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132-155 Asbestos Notification Forms'/03/2013 TUX 12:49 FAX Important (Mien filing out thous on the computer,use only the tab key to moue your cursor-do not use tie return key. INSTRUCTIONS +++ Northarepton Board Health Commonwealth of Massachusetts Asbestos Notification Form ANF-001 00O1/021 • 1100184533 0a F I Decal Number`" • Or ea4tlo9E9 A. Asbestos Abatement Description I. a.Is this facility fee exempt-cityjown,district,municipal housing authority,owner-occupied residence of four units or less?[/]Yes ❑No b.Provide blanket decal number if applicable: 2. Facility Location: NHA-FORSANDER APARTMENTS,BUILDIN a Nane of Facility Northampton c.CiWown 3. Warksite Location: 1.At sections of this form must be competed in ado to comply rem 4 DE nattmlm requirements of 310 CafR 15 5 and the Division of Cccaaeaen So (ODS) rokrufwn requirements of 453 CMR 6.12 10 NHA-FORSANDER APTS. a Bolding Name/SL g Location J MA d.State J O.BWldkg t Is the fadldj occupied? O Yes ❑No Asbestos Contractor ABIDE INC a.Name EAST LONGMEADOW Clyfmm IAC000254 f.DOS License Number 01028 d.Zip Cue (BILL CELATKA/B-G MECHANICAL SERVICE,i It Facility Caned Peron [CHRISTOPHERJ.COOPEE a.Name of On Sk S en4sor!FNeman ITBA a Name of Protect Meador ITBA a.Name of Asbestos Mnlrrmtal Lab [9/16/2013 a.Project Start Date(rmt441yyyy) frAM•SPM C work hours Mon-Fd. a What type of project is this? ❑Demolition Renovation ❑Repair ❑Other,please specify a.Check abatement procedures: l7 ■ • Glove bag Enclosure Cleanup Full containment Encapsulation 0 Disposal only ❑Other,specify: Blanket Decal Number 184-91 HIGH STREET b.Street Address [01062 e.Zip Code c wtg Talepwne Numbs d.Floor MECHANICA e Room 1483 SHAKER ROAD b.Address 14135250SM e.Telephone Number g.Contract Type: ❑Written ©Verbal (GENERAL CONTRACTOR i.Contact Person*Tifie IAS070247 b.S9avieaiFpreman DOS Cerfifwton Number IN/A It Protest blonder DOS Cadfimwm Number (N/A • b.Asbestos AnaNtlwl Lab DOS canivortion Nistar 19/1612013 b.end Dora IrmdddNyry) - d.VNrk hour SatSu,. D.Desaine b.Describe 12 Is the job being conducted: D Indoors? ❑Outdoors? ■ an1001ap.doc•10/02 Asbestos Notb®Imn Fun•Page 1 d3 X r4131201i TUE 1[:u Cl i 0 0 N e 0 BEEBE. 2 FAA + + e0 tnampran EOM' neaic Commonwealth of Massachusetts Asbestos Notification Form ANF-001 • 1100184635 1 Deal Number A. Asbestos Abatement Description (cont.) 13.Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or enwusulated: 16 a.Tod pipes or dude*Mr A) c Beier,breaching duct tae ssgce coMM09 e.Cangebd a 4yead papet pee lowbnean g.Spray-on keproetg I.Paha woven fairies k.Thermal,solid core pee insolence hoe b.rata aim aunaoe(qwe II)� Lin.B. Left d.Insulating canard IG a I t Trowel/Sprayer wafts Trenab bawd,wY bowel y OM,please specify [CAULK Sat Ls/peaty 14. Describe the decontamination system(s)to be Used: Left Len.It L'm.a I6 Lin.It 100 St It REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/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 Opastions,the DEP and DOS officials who evaluated the emergenq: [WA a.Name of DEP Official a Cale(aauikdyyyy)aAUdNaa4on [WA e.Name of DOS Oawl 0.Deb(n.Wdyyyy)ofAUltabagen I IWA d.DEP Waiver* I If.DOS Odsdi The [ IWA It DOS Waiver* 1 17. Do prevafmg wage rates as per M.G.L c. 149,§28,27 or 27A-F apply to this project?i]Yes(]No B. Facility Description 1 Current or prior use of tastily. [110US 6 2. b the facility owner-occupied residential with 4 units or less? NORTHAMPTON HOUSING AUTHORITY 3. a Faddy Owner Name [NORTHAMPTON CilyITaen •.re 4 (BILL CELATKAtB G MECHANICAL SERVICE,I a.Nan a Feely Owner's OnSW Manager IV"N~OPE C.Cliwrown 1 • anDDtap.doe•1092 ❑Yes No 149 OLD SOUTH STREET b.Milan 1413584.4030 a.Telephone Number(area code and aabnbQ [12 SECOND AVENUE s OnSBe Manager Admen 1413588-1560 a Teleplxne Hurls(am code and aedebn) Agleam Noefeadon Fan•page 2 al 3 I I US/let! Toe 14244 sea ono cmapxoa aaama nee Note:Tweet Stations ma comply win the Sold Waste Division i CAR 19.00vo 310 Regulations CA 0 0 t) N 0 0 SEM° Commonwealth of Massachusetts Asbestos Notification Form ANF-001 V47 1100184535 Dead Number B. Facility Description (cont.) 5. a.Name a(General Coubnr 'CHICOPEE c.Wrens BILL CELATKNB•G MECHANICAL SERVICE, 01020 4.ap Code ( t Cmbacto(s%Mum's Coop.halter 6. What is the Me of this facility? 