881 Project Revision Notification 2008 ii ;A v va
1
Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor,do not
use the return
key.
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Mtn
INSTRUCTIONS
1. This form is
only available for
online filing of
project date
revisions.
2 Enter project
decal number.
3. Validate that
the project
location is correct
for the entered
decal.
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100069701
Decal Number
A. Facility Location
MASSACHUSETTS HIGHWAY DEPARTMENT
1.Name of Facility
881 NORTH KING STREET
2.Street Address
NORTHAMPTON
3.City
4135820523
6.Telephone Number
MA
4_State
5.Zip Code
B. Project Cancelled
C Check here if this project is/was cancelled.
C. Project Dates
06/04/2008
1.Original Start Date(mm/dd/yyyy)
3.Latest Revised Start Date(mm/dd/yyyy)
111/08/2008
2-Original End Date(mm/tltl/yvyy)
4.Latest Revised End Date(mm/dd/yyyy)
D. Revised Project Dates
1.Revised Start Date(mm/tld/yyyy)
2.Revised End Date Date(mm/tltl/yyyy)
E. Other Project Revisions
F. Revision History
MAY 1 9 top
NORTHAMPTON BOARD OF HEALTH
anfO6pdm.doc•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100069701
Decal Number
G. Certification
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of
Massachusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310
CMR 7.15,and that the information contained in this notification is true a d correct to the best of his/her knowledge
and belief.
HEATHER R.CREPEAU
1. Name
OFFICE MANAGER
2. Position/Title
ACCUTECH
4. Representing
uthorized Signature
05/15/2008
3. Date(mm/dd/Wyy)
(413) 583-5500
5. Telephone
100 STATE STREET
6. Address
LUDLOW
7. City/Town
anfO6pdm doc•rev.2/5/04
01056
8. Zip Code