Loading...
137 L Asbestos Notification Form 2013/2013 Tura 12:43 Important When rrng out forms on me computer.use only the tab ksy to move your moor- not use the return trey. GIO INSTRUCTIONS 1.AI seams der form oast be wmpMed b order b comer— DFP wrrmEw repiamene Or 310 CMR 7.15 and the 0iA0On dompewral Smarr 0300) wmaem OW 012 4 453 cM OW012 C a 0 n 0 MEW a r Mail o 2 MIN‹ FAX --- Northampton Baas* 9ealta Commonwealth of Massachusetts Asbestos Notification Form ANF-001 QUUI/V<I k00184535p 3- DooMNfl Or1o�1 m1'•591001 A. Asbestos Abatement Description 1. a.is this facility tee exempt-citydown,district,municipal housing atMordy,owner-occupied residence of four units or less?ai Yes ❑No b.Provide blanket decd number if applicable: a Facility Location:. /MIA-FORSANDER APARTMENT.BLDG L a.Name of Facile 3. Worksite Location: NHA-FORSANDER APTS. MA a.State L a.Belding Nemmetimre Location b.Buinkp t 4. Is the facility occt ied? l7 Yes ❑No Asbestos Contractor: ABIDE INC (EAST LONGMEADOW c Cdyrrov/n 1AC0002u r DOS Limes Number lBtI Cantata-0 MECHANICAL SERVICE.) II.Flab Contact Penal ,CHRISTOPHER J.COOPEE � 7. a.Name d em M-SlSemester/Foreman• 01028 d.2b Carle e.Name of Rand WM* 8. a Nana dAWeelue mower tab 1011012013 9. a.Om eta tart Dee ov AW6PM c Wail hams Son-Fri. 10. a.What type of project is this? ❑Demolition I Renovation ❑Repair Older,please specify: 11. a.Check abatement procedures • ■ Glove bag Enclosure Cleanup Fult containment Encapsulation Disposal only ❑Other,specify. Blanket Decal Number 100-107 HIGH STREET 1 c Meg 0.BMW MECHANICA e.Room 1483 SHAKER ROAD b.ANew 14135250644 e.TebpnNrb Natter g.Contract Type: ❑Witten 0 Verbal GENERAL CONTRACTOR i Coded Perwnt The JA5070247 4.SwavisodFa®nan DOS Caae:Wm Number �WA b.embed Muria DOS Cmutarbn Number IWA 4 4 6.--- as�i Rwier 812013 b.Bid Dail(00a040/1yn) d.Wok hams SaSSn. b.Desoto 12. Is the job being conducted: i]Indoors? ❑Outdoors? ■ amgoiw.dac•1O0)2 Asbestos Ndaa-On Fan•Pape 1 of 3■ Nob:Trasbr Station mat caerk el*die Solid Waste Division Reputations 310 CAR 19.000 Pie 0 MIIMNIMI10 gliMMN iC 1110 alaia EffilM 0 satio IffilMz aseOlap.doc-10702 NEEL Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184534 Deal Plantar B. Facility Description (cont.) BILL CELATKNB-G MECHANICAL SERVICE, a.wee of General Contractor !CHICOPEE c.Calyfawn 01020 d.Zip Code t Contractor's Worker's Cane_Meer 6. whet is the size of this fealty? 112 SECOND AVENUE 0.APS 1413288-1500 I e.Telephone Number l(code and Solon) Ih.F� Os(mwyyyYr) 1 19.Policy Number 1,800 a Squad Feet 0.Number of Socra C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing materiel from site to temporary storage site(if necessary): ABIDE,INC. a Name of Transpose b.Abbas. LEAST P.O.BOX 886 LONGMEADOW I 101028 141 50844 Cayfrom tl.2rp Code a Telephone Number 2. Transporter of asbestoecmFaning waste materiel from removal4enpwary site to final disposal site: TRANSWASTE,INC. a.Name of TrMsOabr IWALLINGFORD,CT G Chy/Tawr 3. INAA a.Refuse Transfix Stalks.and O.IN 06492 d.Zip Code c City/Town 4. !MINERVA ENTERPRISES It4C a.Fowl Disposal Site LcaNOn Mn.a 19000 MINERVA ROAD C.FMl Disoaal sit Add,A JOH Sole d.Zip Code 3 BARKER DRIVE ..33698 e.Magma,Punter ▪ maress II .▪ Telephone Mather b.Final Ocoee'lie Location Owners Na,,. ;WAYNESBURG d.Cihtfa n • Telepinn Kanter 44688 t Zip Code D. Certification The undersigned hereby zalac,under the penalties of penury,that lelshe Si reed the commonwealth of Massachusetts rag ore (orate Removal.Containment or Encapsulation of Asbestos.453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this noti aaan is ere and COMP( to the best of dater bevMedge and beret. MARDI TALI a.Nara !PRESIDENT c.Position/Tip 14135250644 a.Tebplae Manber loo Box 0116 y mess (EAST LONGMEADOW h.ales Town Maria TIM 0.MIuSd Somas I 18/30/2013 d.Date tamMi an! I 1A68)E,INC. f.aerate** 101028 Zip Code wasferace Fans•Pap 3 O 3r' - Ma NULtILCIZIWI. MUGS aco Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184534 Paw Wilmer A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or envausulffied: 16 a.lad pass or ducts(lnea ft a Soler,breaching,duct,tai surface outings On.ft Sp.i e.Corrugated or layered papa pipe Station 1166 b.total Mbar wastes 1LQIare1) 6 9.SpraymlreproceV 1.Cbew.amen fabrics k.TbanW sold are pies summon a.Insulating ranee t.TnaeOSgayer nYips b.Trend*board,wall board I.Other,please a4MWS: Lin.IL Ss. Lvi.It 6 bt 14. Describe the decasmninaton system(s)to be used: (REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMmATION UNIT W/SHOWER 15. Describe the oontthiet¢atio&dtsposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): 'ACM ADEQUATELY WETTED,DOUBLE BAGGED,SEALED AND LABELED 16. For Emergency Asbestos Operations,the DEP and DOS officials who ovahiated the emergency: 1N/A a.Name of OUP.OacW INA a Date(nmldlyyyy)or AWUnalm rt.DEG Wave IIt.DOS ODstal Tae I J IWA 1N/A t Name of DOS Official O.OS(mmMc1SWS of A W ediauai It DOS Wails i 17 Do mending wage rates as per M.G.L.c.149,§26,27 or 27A-F apply to this project?©Yes❑No B. Facility Description 1 Current or prior use of facility: (HOUSING 2 is the facMy owner-occupied RSMef4at with 4 units or Mse7 NORTHAMPTON HOUSING AUTHORITY a.Faddy Omer tine c 'NORTHAMPTON City/Tom 01060 tl.2rp Code 4' 1BILL CELATNA/B-G MECHANICAL SERVICE,1 a.Name of Sadly Owneis On-Sree Manager 'CHICOPEE • ad001 ep.doe•10/02 C,CD/frawn I. (01020 1 d.2 p Code ❑yes. NO 49 OLD SOUTH STREET b Address 1413534-4030 e.Telephone Number fame m pis ad mda alanj_ (12 SECOND AVENUE b.OnSt Manager Mimes 1•13230-1500 e.Telephone Number(area axle end aoanoan) Asbestos Natlloa oo Fare•Pea 2 pia II Important When Wm out forms on the WyMm b key to move your cursor-do not use M amn 43 a . . La ne. CU Commonwealth of Massachusetts Asbestos Notification Form ANF-001 • I100184634pyp I .590999 A. Asbestos Abatement Description 1. a.is this faclity fee exempt-cityttavn,district,minidpal Musing aulhodty,owner-occupied residence of four units or less? tt Yes 0 N b.Provide blanket decal number if applicable: 2. Facility Location: NHA-FORSANDER APARTMENTS,BLDG K a.Name OF WOW /Northampton c.City/fawn hNSiRUC1mNe 3. Waknie Location: 1.MI section.mthis form mai be =SEW in aver Da comply es 4. DEP marmite mrsaemrmmd310 CMR 7.15 5. end The DMHpn d Ctoperonm safeb 1DOS) essutim remranmms of453 CUR ell 6. 