112 SECOND AVENUE b.Maness 1413-888-1500 .Telephone tanner Pees and eaknsb0 1 I g.Poty numbs I II,.Eap.Date(ntn ervl l 2 11,800 a.Square Feel It Number of Seers C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material horn Me to temporary storage site OF necessary). IABDE.WC. a.Nano of Tisworkf 'EAST LONGMEADOW I c.CaylTeen 181028 d.ap Code P.O.BOX 886 Is Address 14135250644 e.TSNP4Nne Nutter 2. Transporter of asbestos-containing waste materiel from ranwalterrpmaly site to final 6aposM site TRANSWASTE,INC. a.tame ofT,w*oo ter 1WALLNIGFORD,CT C CAW Tau 3. INIA a.Refuse Transfer Stake and Oars I 1 4.Zip Cods C.CMramn 4. 'MINERVA ENTERPRISES INC e.Rad Dispesm Site Location Name 19000 MRIERVA ROAD Ic End Depose Ste Addles* oN e.Stale d.ZN Code 3 BARKER DRIVE b.Address *2698300 I•Telephone Neater 0.Addmas II e.Telephone Number b.Flat Disposal Sod Localloc oamees Name I IWAYNESBURG l4.CYWrmn p.TMapbae Number 44688 I t Zip Cade D. Certification The undersigned hereby states,muter Co penalties of perjury.that he/We has read the CommNAee .of Massachusetts selb regulations for the Removel,Containment or Encapsulate of Asbestos.453 CMR 6.00 and -310 CRft 7.15,and that the nfowASah °Mane]n this notification is 111e and toned to the best or hislls knowledge and bees/. Onlr,\c r,�' 11001 10032 MARIA TILLI a Nee IPRESIDENr PconlonlIne 4138250614 e.Telephone Napa [P.O.BOX 086 a.Marina (EAST LONGMEADOW I h,O t ero's, Musa Tali n AUma ed Semen 1 I9/30120+3 d Dela Said hml 'ABIDE,MC. t RNeaontM boon Zp Cods Asbestos Noabaon Form•Pape 3 of 3 03/2013 TUE 1214” FAX ,et?‘' Important When Sling m for the computer.use mtlyt the tab key to mow your Cursor-do not use the return INSTRUCTIONS t. rectum of tie ban must be co peudnorder bcorsOYMth £ OSP eat on m@i1.15 m310 Cie 1.15 told the OiMmm arommaVrw Safety(COS) noncetian CIIW 6.12 12 01+53 CAIR 5 =r + eo eaaawcoa =an{ ACOALA Commonwealth of Massachusetts I1001845360yky Asbestos Notification Form ANF-001 p:; .1,751 1 A. Asbestos Abatement Description - 1. a.is this facility fee exempt- tam,district.municipal housing authority owner-occupied residence of four unite or tease L.ej Yes ❑No b.Provide blanket decal number if applicable: 2. Facility Location: INHA-FORSANDER APARTMENTS,BLDG M a.Nano of Fay c O gTavm 3. worksite Location: NHA-FORSANDER APTS. MA 1 O.SO* M a Bk*ug Nwneatidrp Location b.Beane* 4. Is the facility occupied? D Yes ❑No 5. Asbestos Contractor: IABID E INC a.Name EAST LONGMEADOW 1 e.Wren! d.2¢Cabe 1Am2.% f.008 License Number LL CELATKAIBIa MECHANICAL SERVICE 1 01028 h.FeriiitY Canted Person 6. !CHRISTOPHER J.COOPEE a.Nome of OnSA,SOekvbaurmmmse TBA ?. a.Fbme01 Blanket Decal Narbm 1108-115 HIGH STREET 01062 a 4,Code I.Telephone Number a Root 1 MECHANICA a Room 1483 SHAKER ROAD I b.Address 14135250644 a.TeMpmre Nmba g.Contract Type: ❑Written Verbal 1 9 m O 10 a What type of project is this? ❑Demolition f2 Renovation Mita ❑Reps ❑Other,p spay. 11.a Check abatement procedures: sMo MENEu. z 51 • • Glove bag Enclosure Cleanup Full containment 12. Is the job being conducted: • an1001eg.doc•10M2 Encapsulation Disposal only ❑Other,specify: b.Describe b.Describe Indoors? ❑outdoors? Asbestos Nalkation Fore•Pegs 1 01 3 MI 03/2013 TUE 12:50 FAX No tnampton aoa a seasto e 0 "-n 2 antolap.dot-10(02 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184536 Devi Number A. Asbestos Abatement Description (cunt.) 13.Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: 6 a.Total Ayes mdaos(Memfl) c Boger,breeding,dud.lank surface cosalge a Corrugated or layered paper pipe-a p.sprayan 6eprooS i.Cloths.woven fabrim Ir.Thermal,sold can Pipe insulation 1166 b. coral other surfaces(squarest 14. Describe the decontamination system(s)to be used: a insulating cement t Trowel/Sprayer coatings h.Tractile board.waft board I.Other,please sped*: 'CAULK Biwa), 1 un.ft 100 So,ft. n.f Sa.A 6 urn.lt 'REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT WISHOWER 15. Describe the containerizationidisposal methods to comply with 310 CMR 7.15 and 453 CMR 614(2)(g) 'ACM ADEQUATELY WETTED,DOUBLE BAGGED,SEALED AND LABELED 1 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency 1N/A a.Name of DEP Official c.Dale(rm.b id yyy)of Augmr¢ation 'N/A e.Neme of DOS Official it b.The 'NIA d.DEP Waiver s 1 ( f.DOS Official Thee I [12/A s.Date(nmddtWyy)ofAUthr¢ oabon h.DOS Waive s 17 Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to the project? 0 Yes❑No B. Facility Description 1 Current or prix use of facility. 