421 Asbestos Notification Forms N
• 17 Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this project? ri Yes❑No
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
•
100107199
Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
encapsulated:
189
a Total pipes or ducts(linear fl)
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
450
Total other surfaces(square ft)
En.ft.
189
Lin.it.
L
Lin.ft.
Sq ft.
Sq ft
l
Sq ft
Lin.ft.
Sq ft.
14. Describe the decontamination system(s)to be used:
d.Insulating cement
r Trowel/Sprayer coatings
k Transite board,wall board
j.Other,please specify:
Lin.ft
ft.
Em.ft.
Lin.ft.
SQ.ft
450
Sq.ft.
BLOCK WALL
Specify
!SEAL CRITICALS W/6 MIL POLY ATTACH 3 STAGE DECON UNIT&INSTALL AIR FILT EQUIP
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2)(g):
ACM TO BE DOUBLE BAGGED OR WRAPPED IN 6 MIL POLY AND DELIVERED IN A SEALED
16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency:
N/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
b.Title
d.DEP Waiver ft
f.DOS Official Title
h.DOS Waiver ft
B. Facility Description
O 1 Current or prior use of facility:
0
0
0
• 4
2
C
!VETERANS MEDICAL CENTER
2 Is the facility owner-occupied residential with 4 units or less?
3
US ARMY CORP
a.Facility Owner Name
CONCORD
c City/Town
01742
d Zip Code
NIKKI EMOND
a.Name of Fa
Ity Owner's On-Site Manager
■ anfOolap.doc•1 @02
c.City/Town
❑Yes
No
696 VIRGINIA ROAD
b.Address
(978) 318-8022
e.Telephone Number(area code and extension)
d Zip Code
b.On-Site Manager Address
(413)733-6544
e.Telephone Number(area code and extension)
Asbestos Notification Form•Page 2 of 3•
Note:Transfer
Stations must
comply with the
Solid Waste
Division
Regulations 310
CMR 19.000
m
o
0
0
0
0
LL
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
B. Facility Description (cont.)
5 EASTERN GENERAL
a.Name of General Conbador
SPRINGFIELD
c.CI /Town
AIG
f.Contractors Worker's Comp.Insurer
6. What is the size of this facility?
100107199
Decal Number
52.60 BERKSHIRE AVENUE
b.Addre
01109 (413)733-6544
d.Zio Code e Tel hone Number(area cod and extension
WC5312904 11/4/2010
Pdl Number h.Fxo.Date(m`dd/ act
C. Asbestos Transportation and Disposalare Feet b.Number of floors
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
ACCUTECH INSULATION &CONTRACTING
Name of Trans d
LUDLOW
C.City/Town
01056
d.Zip Code a Telephone Number
2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
RED TECHNOLOGIES 173 PICKERING STREET
a.Name of Trans d
PORTLAND --- -------
3
a.Refuse Transfer Station and Owner
b.Address
c.CiNTown d Z Code MI e_Telephone Numbe
4. NERVA ENTERPRISES INC
a.Final Di s sal Site Location Name
9000 MINERVA ROAD
Final Dis sal Site Address
H
e.State
44688
I.Zip Code
D. Certification
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 belie/
Z
Q
• anf001ap.doc•10/02
b.Final Dis sal Site Locatio
WAYNESBURG
d.City/row
n
g.Telephone Number
OURTNEY SHIELDS
a.Name
ADMINISTRATIVE IS
c.Position/Tale
413583550------ 0 ---------'
a Tele•hone Number
100 STATE STREET
Address
LUDLOW
h.City/Town
Co
er's Name
b.Authorized
6/3/2010
d Date tumid
06/03/2010
f,Re.resentin4
01056
Zip Code
eld
ature
IAA
Asbestos Notification Farm•Page 3 of 3•
ICommonwealth of Massachusetts
Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
INSTRUCTIONS
Asbestos Notification Form ANF-001
•
100118148
Decal Number
A. Asbestos Abatement Description
a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied
residence of four units or less? ❑Yes 'Z No
b. Provide blanket ecal number if applicable:
2. Facility Location.
(VA MEDICAL CENTER
a.Name of Facility
j Northampton
c.City/Town
3. Worksite Location:
1.All sections of this
form must be
completed in order
to comply with 4
DEP notification
requirements of 310 5
CMR 7 15
and the Division
of Occupational
Safety(DOS)
notification
requirements of 453
CMR 612
6.