7. 8. 9 MEW EN " C o 1D. IMEE0 IEEE Ear MIMIZEI0 LL z a NHA-FORSANDER APTS. 1 IPA K a Baling NSKRaid*g Lanka b.&t* t is the faddy occupied? O Yes ❑No Asbestos Contractor ABIDE INC e.Name 'EAST LONGMEADOW I Cap/Town d.no Code �A.0000254 i%DDS License Number BILL CELATKA1B-O MECHANICAL$ERVICE,J it Fedi&comsat Person CHRISTOPHER J.COOPEE a.Name of On See 9gurisalFawen 01028 Ilea a.Name of Prolog Mo r ITEM a.Na,,.of Asbestos AnYyktl Lab /4117/2013 a Project Start belm mitminwl 17A11-5PM c.wwk hours Mon-Fri a What type of project is this? 0 Demolition Autoee5un Repair ❑Other,please specify: 11. a Check abatement procedures: Glove bag Enclosure Cleanup �]Fu8 containment 8 Encapsulation Disposer only ❑Other,specify Blanket Decal Number I22A0 HIGH STREET 01062 e.2b cote Wog f.Telephone Number IMECHANICAI e.Rowe 1483 SHAKER ROAD b.Address 14135250644 a Telephone number g.Contrail Type: ❑Written Verbal IGENERAL CONTRACTOR I.Contact Pbannh Tee IAS070247 b.SupeaiwlFarwen 00$Cedfu*m Number IN/A b.Prefect Monitor DOS Cernloadon Number IN/A b.Aaaegm Anthem,Lab DOS C.1 on Number Ien7/2013 b EMI ass Oaaldawyyyl d.won hours Smsmp b.Desate b.Deaabe 12. is the job befog conducted: ©Indoors? ❑Outdoors? ar1001ap.doc•1002 AebsMoe Nibxan Form•Pap 1 d3 II 1 fEOLJ TUE 1.2:4U VAX +^ p0 CEaapCOE BOarQ nEEJCe 0 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 Note:Transfer Slates must corn*am the Sold Was Malden Regret=310 CAM 19.000 O t N Mato 0 u z a ■.adOMMp4oc•10/02 WVVa/V<I 1100184533 Dee Weber B. Facility Description (cont.) BILL CELATKAIB-G MECHANICAL SERVICE, e.Name of General Come CHICOPEE OM/Tarn f.Cenfct&s Wr bah Damp.bwrtr 6. VNiat is the size atthis facility? 10 o d.bp Code 112 SECOND AVENUE b.Mdems 413-888-1500 IIa.Poky Number 11800 a.Square Feet e.Telephone Number(am code and etlxoobn) I I I Ih.Exp.GO fw.Vddyyl'y)I 2 P Minter of lows C. Asbestos Transportation and Disposal 1. Transporter of mining material from site to temporary storage site(if necessary): (ABIDE,INC. a.Mn of Transporter [EAST LONGMEADOW G caynream 01028 d.np Cade !P.O.Box 888 b.Mdreea 14135250644 e.Telephone Mobs 2. Transporter of asbestos-containing waste material from removakenlporary site to final disposal site TRANSWASTE,a1C. a.Name ofTanbwNr IWALLINGFORD,cr G CNrovm 3. 1N/A a.Reuse T=ruer Maim and Omar G Cayfroan 4. !MINERVA-ENTERPRISES INC s.Final Deposal Me tombs,Name 10000 MNERVA ROAD c FVW risoose Site Address OH e.Sate 106462 d.Zip Cods 13 BARKER DRIVE b.Address 12032687300 a Te4 Number ber I I b.Address d.ilp Code e.Telephone Naha II 1 rattan f.21p Code b.Final Deposal sins Location Owner's Nan IWAVNESBURG d.Gtwtom 1 g.Teleran.lumber D. Certification The undersigned hereby states,under the penalties of eatery,mat he/she has read the cwnnnn%BBnh of Massachusetts regulators for the Removal,CaMkeem or Encapsulation of Asbesba,453 Chat 6.00 and 310 CMR 7.15,mid that the idWmalbn contained in ads notifatlw is true and corned to the beet of higher knowledge and belief. bfk &.5AOI$9 MARIA TIW a.tans (PRESIDENT PpOnwl/tale 14135250644 a Teepna PMtha (P.O.BOX 886 a.Adeest !EAST LONGMEADOW Maria T40 b.Authorized Sendai I 18/3072013 d.Date fmrddteyn) IAB10E,OdC. f.Repnsaohp n CtiITOwn 01028 21,Code Asbestos Noftaan Foe•Page 3 d 3 (201J TUE 12a9 a o 0 Mc* o timer MBM0 air 0 LL Z FAX +++ AOrtUAMptan Mara tldastn Commonwealth of Massachusetts Asbestos Notification Form ANF-001 apUVL/V"/ 11081&1533 Dad Number ■ A.Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Meteria6(ACM)to be removed,enclosed,or araavietect 6 a Teel plate a duds rye.t e eabr,bre.tlt aid,tart &dace cutups e.Competed or bayed psoa pipe Insulation p.Spay-on bapracfig L Coops,wor nfabrics 1.Trans,sold cue de i 1188 0. l aal other surfaces(MOOR q 14. Describe the decontamination system(s)to be used: a.Maud%seat tTrowt!Sprayer caeligs h.Treed boas,del bud 1 Omer,pease smelly: (CAULK SPY* In.It Ix.I. 100 (REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNfT W/SHOWER 15. Desoto the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): 1ACM ADEQUATELY WETTED,DOUBLE BAGGED,SEALED AND LABELED 16. For Emergency Asbestos Operat ions,the DEP and DOS officials who evaluated the emergency: IN/A a.Name of DEP Oatlal 11 b.Tlia IN/A c Date(mddeYyyy)d AulaSa®m a.DEP Willer s IN/A a.Name W DOS OSUMI f.DDS Oadal tae INiA g.Dale famWdlynyl ofAulerbadon b.DOS Waivei 11 17 Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A-F apply to this project? O Yes❑No B. Facility Description 1. Conant of prior use of facility: (HOUSING 2. Is the facility owner-occupied residential with 4 units or Ima9 3. a.Faddy Oder lime NORTHAMPTON NORTHAMPTON HOUSING AUTHORITY 1 101000 d Ze Code ❑Yea a No 149 OLD SOUTH STREET b.Aden 413-584-4030 c.City/Town a.TeepMye Number(ad code and added) 'BILL CEIATKAIB•G MECHANICAL SERVICE,I 112 SECOND AVENUE b.OnSla Monad Adbew 1413-588-1500 s.Taephoe Member(area wde and e>aemM) Aabema MoWetlm Fan•raga 2 an• 4. a.Ned of Sadly Owners Oo-ee Manager ICHICOPEE aMe1w4oc•11102 Clyffadn 01020 O.a'Code t2013 TUX 12:35 FAX ••.. Nb tnaaptOn BOaaa Beaten \ 0 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 Important Wen tom out brim on dhe 1. a.is this tecibty fee exempt-citytown,district municipal housing authority,owner-occupied arty Me lab Vey residence of tour units or less?DO Yes DNo glUVi VS, • 17°0184633(NO- { (ON:theastg A. Asbestos Abatement Description to move Mar an-do not b.Provide blanket decal number If applicable: use to retum INS1RUCT1ONS M man of a6 Wm nun completed in ceder to corny wit DEPmacaw requirements or 310 ClR7.15 5. and the Mao at OCOMakoral a—,(D:S) iega. rewn aeaenb of 453 CMS 612 2. Facility Location: 'NHA-FORSANDER APARTMENTS,BUILDIN' a.Name of Falb• 'Northampton GltylTown { 3. Wmksae Location: 4. ENEERiP io B '0 iii=INI- 0 0 MSEtv z !NM 6. NHA-FORSANDER APTS. a.Bvidkl Nat elevifig Lotadoo MA d.State b.Snkdlg Is the facility occupied? 12 Yes 0 No Asbestos Contractor. ABIDE INC a.Nate 'EAST LONGMEADOW c Cib/rown 'AC000254 f DOS Lime Hurter { 01028 d.Zle code BILL CELATKAIB-G MECHANICAL SERVICE,' R Faddy rand Penton 'CHRISTOPHER.1.COOPEE a.Nara ofOnSlte Swaim/Fawn 7. i 9 a.Project Scat Date(atddhyyr) 17AM3PM c Work hies Mon-Frt. a.Name of Protect Haub 'reA a.Name of asbestos ArSyiai Lao '9/162013 i { 10. 