'HOUSING 2. Is the facility owner-occupied residential with 4 units or less, NORTHAMPTON HOUSING AUTHORITY a.ready Owner Name 'NORTHAMPTON a.Cgirown d.Zip Code 4- 'SILL CELATKA/B-G MECHANICAL SERVICE,' a.Name of Family Owner's Onsme Manager 'CHICOPEE c.Clynown 01060 01020 d.Zip Code ['Yes rA No 149 OLD SOUTH STREET b.Addess 413.584-4030 e.Telephone Nun ter(area cads and extension) 112 SECOND AVENUE b.OnS4e Manager Address 1413.888-1500 e.Telephone Nunter(area code and extension) Asbestos NollIcatkei Fenn•Page 2 of 3 S )3/2013 TUE 12:51 FAX +++ Northampton Boa a neasto Note:Tams(w Stations most comply with the Solid Waste Division Regulations 310 CMR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 (100184536 Decal Number B. Facility Description (cunt.) BILL CELATKAB-G MECHANICAL SERVICE, 5- a.Name of General Contractor 'CHICOPEE a CtwTown f.CaMredols Workerk Cony.lnalrer 6. what is the size of this facility? 01020 d.2 Code 12 SECOND AVENUE b.Address 413-888-1500 a.Telephone Number(area code and extension) 1 II g.Policy Number h.EN).Dale(nmiMryly) 11,800 I 12 i a.Spare Feet k Number Weems C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(d necessary): ABIDE,INC. a.Na l* TranapoMr 'EAST LONGMEADOW c City/7mm 01028 d.zip Code P.O.BOX 886 b.Mdrecs 14135250644 a.Telephone Number 2. Transporter of asbestoscontaining waste material from removal/temporary site to final disposal site: TRANSWASTE,INC. a.Name of Transporter 'WALLINGFORD,CT c CM/romn 3. IN/A a Refuse Transfer Stetlor,and Owner 1 06492 d.Zp Code d. a City/Town 4. 11ANNERVA ENTERPRISES INC a.FNW Disposal She Location Name 19000 MINERVA ROAD c.Final Cesocsal Site Address fold e.State Zip Code 3 BARKER DRIVE b.Addnass 12032698300 1e.Telephone Molter b.Mdmsa II a.Telephone Number b.Feel Diposal Sea Location Dames Naive I IWAYNESBURG d.Cih/iown Q.Telephone Number 144668 f.Zip Code 1 D. Certification The undersigned hereby states,under the penalties of perjury.that he/she has read the Commonwea0h of Massachusetts regulations for the Removal,ConfainmoM or Enespad'tion of Asbestos,453 CMR 600 and 310 CMR 7.15,and that the information contained in This notification is true and correct to the best of hither knowledge and Whet \ S\\-591011 Q aM001ap.doc•10/D2 MARIA TILL! a Name PRESIDENT c PospaYN@ 4135250644 e.Telephone Number 1P O.BOX 8s6 p.Address 1 IEASTLONGMEADOW It Oty/ibwn Maria Tile b.Authatzed SpaLm 1&30/2013 d.Dale(nn liwww [ABIDE,INC. f.Regrowing 01028 i Zip Code Asbestos Nothcalbn Form•Pape 3 of 31 2013 TUB 12:45 FAX -a+ NO tnamptOn gOaro aeaaMa EllCommonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184536 Decal Number ■1 A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: a.IOW capes or ducts(linear ft) cattier,breaching,dip,tank surface apathies Lin.ft 59.4 e.Corrupted or laymed paper pipe ireufafon p.SgayonaeproOn9 Lin L deem,woven fabrics Li. It Thermal.solid we pope 1186 1 b.nom other wnema Lavern 4) 6 Lin Insulation it Describe the decontamination systems)to be used e.Insulating cement f.Trowel/Sprayer coatings R Tint board,wall board '.Oder,Hesse pecIfy: ICAUUK I.SAGS/ Lin.it Lr.IL J 100 'REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/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 official who evaluated the emergency: 'GENERAL CONTRACTOR i.Contact Prarnt Tree 1ASO70247 b.S cervteor/Fdeman DOS Crtl&sbn Plumber NIA b.Pr*U Mentor cos Dedication Number 'NIA b Asbestos Anahlral Lab DOS Cathodal Number 19/2012013 b.end ale(mrN4d'yyyy) 3/2013 TUE 12: 5 Important wadi Mkg out tomes an the computer,use only the tab key to move your awsar-do not use the return key. F7X +++ Northampton Board aealtn Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184537.a Deal Mmber Ofilir.\.-5910119 A. Asbestos Abatement Description 1. a.Is this facility fee exempt-cayovm,district,municipal housing authority,owner-occupied residence of four units or less2 01 Yes ❑No b Provide blanket decal number if applicable: 2. Facilfy Location: 1NHA-FORSANDER APARTMENTS,BLDG N a Name of Fader Northampton c CVyfown INSIrkUCTIONS 3. Wodksde Location: 1.All sections deco fom,mutt be completed N order to o+npywm+ 4. Is the facility occupied? DEP mIfafim reWkemarea of 310 CMR 2.15 5. Asbestos Contactor and the Division of Occupolional Safety(DOS) nodes Y0 remnant of 453 CAR 812 NHA-FORSANDER APTS. a.adding Naneratlaag Laatio n o 0 0 imisassa sto z C • angMapAUe•10/D2 MA d.Slate N b.9ddkg w Yes ❑No (ABIDE R4C Name 'EAST LONGMEADOW 01028 