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33A 33B Notification of Deleading 1998 JMN MIST ENVIRONMENT PHONE NO. : 800 246 6316 Q\ Jun. 08 1998 12:50PM P1 COMMONTgE `{ ALT$ OF M.vS$ACsu•BE 'moo' t LIU )Deparement of La....f L I'i�iS:Tl45 0.n1 L:pq; . .nt of i Health t 1 8 L NOTTEICAr taN C LI1 J ZNG WORT( .NORTHAMPTON BOARD OF HEALTH all 480910 9$ of thie tet..aunt be eemaNletod lm ozdar to ceaply with the notifio.tion i.gniteaenta of H.G.L. e.111 S 197, 22.99 and 105 Ott 460.000 as moat tecently amended PILE NOliann fAGENCY pat) M :o2ttot performing project J license g (' e_ailifli cad Paint inspector Exp.date / -., _ fJeQ. ai>eator may) ,� License p 28(4, Dace of inspection E low-risk deleading work is bein i""'e g pe;formed, complete the following line: :operty owner ._______ , Agent( ;s rexess of ejwae ilding Name (if any) _Floor reel Address 3 �„— _ Apt. No.» ate- a k Leading Method: -- - -- - --- Heat Gun caustics paid Encapsulant Demolition placement "Other" selected, _. Other Please explain k 09e: dwelling is meld-family J\ stogie family�` rt date !o / 98� comp;ecion dace __Vet) .449 will Work be done: A.M. 7, — P.M. 4%'-- -�---- WeeaendcT _�`, ect Supervi$or.s name I _ ns " iiF nn .iltai arty Owner e$S State '`7.119.7._ _ Zip ©/O,;g. ?hone a 140_ n I �, met: of emergency conCact I day 2A5-AVS evening (oven) ST ENVIRONMENT PHONE NO. : 800 246 6316 /M6 Jun. 08 1998 12'50PM P2 COMMONWEALTH OF MAGSACtirmrTTS Department of Labor 6 Industries and Department of Ptblic aea1tr NOTIFICATION OF DFLEADING WORK All mactiona of this ton. gust ne completed to otdec to comply elth the notification requirements at H.G.L. a.111 5 197• 656 CA 22.00 And 105 Cat 660,006 as moot recede/1F amended R:S I416878n: (50Et1r ME) ,/ &actor pedoming pole le_,e.� -"' C"-4-- License t{ DG 00//4/111 Exo.date %y-a �/ nicense py. 2l'1.31 inrpector ��1 98 Date Of Inspection ate low-rink deleading work is being performed, complete the following line: Agent(s) td Paint ,party owner tress of Project ilding Name tit any) -- Floor - - - - " W - B rest Address /�S R �nMZ_ S21' Apt: 33 . — ty -17. Zip leading Method: "'r+ Heat Gun Caustics quid Encapsulant nemolition Cvlacement,.) Other `her 6eleuted, pi ease exp Eck Cott ;art date atoning Is multi-( (7/e /58 len will work be done; Y Completion date A•M• % P.M. 7.._= r n9 :eject Supervisor's name .� T.zet t-,..(:6><a eiCarW-0`'fn-2-^ ,...: ddrass i„iza SC J elephonL� g/i it 6 State `ill" 740 be Weeknds? r/1 License # 16100141/ . 'Y �tv ",f coos cf cr---cgpr-1 c, c.::ta:t _ - h Cyi.3) -2_ evening __�M�+-AL.• hone: day [ST ENVIRONMENT OK PHONE NO. ' 800 246 6316 0111% Jun. 08 1998 12:51PM P3 .,rani:• with Mas lehu n cn • nl lew ,. Ill O. Iol (1411 71.00 a 105 (MP 400.080 notice Oats ats and mnlho ds0l of eI..vAl n. rovni .uV ^r 0#11“T1 PlAete1 e, i other ec s.U1e materials one, A armor. ..r levels of r lead i In eg nmlmg provided and wt be ed by the following .one, al loon( ten (tto) QAVaydva to IJnyi ul.l nv n( ( nl rant n,l. Ur. ;slArds of 110 dwelling " nil All otbel occlupantr of the reSido.l ial 1"omiens, if ars Direr/o1.• ChllrLrood Leading rminonimg Ittlantrc ention lnffr ta' MA gZ110 Department of rublic hea 11U lth. . . rag 1817) 727-1568 Departme !robe stns 6 Lead Stoyta^' Department 0906 of 0a Car f !lulu Street Bnetvn,D� 08202Cambridge • Fax (.0}38-0830041470 f �a -al !final nt n omit ,/Cwt IA.PU..msent Ay^ rV Massachneet to historical coevalsol•., HostHorriS yY 02125vd. (I( °remlao.s Is I istnn or, the State oo letelbe made upon!reeoiptsoft An Order to Correct violations ror at loss<I 30 days pc%or to initiating preventive selest6I1q) 127-5120 fair as ediug Co�tra_k_ Ile undersigned hereby states, under the pains and penalties of perjury, that a/she as egulatlionsCe 454at14RU 22.001 and the eading Poisoning Prevention and ing nd control egulations, 105 CMR 460.000, and that the information contained in this otificettion is true and correct to the best of his/her knowledge and belief. eta 47 . er" 94f- — .__- sign /�y� � Tit In: Claw-air/ enniCanyt "' q. Rio 3Y' PQ, .30/( H7 I `AI m risk del eading wr.rxl ilf , nil sed owns. , ages will be perfo g irooertY Oanat erne[ ar a crtn I certify that I have complied with the training requirements of the Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations. 105 CMR 460.175, for owner/agent low-rink abatement and containment. I further certify that I or my agent will be performing the following low-risk activities (1 have circled all that apply) : o +I•nlging lirmi.l nn-apsl !ale "'Wing ba snPn.vdn a Ppl Yi ng 71xleriru vinyl siding coveting Asnieres removing doors. ca!i1.+1 J.•ns, ebot tel.n t • .tir Y that all rho i n(rbncm l flr � mta'^ed in. this v if i!m i Tine and Mrrert tone. two” . [ my knowledge 410I IV,v I012/Ac