11. 12. / a100l1pddc•lom2 a.What type of project is this? ❑Demolition o Renovation Repair ❑Other,please specify: a.Check abatement procedures: Glove bag Encapsulation Enclosure Disposal oly Cleanup 0 Other,specBY. Era containment Is the job being conducted: o Indoors? Q Outdoors? • I F' Blanket Oerel winter { 8441 HIGH STREET { i e. Zb Cade i Tseptae winter c WAN d.Floor MECHANICA 1483 SHAKER ROAD b.Addams 4135250844 e Telephone Number g.Contract Type: ❑Written 0 Verbal GENERAL CONTRACTOR ▪Conrdl'erson's Tae IILS070247 b.SY*niso.Fereraf DOS Cellamn Number (WA b.Pfobt Mats DOS Ce.t on Number tWA a Add tat 005 Ca111niion 7612013 b.BM Deb InenlO ryyyy) {d.Wyk hots Sah9n b.Desate b.Describe asbestos Ndfalar Form•Page 1 of II 13 TUE 12± 23 FAX ■■-• BOrtoampton Hoare! eealtn Commonwealth of Massachusetts S' ' Asbestos Notification Form ANF-001 WJULUIUL ■ 100184542 Dealt A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encaosulaied: �6 � 166 /2013 T03 1.2:23 FAX F »-. a0 tnareeton Bea=O Hearn LiCommonwealth of Massachusetts Asbestos Notification Form ANF-001 Important Wren Nang out forms at Me computer.me aayde sib key to mow your oasor-do not use the return key. INSTRUCTIONS I$IV1Y/V r J1001NC542.mum** D.m Number NI 014-415:11035 A. Asbestos Abatement Description 1. a.Is the facility fee elanlpt-oitytown,district,municipal housing authority,avntereccupied residence of four utfs or less? i Yes 0 N b.Provide blanket decal number if applicable: 2. Facility Location: INHA-FORSANDER APARTMENTS,BLDG P I i.Name of redly a 3. Wotksde location: 1.Al,rile*of Mb Aare must be completer]b order to con*mtb •4. DFP nolfcalon requiems of 310 lie S 5. end M ace ddeion Sy O Safely s (DO6S) rmmalm egagl0/11101463 CNN 6.12 MMINi o MEM" O MIZIN0 0 0 2 NNA-FORSANDER APTS. MA d.State P a.B Nam Namet /tang Leath* b.a.*OYc 3 Is the faddy occupied? O Yes ❑No Asbestos Contractor. (ABIDE INC (EAST LONGMEADOW 1 C.c awroan 01028 d.Lp Code 1AC0002.54 I.DOS beetles Number �LHLL CELATKA03-G MECHANICAL SERVICE,( .Fealty Cost Peram 'CHRISTOPHER J.COOPEE 6. a Name of On-See SmwMrafawen 7 (TEA a Name of Protect Neater eI a.Name of Asbestos MMhiYal Lab A '0/142013 a.Project Start Date gpmlddhyyy) ITAM-SPM C Work hours Mort-Fri. 10. a What type of project is rtes? ❑Demolition 17 Reriwaton ❑Repair ❑Other,fleece specify: 11. a.Check abatement procedures: ©Endo ba0 ❑❑Filctosure Cieanp Full containment t7 12. Is the job being co.Nuctet • gOmap.doc•10102 ❑Encepsrdation ❑Disposal only ❑Other,specify: O Blanket Deal Nutt. 132-138 HIGH STREET b 01082 e.Lp Code C.wag I Telepbene Manbar d.Flocs MECHANICA e.Roan ion SHAKER ROAD b.Address 14135250644 a.Telephone Hama g.Contract Type: 1 ❑written p Vertal GENERAL CONTRACTOR 1.Caned Pam Tae IAS070247 b.Supervisor/Rieman DOS CeMObn Number IwA b.Protect Waiter DOS Cataatlan Number IwA Ate 5 2013 b.End Data gmiNdMri) Id work hops Sat-Sun. b.Desoto b.Deflate Indoors? ❑Outdoors? Asbestos NedeaOpn Form•Page 1 of 3• b.Address 1413-88341500 a.Telephone Numberless code and ederebn) ! 