clyffawn ti.7b Code 'Ac0e0254 f.DOS Late Weber 'BILL CELATKAIB-G MECHANICAL SERVICE,( h.Faddy Carded Person 'CHRISTOPHER J COOPEE 6. a.Name of On-Ste StmervlscdFocem n 'TeA 7' a.Name of Proied Monitor 6 a.Name of Asbestos Analytical Lab 1912012013 a.Protect Start Date 1mmhlNyyyyl 17AM-5PM G Work hours Monier 10 a What type of project is this? ❑Demolition 51 Renovation ❑Repair ❑Other,please specify: 11. a.Check abatement procedures: • • CA Glove bag Encapsulation Enclosure Disposal only Cleanup ❑Other,specify Fufl contairr rent Blanket Decal Number 1116-123 HIGH STREET e.Zip Code GYkg f.Telephwre Number d Floor MECHANICA e.Roue 1483 SHAKER ROAD b Address 14135250844 e.Telephone Number g.Contract Type: ❑Written IS Verbal a.York bows Sal-Son. 1 b.Deewbe b.Describe 12 Is the job bettg conducted: ©Indoors? ❑Outdoors? Asbestos No laden Farm Pape 1 of 3 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 3/2013 TUE 12:52 PAZ --- Northampton Board Health =MCI 0 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 • 100184537 Den A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: '6 I a.Total pipes or duds(linear k) c Boller.breaeSg,drdl,tank swam coatings Lin.ft .ft e.Corrugated of byerad papa pipe insulation 1166 b.I dal other surfaces(sauare A) 6 g.Spray-on IlreproMng i.Cloths,woven fabrics k.Thermal,solid core pipe insulation L"n.IL lin ft Lit.ft ft Sett 14. Describe the decontamination systems)to be used: d.Imolatig cement I.Trowttsprayer coatings h.TransM board,wag board f.awa+,pease specify: 'CAULK L SPealy Ln.ft 1m.rt Lm. 100 sa.t 'REMOTE AND1OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT WISHOWER 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: NIA a Name of DEP Obi c Dale(minted/owl ofARlelwaaon. !WA II b-Tole ' e.Name of DOS Vidal f.DOS OfiM No 'NIA ff Dale(mmMdlyyyy)ot Authorization h DOS Waiver t 17. Do prevailing wage rates as per M.G.L.C. 149,§26,27 or 27A—F apply to this project? 17 Yes❑No B. Facility Description 1. Current or prior use of facility: 2. Is the facility owner-occupied residential with 4 units or leas? 'HOUSING 3 a Faddy Ostler Name !NORTHAMPTON HOUSING AUTHORITY 'NORTHAMPTON Clryfruw, d.Zip Cade 4 !BILL CELATKA/B-G MECHANICAL SERVICE,' a.Name of Fealty Owners On-Site Manager Tager 01060 1CHICOPEE C.Cky/To n d.Zip Code 01020 •1602 ❑yes • No 149 OLD SOUTH STREET b.Address 1413.5844030 e.Te@phoa WITS((area code and extant** I12 SECOND AVENUE b.On-Sae Manager Address 1413-088.1500 e.Telephone Number(area ride and e*aabn) Asbestos Ndaallon Fran•Page 2 ot 3• 'WALLINGFORD,CT e.ON/Rival 4. IMINERVA ENTERPRISES INC a.Final Dppwsl See London Name 19000 MINERVA ROAD c Fiat Depose S8e Adtraas 1OH e See 13/2011,3 TOE 12: 53 tG / Noe:Transfer Stations ram mnmlyagh the Soil Waste Division Regulations 3t0 CMR 1E000 FAX --- Northampton Board aealan Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184537 lama Number B. Facility Description (cont.) 5' a.Name alGeiegSCmnmahr BILL CELATXA/B-G MECHANICAL SERVICE, CHICOPEE 101020 e City/Town d.Tip Code 12 SECOND AVENUE b.Address 1413-888-1500 1 la Telephone Number((au code and amadq I.Contractors Waters Camp.Maurer 6. What is the size of this facility? p.Poll Numbs h.Exp.Date annadd/W1O) 12,000 I 12 a Square Feet b.Numbs decors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary} ABIDE,INC. a Nameat Transporter [EAST LONGMEADOW e.CdyfTown 01028 P.O.BOX 886 b.Aedress 14135250644 it Zip Come a Telephone Number 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal sits: !ABIDE,Ric. a.Name c4Trrwedater (EAST LONGMEADOW c.City/Town 3. 1TRANWASTE,INC. a.Refuse Transfer Station and Owner 01028 d.rip Code P.O.BOX 886 b.Adding 14135250644 e.Telephone Number I 13 BARKER DRIVE b.Address 06492 d.Zip Cot ( 2032698300 a.Telephone rimiar 1 b.FN Disposal Site location Owners tame 1 ;WAYNESBURG a Chit M1 44688 f Zip Code 9.Telephone lamber D. Certification The undersigned hereby states,under the penalties of perjury,that he/she has mad the Cornmennealth of MassaUrusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this notification is true and cones to the best of Nether knowledge and belief. Oin u.s..szkV n ti oas a =z< r ard001apAOC•10/02 'MARIA TIW a Nerve 'PRESIDENT c.POBItor/ri e 14135250644 a Telehhone Writs Marla Tttli b.Authorized Signature 18130/2013 e.Date US a1 !ABIDE,INC. t Reaeeeni o 'P.O.BOX 886 g Addrna [EAST LONGMEADOW I R Cdy/foen Asbestos 01028 L Zip Code Von Form•Page 3 