130 Notification of Asbestos Removal 1987 7. TRANSPORTER FINAL DISPOSAL SITTEE
AtiAfE: 46-4- .156c-src ✓fE/% eme„- NAME: Jr 4,87)//‘;q d-��YrPJ
ADDRESS: ADDRESS: Cy,0:.8 E
8. AIR MONITORING
ENVIRONMENTAL: YES NO IF YES: PRE ON-GOING POST
PERSONAL: YES NO
9. ASBESTOS CONTAINMENT, REMOVAL AND HANDLING METHODS (AS PER EPA REQUEST)
(BE SPECIFIC, NOT "AS DESCRIBED BY EPA, DEQE")
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10. ADDITIONAL COMMENTS
11. NOTIFICATION PREPARED BY: SQ°� A^t"d C)
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(SIGNATURE) (DATE)
CPk-44p D SHE/9/?5,q
(PRINTED NAME)
*** PLEASE NOTE ***
I. MASSACHUSETTS REQUIRES 20 DAYS ADVANCE NOTICE OF ASBESTOS REMOVAL. HAND
DELIVERY DATE OR POSTMARK INDICATES THE START OF THE 20 DAY PERIOD.
2. CHANGES IN STARTING OR ENDING DATE OF ASBESTOS REMOVAL REQUIRES
NOTIFICATION TO THIS OFFICE IN ADVANCE OF THE REMOVAL.
DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING
Division of Air Quality Control
Western Region, 436 Dwight Street
Springfield, MA 01103 (413)785-532 2 (�
c/a Roberta R. Ken 111 LS lS
Federal Regulation (Title 40 CFR, Part 61, Subpart B, Sec
State Regulation (310 CMR, 7.15)
NOTIFICATION OF ASBESTOS REMOVAL
(COMPLETE BOTH SIDES OF FORM)
DATE:
3/86
M1 gal!
Bit Io19871j
i 1
NORTHAMPTON BOARD OF HEALTH
1. WORK LOCATION/DESCRIPTION tic:STREET: /3 949 S'I' CITY/TOWN: /)/o/777// I4 /V
SPECIFIC SITE OF REMOVAL: EASEMENT
(FLOOR,LEVEL,ENTRANCE,ETC.)
SURROUNDING NEIGHBORHOOD: L-RESIDENTIAL INDUSTRIAL _COMMERCIAL
PRESENT USE OF STRUCTURE: /'ESIO[-NT,,4
2. NATURE OF WORK
A. DEMOLITION RENOVATION OTHER: ( tCN 4-E4'(4FSucia.7E
B. RESIDENTIAL INDUSTRIAL COMMERCIAL
3. ASBESTOS REMOVAL
AMOUNT OF FRIABLE ASBESTOS TO BE REMOVED: /0 LINEAR FEET SQ FEET
LOCATION OF ASBESTOS TO BE REMOVED: '- PIPE DUCT _BOILER
TANK ROOF TRANSITE BD.
I-BEAM CEILING FLOOR
OTHER:
4. REMOVAL SCHEDULE Arn
STARTING DATE: 465-7 ENDING DATE: /2/47 HOURS OF OPERATION: /°-
5. TYPE OF ASBESTOS TO BE REMOVED
AMOSITE v CHRYSOTILE CROCIDOLITE OTHER:
6. GENERAL CONTRACTOR (if applicable) REMOVAL CONTRACTOR
NAME: 4c ,1S6OE tO fe MetML d 6/✓CAFNti4 TNAME: 6-4Mr
CONTACT PERSON: cS 41,MP D SNc9R6R CONTACT PERSON:
TITLE: fogs/VAN TITLE:
ADDRESS: 539 MuLCRS re4S Rd ADDRESS:
//o+(THF/t t' /44
PROPERTY OWNER ENVIRON. CONSULTANT/IND. HYGIENIST
NAME: g1-w/c Of &Ls,
CONTACT PERSON: i/iyvSt Dept.
ADDRESS: fro RfH9M%<+Y
NAME:
CONTACT PERSON:
ADDRESS: