73 APT#8 Deleading Notification 2004 10 15/2004 FM 13:MI ffkA
1¢fVUZ/VUS
a—partment of Public Health/Department of Labor&Workforce Development
NOTIFICATION OP DELEAD1NG WORK
All sections of Mk firm mist be completed in order to comply with
the aotifuatlon requirements etM.G.L.C.1(1%197,
454 CMR 22.00 and 105 CMR 460.001,as most recently amended
OCT 15 200i
contractor Abi de,Inc. (F.Till 311„,## DC0016/9 09 08 S HE
��Ofpi1oa ql° easep Exp.Date - AMPTON BOARD OF HEAVY'
Lead Paiat inspector -- 04Vari
ex\ Date ofInspection 68I36/04 umsedl-31lflx .Dale -rp.q,
ADDRESS OF PROJECT:
Street Address Via Uri djc 51, f Zt. ApLNumber -# S
City Ain r4'h0.W.pjthhs \I Zip U tC L0C
Property Owner-(tin fAcsccxc*es Address-i.(1."t,ax 753/ Amlurri€
Telephone Number(1j l'1il.;53— t1 i O j�li
Deleading Method:\WctIDry Scraping Hat CAM Liquid Encapmrkat
Demolition Caustics Replanment
Other
Irothet'selected,please explain
Check on: Dwelling is multi-family X Singk.fonily Omer
Start Date i() per 5/n4 Completion Date
itiam/o'
Wbea will work be done: AM7:00Ppd 5:0¢Spaib'times ensile) Weekeedry no
Projett Supervisor Name Jerry Gray Licensed.D900377(4.Dale
Workers Compemtin Policy Number AWC7013278012003000 Carrier ATM
foram oftmmgeoey contact Frank Ti11i,President Tda 413 525-0644
(Contractor's Representative)
DELEADDYGCONTRACTOR
The oederdgeed hereby states,aader the pain sad penalties of perjury,that be/she has read and understood the Commonwealth of
Mamaehasett,Deleading Regulations,454 CMR22.0,end the Lead Poisoning?mention and Control RapulatM ,105 CAfRt460.101,and
that the infonnaties contained he thinotWeetnn is true and unmet to the bat ofbWhcr kaewkdge sad belle&
Doc 10i5 o4
Signed indntlL11We
CompanyName Abide, Inc.
Aaarae P 0 Box 886 (483 Shaker Rd. ) , East Longmeadow, MA 01028
Ideation Number (413) 525-0644
Frank Tilli , President
OVER-t
IU/1h/2UU4
IJ:U0 Y.iA
Page of 2
b accordance with Ma advdsG am iLaws C.1114197,454 CMR 2200 wed l05 CMR 460400 ielke of the late ad metb0d(4of
removal or covering ofpaw4 planer or other acnaaLk materials raofabbg dngerous limb of led into be prvvided and mast herereird
by the following agates,at Bast TPdl(10)days prier to the begin Mg ofdeMadmg.
NOTIFICATIONS MAY RE FAXED.
Department of Labor ad Workforce Dmefapme4 Division of Oceopatb W Safety
399 Washington Street,5a Floor,Boston MA 01108 FAX(617)717-7568
2. Director,Childhood Lad Poisoning Prevention Program
Department of Public Halth,56 Robed Slma,Snite 100,Baba MA(12129
Occapaetsefdwelling nit
All other occupants of the madman premises,If any
5, Local Beard of Heath/Code Enforcement Agemy
6. Massachusetts Hbtorital Commission
220 Morrissey Bind
Borten,MA 02282
FAX(6I7)7275128
-CeM-slwT,
FAX-1 6-_G707
csk 04 may A v v a R.c - 5 8 7 ) s a l
(if promises are Freed a the State Register of Historic
Places,this netAkmioa meet be made wpm receipt of aa
Order te Correct Ylobtion or at Inst 30 days prier to
bbiadeg prnntive delndkg)
NOTIFICATIONS SHALL BE COMPLETED IN THEIR ENTIRETY,DATEDANDSIGNED-INCOMPLETE NOTIFICATIONS WILL NOT
BE ALLEPI12)AND WILL BE EEIIJWRD BY THEDEPARIMENT OF LABOR•WORKFORCE DEVELOPMENT.
PROPERTYO ng(1fownerortmScmM owner's agent will be patenting deleadlag work,complete the k1lowi sib
Property Owaer
Address
Box 886 (483
Ageale) JO Densmore - Abide Inc.
Shaker Rd. ) , E.Longmeadow, MA 01028
TekphweNnmber (413). 525-0644
I ratify that I have conmlied with the training requaments of the Commonwealth of Itaasichusietts Ind
ChB[660.175,for owtW Poisoning nning Prevention mowannhalRegulations.sk cty s05
egret low-risk adamant adrmbimtat. 1 farther that I or my agent will be per0omng Oc bibwbg tenon activities
O have arced all i6atapply}.
applying D9old enapmbnt tapping baseboards
applying exterior vinyl aiding covering surfaces
I certify that all the information contained in this notification is true and cone*to the bat of my knowledge and belief
Date Sid
Jo Densmore - Abide, Inc.
Authorization # 04488-AL
reeving deers,naiad dews,shatters
02/02
•
a
a b i d e
Abide, Inc., Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: I bi 15/0(-1
ATTENTION: 1t
FAX #:
[X Jlirector,CLPPP(Boston) 781-774.6700
[ Director,LEAD PROGRAM(Boston) 617-727-7568
IA Town/City of k &-lbca,w 4tM 587- !a a
(Local Board of Health)
I [ Massachusetts Historical Commission 617-727-5128
FROM: FRANK TH.LI/ABIDE,INC.
REGARDING:
[ PROJECT NOTIFICATION
[ ] REVISED NOTIFICATION
[ l OTHER:
NUMBER OF PAGES (including this one
COMMENTS:
3
If you experience problems in receiving this transmission,please eal1413-525-0644.
CONFIL WRHA 11Y NOTICE The doumems axampmting tba tekcupy transmission trey contain confidential and privileged
infmmtion from Abide,bc. This igmmmioe is ineauledfor meue dine addressed indivwualo
entity. aymu are not the heeded recipient,be aware thatsay disclosure.copy*.Smaudon.or
uscd0eromeneddus tram is proho1ed. VyaaMeierdrodthktravwaoiouinaror,
Vase notify=by telephone(41T-52SUW4)immoiiatdy. Thavkyon
P.O. Box 886 East Longmeadow, MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • www.abideinccom
Abide.Ic.'s standard TERNS AND CONDITIONS require payment to services upon preaetda8on of invoice. Invokes unpaid attar 30 DAYS are pee due and subject a
a FINANCE CHARGE computed at a=Wily rate at 11/2%(ANNUAL PERCENTAGE RATE OF 18%)or the maximum percentage abwedby the lax. CNen4 S
responsiNe for legal and collection costs I necessary to collect past due amounts.