70 Notification of Deleading Work 2006 Illakelartneat of Public Health/Department o1—.nor&Workforce Development
NOTIFICATION OF DELEADING WORK
All sections of this toes must be completed in order comply with
the notification requirements of M.G.L C.111§197,
454048 22.0 and l05 CMR 464000,as most meanly minded
c,####a„##,#„„###project Abide,Inc. (F.Till i
---�__ aose$ 00001619 gxp.Dak 8/30/06
Lead Paint LupectorDrkoflotPMion li p
mau$__Ragleisl L..
ADDRESS OF PROJECT;
Street Address SUMyyS10E 1i6.yf4a< 70 PARanle
£ � ApL N•mbrr
City_ NORtµAA4a1p.i
Zp 01060
Property Owner SM TFi DLIE+F Addren 1240 W CS r sr,NO ktbIAMp7UN
Telephone Number !{(J _
Deluding Method:
if"Other selected,please pylahi
Heat Gun
Caustics
Other
Liquid Encap•hnt
Replecaneat
Check one: Duelling is multi-family a y /
Other ✓
Start Date_5(.2 pl 941/2006 Cie Completion Date
When will work be doers AM 77 000TM 5:O((Specify twin oat mite) Weekends• no
Project Supervisor Name Jerry Gray DS00377 ,�mu 71 aLi /07
I.kensed
Worker's Compensation Policy N•sher AWC701327807 2005
Carrier AIM
In case dune/gamy touters Frank Tilli, Abide.Iocids 413 ) 525-0644
(Contractor's Represepbtive)
DELANDING CONIRAeros
The undersigned hereby states,under the pains and penalties of perjury,that he/she his read and ram dentood the Commonwealth of
Massachusetts Deluding Regulations,454 CMR2200,and the Lend Poisoning Prevention Mad Control Regdatioos,105 CMR 460.000,and
that the information contained i•this notification is Inc and correct to the best of limiter kaawIdge and ballet
Date 8444,2006 sgnad. 77.0- Frank Tilli, Abide, Inc.
��RP/fR.. l����irr_
Company Name Abide, Inc.
Address
P.O. Box 886 (483 Shaker Rd. ) , East Lonemeadow MA 01028
Telephone Number (413)_ 525-0644
OVERT
a
AMPTON EOAiID OF HEALTH
(16/2uub m.0 I
•
Page 2 of 2
�R 1 In accordance with Manaebumry CUR r GeneralLaws C.1II$197,4M C 22.00 and IRS CMR 460.000,notice of the date sod method(r)of
J removal or covering of paint,plaster or other accessible onterialr containing dangerous levels of lead is to be provided and most be received
b y the following agent i m,at amt 3 (10)days prior to the bcgimtog ofdekading.
NOTIFICATIONS MAY BE FAX
1. Department of Labor sod Workforce Development,Division of Occupational Safety
399 Washington Street,5n Floor,Boston,MA 02108 FAX(617)727-7568
2. Director,Childhood Lead Poisoning Prevention Program
Department of Public Health,56 Roland Street,Suite 100,Boson,MA 02129
3. Occupants of dwelling unit
All ether occupants of the residential premises.if any
FAX Oi
�q 77Y-67°n'
5. Local Board orHnuhtCmefArwnm tat Agency(NRmAMPTDN) '/13-387-/22/
Massachusetts Historical Commando,.
220 Morrissey Blvd.
Boston,MA 02202
FAX(617)727-5128
(if premises are Rated on the State Register et Historic
Places,this notification mop be nude upon receipt dam
Order to Cornet Violetion prat east 39ddys prior to
initialing preventive delndlog)
NOTIFICATIONS SHALL BE COMPLETED IN IBM DITIRE y,DATED AND SIGNED-INCOMPLETE NOTTFICAT IONS WILL NOT
BE ACCEPTED AND WILL BE REMISED BYTBBDEPAtIMENT OF LABOR&WORKFORCE DEVELOPMENT.
PBOPEKIY o\tq t(ffonwm tmfirmrtd owner's egmt will be pufatmmg)ow.istdceading wtk,
Property Owner
P.O. Box 886 (4
Ike following):
Telephone Number (413). 525
I certify that I have mnpled with the
CMR 460.175,for owner/agent low-risk
(I hive circled all that apply);
applying liquid rocapuiaut
applying exterior vinyl sidlag
I certify that e6 the iukematwn aonmocd
nee.
and Conhvil Regulation,105
loweisk activities
u
Date
02/02
Signed
ides Inc.
Aut !a ization 04488-AL
abide
Abide, Inc., Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: 4/4106
ATTENTION: FAX#:
[ vr-Director,CLPPP(Boston)
[ Director,LEAD PROGRAM(Boston)
[ 4 Town/City of A/ORTi/AmPTDN
(Local Board of Health)
[ I Massachusetts Historical Commission
FROM: PRANK TILLI/ABIDE,INC.
REGARDING:
[ PROJECT NOTIFICATION
[ ] REVISED NOTIFICATION
[ ] OTHER:
NUMBER OF PAGES (including this one): Q
COMMENTS:
781-774-6700
617-727-7568
w3 -517-122J
617-727-5128
If you experience problems in receiving this transmission,please call 413-525-0644.
CONFIDENTIALITY NOTICE The documents actmpaaying this tdcopy transmission may contain conf darialsvd privileged •
infomadoo fim Abide,Inc. Ibis information is intended forthe use of thc addressed individual or
entity. If you an not the intended recipient,be arme that any disclosure,copying,dismbudoa,or
lase of the aortas of this tremmissionspohsbittd. if you hive receivdth%transmission in wen;
please notify us by telephone(413-525-0644)immediately. Took yon
P.O. Bar 886 East Longmeadow,MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • wwa.abideinc.com
ide.Ines standard TERMS AND CONDITIONS require payment for services upon presentation of Invoice. Invoices unpaid after 30 DAYS are past due and aublect to
:INANCE CHARGE computed at a morally rale of 1 1R%(ANNUAL PERCENTAGE RATE OF 18%)or the maximum percentage allowed by the law. Client is
ponsible for legal and collection costs if recessary to collect past due amounts.