7.
8.
HOSPITAL
MA
d.State
J
a.Building Name/Building Location b.Building#
Is the facility occupied? '[7i Yes ❑No
Asbestos Contractor:
ALL STATE ABATEMENT PROFESSIONALS
a Name
PLAISTOW
c City/Town
IAC000331
03865
d.Zip Code
f.DOS License Number
Blanket Decal Number
421 NORTH MAIN STREET
b Street Address
01053 I
e.Zip Code
LI. SCOTT CURLEY
h.Facility Contact Person
JEFFREY CURLEY JR
a.Name of On-Site Supervisor/Foreman
Al SPECTRUM SERVICES
a.Name of Project Monitor
[Al SPECTRUM SERVICES
a.Name of Asbestos Analytical Lab
112/30/2010
0 g la.Project Start Date(mm/dwyyyy)
0 17-3:30
N
0
0
LL
z
6.Work hours Mon-Fri.
10. a. What type of project is this?
D Demolition J Renovation
• Repair ❑ Other, please specify:
11. a. Check abatement procedures:
•
Glove bag
❑ Enclosure
❑Cleanup
Full containment
❑ Encapsulation
❑ Disposal only
❑Other, specify:
12. Is the job being conducted iZ Indoors?
• anf001ap.doc•10/02
f.Telephone Number
BSMNT, 1ST
c Wng d Floor
1
e.Room
14 WILDER DRIVE SUITE 12
b.Address
16033780600
e Telephone Number
g. Contract Type: iZ Written ❑Verbal
PRESIDENT
i.Contact Person's Title
AS034502
b. Supervisor/Foreman DOS Certification Number
AA000152
b.Project Monitor DOS Certification Number
IAA000152
b.Asbestos Analytical Lab DOS Certification Number
101 /05/2011
b. End Date(mmlddiyyyy)
d Work hours Sat-Sun.
b Describe
b. Describe
Outdoors?
Go To Top
Asbestos Notification Form•Page 1 of 3 II.
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
100118148
Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
encapsulated
160 275
�ora'pes os dup (lneat fl) . o a o er su aces square
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
LL .R; I9q ft. d.Insulating cement
I I
Lin.ft. Sq.ft. I !Trowel/Sprayer coatings
f
Sq ft. h.Transite board,wall board
Lin.ft.
Lin ft ISg1 j.Other,please specify:
61:1] I (GLUE/CAULKING
Lin.ft. Sq.fl. I. Specify
14 Describe the decontamination system(s) to be used:
PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
Lin R
Lin R, '§q.N.
1275-1
Lin.R. S
■
Sq.ft
Sq�J
DOUBLE 6 MIL POLY.
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
a. ame o DEP Official
c.Date(mm/dd/yyyy)of Authorization
e.Name of DOS Official
(g. Date(mmlddlyyyy)of Authorization
° 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A–F apply to this project? 7._ Yes L No
° B. Facility Description
° 1 Current or prior use of facility:
icia itle
h. DOS Waiver#
(HOSPITAL
2. Is the facility owner-occupied residential with 4 units or less? - Yes Z No
3' (DEPT OF VETERANS AFFAIRS '
a.Facility Owner Name 810 VERMONT AVE, NW -j
b.Address
° (WASHINGTON, DC
[20420
o c.City/Town d.Zip Code
Z
4 'SCOTT O'NEIL
a.Name of Facility Owners On-Site Manager
'WAKEFIELD, MA I 101880
c.City/Town d.Zip Code
1 anfODlap.deo•10/02
e.Telephone Number(area code and extension)
1385 MAIN STREET
b.On-Site Manager Address
1339-203-1172
e.Telephone Number(area code and extension)
Asbestos Notification Form•Page 2 of 3 1
0 Asbestos Notification Form ANF-001
Note:Transfer
Stations must
comply with the
Solid Waste
Division
Regulations 310
CMR 19.000
0
Commonwealth of Massachusetts
1100118148
Decal Number
B. Facility Description (cont.)
5.
