn. :7 'WKS Mims om21erec iply with n1 al al tukaton 11310 CMR kng Cay5 On 1s yabalemenl ot ra Libor in 5 12 (l en a.¢ lien YdLCVl N 6 r pled ry eater Ya101 ,gina,Form oelth of setts Program 7ov W 112112 Ti may De !JMng the r oenlal AoencY Region DS Cern al ION Commonwealth of Massachuse t s 001 Asbestos Notification Form -- Asbestos Abatement Desccrription 1. Facility location: pp II$/o' dresnitZ re5ich ei Nano City lown 14 lam MA babefr Pm.t Mulls Me YWp'lle Ix n?bolding wife./ wing.llm1.room 2. Is the tacdity occupied? 14k Yes No 3. Asbestos Contractor: Shearer & snide Inc N 01360 Northfield MA ' 1I_" ciwown -iie n A0000006 c rrrna rwnnn✓+ulwl bp colt ouOces t AJO 54_ Coaldse, 1-90e- 01,060 _ 4113-5gq- 7 8aa II We (:91 4 CC' ivt doff 3d ._. dba/Ace Asbestos 716 Pine Meado'+_......... .._..._....._ moans 3 498-0201 4. On-Site Project Supervisor/Foreman Ed Shearer/Tors Shearer nrpnone AS7024..51 AS70066 OLI cwla aUw NAT. 5. Project Monitor' !� n /� 4 n. 051. Monitor: 7 . . A<ees nakW oalc<r4liaYalAn Nmr l 6. Asbestos Analytical LabDOO i TA-)C L IXl re.olnwll lane q/;4%a/1L....S.ft'M.N B Wab/o/ p xroj ^]'r$dd ��� 0 pR (Sat Sun ham. d date-rail mworkhours(Mon-Fri,) update 7 Project start date ranraxn aeaw�o, e a t � «pal � _y5tem this? (circle one '. celrolelion comp*with the Solid Waste Division regula- tions 310 CMR 18.00 Note:Contractor must sign this form for DV notification purposes v. peruse transter station and owner(if applicable): N/A Name clhAmm 4. Final Disposal Site: Valley Landfill Waste Management/ Logano Truc Admen /auto:finIX Pleasant Valle `rs Name y Rd . Certification . The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Re for the Removal,Containment or Encapsulation of Asbestos.453 CMR 6.00 and 310 CMR 7.15 and that the information cor this notification is true and correct to the best of his/her knowledge and belief. -Devised 1) Edu/a,r--d± Shrarec •,. - &/8%/ Pnnl Name Attain-wed Staniatt .----� Shearer & Snide Inc. dba/ %QES/b T Ace Asbestos Removal 413 498, PA 15642 724 744-7446 PosleanOme itenne h,ig lelenlnne 716 Pine Meadow Rd . Northfield , MA. 01360 Arum, Wow loran Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?Ryes Sticker t(from front of form): • [/Cbtu/e I EStan n aeN, procedures to be used (circle)'. el°t bay variable air pressure , 9. Describe the asbestos abatement p set–up HEPA 'vac , HEPA om.Irunmfl; poly work area , [rcapmurbn msms+""" p wet asbestos filter res;pi rater , 10. Is the lob being conducted indoors C outdoors J2� wovrzr 11. Total amount of each type of A bestos C 000einMaterials erianACM)to or encapsulated: a lnlpiipes or ducts(linear n.) surfaces(square ft.) lneanso�u �reef bailey breathing,duct. coatings thermal,solid ror epp a usulanon -_- - sprruparedo p-w pipe insulation I insulating ce ... � owe/sprayer cloths.wow b.br �_ yyple board.rail DOard. _. / cloayonarepto0f Q _J gDf(please describe).12. Describe the deconlaminationsyslem(s)I be used: c chamber de con unit w/w arm ea Ler shower , tyvec• suits ,YEPP, vac for clean-up • labeled doubt sealed poly 9) 13. Describe the contameraabonldlsposal methods to comply with 310 CMR 7.15 and 453 CMR 6 14(2)(9)tacro be or asbestos removal Fat before removal from 14. For Emergency Asbestos Abatement Opelahons,the DEP and DLI officials who evaluated the emergency. One 1411041:0.4 1 5. Do prevailing wage rates apply as p e r N. c. 1 4 9.