1 1 013 TUE 12:22 FAX --. Northampton Boa a seaico Nob:Tacaler Sasons met comply well the SW Yee Division n5310 CUR lt CUR 19.909 m MIONIME aaei 0 e t1 namassna C1 0 a Z a Commonwealth of Massachusetts Asbestos Notification Form ANF-001 aao u,var 11001&1538 Decal Mo nber B. Facility Description (cont) !BILL CELATKAIB-G MECHANICAL SERVICE,I 5. a.Name ofGawal Contractor ICHICOPEE 9 City/Town I.Contractors Wake's Comp kroner 01020 d.Zp Code 12 SECOND AVENUE II 6. What is the size of Odsfacity! a.Policy Meter 12,000 I t En,.Oete f ddrnr) 1 a.Square Feet b.Number of loons C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(d necessary): (ABIDE,INC. a Nyne of T,wl.a* !EAST LONGMEADOW c Menem 01028 IP.o.BOX 888 b.Adam 14135250644 d.no Code e.Telephone Number 2. Transporter of asbestos-containing waste material from rarovMltei wwaIy site to final disposal she. ITRANSWASTE,INC. a Name of Top/sooner !WAUNGFORD,CT Oa/Town 3. t 1 Refuse Transfer Stever,end Caner 06482 d.1ip Code ( CinROwn 4. !MNERVA ENTERPRISES INC a.rtes Opposer Stie Leeson Name 19000 MINERVA ROAD c Final MOONS Sca Addeo IOH e.Sae 3 BARKER DRIVE mama b12 a0 I e.Telephone Number I 1 b.Address d.Zip Code e.TelepMne Hurter Ib.Feel Deposal Sat location Owners Name 1 IWATNESBURG d.OWrmm I.Zip Code Ie Telephone Norther D. Certification The undersigned hereby sates,under the penalties of perjury,that hsaM hes reed the Cnnmanwevkh of Iassudhuaata regulations for the Removal,Containment or Encapsulation of Asbestos.453 CMR 0,00 and 310 CMR 7.15,and that the information contained in Ibis notification is true and cone[ to the best of hisser knohYdge and belief. • anlOPlaptoc•10/02 MARIA TILL! P Nene IRES DENT c cases-Me !4135250844 a.Telepltre Neuter 01.0.BOX 886 a.Addmes LEAST LONGMEADOW I h Cayfroen Maria T011 e.IWOaraed Signals. 16/3012013 d Dale ImNddww) IMIDE,INC. f.ReprwanOM johns L Zip Code Asbestos Notificstion Fenn•Pape 3 of 311 (2013 TUE 12:21 PAX -.-» Northaa'p ton Hoard health IpluLriusi S =naN e e C Eari EMS 0 0 Essis 0 2 • .M00tpAoc Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184538 Decal Number • A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or ertcepslMted: 'e a.Total pan or duds(Vomit) o eater,b eehtng,duct tank surface wafts Lint. .R e.Comgasd or(awed papa ply insulation 116 b Toll other arsons(arose a) 6 g.Spray-on leproWtg i.oaths.woven hbin un.a Lin.It d.swlrirg omen f.TroweISpaya coatings h.Trdmio boar&wet land I.Ono.please epeelk k.Thema!sore me CPa 1� [CAULK esuleon Leta !Speedy 14. Describe the decontamination systems)to be used: Lin IL It" I Se_R 160 1 Se.a L u,.a sera REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT NY/SHOWER 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): (ACM ADEQUATELY WETTED,DOUBLE BAGGED SEALED AND LABELED 16. For Emergency Asbestos Operations,the DEP and DOS of/oasis who evaluated the emergency: f•A a Nine of DEP Oft* C.pas(nedddytyty)dAUeronntlan IWA e.wee of DOS Official g.Des(mMddyyly)ofAtm&alur II b.Tae 4 DOS ardor rMta IWA R DOS Waiver* WA d.DEP Miter 17 Do prevailing wage rates as per M.G.L.c.149.