a.Name of General Contractor
c.City/Town
d.Zip Code
f Contractors Workers Comp.Insurer
6. What is the size of this facility?
b.Address
e.Telephone Number(area code and extension)
q.Policy Number lh.Exp.Date(mm/dd/yyyy)
145000 1 12 r
a.Square Feet b.Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
ALL STATE ABATEMENT PROFESSIONALS,
a.Name of Transporter
;PLAISTOW, NH I 103865
C.City/Town d Zip Code
4 WILDER DRIVE, STE 12
b.Address
(603) 378-0600
e.Telephone Number
2, Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
APO BOX 6037
b.Address
;02150 x(617) 387-1495
d.Zip Code e.Telephone Number
iJ.O.B./ROLLOFF, INC.
a.Name of Transporter
;CHELSEA, MA
c.City/Town
3. IN/A
a Refuse Transfer Station and Owner
G.City/Town d.Zip Code
4 !TURNKEY LANDFILL(WASTE MGT NH) 1
a.Final Disposal Site Location Name
17 ROCHESTER NECK ROAD I
c.Final Disposal Site Address
1NH I
e.State
103839
f.Zip Code
b.Address
e.Telephone Number
b. Final Disposal Site Location Owner's Name
ROCHESTER
d.City/Town
1(800) 847-5303
g.Telephone Number
° D. Certification
N
The undersigned hereby states, under the
0 penalties of perjury,that he/she has read the
C e Ith f Massachusetts regulations
for the Removal, Containment or
Encapsulation of Asbestos,453 CMR 6.00 and
310 CMR 7.15, and that the information
ta' d th' tfi t 's t d correct
o to the best of his/her knowledge and belief.
0
2
• anf001ap.doc•10/02
iIJUDITH BEREZANSKY
a Name
(OFFICE MANAGER
c.Position/Title
I(603) 378-0600
e.Telephone Number
j4 WILDER DRIVE, STE 12
g.Address
b.Authorized Signature
1 12/15/2010
d.Date(mm/dd/yyyy)
ASAP, INC.
f. Representing
PLAISTOW, NH
It City/Town
03865
Zip Code
Go To Top
Asbestos Notification Form•Page 3 of 3•
0 Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
■
100102944
Decal Number
A.
Asbestos Abatement Description
a.Is this facility fee exempt-citvtown, district, municipal housing authority, owner-occupied
residence of four units or less? Al Yes ❑No
b.Provide blanket decal number if applicable:
2. Facility Location:
INSTRUCTIONS 3'
1.All sections of this
form must be
completed in order
to comply pith 4.
DEP notification
requirements of 310
CMR 7.15 5.
and the Division
of Occupational
Safety(DOS)
notification
requirements of 453
CMR 6.12
0
0
0
U.
Z
C
IDEPT VETERAN AFFAIRS MEDICAL CTR
a.Name of Facility
NORTHAMPTON
c.City/Town
Worksite Location:
DEPT OF VETERANS MED
a.Building Name/Building Location
Is the facility occupied?
Asbestos Contractor:
0
MA
d.State
12
b.Building k
Yes ❑No
IACCUTECH INSULATION 8 CONTRACTING I
a.Name
LUDLOW
c.City/Town
IAC000005
f DOS License Number
01056
PATRICIA O'FLAHERTY
h.Facility Contact Person
6 (BRANDON E. BESAW
a.Name of On-Site Supervisor/Foreman
IATC
7.
9
O.Zip Code
1
1
Blanket Decal Number
421 MAIN STREET
b.Street Address
01053
4135844040
e Zip Code C Telephone Number
c.Wing
d Floor
e.Room
100 STATE STREET
b.Address
4135835500
e.Telephone Number
g. Contract Type:
Written ❑Verbal
i.Contact Person's Title
AS070407
a.Name of Project Monitor
SCILAB
a.Name of Asbestos AnalNi
Lab
3/30/2010
P eject Start Date(mmlddlyyyy)
7:30-5:00
c.Work hours Mon-Fri.
10 a What type of project is this?
❑ Demolition S Renovation
❑ Repair ❑Other, please specify:
11. a. Check abatement p ocedures:
❑Glove bag
❑ Enclosure
❑Cleanup
Full containment
n
12. Is the job being conducted:
■ anrootap.doc•10/02
❑ Encapsulation
❑ Disposal only
❑Other, specify:
i7
Indoors?
b.Supervisor/Foreman DOS Certification Number
AA000005
b.Project Monitor DOS Certification Number
AA000162
b.Asbestos Analytical Lab DOS Certification Number
4/6/2010
b.E nd Data(mml dd/yyyy)
N/A
d.Work hours Sat-Sun.
b.Describe
b Describe
Outdoors?