or 3• 1124-131 HIGH STREET aadiess 01062 I I e.np Code r Telephone Number [4135250544 e-TSepfene Number g.Contract Type: ❑Written IA5070247 b.S'gerWrmffbnen n DOS Cat W ion Number INIA b.PrgM Monitor DOS Cedbcdan Number 'NIA b.Asbestos MAWS Lab DDS Certification Nutter 19/2312013 b.end Dw(,m Mdk'non 13/2013 TUE 12:53 FAX -- NO Cmamptpn Boa a ueaaca anponant When Wag out forms an the computer,use only the tsb key to move your claw-do nor use the return Commonwealth of Massachusetts Asbestos Notification Form ANF-001 1100184538 Qms•d�y�a Deal Number 6 A. Asbestos Abatement Description 1. a.Is fhb facility fee exempt-citQovin.district municipal housing authority. owner-occupied residence of four units or less Eij Yes ❑No b Provide blanket decal number W applicable: 2. Facility Location: 1NHA•FORSANDER APARTMENTS,BLDG 0 1 p.Fame of Facay 'Northampton c.City/Town [MIMIC-DONS 3. Worksde Location: 1.Ana :thee cribs tmmmustto completed n order a comply with 4 DEP notification epueemaia dOla 5 WAR 7.1s and the Dimon of ocapaiionel Safety(DOS) notation Cwyeme nb or 463 CDR 6,12 INHA•FORSANDER APTS. MA d.State 0 a.Buimrg NamSez*k'g Location b.Bolding a Is the facility occupied? Asbestos Contractor. El Yes ❑No 'ABIDE INC ( a.Name 'EAST LONGMEADOW [ 01028 c Cayrrorm it no Code [AC000254 I.DOS License Number 'BILL CELATKAB-G MECHANICAL SERVICE,' h.Faddy Contact Person 'CHRISTOPHER J.COOPEE 6. a.Name of On-Sae orenen ITBA 7' a Name of waled Mat 8. 9 i 1TBA a.Name of Asbestos A.aMNal Lab 19!2312013 a.eroded Stud DaDtouMddrvw) (7AM5PM c.Work lours MW-Fr4 N 0 10 a What type of project is this? o ❑Denoktion !7 Renovation ❑Repair ■ Other,please specify: arterwmor'_ 11. a.Check abatement procedures: a o ©Glove bag 0 Encapsulation o ❑Enclosure Disposal only a ❑Cleanup El Other,specify: O Full containment 2 1. 12. Is the job being conducted: II anlOOlap.aoc•10/02 l7 Blanket Deal Number d.Floor MECHANICA e.Room 1483 SHAKER ROAD b.Address t7 Verbal 'GENERAL CONTRACTOR Contact Penton's The d. AS1 hours Sat-&n b.Describe b.Describe Indoors? ❑Outdoors? Asbestos NaCfance Fenn•Pape 1 d3• d.rip Coco 4' 'BILL CELATKAIB•G MECHANICAL SERVICE, a.Name of rack/Ownersora Manager I '01010 d.ip Cade 13/2013 TUE 12:54 Northampton soara ueaic LaCommonwealth of Massachusetts Asbestos Notification Form ANF-001 d 0 aino • 100184538 Dead Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: le 1 116 a.Total pees a duck(Sneer TO b.Total other stria=(awns It) a Bala breading.duct.tack surface maims e.Corrugated or larded paper ppe Insulation 9.Spray-on fireproofing Un.R tin.ft Lin ft 6 d.Insulating onwm t.Tuned/Sprayer coatings n Trerme board.was board I.Cloths,woven fabrics 1 Other.( apactFj' 'CAULK Sq.f L Sped 14. Describe the decontamination systein(s)to be used: k Thermal,sold core pipe • iaumgo, Um ft Lin.ft Lm.1t Lm.it Um ft 6 Lin.A 100 S4.s 'REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/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 officials who evaluated the emergency: 'N/A a.Name of DEP Official a Date(nrWwyyyy)of Authorization 1WA a Name of DDS Official ( 11-DOS r.DOS Daaal14k N/A d.DEP Waxer I (WA F Data(mmiddryyyy)of Auacriralbn h.DOS Warder 4 17 Do prevailing wage rates as per M.G.L.c.149,§26,27 or 27A-F apply to this Project? !7 Yes D No B. Facility Description 1. Current or prior use of faciNy: 2 Is the factity ownerorcupied residential with 4 units Or less? ❑Yes 'HOUSING 'NORTHAMPTON HOUSING AUTHORITY 3. a.Faddy Owner Marne 'NORTHAMPTON c.My/Town 01060 'CHICOPEE c.C ylfdwn • anmd1aPdac•10.2 fl NO '40 OLD SOUTH STREET b.Address 1413-694-4030 e.Telephone Number(area code and extensta0 111 SECOND AVENUE OnSite banger Atldesa 1413899-1500 a misplay Number(area code and extension) Asbestos Noldttbon Form•Page oft• 3/2013 TUE 12:55 FAX +++ Northampton 'Marc tleaitn ElkCommonwealth of Massachusetts Asbestos Notification Form ANF-001 Nola!Transfer Stations meet canary with the Solid Waste Division Regulations 310 CMR 19.000 N I1oo184538 Decal Number B. Facility Description (cont.) 5. 