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61 Asbestos Notification Form 2000 0 Facilityf.~riplion 1. C iurent or p1 ar use of far.!ily: Telecommunications 2. Is the facility owner-occupied residential with 4 units or less? LI Yes % No 3 Facility Owner: Verizon 114 Adams Street Name Address Milton 02186 617-696-4112 wow, Lo cone Telephonx 4. Fatuity's Owner's en-Site Manager: Nike Carrigan 114 Adams Street xame Address Milton c eziwn 02136 617-696-4112 bp nee, Telephone 5. General Contractor: Catamount Environmental , Inc . P .O . Box 160 Name Address Wilmington, Vermont 05363 802-464-2754 c;o/Town Zip code Telephone American Guarantee & Liability Ins . Co . 6/6/01 Conflate),a workers Comp.Insurer r„rrcyz W C 3763082-0(k=p.oaia 6. What is the size of the facility74 0,00 Qsg 11) 4 (1 of floors) 0 Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site Catamount Environmental , Inc . P.O . Box 160 Name __. Address Wilmington, Vermont 05363 802-464-2754 Pb/Iown zip code Telephone 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site: Waste Management/Logano Trucking P . O . Box 144 fame Address Portland . fnnnecticut l6LAn 9n1_,Al_nc47 UC118M5 as of this form 'dieted In order ith the Il at nlal notification s a1310 s Won I fi days on s 1 Ibe lement the it al tabor des repulemen%s of 12 (len days align Is IWYabatement let than three lala!eeti. Idpinat Form (wealth of husetts s Program 1120087 MA 087 n may be used the U.S. tal Protection Ion I of mallllon/ iperalions [SNAPS(40 Commonwealth of Massachusetts Asbestos Notification Form — ANF-001 Asbestos Abatement Description t. Facility location: Bell Atlantic Name Northampton GfROwn Penthouse Mechanical Room 61 Masonic Street MMus 01060 Zip code $ al is lbeim&ihrcAlo?buildup rums/wing.Ilx(room 2. Is the facility occupied? C1 Yes X No 3. Asbestos Cantrartor. Catamount Environmental Inc. P.O . Box 160 Nance Address Wilmington , Vermont 05363 Clrynown hp code reirobone AC000194 Written DI lfkense/ Carew:rays(Mderv4mbp 4. On-Site Project Supervisor/Foreman: Tony Martin AS 70816 Hall 01/CVO ealiai/ 5. Project Monitor: Gary Marchant AM 71094 Name oucennaaaon1 6. Asbestos Analytical Lab: Diversified Env. Corp. AA000107 Name nu Ce,Miwnpn/ 7. Projectstartdate. P@nddat€1 /8 /00speciticworkhours(Mon.-Fri.) 8am-8pm (Sat.Sun.) AMPTON BOARD OF HEALTH 802-464-2754 B. What type of project Is this? (circle one): demohtion repair 0 Mel(emlain) Note: Transfer Stations must comply with the Solid Waste Division regula- tions 310 CMR 1800 cep/mm Anode Telephone 3 Refuse transfer station and owner(If applicable): N/A Name Address CxryOown Ipcode Telephone 4. Final Disposal Site: Valley Landfill Inrvlion Mme pwors Naoe RD 2 P.O . Box 282A Address Irwin , Pennsylvania 15642 by code 724-744-7446 telephone Q Certl/Icatlon The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulx for the Removal,Containment or Encapsulation of Asbestos . R 6.00 and 310 CMR 7,p,arid that the Information contair this notification is true and correct to the best of his/her owledge a belief. Donald Yanke MOM Name Note:Contractor must sign this President formforVLI scsd;owime --- nolificaUr'1 purposes P . O . Box 160 Address 11/17 /00 Pale Catamoue t Env . , Inc . 802-464-275, Reim esentop telephone _.... Wilmington , 05363 Cy/Tuxn Ip code Fee exeriipt(City,Town,district,municipr authority,owner-occupled residential of four units or less) ?El yes C Slicker# (lrarn front of form): 544013 199 9. Describe the asbestos abatement procedures to be used (circle): One ban enclosure (lull containment cleanup encapsulation disposal onry age,(explain) 10. Is the job being conducted AIndoors 0 outdoors? 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) surfaces(square It.) . to be removed,enclosed or encapsulated: linear/square feel boiler,breaching,duct,lank surface coatings. / Thermal,solid core pipe insulation 20 / corrugated or layered paper pine insulation.... / insulating cement _/ spray-on fireproofing _/ Impel/sprayer confines cloths,woven fabrics /942 transile board hall board _/ other(please describe) 12. Describe the decontamination system(s)to be used 3-chamber decon unit and portable shower oratha' 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(0): 2 ply, 6 mil polyethylene bags with asbestos materials _properly wetted inside 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency: llama of DEP Official Idle oafederuftfjalian Wums/ Name o1DLI Dllidal fine Dale o(AuMorualim IVairr/ 15. Do prevailing wage rates apply as per M.G.L.c. 149,§26,27,or 27A-F to this project? ❑ Yes X No