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7 Project Revision & Asbestos Notification Form 2008 u Is Massachusetts Department of Environmental Protection Bureau of Waste Prevention -Air Quality Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 A. Facility Location 00066706 Decal Number 7 BARDWELL STREET 2.Street Address NORTHAMPTON 3 City 4135840161 6.Telephone Number B. Project Cancelled u Check here if this project islwas cancelled. et C. Project Dates at 01/24/2008 re ct tl 3.Latest Revised Stan Date � r new ur D. Revised eJ Project Dates 01/2812008 Revised ldtllyyyy) E. Other Project Revisions l _ _ F. Revision History pdrn.doc•rev.215104 MMA t 4.State 01124/2008 r . 2 End Date mm/dd 4.Latest Rev ( ' 2 Revised End vyy) 2./28/20 Entl Date Date(m RECIEEIVE JAN 1 4 2008 0 NORTHAMPTON BOARD OF HEALTH r► Massachusetts Department of Environmental Protection Bureau of Waste Prevention—Air Quality .. 100066706 Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 G. Certification of The undersigned hereby states,under the penalties of perjury,that he/she has read the CMCommonwealth 3f0 Massachusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. ---i / HEATHER . CREPEAU 1. Name ----' OFFICE MANAGER PositioNTitle 4. Re.resentin, 00 STATE STREET 6. Address LUDLOW 7 CIty/Town imdoc•rev.2/51114 Authona $frffi 01/11/2008 3. Date mmld (413) 583-5500 5. Tele.hone AA 01056 8. Zip Code IS (fu • Commonwealth of Massachusetts Asbestos Notification Form ANF-001 100066706 Decal Number A. Asbestos Abatement Description 1. a Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied residence of four units or less?Li Yes a No b. Provide blanket decal number if applicable. Blanket Decal Number 2. Facility Location: SHEBEK PROPERTY a.Name of Pad NORTHAMPTON c.City/Town 3. Worksite Location: BASEMENT b,Building a.Building Name/Building Location 4. Is the facility occupied? 7 Yes L. No f this der - b.Street Atld res _.. '.Nip �'i 01060 x(413)584-0161 d e.Zip Code 1.Telephone Numbe State 0 n 310 5. Asbestos Contractor: IACCUTECH INSULATION 8 CONTRACTING II a Name of 453 IL DLOW _--- 101056 d.Zip Gotle' c.c'i now ---- rl AC000005 DOS License Number JAMES BEADLE h F Tty Golkact cerson 6 DOREY BESAW a.Name o�So a^'isorlFOremg--�'---"I IATC T a.Name of P ISCILAB c $ Name ASbes os An mldcda YLYayb 0 9 Protect Start m e c 10112412008 o ect Monitor —' 1 0 18:00-5:00 --------'J c.Work flours Mon-Fri. —-N 10 10. a.What type of project is this? _'.. Demolition iL Renovation Repair [ Other. please specify'. 11. a. Check abatement procedures: o rl Glove bag 1 Encapsulation "-1 Enclosure Cleanup Disposal only o _ Other, specify 1L 7 Full containment z Indoors? Outdoors? Q 12. Is the job being conducted: 7 Indoors '_i c Wing d Floor 1,100 STATE STREET b.Atltlress 4135835500 e.Telephone Number g. Contract Type: Written e Roam Verbal i.Contact Person's Title AS071928 b Su _rv_is_o_rtsmgman DOS Certification b Pro ea Momtor DOS Certification Number —i IAA000162 best bestos Anal Lab DOS Certification Number--� 0112412008 L--- b.End Dale mmldtllYYYY)—_-----'— iN!A 0.Wok hours Sat-Sun. 101ap doc•10102 os NotlfiCatlen Form•Page 1 of 3 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 [100066706 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed, or erica osulated: - a. otal pipes or ducts(linear ) er su aces squa d.Insulating