§26,27 or 27A—F apply to this project? O 1 Yes❑No B. Facility Description 1. Current or prior use of fatly: 2. Is the fatllty owner-cccayied residential with 4 units or less? HOUSING 'NORTHAMPTON HOUSING AUTHORITY 1 3. a FacRa Owner Name !NORTHAMPTON a Cdy/Town d.$Cade 4 'BILL CELATKAIB-G MECHANICAL SERVICE,' a Name of Family Donets OnSk Manage 01060 /CHICOPEE a.City/Torm •10/02 01020 d.ap Coda ❑yes 10 No 149 OLD SOUTH STREET b.Addiess 1413369n030 e.Tdegas NmW(area and extension) 112 SECOND AVENUE b.On le Manager MS... 1413488-1500 a Telephone Number(area code and extension) Asbestos Neekat n Fen•Pap o13■- r 2013 TUN 12:20 Important kerns on be se oe to move yow notcuria t use the return key. FAX -. Northampton Board Health Commonwealth of Massachusetts Asbestos Notification Form ANF-001 igu ■ 100184538 ?Iowa I Decal Nmi \0 - CV11D .b5°}1032 A. 1. Asbestos Abatement Description a.is this facikty fee exempt-citytown,district muniipal housing authority.owner-occupied residence of four units or less?kJ Yes ❑No b.Provide blanket decal nunter if applicable: 2. Fatality Location: INSTRUCTIONS 3 1.Al comae area to T, be complte:in order to cal*e m 4 DEP activation cop 76s of 310 7.15 CMR 7.15 5 and be Diekion of Occupant Salary Naar notification requimmeras ore CAI 6.12 E MEW 0 iiiiiiIMC. GO MEM 0 bx•moo LL z k4HA-FORSAIAER APARTMENTS.BLDG 0 } 2.Name of Faith, 'Northampton Cayfrown Works ite Locaion: NHA-FORSANDER APTS. a.Suring Name/Bulkeng Location MA a.Stria O b.BuMkp N Is the fealty occupied? O Yes ❑No Asbestos Contractor Imam Inc a Name 'EAST LONGMEADOW 'mot$ c Ciry/rawn tl.Iq COre jAC000254 f.DOS beams Number (BILL CELATKNBC MECHANICAL SERVICE.} h.reeky Coma Person 6 !CHRISTOPHER J.COOPEE a.Name of di-SIN Sseervlao Foremen 7• B . A a.Name of Project Mauler TBA a.None of Asbestos Analytical Lab 372013 a.linnet Slut Date QuMtlwriri{ I7AM6PM c Work hours Mon-Pd. 8• 9. 10. a What type of piled Is 81a? ❑DBunrokSo 1 0 Renovation ❑Repair ❑Other,please specify 11. a Check dent procedures: O • 0 Glove bag Encapsulation Enclosure Disposal only Cleanup Flat containment 12. Is the job being conducted: ■au Olp.doo•10102 ❑Other,specify t7 Blanket Decal Number 124-131 HIGH STREET 0.Street Address j01062 e. zip Core C.Ain f.Telephone Number d.Floor MECHAMCA e.Room 483 SHAKER ROAD b.Address 4135250644 a Telephone Number g.Contract Type: ❑Written }GENERAL CONTRACTOR I.Contact_ Verbal A8070247 b.Super+bodFouman DOS Caron timber !WA 0.Prefect Mot DOS 1. !WA b L ktn 9123ft013 I b.err Dry&madMmyn d.Wadi hours Sat-Sta Number b.Mamba b.Desalts Indoors? ❑Outdoors? Asbestos Notalcalien Finn•Page 1 of 3■ !WALLINGFORD,CT C.C3yITcsn 4. [MINERVA ENTERPRISES INC a.NMI Dame Site Location Nane I90001aNIRVA ROAD OH t Stab /2013 208 12:20 PAX +»» Northampton Board Health Note:Transfr Staircase's' comply with the Sold Bate Ragudone 310 Gala i CMR 19.000 ° 0 N C 11 2 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 Im015/027 11001M537 Dec al Manta. B. Facility Description (con.) 'BILL CELATNAB•G MECHANICAL SERVICE,' 5 Name of General Contractor 'CHICOPEE 4 CaWroxB f.Contractors~Ws Comm.Insurer 6. What is the size of this facility! 