Asbestos Notification Form•Page 1 of 3 111
Commonwealth of Massachusetts
s.-
Asbestos Notification Form ANF-001
•
100102944
Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or
encapsulated:
65
a.Total pipes or ducts(linear ft)
c.Bailer,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
200
b.Total other surfaces(square d)
Lin.ft.
65
Lin.it
Lin.fl.
Lin.fl.
Lin.(I.
Sq.ft.
Sq.ft.
14. Describe the decontamination system(s)to be used:
d.Insulating cement
f Trowel/Sprayer coatings
h.Transite board,wall board
j Other,please specify:
Lin.ft.
Lin.ft.
Lin.ft
Lin.ft
Sq.ft.
5q.ft.
200
Su.It.
BLOCK WALL
I.Specify
SEAL CRITICALS W/6 MIL POLY ATTACH 3 STAGE DECON UNIT&INSTALL AIR FILT EQUIP
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2)(g):
ACM TO BE DOUBLE BAGGED OR WRAPPED IN 6 MIL POLY AND DELIVERED IN A SEALED
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
N/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
.Title
d.DEP Waiver
aal uue
h.DOS Waiver a
17 Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this project? 0 Yes❑No
B. Facility Description
1 Current or prior use of facility:
VETERANS MEDICAL CENTER
2 Is the facility owner-occupied residential with 4 units or less? ❑Yes
3 a.Facility Owner Name
° 'CONCORD
US ARMY CORP
o c.City/Town
44 'NIKKI EMOND
a.Name of Facility Owner's On-Site Manager
z
C
01742
d.Zip Code
anf001ap doe•10/02
c.City/Town
12
No
696 VIRGINIA ROAD
b.Address
(978)318-8022
e.Telephone Number(area code and extension)
d.Zip Code
b.On-Site Manager Address
(413)733-6544
e.Telephone Number(area code and extension)
Asbestos Notification Form•Page 2 of 3 U
0 Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
Note:Transfer
Stations must
comply with the
Solid Waste
Division
Regulations 310
CMR 19.000
0
0
Z
100102944
Decal Number
B. Facility Description (cont.)
EASTERN GENERAL
5' a.Name of General Contractor
SPRINGFIELD
c.City/Town
01109
d Zip Code
COMMERCE 8 INDUSTRY
C Contractor's Workers Comp.Insurer
6. What is the size of this facility?
52-60 BERKSHIRE AVENUE
b.Address
(413)733-6544
e Telephone Number(area code and extension)
WC5312904
I
q.Policy Number
a.Square Feet
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site Of necessary):
11/4/2010
h.Exp.Date(mmrdd/yyyy)
b.Number of floors
IACCUTECH INSULATION 8 CONTRACTING
a.Name of Transporter
LUDLOW
c.City/Town
01056
1100 STATE STREET
b.Address
4135835500
d.Zip Code e.Telephone Number
2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
RED TECHNOLOGIES
a.Name of Transporter
PORTLAND
a City/Town
06480
a. Refuse Transfer Station and Owner
c City/Town
d.Zip Code
d.Zip Code
MINERVA ENTERPRISES INC
a.Final Disposal Site Location Name
9000 MINERVA ROAD
c.Final Disposal Site Address
OH
e State
44688
f.Zip Code
173 PICKERING STREET
b.Address
8603421022
e Telephone Number
b.Address
e.Telephone Number
b.Final Disposal Site Locati
Owners Name
WAYNESBURG
d City/Town
g.Telephone Number
D. Certification
The undersigned hereby states,under the
p Iles f p d ry,th t h / h ha d th
C 0 Ith of Massachusetts regulations
f theR al C t ' t
Encapsulation of Asbestos,453 CMR 6.00 and
310 CMR 7.15,and that the information
ta' d th' ot'f f t d ct
t th b t of h' /h k I dg d b l f
I anf001ap.doc•10/02
JEAN A KUMIEGA
a.Name
ADMIN ASSISTANT
C.Position/Title
4135835500
e.Telephone Number
Jim anturAetb46"
N
uOrized Signature
(3/17/2010
d.Date(mm/dd/yyW)
ACCUTECH INSULATION
f.Representinq
100 STATE STREET
q Address
LUDLOW
h.City/Town
01056
i.Zip Code
Asbestos Notification Form•Page 3 of 3 U
[01056
d.Zip Code
(4135835500
e.Telephone Number
g.Contract Type:
Lil Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
nportant:
then filling out
urns on the
amputer,use
my the tab key
move your
ursor-do not
se the return
ey.