§2 6,27.or 27A-F to this project rigs No V Facility Des. .,tlron 1. Current or priorig priori of facility: ........................_ &St.bENCE) 2. Is he facilit y owner-occupied Yes................... ccupied residential with 4 units or less? y ❑ No 3 Facility Owner: VI J I.... Name K7NAMG7D t1 MA w cO?k.,/ 4 Facility's Owners On-Site Manager- r3/Q Mr/ 0111/ 5. General Contractor A%ress AP roue releMoee s9 _ as lwdy e■ PVC- /0e0 99/3- 5FV-- AdNn, nrvne _.._....... . _... rielemu Shearer & Snide Inc dba/Ace Asbestos 716 Pine Name Meadow Rd . Address ..__.. __.. 01360 413 498- 0201 Northfield NM . nerepa Granite State Ins . Co. CemtlaCtO a women coma Insure/ 6 What is the size of the facility? 4 Policy fm.Dare 11) (A of floors) Asbestos Transportation and Disposal 7. Transporter of asbestos-containing Shearer & Snide Inc. ZIP Cede Telephone __._......... wC8540584 09/01/01 mains Northfield nbAani waste material from site to temporary storage site(if necessary)to final disposal si; dba/Ace Asbestos 716 Pine Meadow Rd . AOUress MA 01360 413 498-0201 dry rd/e 2. Trans lelephre porter of asbestos-containing waste material from removal/temporary storage site to final disposal site: Logano Trucking-Waste Mgmt 209 Pickering 4 Street Portland CT Nate: Transfer whim, Stations must o.r Ln rare 860-342-0667 Telephone Comonweehofhlassachusetts AsbestosNotificationForm — ANF-001 Asbestos Abatement Description 1 Facility location: 52:1TE.Snit ff..P KS this spleteil y wile ol 310CMF1 rig days (Its abatement e of Labor fU aments 12 (ten Manen4 Yr rise'qf eater saa nconal rare sallh of U tu Program 3081 02111- 01 may De kiyag the menial Agebby RebiOn LOS MM01010M crorions die2201(0 —Da tes Chan5a 54 aate'dy, dUe, accu cfr+harn HA ,,,,,2119.6,,,. Telephone MMO b415ern @tit ma is Mg aodailg Icelion7 adlilka;aria/,any.lloo a scan 2. Is the lacility occupied? TilZ Yes 0 No 3. Asbestos Contractor: Shearer & Snide Inc dba/Ace A tau Northfield urea.° AC000006 00 liana I 4. On-Site Project supervisor/Foreman Ed Shearer/Tom Shearer Nana 5, Project Monitor. MA. MM 6. Asbestos Analytical Lab. Enhi.igaA) • Nang 7. Projectstart date sbestos 716 Pine Meadoi, R d . AW(Us 413 01 493-0201 aorta =ow« -41-en Cony xi I am Menialuvarbal) AS70245, AS70066 Ott Culacaliaa/ " Ceanicaliaa \000 i„z", rir02i AMPTON BOARD OF HEALTH PfrigN)6 ea ' .-----------------a -- T1 ‘ va4/ai Cara caliad ddatett2147ispecilicworkhours(Mon.-Fri) df 741 (Sat.Sun) k0 update iorrpoil Oanwpai heat system Ibis? (circle one): ciemoode neat °•Y/ w"/Ili Ine Solid Waste Division regula. (ions 370 CMR 18 00 Note:Contractor must sign this form for DLI notification Purposes 1141,b1 C1 b14111/11 e11111 owner 01 appncame): N/A Name cream 4 Final Disposal Site Valley Landfill Ir.-Jiro/IN./7e Pleasant Valley Rd . ACOrm Irwin Certification The undersigned hereby states.under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts R for the Removal.Containment or Encapsulation of Asbestos.453 CMR 6.00 and 310 CMR 7.15,and that the information Cr this notification is trim and correct to the best of his/her knowledge and belief. PA Ardms rinrule releMmne Waste Management/ Logano Tru CM es Name _...................._.. 