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712 Asbestos Notification Form 2003 AWA Facy 0esctiption 1. Current or prior use of facility: (ZCSI DEh1C L 2. Is the facility owner-occupied residential with 4 units or less? $ Yes 0 No 3. Facility Owner: -E2 +- (,cfceen Re[kncUZL 7 ( -6YI(IkC1C Rol Nm Mims �c(d-YYM FELn in / 416 4e $4.: 930 CWIem Mande reone 4. Facilhy's Owner's On-Site Manager: WA Mew Reef Cf fno.n 5. General Contractor: Ace Asbestos ..Removal. b,._.Insulation 716 Fine Meadow Rd. Nme Address Amen MeMe Northfield MA 01360 413 498-0201 nyao.,, np coe res. Granite State Ins . Co. WC8510584 09/01/03 Conbbrors workers Comp Insurer Pew I 6. What is the size of the facility?_30Yo9sq fqc"? (t of floors) f+p.Date Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site: Ace Asbestos Removal & Insulation 716 Pine Meadow Rd . Northfield, MA 6410,,m 01360 413-498-0201 ➢p cote Telephone 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site: Waste Management of CT, Inc . 203 Pickering St . Mane Portland CT 064Rl Pee_ano ncce AUCTIONS dices al this a be completed o comply with artment of mental ion notilkation rent of 310 CMR n working(lays fli ariM is folanraaatenCnf and the meat of Labor It atria ion requirements 1MR6,12 (ten 101 noblratlm 5 1 oIANY ante ged crater -a Iirear or feel me Original Fc iomsaallh of achualts In Program .120087 is MA 02112- is Imm may be ar notilnn9 the nvuanmentai lion Agency Region ;bales demolniaN anon operations a to NESHAPS(40 mmonwealth of Massachusetts Asbestos Notification Form — ANF-001 CIAsbestos Abatement Description 1 Faclbry location ?cd, 15cee 1-CS ldew 7th �rlci � Addree, -41 ,amp { n FI.Al tom LCSc . ∎ h9W m f■e w/.offal Lath LUJI0/4 ndlre./ reJI9.ll:ar.WOO 2. Is the taciaty occupied? AS Yes LE No 3. Asbestos Contractor: Ace Asbestos Removal &wise 0 lei(yr. ()) 201/J08 -5930 T M N FEB - 32003 ' AMPTON BOARD OF NEAtmN insulation 716 Pine AteaHbw rc AC 000006 C(LLCenm/ 4. 0n-Site Project Supervisor/Foreman: Fd Shearer/Ton Shearer tele 5. Proles; Monitor. ".resnahan R°CeSS 01.'50 novae LAIC t-t( co,iun the t.nrennnoai qi a_n4P-.Q207 terepme A 570245/A 570066 ou eea kaliad Av16 C4 al CanI?cav,r/ AsdeStos Analytical Lab: Environmental Sapling S Testing AA000132 O(ilen/amn/ [[5O 0 rune Z b r y3 (Sal Sun.) n 7 Project start date Ar�On nd Gate 5t)ir C Apecific work hours(Mon.-Fri-)�� update om/1 NOW) teat P0°"p0°n system wnn t°ne of omled is this? (circle one)'. Oil/oh/WI Note:Transfer Stations must comply iWm the SoId Waste ONiston regula- tions 310 CMR 18.00 Note:Contractor must sign this form for Old notification purposes tlry/row 3. Refuse transfer station and owner Of applicable): N/A Name dpnae /Whom Address etn/rgM rn rA1P Telephone 4. Final Disposal Site: Turnkey Recycling S Envir . Enterprises, Waste Mgnt of NH, Inc. ImIAn Nam 97 Rochester Neck Rd . LM"ei NLnP Mfrs Gonic NH- 03839 Warr /,rode 603-330-0217 telephone D Certification The undersigned hereby states, under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulal for the Removal.Containment or Encapsulation of Asbestos.453 CMR 6.00 and 310 CMR 7.15.and that the information contains this notification is true and correct to the best of his/her knowledge and belief. Edwards Shearer PfMAbik � �2iSID F.NI f7 Au., ipnaure .Ace Asbestos Removal S Insulation PosalaVinle 716 Pine Meadow Rd . I)30/03 Os9 413-498-0201 aepesenrnq rele$ooe Northfield , MA 01360 As CiPy/TUwn Zip n+h Fee exempt(City.Town.district,municipal housing authority,owner-occupied residential of four units or less)? yes ❑ Sticker a(from front of form): 7379 ) Ira only Ale WWW TC Oa Rev.6/92. 0. Describe the asbestos abatement procedures to be used (circle): clove at mawave variable<ble damp set—up variable air pressure, mneriWmam/ poly work area ,HEPA vac ,HEPA filter respirator , wet asbestos 10. Is the lob being conducted A indoors outdoors? 11. Total arnou nt oteach type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) i`i0 wgther surfaces (square e.) Yl c to be removed, enclosed or encapsulated. Im ea rIsquare feet to Jet,freacmrvy,duo.lane coo/ace coalmgs me mo, so core pipe u6Naripn __ ccrruga;ed or uyerza Pape'pipe msulalon / inmGpng cement -... - 3DmYpn fireproofing / IroweVSpayer coat'SS_. cloths.woven,pia _____J UarSite OOtq wall Data.. —. --1 aUer(pPase JeYnbp / 12. Qescrine the becortammation systems)to be used 3 c h a rc e r d e c 0 ri u ni t w 1 th wa rm sa ter sholrer, tyve'c suets , Y.E9A vac Car clean—up. 13. beset-10e tthe containerization/disposal methods to comply with 310 CMR 7 15 and 453 CMR 6.14(2)(g) asbestos & sac': in labelled double sealed poly 'bags xore re nos al Eroc. e.i t e 14. For Ei set;easy Asbestos Abatement Operations,the DEP and DL',officlais who evaluated the emergency brie corer/ one / 15. Do pressing wage rases apply as per M&1 c 149, § 26, 27,or 27A-r to this project? ❑ Yes 'j No