NSTRUCTIONS
100102779
Decal Number
A. Asbestos Abatement Description
1. a. Is this facility fee exempt-city town,district,municipal housing authority,owner-occupied
residence of four units or less?1141 Yes ❑No
b. Provide blanket decal number if applicable:
2. Facility Location:
(DEPART VETERANS AFFAIRS MED CTR I 1421 MAIN STREET
a.Name of Facility b.Street Address
1 I
(NORTHAMPTON
c.City/Town
(
Blanket Decal Number
3. Worksite Location:
1.All sections of Nis
brm must be
>emulated in order
to comply with 4.
DEP notification
requirements of 310
CMR7.15 6.
and the Division
of Occupational
Safety(DOS)
notification
requirements of 453
CMR 612
0
01
0
0
LL
z
(CRAWLSPACE
a Building Name/Building Location
Is the facility occupied?
Asbestos Contractor:
(ACCUTECH INSULATION &CONTRACTING I
a Name
(MA
d.State
b.Building#
Yes ❑No
(LUDLOW
c.City/Town
(AC000005
1.DOS License Number
(PATRICIA O'FLAHERTY
h.Facility Contact Person
(BRANDON E. BESAW
6. a.Name of On-Site Supervisor/Foreman
(
7.
(ATC
eat Monitor
a.Nam
(SCILAB
8. a.Name of Asbestos Analytical Lab
13/2612010
a.Project Start Date(mmlddlyyyy)
(7:305:00
c.Work hours Mon-Fri.
10. a.What type of project is this?
❑Demolition fl Renovation
❑ Repair ❑ Other, please specify:
11. a. Check abatement p ocedures:
0
Glove bag
❑Enclosure
❑Cleanup
❑ Full containment
12• Is the job being conducted:
anfoolap.doc•10/02
❑Encapsulation
❑Disposal only
❑Other,specify:
0
(01053
e.Zip Code
c.Wing
(4135844040
f.Telephon
(
(
d Floor
(
(
e Room
(100 STATE STREET
b.Address
(
I.Contact Person's Title
tAS070407
b.Supervisor/Foreman DOS Certification Nu
(AA000005
b Project Monitor DOS Certification Number
0
Written ❑Verbal
(AA000162
b.Asbestos Analytical Lab DOS Certification Number
( 419/2010
b nd Date(mm/dd/yyyy)
( (N/A
d Work hours Sat-Sun.
b.Describe
b.Describe
Indoors? ❑Outdoors?
Asbestos Notification Form•Page 1 of 3
ACM TO BE DOUBLE BAGGED OR WRAPPED IN 6 MIL POLY AND DELIVERED IN A SEALED I
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
•
100102779
Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or
encapsulated:
0
a.Total pipes or ducts(linear X)
a 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
8000
total other surfaces(square X)
Lin.ft.
Lin.X.
Lin.ft.
Lin.ft
Lin.ft.
Sq.ft.
Sq.ft.
d.Insulating cement
L Trowel/Sprayer coatings
h.Transite board,wall board
S X
j Other,please specify:
DEBRIS
Sq.ft. I.Specify
Lin.ft.
Lin.ft.
Lin.ft.
Sq.ft.
Sq.ft.
8000
Sq.ft.