15642 724 744—749 6 • Ed darrct.J Shearer Pnnl Name Nunvn/rine ketli//Sod 4 • Odle Shearer & Snide Inc. dba/ / Ace Asbestos Removal 413 49E ReprznmilW Ie/ePlwne 716 Pine Meadow Rd . eu Northfield, MA. 01360 Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)/(yes Sticker a(from front of form). — (1 ` ute NI, fan pressure,set—up variable H EPA pressure 9. Describe the asbestos abatement procedures to be mead (circle oly work area , wet asbestos mil e,�pealxwn emavIDa0o filter respirator , ]indoors ❑outdoors 7 'jam orate! 10. Is the job being conducted DM to be handled on pipes or ducts(linear ft.) 11. Total of each type of A beslos Containing Materials(ACM)_ to be removed.enclosed or encapsulated'. surfaces(s4uare tt.) linear/sQu feet Z_ thermal,sold cote p; uWi0n . J coikrdred or to dud,tank pieaisuoaiin95 ./ insulating cement. „• J� conuWedwdofing .W pipe insulation. aowetrspaW well d ... �� cites,woveWoatm .. J yarsite board, POW(please describe) llnit W�wd Lm water ogescribet 3 chamber decors 12. Describe thedVec�decontamination be vasc for clean—up. .:.. shower a ty....... - .. ask in labeled with double sealed poly ba�- __ 13. Describe the containerization/disposal methods to comply yd double 7.15 and le CMR 614(2)19 bewor a removal from site 14. Fr e removal 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency. 'NM Name SNP unitial _....._.._._..__...__ Da o Morava in fit) ................................ ......._._.. ._..___._.............. ...... Tau sum dODUYd .... ..._........_. _._..................... Nam e_. Dam lYNNIY'Y1iYm 15. Do prevailing wage rates apply as per M.G.L c. 149.§26.27.or 27A-F to this project? ❑Yes !d No Note: Transfer Stator ee Facllfry Descrlpfion I. Current or prior_u�J of facility: 1s 2. Is the facility owner-occupied residential with 4 units or less' Yes ❑ No 3 Faced)/ VIVi• c£iaill-z GOee_ H-A-Mrraitl M�4 Otilrnw Name d. Facility's Owners On-Site Manager' Name cinnnwi, 5_ General Contractor: Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow Rd . Name _. Addles: Northfield MA . aore»n 01360 413 998-0201 Lo code Telephone w08540584 09/01/01 AONPA to raw Add IPn Sp Tare s9 Coo.1.4.4 . igUe- /040 tone 44-78, ph releoliew Granite State Ins . Co. commnprtr workers Comp Nastily PoOcyd &p Odle 6 What IS the size of the facifity7 3 O s/�'X (aph) a1R of fl00rsJ Asbestos Transportation and Disposal 1 Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal Shearer & Snide Inc. dba/Ace Asbestos 716 Pine Meadow Rd. Name er, Northfield MA 01360 ciynow„ 413 998-0201 rn rare tenmmnerz 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site: Logano Trucking-Waste Mgmt 209 Pickering Street Nd nd A'J Portland - Nt., CT 06480 860-342- cyRuwn 0667 et W/e INS R6 yplelen y Icanon 310 CMfl g dam lIs abatement it Labor 3 uilemenm ,2 (ten libation 5 r lea dr ealel ar al gmal Form alth of sits rogram 337 02112 Commonwealth of Massachusetts 001 Asbestos Notification Form — Asbestos Abatement Description 1 Facility location: 561e5nit z_. .. ..res i�Enc e� Name Imay be (png The , total ,g rim Region s demolition/ stations IESHAPS(aO City/lowe No-r hamp im ba. n rl t.. Kai s the*aba Ittl o Y eu Idn a sane.1.ei m 9 IlroUrom 2. Is the bodily occupied? yes E. No 3. Asbestos Contractor. 