47 Asbestos Notification Form 2003 Pa.
Foci/ity Description
1. Current or prior use of far 'I.
'FEs (0E46 e-
/Meek
2. Is the facifhy owner-occupied residential vu h d units of 'es- X Yes - No
3 Facility Owner
50- 1)r Mcdc_t+ta14-
Name
rariao.a
FaclHt,s Owners On-Site Manager.
N1)A
5. General Contractor
`1-_1 Flo iz j & Rp
otc44 4i3 - jYy
Ace Asbestos Removal 3 Insu la '. : c;: _- -
Name _T r
.., s . ipe 'iea d9_W Rd e_
Sorthfie;t stn
oyCfn»„
Granite State Ins .
.,.N,r
6. What is the sine of the lacihty".1C.15Z(so ft) ay('of foors)
Asbestos Transportation and Disposal
413 49R-0201
rereDfine
09/01/03
t Lr,
1. Transporter of asbestos-containing waste material from srt to temporary storage site (if necessary)to final dispo!
Ace Asbestos Pemoval & insulat { on 716 Pine `ieadow Rd .
Wane -
Trorthfield ,
° '- -498-0201
2. Transeorter o ashes os cc a n g waste manna'from rem:al _mporary storage site to Hal disposal site
haste Maraoement of (67, Inc .
203 Pi ckerinc fit.
Portland
C
Commonwealth of Massachusetts 001
Asbestos Notification Form —
Asbestos Abatement Description
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u1dt, O'1 wvrtyP
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4, CniSne Protect Supe Moor/Foreman
Fri Sneed Ce} / a '
Simi :er
xm.
Proierr Monitor:
Ray�ppnd j . laresna`;an
0
021
6. AsnesPeo And,nnos. Lao.
J r t uu',9c
) �3' vSat.Sun
� '/j 03specBicw-13 ;srMon-Fo rate
7_ P■c ec art Care� a3 L enCO e —
rene
inlzc ictrs,e :no,
mute. feaster
Stations must
campy with the
Solid Waste
Division regula-
tions 310 CMR
1800
Note:Contractor
must sign this
form for DL!
notification
purposes
OAT
3. Refuse transfer station and owner(if applicable):
N/A
Nan.
cn/r w.n
d. Final Disposal Site:
Turntcey Recycling & Gnvir . Enterprises, Waste Rgmt of NE, Ir
loorifyonNaine
97 Rochester Meet Pd .
Adrs
Gonic
cmA„on
D
rem
603-330-0217
Certification
T r; e-h — '! d 'no pe°ahies of nriun. "a' e/she has read the Commonwealth of Massachusetts
for the Removal, Containment or Encapsulation of Asbestos 4 55 C MR 5.00 and 310 CMR 7.15 and that the information cc
this notification is true and correct to!he best of his/her knoweage and belief.
ka.aUC1a( Shea.(
P,en Name
TRI ESIFj iC.
ronton,NM
716 Dine Meadow Rd.
adems
A oTh v :S,on we Cp15.14'z...
Oae
Ace Asbestos Removal
413-498-02t
ameu';n" rerewrox
S Tnsulation
Vortbfield , MA 01360
Fee exempt(City.Town,district, municipal housing authority owner-occupied residential of four units or less)?X ye:
Sticker I(from front of form) / 0 7
variable =lr pressure ,
9. Describe the esces os aoateir eru pr 'es res .c be use set—ice
;merfwnun ,.lily IE?A - c , HE.PA
cfmsemr, work red ,
Ciltar respirator , det asbestos
19 Is melon being conducted S,'.n000rs -outdoors?
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear h-)�pr other
to be removed, enclosed or encapsulated:
sadaces (sguar^K ) �� en ea r/SC are le et
/1 re a' 5611C C e Oe rsulalon......
b:iNpleacr�M$d,pacer t Crn c 'm'r as'a g cemer �-
ao
couegateder 6yered paD+/GfOe msolaoon ucweVSWaYa=camgs
sGmrtin`een'o:4nS uamne acva..a:Lcars
c,a:r.womr acnrs
L:. ,-�Jrt L t1t
12. Desch oe toe deoetamination sy se , one useC lea _dp
ii i,er _ '.u: er,
!t ;,plt5, •
,. m :mom, 'r 31 8715 and 453 CMR 614(2)(8 Is
13 Cesoi r_ca tan .ohms emoos
Gaols sealed pea
19 For Emeigeem,As estossAbatem of Aerations,me DEP and D'J.ot1..cials no evaluated the emergency.
15. Do prevailing wage rates apply as per M.G.L c.199. §26. 27.or 27A F to this prolect? ❑ Yes )1 No
6,92