14. Describe the decontamination system(s)to be used:
SEAL CRITICALS W/6 MIL POLY ATTACH 3 STAGE DECON UNIT&INSTALL AIR FILT EQUIP
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2)(g):
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
N/A
a.Name of DEP Official
c.Date(mm/dd/pyyy)of Authorization
N/A
e.Name of DOS Official
b.Title
d.DEP Waiver#
L DOS Official Title
g Date(mmidd/yyyyl of Authorization
h.DOS Waiver#
17 Do prevailing wage rates as per M.G.L. c. 149,§26, 27 or 27A—F apply to this project? Q Yes ❑No
B. Facility Description
1 Current or prior use of facility:
VETERANS MEDICAL CENTER
2. Is the facility owner-occupied residential with 4 units or less/
3 a. Facility Owner Name
o 'CONCORD
US ARMY CORP
o c.City/rown
2
4
01742
d.Zip Code
NIKKI EDMOND
a.Name of Facility Owner's On-Site Manager
I anf001ap doc•10/02
c.City/Town
d.Zip Code
❑Yes
No
696 VIRGINIA ROAD
b.Address
(978) 318-8022
e.Telephone Number area code and extension)
b.On-Site Manager Address
(413)733-6544
e.Telephone Number(area code and extension)
Asbestos Notification Form•Page 2 of 3 El
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
rte:Transfer
3tions must
mpW with the
did Waste
vision
:gulations 310
NR 19.000
B. Facility Description (cont.)
EASTERN GENERAL
5. a.Name of G
SPRINGFIELD
c.GNT
OMMERCE &INDUSTRY
f Contractor's Insurer
6. What is the size of this facility?
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
100 STATE STREET
b.Address
4135835500 �--
01109
d Zip Code
52-60 BERKSHIRE AVENUE
b.Address
nd extension
e.Tele lor_Jp_ ei--L—luniber area code a
111412010
WC5312904
P Numbe
li r
a.Square Feet
M1 E D D t ( MtltllyyyyL
0.Number of floors
ACCUTECH INSULATION&CONTRACTING
a.Name of Trans
LUDLOW
a CityT
der
01056
d.Zip Code e.Telephone Number
mn
2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
RED TECHNOLOGIES
NNE
PORTLAND
c. /Town
3.
m
0
io
io
0
LL
IQ
4
a.Refuse Transfer Station and Owner
c
Town
MINERVA ENTERPRISES INC
a.Final Dis.osal Site Location Name
9000 MINERVA ROAD
c.Final D ss
OH
e.State
06480
d.Zip Code
173 PICKER ING STREET
b.Address
8603421022
e.Tele.hone Numbe
b.Addre
e.Telephone Number
44688
f.Zip Code
D. Certification
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 600 and
310 CMR 7.15, and that the information
contained b st of h s/her knowledge and belief
f
to the
an1001apdoc•10102
b.Final 0
WAYNESBURG
d.Cit Tow
Site Location 0
n
ner's Name
g.Telephone Number
JEAN JEAN AEGA
a.Name
ADMIN ASSISTANT
c.Position/Title
4135835500
e.Telephone Number
100 STATE 100 STATE�---
Addresfl_ s—�----
LUDLOW
h.City/Town
FTa s�'1' '8 ire
Authorized Slanature
311512010
d o t 1 Mdtll 1
ACCUTECH INSULATIO"
1056
Zip Code
Asbestos Notification Form•Page 3 of 3 U
A
r
Commonwealth of Massachusetts •I
1100102961
10 Decal Number
Asbestos Notification Form ANF-001
Important: A. Asbestos Abatement Description
When filling out
forms on the
computer.use 1. a.Is this facility fee exempt-ci town,district, municipal housing authority,owner-occupied
only the tab key residence of four units or less? IL Yes II2No
to move your
cursor-do not b.Provide blanket decal number if applicable: Blanket Decal Number
use the return
key. 2. Facility Location:
111111 VA HOSPITAL-NORTHHAMPTON 421 NORTH MAIN STREET
a.Name of Facility b.Street Address
NORTHAMPTON I MA 101053
c City/Town
RTHA d.State e.Zip Code f.Telephone Number
INSTRUCTIONS 3. Worksite Location:
1.An sections of this THROUGHTOUT BLDG. 1
form must be a Building Name/Building Location b.Building# c.Wing d.Floor e.Room
completed in order
to comply with 4. Is the facility occupied? ❑Yes GI No
DEP notification
requirements of 310 5. Asbestos Contractor:
aMReDi
and ccuOlNSnal LVI ENVIRONMENTAL SERVICES INC 401-S SECOND STREET
SfOCy(DOS) b.Address
Safety t005) E Name a.
notification EVERE7r 02149 6173898880
CMRrequirements of 453 C City/Town d.Zip Code e.Telephone Number
AC000097 g.Contract Type: 0 Written ❑Verbal
f.DOS License Number
GARY BROCKMAN VA HOSPITAL REP.