cement in fl. Sq. ft. —I 35 c.Boner,breaching,duct,tank surface coatings e.Corrugated or layered paper pipe insulation g Spray-on fireproofing f.Trowel/Sprayer coatings Lin.ft__, 59�, _,J l h Transile board,wall board Lin ft ISgft L�_� j.Other,please speciiy. I.Cloths,woven fabrics Lin fl Sp fl 1125 IJ in k. elation solid core pipe Lin.ft Sq ft. I.Spec[ insulation 14. Describe the decontamination system(s)to be used. (SEAL CRITICALS WI 6MIL POLY,ATTACH 3 STAGE DECONTAMINATION UNIT 8 INSTALL AIR 1, 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 614(2)(9): -- _ ACM TO BE DOUBLE BAGGED OR WRAPPED IN 6 MIL POLY AND DELIVERED IN A SEALED 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: • c.Date(mm/ddlt#l)of Authorization NIA — icial [tie___. e.Name of Dial-- --- h.DOS Waiver# r. g.Date(mMdd/wyy)of Authorization 7 '-'YES _m X26, 27 or 27A—F apply to this project. E0 17. Do prevailing wage rates as per M.G.L. c. 149, § =O B. Facility Description (d.DEP Waiver# .r (RESIDENCE 1. Current or prior use of facility. 2. Is the facility owner occupied residential with 4 units or less. Yes T. No -" 73 MAIN STREET SHE ___-- - —'--"_-- [PETER S F rtv Owner Name [61602 AMHERST 4. JAMES BEADLE ----- a.Name of FaciliYCwn_r's On-Site Manager_—__ b_Address __ _-- ------ 1413-256-3442 _ e.Telephone Number_(area code and ew ens i iron-Site Manager=ddress _ _--- '�413-256-3442 a City/Town d.Zip Code e.Telephone Number(area code and extension) Asbestos Notification Ram•Pa a 2 of 3 tap tloc•10102 I- .r Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100066706 Decal Number B. Facility Description (cont.) IC do =m =o 1N/A a.Name of General Contractor c.City/Town (COMMERCE&INDUSTRY f.Contractor's Worker's Comp.Insurer 6. What is the size of this facility? d Zip Code b.Address e.Telephone Number(area code and extension) 1WC5310868 1 111/04/2008 q.Policy Number i.Exp. Date(mMdd/Wyy) 1 2 12,000 a.Square Feet b.Number offloors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site Of necessary).'IACCUTECH INSULATION&CONTRACTING I 1100 STATE STREET _ b.Address a.Name of Transporter b. 1(413) 583-5500 . LUDLOW d.Zip Code e.Telephone Number C.GitylTOwn 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: (RED TECHNOLOGIES � 1173 DICKERING STREET _: b.Address PORTLANND a.Name of Transporter 106480 1 1(860) 342-1022 c.DItVITOVm tl.Zi p I Code e.Telephone Number — I a.Refuse Transfer Station and Owner b.Address I 3. c.CiryROwn d Zip Code e.Telephone Number__ 4. IMINERVA ENTERPRISES INC __J I a-Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 19000 MINERVA ROAD 11 IWAYNESBURG c.Final Disposal Site Atltlress , d.City/Town IOH 1 1144688 1 L e.State f Zip Code g.Telephone Number -° D. Certification WMN The undersigned hereby states, under the -° penalties of perjury,that he/she has read the kr- Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asoestos,453 CMR 6.00 ano 310 CMR 7.15, and that the information contained in this notification is true and correct ° to the best of his/her knowledge and belief. =0 I ap.doc•10/02 (HEATHER R.CREPEAU a.Name ;OFFICE MANAGER c_Position/Title _-.- !(413) 583-5500 e.Telephone Number 1100 STATE STREET rg.Address 'b.Authorized nature - 101111/2008 d Date(mmltldlyyW) IACCUTECH f.Representing LUDLOW 101056 h.Ciry,'TOwn i.Zip Code Go To Top Asbestos Notification Form•Page 3 of 3