01020 d.Zip Code 12 SECOND AVENUE t Address 4138-1500 II e.Teleshore Nutter lane cone and elision) a.Palm Monte 12aoos 1 12 a.Spume Feel b.Number otters h.Exp.Dale(meaVdf rvy) C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if fury): 'ABIDE,INC. a-Name of Transporter 'EAST LONGMEADOW Cgfrown 01028 d.Zip Code 117.0.BOX 886 14135250644 e Telephone Meter 2. Transporter of asbesloscontaining waste material from temovalftenporary Me to final disposal site: (ABIDE,INC. a.Nane ci Traaporbr 'EAST LONGMEADOW C CIbfrean 3. 'TRANWASTE,INC. a.Refine Transfer Shim end Owner /01028 d.Zip Code P.O.BOX 888 A Address 14135250644 e.Telephone Number I 13 BARKER DRIVE b Address 06492 d.Zp Code le.Telephone Number b.Final U+Pas l Site Lemke Owner's Neal I IWAYNESBURG d.City/Town 9.Telephone Numbs 44688 1.Zip Code D. Certification The urce:Signed hereby states,uncles the penalties of pen ury,that fdde has red the Commonwealth of Massachusetts regulations forthe Removal,Contained or EncapsSS00n of Asbe$tos,453 CMS 8.00 and 310 CUR 7.15,and that the infonneeon cantered in this eoMSetion is bum and correct to the best of hisih r knowledge and bell. Ofi t•GL 5j10110 en1001ap.dm•10A32 'MARIA TILL' I a Nane 'PRESIDENT F POM/aVGW 14135250644 a.Mahone Mamba 10.o.BOX 886 g.Addren 'EAST LONGMEADOW h.Clhirawr Maria TIM b.AudnMBd Signature 1 18130/2013 1 ABIDE,mC. L ReaNenF4 'ousts i.Le Cade Asbestos Noncaton Form•Page 3 of 3 IN/A d.DEP Waiter /2013 TUE 12:19 FAX ha on Hoard Health Commonwealth of Massachusetts ," Asbestos Notification Form ANF-001 EMM EM MEM EIZC N 0 o 0 �LL 2 4014/027 • 100164537 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: (6 a.Total pipes or ducts Naar f) e eoaer.breadline,dud,tank surface coatings e.Corrugated or layered paper pipe nsiebon g-Spray-on fireproofing I.. Cloths,*swan repo k Thermal.sold me pipe MeuNdan 1166 b.lag other senates(square l) Lin.ft Lin.ft. 6 d.Insulating cement R 14. Describe the decontamination system(s)to be used. TrawepSprayer coatings h.Trarmte board.wall board j.other.pease wean CAULK Sadly Lin.R l—J L'n.ft 6 100 Ea.R. 'REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/SHOWER 15. Describe the container¢ation/disposvd methods to oomph/with 310 CMR 7.15 and 453 CMR 614(2)(g): 'ACM ADEQUATELY WETTED,DOUBLE BAGGED,SEALED AND LABELED 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: (rue e.Named DEP Ofrcul G Date(maHnaryyyy)aAUtraLTatim IN/A a.Name of DOS Official g.Date(wt'ddtyyyy)of Authorization I1 L DOS Official Title I IN/A b.DOSwaier: 17 Do prevailing wage rates as per M.G.L.c. 149,§26.27 or 27A-F apply to this project? A Yes❑No B. Facility Description 1. Current or prior use of facilty 2. Is the facility owner-occupied residential with 4 units or less? 'HOUSING 'NORTHAMPTON HOUSING AUTHORITY a.Fealty Owner 'NORTHAMPTON c Cily/rown 01060 d.Zip Code 4 (BILL CELATKA/B-G MECHANICAL SERVICE,' a.Name of Fad*Owners On Site Manager CtyITOSa d.lip Code 'CHICOPEE ■ aaEmap.doc•10102 01020 ❑Yes No 149 OLD SOUTH STREET b-Address 14134644030 e.Telephone Number(area code and olenwon) 112 SECOND AVENUE b.On-Site Manager Midges. 1413-86 8-1500 e.Telephone Nuneer(area code and extension) Asbestos Notification Form•Page 2 o3 II