h.Facility Contact Person i.Contact Person's Title
CESAR E TERRERO AS000452
6. a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number
1COVINO AA000006
T
a Name of Project Monitor b.Protect Monitor DOS Certification Number
IYEE CONSULTING GROUP AA000145
6' ta.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number
iilillnia 104/01/2010 x04/08/2010
° . a Project Start Date(mmlddlyyyy) b.End Date(mmlddlyyyy)
o 7AM-3PM 1 1-N/A
Mil c.Work hours Mon-Fri. d.Work hours Sat-Sun.
N
o 10. a.What type of project is this?
o ❑Demolition Fl Renovation
❑ Repair ❑ Other, please specify: b.Describe
11. a. Check abatement procedures:
MEE° ❑Glove bag ❑ Encapsulation
satiao ❑ Enclosure ❑ Disposal only
SiiiiEu. ❑Cleanup ❑ Other, specify:
p Full containment b.Describe
Z
4 12. Is the job being conducted: 12 Indoors? ❑Outdoors? gre
• anfiOlap.doc• 10/02 Asbestos Notification Form•Page 1 of 3 1
--
Commonwealth of Massachusetts U
100102961
Decal Number
Asbestos Notification Form ANF-001
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or
encapsulated: 1200
6 0 of ersusquare' C
a. ota pipes or tlucls(linear •
C.Boiler,breaching,dud,tank LinL Sq R d.Insulating cement Lin.ft. Sq ft
surface coatings F^'�I (� C
a Corrugated or layered paper L—� t_-- f.Trowell5prayer coatings Ling Sq tt
pipe insulation Lin ft Sq ft. C
CC h.Transite board,wall board Lin.
g.Spray-on fireproofing Liv.g. Sq.R� 1200
.s. j Other please specify ft--Lin. S-q R
k.i.Cloths,woven fabrics Lin.ft. SI CRTIFLITL
in elation solid core pipe Lin.ft. Sq.ft. I.Specify
insulation
14. Describe the decontamination system(s)to be used
3-CHAMBERED DECON W SHOWER AND/OR 2-CHAMBERED DECON W WASH STATION.
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2)(8):
ACM WILL BE WET(HAND TO BAG)ACM WILL BE LABELED,PACKAGED &TRANSPORTEC
16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency:
NIA b.Title
a.Name o DE• official --
dDEPWaiverC --
c.Date(mmlddlyyyy)ofof Authorization
NIA __ -- -- T-6b'S ¢ia itT
e.Name of DOS ORCial
EMM (mmlddlryyy)of Authorization h.DOS Waiver k
N
0 17. Do prevailing wage rates as per M.G.L. C. 149,§ 26, 27 or 27A-F apply to this project? 0 Yes 171
B. Facility Description
N HOSPITAL —
o 1. Current or prior use of facility:
mlaWWW 0
2. Is the facility owner-occupied residential with 4 units or less? ❑Yes ni No
VA HOSPITAL 421 NORTH MAIN STREET
Sr 3. b.Address
a.Fadlib Owner Name 613 752 2959
o LEEDS MA a Telephone Number( d d extension
So c.C' Y B
d.Zip Code
LL 4 GARY BROCKMAN -CONSTRUCTION TECH b.On-iteMa agar A dress
a.Name of Facili Owners On-Site Manager 813 752 2959
2 PLANT CITY FL 33563
Q c.City/Town
d.Zip Code e.Telephone Number(area code and extension)
II Asbestos Notification Form•Pa e 2 0
80(001 ap Ooc•10/02 '
r
•
Commonwealth of Massachusetts 100102961
Decal Number.
� _
Asbestos Notification Form ANF-001
a Facility Description (cont.) —
b.Address
5' a.Name of General Contractor err--��7
d Z,Code e.Tele hone Number area code and extension
c.Ci gown mlddlYYYYI
.Poll. Nub h EpDh Ep Dt�
C Contractor's Worker's Come.Insurer
6. What is the size of this facility?
a.Square Feet b.Number of
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary)'.