'BILL CELATKAIB-G MECHANICAL SERVICE,' a.Name of Genmel Cabmdor CHICOPEE 01020 12 SECOND AVENUE b.Address 1413-888-1500 c.Cbynown d.at Code a Tebphorm Number(area mde and edaeion) 1i.Contractor's Workers Comp.have 1 Ig.Pdcy Number col Exp.Date lmmlWyyyy) 6. What is the size of this facility? a, 12 a.Snqu are Feet b.Malta'Of WOp(b C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary). ABIDE,INC. a.Name of Transporter !EAST LONGMEADOW C9y/Town !01028 P.O.BOX 886 b.Address 4135250044 d.Zip Code a.Telephone Mather 2. Transporter of asbestos containing waste material from removabemporary site to final disposal site: TRANSWASTE,INC. a Name of Transporter /WALLINGFORD,CT c Citgown 3. IN/A a.Refuse Transfer Sagan and Owner 106492 d.Zo Cede e City/Town 4. !MINERVA ENTERPRISES INC a.Fins/deposal Sae Location Name 19000 MINERVA ROAD a.Mal OHMS Ste MdreSs 1OH I e.State 3 BARKER DRIVE b.Address 2032698300 e.Telephone Number II 4 Address d.Zp Cede e_Tekgdne Number II b.Final DlepoaN Site Location Owners Nam I 'WAYNESBURG a.City/Town g.Telephone Number 44688 f.Zip Code ( D. Certification The undersigned hereby states,under the penatties of perjury,that he/afe has read the Commonwealth of Massachusetts regulations for the Rertmval,Comalnment or Encapsulaton of Asbetdos,463 CMR 6.00 and 310 CMR 7.75,and that the information contained in this notifications true and correct to the best of Nether knowledge and belief. 0.61 4,\.511oaa- 1092 MARIA T11LI a.Name (PRESIDENT c PosboWIWe 14135250044 e.Telephone Number Maria T86 b.Authorized Signature 8/30/2013 BIDE,INC. I Reaeaenbm 'P.O.BOX 886 9.Address 'EAST LONGMEADOW I It CSy/rown 01028 Zip Code Asbestos Notification Form•Page 3 of 3 Important: When filling out forms on the computer,use only the tab key to move your cursor-do not use the return key. INSTRUCTIONS Commonwealth of Massachusetts Asbestos Notification Form ANF-007 •I 1100184542 oxyrwdt- OricreA:5511035 A. Asbestos Abatement Description 1. a. Is this facility fee exempt-cit ,town, district, municipal housing authority, owner-occupied residence of four units or less?1 Yes ❑No b. Provide blanket decal number if applicable: 2. Facility Location: NHA•FORSANDER APARTMENTS, BLDG P a.Name of Fa .11 Northampton c.City/Town 3. Worksite Location: 1.All sections of this f rm must be completed in order comply with 4. D P notification 'equirements of 310 BMR715 5, dthe Division Occupational 3 fety(DOS) tification quirements of 453 ;MR 6.12 0 NHA-FORSANDER APTS. a.Building Name/Building Location Is the facility occupied? Asbestos Contractor 0 Yes MA d.State P b.Building C ❑No ABIDE INC a.Name EAST LONGMEADOW C.City/Town 01028 d.Zip Code AC000254 f DOS License Number BILL CELATKA/B-G MECHANICAL SERVICE, h.Facility Contact Person 6 [CHRISTOPHER J.COOPEE a.Name of On-Site Supervisor/Foreman 7 TBA a.Name of Project Monitor TBA 8' a.Name of Asbestos Anal Ni 9 a.Project Start Date(tumid I Lab 9/24/2013 Wry) 7AM-5PM c.Work hours Mon-Fri. 10. a. What type of project is this? ❑ Demolition F4 Renovation ❑ Repair ❑Other, please specify: 11. a. Check abatement procedures: 15 Glove bag ❑ Enclosure ❑Cleanup Full containment 151 12. Is the job being conducted: an1001ap.doc•10/02 ❑ Encapsulation ❑ Disposal only ❑Other, specify: Eg Blanket Decal Number 1132-139 HIGH STREET b.Street Address 01062 e Zip Code c.Wng .1 f.Telephone Number d.Floor MECHANICA e.Room 483 SHAKER ROAD b.Address 4135250644 e.Telephone Number g. Contract Type: ❑Written 151 Verbal GENERAL CONTRACTOR i.Contact Person's Title AS070247 b.Supervisor/Foreman DOS ificatlon Number N/A b.Project Monitor DOS Certification Number 1N/A b.Asbestos Analytical Lab DOS Certification Number 19/24/2013 b.Did Date(mm/dd/yyyyj d.Work hours Sat-Sun. b.Describe b.Describe Indoors? ❑Outdoors? Asbestos Notification Form•Page 1 of 3 51 N 0 0 N 0 0 0 0 LL z Q Commonwealth of Massachusetts Asbestos Notification Form ANF-001 • 100184542 ecal Num 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(linear ft) c.Boiler,breaching,duct,tank surface coatings e.Corrugated or layered paper pipe insulation g.Spray-on fireproofing i.Cloths,woven fabrics k.Thermal,solid core pipe insulation 166 b.Total other surtaces(square fl) Lin.ft Sq.ft. Lin.ft Lin.ft. Sq.ft Lin.ft. Sq.ft. Lin.ft. Sq.ft. 14. Describe the decontamination system(s)to be used: d.Insulating cement TrowelSprayer coatings h.Transite board,wall board j.Other,please spedfy: 'CAULK I.Specify Lin.ft Lin.ft. Lin.ft. 6 Lin ft. 100 Sq ft Sq.fl. '60 Sq.ft. Sq.ft. REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/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 officials who evaluated the emergency: IN/A a. Name of DEP Official c.Date(mm/dd/yyyy)of Authorization N/A e.Name of DOS Official g.Date(mm/dd/yyyy)of Authorization 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? IN/A