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Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100050238
Decal Number
A. Facility Location
VACANT HOUSE
1.Name of Facility
77 MAPLE STREET
2.Street Address
NORTHAMPTON
3.City
6.Telephone Number
MA
4.State
5.Zip Code
B. Project Cancelled
n Check here if this project is/was cancelled.
C. Project Dates
01/24/2007
1.Original Start Date(mm/dd/yvvy)
3.Latest Revised Start Date(mm/dd/yyyy)
01/26/2007
2.Original End Date(mm/dd/vvvv)
01/29/2007
4.Latest Revised End Date(mm/dd/yyyy)
D. Revised Project Dates
1.Revised Start Date(mm/dd/yyyy)
01/31/2007
2
Rev
ed End Date Date(mm/dd/yyyy)
E. Other Project Revisions
F. Revision History
EDEP: 01/25/2007 11:00:08 AM
C
JAN 3 0 2007
NORTHAMPTON BOANO UF HEALTH
EDEP: 01/25/200712:00:12 PM OTHERPROREV: JOB WILL BE PUT ON HOLD 1/26107 DUE TO
FRIGID CONDITIONS.
)6pdmdoc•rev.2/5/04
3
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100050238
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 and correct to the best of his/her knowledge
and belief. ,
JUDY CROWLEY
1. Name
OFFICE MANAGER
2. Position/Title
IACCUTECH INSULATION 8 CONTRACTING
4. Representing
A ho zed gnature
/29120 7
3. Date lmm/ddlwW)
(413) 583-5500
5. Telephone
100 STATE STREET P.O.BOX 376
6. Address
LUDLOW
7. City/Town
06pdm.doc•rev.2/5/04
01056
B. Zip Code