16 Pine Meadow Pd �_. dba/Ace Asbestos 7 7_ -- Shearer & Snide Inc Address .. _....... Nor 01360 4) 3 498-0201 MA . I Ir 1i Northfield naNae � bp code _ Dry/kw ��,}}en AC000006 p� i 32001 tl n,<Iw tw �, IXl llrtnse/ �, 4. On-Site Project Supervisor/Foreman'. ^p„ 4MPTpN gpgpp tlF HEALTH AS70246 , AS7006 .. ....... ti Ed Shearer/Ton Shearer o curanuwA Name 5, Project Monfort _... M4 54_ Cocadfrz, /hit Address Q.1060 __ 4113-584 7 W7a NI]aie (elephant IXI CeNIioGnr/ Name 6. Asbestos Analytical LabQDD (32 71N "'6 E'tJJ1KOArivara. 5' n pll tern#4000132- traewr o xane qq 0 � � (Sal Sun )! ). � 0/ L- -plots 7. Projectslaridaleill / enddate /2//0 iispecdlcworkhours(Mon:Fri.) Sat Sin: treat «sauna m I1 repot MI System A What type or project is this? (circle one)- cemo�,on comp*with the Solid Waste Division regula- tions 310 CMR 18.00 Note:Contractor must sign this form for DLI notficanon purposes 3. Refuse transfer station and owner(if applicable) Name Cny/rorm 4. Final Disposal Site: Valley Landfill Address Ln We rereniwne Waste Management/ Logano Tri Mellon N,M U*nei,UM Pleasant Valley Rd . Addres Irwin PA 15642 724 744-7446 44/my D Certification The undersigned hereby states, under the penalties of perjury,that he/she has read the Commonwealth of Massachuset for the Removal Containment or Encapsulation et Asbestos,453 CMR 6.00 and 310 CAR 715,and that the informatic this notification is true and correct to the best of his/her knowledge belief. Edajard J Shearer C 0, Pm!Nam Aulhonled 54nIUre 03, Shearer & Snide Inc. dba/ Ace Asbestos Removal 413 Naemarme 716 Pine Meadow Rd . Represents:a roep one Northfield , MA. 01360 Andress ltratuwn Iv Wile Fee exempt(City,Town,district,municipal housing authority, owner-occupied residential of four units or less)2. Sticker t(from front of form): Z5-/ lh 0 9. Describe the asbestos abatement procedures to be used (circle): prove gag ercasme L mwnarx enrvurmron mst+JSa on, omurvp�aml set—up variable air pressure, poly work area , H_PA vac, HEPA filter respirator , wet asbestos 10. Is the job being conducted indoors LT outdoors 7 11. Total amount of each type o'f//Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear h.) /70 or cater surfaces(square ft.) 46, to be removed, enclosed or encapsulated: _ linear/sou�aq feet Gofer.breaching.dud,lank sur face coatings Tb Meuse solid core pipe insulation corrugated at layered paper pipe insulation.../*/ Insulating cement —_/ spray-on lreproofing / VgweUsprayer coalirgs cloths.woken bLria Iramite board.wall board.. .. _... oilier(please describe) 12. Describe the decontamination system(s)to be used. 3 chamber ci e con unit w/warn 'w a to r shower , tyve! • suits , HEPA vac for clean—up. 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g) Rewet asbestos & pack in labeled double sealed poly bars before removal from site . 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency. Name Mai,oniasi Dale of Aul enialmn rolreaIX/meal Dale aAututiwwm one Mawr¢ hoe wu R,/ 15. Do prevailing wage rates apply as per M.G.L c. 149. §26, 27,or 27A-F to this project? ❑ Yes §/No