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