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
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notification
s a1310 s
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it al tabor
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Idpinat Form
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husetts
s Program
1120087
MA
087
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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