61 Asbestos Notification Form 2000 (3) Y facile!escriplion _
1. Current or prior use of facility:
Telecommunications
3.
2. Is the facility --
Y o wner.occupied residential with 4 u
.............
Facility Owner: oils or less? ❑Yes lg! No
HBe11..ALlantic
Milton MINN
114 Adams Street
4. 0218 6 _..
Facility's Owner's On-Site Manager Telephone Ives* 617-696-
411:
r]Mike Carrigan A'kkej
a M, ,
g Milton 114 Adams
General Contractor Street
02186 re,.,a,,,;:...._..._....._.
Catamount _.............
Name mount Environmental, Inc, P. O. Box 160 7 696-4112
Wilmington, kan,:
City/7011N
�tOVermont
,,T �.._._ 05363 _..........._.
eli ance Insurance 210(Ode 802-464-2754
ddrrano.e wor+err tons Insurer C e C om a n _.__ rnrnnone
use What is the site of the facility?,000 poky/ 1795107-01
r Dale
—�-(sp g)4 ft of floors)
Asbestos Transportation and Disposal
Transporter of asbestos containing waste material from site to temporary storage sife (if necessa
.... ... Inc , P. O. rY)lo final disposal ail
imington, Aoness Box 160
cr, ., Vermont ---.
.05363 _._.._................._.
2. Transporter of asbestos conlm footle 802-464-2754
ning waste material from re site fin •
;. Waste Management/Lo removal/ storage site to final disposal site:
.Savo Truck.ing P.0. Boy ar...
RUCTIONS
diets trims
site completed
1a comply with
ndmenl ol
email!
Iron sanitation
mints ol 310 CMR
len working days
idlrirolion
M army abolemml
e as
lament ol Label
Indutldet
cabomeauirements
V7 CMR 612 hen
p prior ndilicalion is
seed of ANY
tenet project Peeler
n One linear or
are/ee0
Submit pi0inal rem
emmerritslth
el
lattaellusette
innate
Pro9tam
0.0.11.1100V
testae,MA 02111
0987
las form maybe
used M ticketing the
u 5.FnvbmineMal
Proledion Agency Region
of asbeslm denol'drotd
emotions
Common nth of Massachusetts
Asbestos Notification Form — ANF•0D1
Asbestos Abatement Description
1. Facility location:
Bell Atlantic .
Nine
Northampton
61 Masonic,
Addmss _.. _.............._.
01060
eleplmm
zqr°1B First
Hall and Wa
Basement.....a __........ _._..
Room in LO»Y.. Floor Toll Area
Mail -. .nn floor.morn
nagl Is the emasileliriiaPn?M1yildiM ant./.
2. I the taciRty occupied? D Yes g1 No
3.
Catamount . n4 � "" re
B02-464-2754........
05363
t M
an R
Written
Is
160 ........._...._ .
Asbestos Contractor: ironment ale Ing• . P � ..... ox
g ada $S ,. ..
aelepM
e Vermont ale
Wilmington
...
firyNr•+
;v,dr4 Ire lwrdbn6erlup
.A0000194
a1 tv<nse/
AS Moab..
4. - On-Site Project SupervisorlFOremart .,.... Nt'LAlb700/
Martin _._.
Tony . '
Nine
AM 71094
5. Project Monitor. _.
GarYMarchant _ Oil u mdo-anord
Nana
....................
6, Asbestos Analytical Lab: AA0.00107
Env . Corp. Ducafianm✓ ) Sam 12 m(Sai.Sun.)
Diversified
6 /161 OQpec0lcworkhours(Mon:Fri.
We
5 22100enddale_.-- dner(m++lnl
7, Prolecl startdate�--- - reran
. -_r..rnleci is this? (circle one)'. demomion
Note: Transfer
Stations must
comply with the
Solid Waste
Division reputa-
tions 310 CMR
1800
Note:Contractor
must sign this
form for DLI
notification
purposes
Portland , Connecticut 06480 203-342-0667
C,lrioav
3. Refuse transfer station and owner(if applicable)'
N/A
Neene
h1 rule Telephone
AdhUs
Cn/Ai'an Zip¢Yle leeldligre
4. Final Disposal Site'
Valley_Landfill
0 raw'Nsm l.wnem Mme
R D #2 , P . O. Box 282A
Arlmn>
Irwin ,
woo
Pennsylvania
15642 724-744-7446
lip ark Telephone
D
Certification
The undersigned hereby slates.under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulat
for the Removal.Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contain.
this notification is true and correct lathe best of his/her knowledge
Donald Yanke
PontNamr
President -
POPImn/Ilae
A, ovM Signal¢
5/5/00
Dale
Catamount Env. , Inc . 802-464-2754
lelgelax
Repreu ano
P.O. Box 160 Wilmington, Vermont 05363
Oa-pore lip rifle
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)70 yes $
Slicker/(from front of form). 536784
IVIwo.IIyur,
Rev 6/92
9. Describe the asbestos abatement procedures to be used (circle): Savo enclosure lunconrinment) demgl
mansulalow
dispfsalwly olba(algain)
10. Is the job being conducted SI indoors O outdoors?
11. Totalamount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear N.) err
surfaces(square II.) 10 be removed,enclosed or encapsulated:
.linear/square feet
boiler breaching.dud.lard surface caalings. /_ thermal solid core plbe imulalion
corrugated or layered paper pipe Insulation .246/ insulating cement ___/_____
spray-on breeloobng / bowe)spayerrcoatings /
cloths.woven fabrics / transile board wall board • /
other(please desoibe) /
12. Describe the decontamination system(s)to be used:
3-Chamber decon unit and portable shower
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
2-ply, 6 mil polyethylene bags with asbestos materials
properly wetted inside
14. For Emergency Asbestos Abatement Operations,the DEP and oil otlicials who evaluated the emergency:
Name of VIP Mel
Oak orAult/many
Moe N IXllgleral
Ode In ANlwgalvn,
•
Tile
Wacer/
rife
Waives
15. Do r evailing wage rates apply as per M.G.L.c. 149.§26,27,or 27A- F to this project? ❑ Yes No