d.DEP Waiver# f DOS Official Ti N/A h.DOS Waiver t7 Yes❑No B. Facility Description 1 Current or prior use of facility 2. Is the facility owner-occupied residential with 4 units or less? HOUSING 'NORTHAMPTON HOUSING AUTHORITY a.Facility Owner Name INORTHAMPTON c.City/Town d.Zip Code 'BILL CELATKA/B-G MECHANICAL SERVICE,' a. Name of Fadlity Owner's On-Site Manager 01060 'CHICOPEE c City/Town anfOOlap.doc•10/02 01020 d.Zip Code ❑Yes No 49 OLD SOUTH STREET b.Address 413-584-4030 e.Telephone Number(area code and extension) 12 SECOND AVENUE b.On-Site Manager Address 413-888-1500 a.Telephone Number(area code and extension) Asbestos Notification Form•Page 2 of 3 rte:Transfer ations must mply with the lid Waste vision egulations 310 AR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 100184542 Decal Number B. Facility Description (cont.) 5. BILL CELATKA/B-G MECHANICAL SERVICE, a.Name of General Contractor CHICOPEE c.City/Town 01020 d.Zip Code f.Contractors Wodcers Comp.Insurer 6. What is the size of this facility? 12 SECOND AVENUE b.Address 413-888-1500 e.Telephone Number(area code and extension) h.Exp.Dale(mmltldtyyyy) b.Number of floors g.Policy Number 12,000 a.Square Feet C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): ABIDE, INC. a.Name of Transporter EAST LONGMEADOW c.City/Town 01028 d Zip Code IP.O.BOX 886 b.Address 14135250644 e.Telephone Number 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: 3 4 1TRANSWASTE, INC. a.Name of Transporter IWALLINGFORD, CT c.City/Town 06492 d.Zip Code N/A a.Refuse Transfer Station and Owner c.City/rown d Zip Code MINERVA ENTERPRISES INC a.Final Disposal Site Location Name 19000 MINERVA ROAD a Final Disposal Site Address OH e.State 44688 f.Zip Code 13 BARKER DRIVE b.Address 2032698300 e.Telephone Number b.Address e.Telephone Number b.Final Disposal Site Location Owners Name 'WAYNESBURG d.City/Town g.Telephone Number D. Certification N The undersigned hereby states,under the penalties of perjury,that he/she has read the ° Commonwealth of Massachusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. 0 u- Z C anf001ap.doc•10/02 'MARIA TILL/ a.Name PRESIDENT c.Position/Title 14135250644 e.Telephone Number (P.O. BOX 886 q.Address 'EAST LONGMEADOW 1 h.City/Town 'Maria Tilli b.Authorized Signature 18/30/2013 d.Date(mm/dd/vvvv) ABIDE, INC. f.Representing 101028 Zip Code Asbestos Notification Form•Page 3 of 3 2013 TUN 12: 56 FAX Northampton Board Health Commonwealth of Massachusetts Asbestos Notification Form ANF-001 WW2U/U2/ • 100184542 Decal Humber A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: I6 a.Total pipes or ducts(linear It) c Boiler,tasaldrg,duct,tarn surface coatngs Iln.IL .IL 1166 b.Total other svdaoes(square f6 8 e.Corrugated or layered paper pipe insulation g.Spray-on&epaoogrg i.Cloths,woven fabrics k.Thermal,said core pipe insulation In.ft. Ln.fl. 14. Describe the decontamination system(s)to be used: d.Insulalkg cement t Trowel/Sprayer coatings I..Transta board.war board t.Other.please specify: ICAUI.K Speofy Lin.ft. Lin.It 100 Tin.It 6 1 60 SA ft. Soft REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/SHOWER 15. Describe the containerization/disposal methods to comply wlh 310 CMR 7.15 and 453 CMR 6.14(2)(g): ipartant: hen filling out ms on the mputer,use ly the tab key move your rsor-do not e the return STRUCTIO S Commonwealth of Massachusetts Asbestos Notification Form ANF-001 • 100184546 INDYC Decal Number -`� od.c troAr 0110423 A. Asbestos Abatement Description a. is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied residence of four units or less? 17 Yes ❑No b. Provide blanket decal number if applicable: 2. Facility Location: INHA-FORSANDER APARTMENTS, BLDG R a.Name of Facility Northampton c.City/Town 3. Worksite Location: All sections nhis m must be mpleted in order comply with 4 P notification luirements of 310 AR715 5 d the Division Occupational fety(DOS) tification luirements of 453 AR 612 NHA-FORSANDER APTS. a.Building Name/Building Location MA d State R b Building S Is the facility occupied? t7 Yes ❑No Asbestos Contractor: ABIDE INC a.Name EAST LONGMEADOW c.City/Town AC000254 f.DOS License Number [01028 d.Zip Code Blanket Decal Number 146-155 HIGH STREET b.Street Address 01062 e Zip Code c.Wing f.Telephone Number d.Floor MECHANICA e.Room 483 SHAKER ROAD b.Address 4135250644 e.Telephone Number I g. Contract Type: ❑Written BILL CELATKAIB-G MECHANICAL SERVICE,[ h.Facility