70 Deleading Notification 2000 OOO WED 15'.31 FAX 413 525 0678 ABIDE INC ,I\
weA ABIDE, INC. PROJECT #
COMMONWEA1all OF MASSACHUSETTS
Department of Labor ° Industries and Department of Public Health
NOTIFXCATXON OF DELEADINO WORE
M1 sestion• of this fors moat b coaplatod an ocaas tc o°Rly
mith the notification canalaamonts of N.G�L. c.111 $ 197.
454 adt 22.00 and 105 CHR 400.000 as west otcontly wended
SILL 91IMACt:—�—�-
Contractor performing proied,
Lead Paint Inspect°
ABIDE
INC. (Fran
MtA)
(wick USE)
License it D 9 tool
Exp.date Seantember 11, ROt
License NM 1226
Date of inspection
If low-tisk deleading work is being performed, complete the following line:
Agent(5)
Property owner
ACt
Building Name
Street Address
City
Deleading Method:
Liquid Encapsulant
If "other" selected,
(if any)
70
NN I OE DA' CFloor �NI
'{(ZEE Apt. No. ?tool-Paa �o1SE s rD
Zip
Heat Gun
Ca U5t1 CS
Re lacement
Covering Demolition P
please explain MAhk-C PANTO.
Check die
Completion date
Stare date \2.( 1 . _ P.N.
When will work be done: A.M. —7 ',OU
31.'414 fa
Project supervisor's name
owner Wa LLE
Property
Adtlre55 1:��a"-LC' Cr
State��
MPTO J
Robert P
It
t 1 l 00
Weekends? Y
LaMDuntnin License % D53605r \
E • c- S 2 sm Kantmlil`dSIC-
City
Telephone Y113
Frank President
In case of emergency contact
Till`i ,
Phone day 413413
evening 4144
(overt
2000 BED 15:31 FAX 713 525 0678 ABIDE INC
'^` It' CM; 22.00 ..�o 105 tF� IaO.000 notice
covering. _o1 5 It' p ° .O0 • oticela
laser o that accessible mat
In accordance dangerous with Massachusetts ll f eaGeneral to be provided d must be received by a Pr
of the date 1pleveuoottleaiac to beginning of dcleading.and
containing np
Pot et least un (Sol da s r
1 Occupants of the dwelling unit
2. All other occupants at the residential premises, if any
170 Atlantic Prevention Boston, 7W 02110
Director,prme trof1 Public Health,Poisoning tic Avenue P5oS°a'
Department of —
[. Director, AsDaet65 s Lead Program
Rupee of Ca u
Cambridge Street
Boston, MA 02202
5. Local Board of Health/Code Enforcement Agency
pogt2,b ac- l.LEHCTHCSTi cFN02,'P7AfAProN
6. Massachusetts Historical Commission
220 Morrissey Blvd.
DC tpn, Igo 02125
Fax LOP) 284-8410
Fax (617) 727-7566
Frew 6(d)Str
If premise) is listed on the
on notification Ragiscar
f Historic ets,f aft Order to Correct be
wade upon totce ip•t< o Ter to
Violations or as days least 30 p<
to a.: c.ng preventive tlFax 0111 7 7.5120
Fax 16151 2
oe ainv Contractor
eI nry, that
under the pains and penalties of P ]
the Commonwealth of Massachusetts neleading
The undersigned hereby states,
22.00 and Leading Poisoning Prevention and Control GMR Regulations,has read 05a CNR understood 6 . , and that the information contained in this
notification 105 MR and correct his/her knowledge and belief.
Aequlaiions,
notification is true and corcece to the best of Fr n T
signed:
Title. President
Company; ABIDE. INC.
r'oPe lif owner of unlicenepd owner's agent will be performing 10W-riek deleadin9 workl
requirements of the
Prevention and Control Regulations,
L certify that I have complied with the training end containment. I
commonwealth 5 GAP of Mfora owner/as ntad Poising
105 her cer ify, for owner/agent towillsb abatement erfolming
further certify that 1 or my agent will be P
the following low-risk activities (I have circled all that app Y
capping baseboards
covering surfaces
Pate I\ 2
t�s
k
applying liquid encapsuant
applying exterior vinyl siding
removing doors, cabinet doors, shutie[e Correct - e ha
i certify the( all the information contained in this t�gaifieation is true and c
best of my knowledge and ballet.
Dace:
ABIDE, INC. PROJECT # �S3
REV 10/12/95
/29/2000 WED 15:30 FAX 413 525 0678 AB1UC J.Y.
anbp
a b i d e
Abide,Inc..Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: 11 )29 I OD
ATTENTION;
I
Q\CN kn8.2EM)o 3K) (m■-04 Co I-4fc G£1
irector,CLPPP(Boston)
/Director, LEAD PROGRAM(Boston)
Ili Town/City of NOILIVIAM ETC t°
(Local Board of Health)
I Massachusetts Historical Commission
FROM: FRANK TILIA/ABIDE,INC.
REGARDING:
PROJECT NOTIFICATION
I I REVISED NOTIFICATION
I OTHER:
NUMBER OF PAGES (including this one): 3
COMMENTS:
FAX #:
tilg— ssS-21.11-0-/
617-284-8410
617-727-7568
11e5-56'7-122—I
617-727-5128
If you experience problems in receiving this transmission,please tall 413-525-0644.
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entity. If you me na the intended recipient.be aware that any disclosure,copying,
ux at the this ved mttmsmu+oa incrm
pleme na"fy us by telephone(413-525-1)644)immediately. Thank
P.O. Box 886 East Longmeadow, MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • E-mail ABIDE I @aoi.com