Contact Person 6 [CHRISTOPHER J. COOPEE a.Name of On-Site Supervisor/Foreman [TBA 7 a.Name of Project Monitor 8 9 0 0 0 LL z TBA a.Name of Asbestos Analytical Lab 9/26/2013 a.Project Start Date(mm/dd/yyyy) 7AM5PM c.Work hours Mon-Fri. 10. a.What type of project is this? ❑ Demolition !4 Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: rA Glove bag ❑Enclosure ❑ Cleanup Full containment t'% ❑ Encapsulation Li Disposal only ❑ Other, specify: O Verbal [GENERAL CONTRACTOR i.Contact Person's TIUe AS070247 b.Supervisor/Foreman DOS Certification Number [N/A b.Project Monitor DOS Certification Number IN/A b.Asbestos Analytical Lab DOS Certification Number [9/26/2013 b.End Date(mm/dd/yyyy) d Work hours Sat-Sun. b.Describe b.Describe 12. Is the job being conducted: Indoors? ❑Outdoors? anf001ap.doc•10/02 Asbestos Notification Form•Page 1 of 3 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 • 100184546 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(linear N) c.Boiler,breaching,duct,tank surface coatings e.Corrugated or layered paper pipe insulation g.Spray-on fireproofing ■ Cloths,woven fabrics k.Thermal,solid core pipe insulation [166 b.Total other surfaces(square ft) Lin.ft. Lin.ft Lin ft. Lin ft fl. 6 Sq.fl. d.Insulating cement ( TroweUSprayer coatings Sq.fl- h.Transite board,wall board S fl. Sq.ft. 14. Describe the decontamination system(s)to be used: j.Other,please specify' [CAULK I.Specify Lin.if Lin.ft Lin.fl. 100 6 Lin.ft. Sq_ft. REMOTE AND/OR CONTIGUOUS THREE STAGE DECONTAMINATION UNIT W/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 officials who evaluated the emergency: N/A a Name of DEP Offidal c.Date(mmldd/yyyy)of Authorization IN/A e.Name of DOS Official g.Date(mm/dd/yyyy)of Authorization b.Title N/A d.DEP Waiver* 1.DOS Official Title N/A h.DOS Waiver tl • 17. Do prevailing wage rates as per M.G.L.c. 149, §26, 27 or 27A—F apply to this project? Yes ❑ No O B. Facility Description O 1. Current or prior use of facility: 0 HOUSING 2. Is the facility owner-occupied residential with 4 units 3. [NORTHAMPTON HOUSING AUTHORITY a.Facility Owner Name NORTHAMPTON [ 01060 o c.City/Town d Zip Code 4 [BILL CELATKA/B-G MECHANICAL SERVICE, a.Name of Fadlity owners On-Site Manager [ LL Z anf001ap.doc•10/02 CHICOPEE c.City/rown 01020 d.Zip Code or less? ❑Yes No 49 OLD SOUTH STREET b Address 413-584-4030 e.Telephone Number(area code and extension) 12 SECOND AVENUE [ b.On-Site Manager Address 413-888-1500 e.Telephone Number(area code and extension) Asbestos Notification Form•Page 2 of 3 te:Transfer Mons must nply with the lid Waste ision gulations 310 IR 19.000 m Commonwealth of Massachusetts Asbestos Notification Form ANF-001 100184546 Decal Number B. Facility Description (cont.) 5' a.Name of General Contractor BILL CELATKA/B-G MECHANICAL SERVICE, CHICOPEE c.City/Town 01020 d.Zip Code f.Contractors Worker's Comp.Insurer 6. What is the size of this facility? 12 SECOND AVENUE b Address 413-888-1500 e.Telephone Number(area code and extension) g Policy Number 12,000 a.Square Feet h.Exp.Date(mm/dd/yyyy) 1 12 b Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): ABIDE, INC. a.Name of Transporter 'EAST LONGMEADOW c.City/Town 01028 d Zip Code 2. Transporter of asbestos-containing waste material TRANSWASTE, INC. a.Name of Transporter WALLINGFORD,CT c.City/Town 'N/A a.Refuse Transfer Station and Owner 06492 d.Zip Code c.City/Town 4. [MINERVA ENTERPRISES INC a.Final Disposal Site Location Name 9000 MINERVA ROAD C.Final Disposal Site Address d.Zip Code OH e State 44688 1 Zip Code P.O. BOX 886 b.Address 4135250644 e.Telephone Number from removal/temporary site to final disposal site: 3 BARKER DRIVE b.Address 2032698300 e.Telephone Number b Address e.Telephone Number b.Final Disposal Site Location Owners Name 'WAYNESBURG d.City/Town g.Telephone Number o D. Certification The undersigned hereby states,under the o penalties of perjury,that he/she has read the C Ph f M ssach setts eg I for the Removal,Containment or • Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information t - d th tficato At ad et o t th b t f his/her knowledge and belief. • p( cya\-.591oy� 2 C anf001ap.doc•10/02 MARIA TILL! a.Name PRESIDENT C.Position/Title 4135250644 e.Telephone Number 'P.O. BOX 886 q.Address 'EAST LONGMEADOW ' h.City/Town Maria Tilli b.Authorized Signature '8/30/2013 O.Dale(mm/dd/vvvvl 'ABIDE, INC. C Representing 01028 i.Zip Code Asbestos Notification Form•Page 3 of 3 U