401 S SECODN STREET
1===211 b.Name of 02149 (617)389-8880
Note:Transfer EVERETT,MA e.Telephone Number
Stations must d.Zip Code
comply with the Transporter
Solid Waste
Division 2. Transporter of asbestos-containing waste material from PYLESIttemP vary site to final disposal site:
Regulatons 310 b.Address
CMR 19.000 SERVICES TRANSPORT GROUP
a.Name of Trans rter 677 Address
9559
NEW CASTLE,DE 19720 e.77)99ne Number
d.Zi. Code
c Ci (town
3. NIA b.Address
a.Refuse Transfer Sta ti —I
ll— tlZp Code,-1 e.Tele hone Number
o. own
q. IMII ERV EStNC b.Flnal Di lion Owner's Name
a.Final Dis Deal Srte Locatmn Name VyAYNEi_-_-__ SBURG___ — —
9000 MINERVA ROAD d.Cd rrow_y nom----
a Final Dis sal Site Address =tin iiil f.Zip Code g.Telephone Number
e.State
M
°
° D. Certification �,
N The undersigned hereby states, under the WENDY CARIA� b.Authorized 5i.nature Name
° common of perjury,Massachusetts chuse has read the PROJECTS 3118/2010
° Commonwealth of Massachusetts regulations c.Position/Tide a D to 1 mltltllvvyYL--
for the Removal,Containment or
Encapsulation of Asbestos,453 CMR 6.00 and (617)(817)389.89 Re•resenG�
M� 310 CMR 7.15,and that the information e.Telephone Number
contained in this notification is true and belief. 401 S SECOND STREET
° to the best of his/her knowledge and belief. Adtlres3.—s--�— 02149
�o EVERETT___,_�`'MA_—_ Zip Code
Su. h.City/Town
Z a
Q
II Asbestos Notification Form•Page '
an/001aP Om•10/02
r 1
Commonwealth of Massachusetts
` Asbestos Notification Form ANF-001
fi<
ohs inns*
Win mW
amply et V
NC Waste
sumo
Iq 310
;le119.00 i 19.W0
B. Facility Description (cant)
5 Hems of General
GQs r CINn de
h.COnasmPS Wubh Camp.Inner
S. Wet is the size af this isd'dY?
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing materiel from site to temporary storage eke(if necessary):
e.T Teed—shoe NIS code
4� h�J
e.Member eloos
a.Square Fey
o Wrenn CT _2W Ccee •Telephone NS
c.cnsrwa removal/temporary nary'MW to fat disposal eke:
2. Transporter d asb6 SC0(G waste materiel from
b.
e.Teimhae Hunter
D. Certification
The undersigned hereby Maces,under the
peneddes Of penury,eat hahhe lea reed the
Camou rwMen ofMaaaadm+eks regu
for thew Removal,Containment or
Encapsulation ofd,453 GMR8.00 and
310 CMR 7.15,and flue the mfmoaion
contained in this noliScabor R sue and correct
to the baste higher kna+Aed9e and baled.
Q
• aaeoieppoC•1(902
abed
Veen..
Hunter L nevi
hh.CSP•T� I.Lee Code
Adman NogaaSn Fenn•Pie S d 3
59£££6£805 lewaw°°"u3 >al mod I4d64Z1 £tOZ 01 ^ON
Common/math of Msasachusetts
Asbestos Notification Form ANF-001
A. Asbestos Abatement Description (cont)
13. Told amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or
1
0 ra
s a p
OF
C.BOW,breeding.dct chic
eubn coSge LN.R
e.Canned or bred peon
Lit It
d.kW Whle aemrd
f.Troeeegprtpr earn
h.Twee bawd,wellborn
Oen.peace specify
L Clothe neon fabrics
k.Theme,solid tart pees
YWa®rr
14. Describe the decontamination system(s)to be used:
e - r a m to comply with 310 CMR 7.15 and 453 CMR
16. Dente the aam>lleri2adarlid peed
6.1
16. For Emergency Asbestos Operations,the DEP and DOS a fICI.%who evaluated the emergency:
iiiiiiiiiis° 17
i®° a
�e
®°
°
MOM
MINIS
a. of.:< :...
on
• ose nd IS Yes No h. ver
M.G.L c.149,$26.27 or 27A-E apply n this project?. Do rending yysi0s�uper
. Facility Description
1. Current or prior wee of facility: ��
2. Is the facility owner-occupied residential with 4 wits or 1.5$?0 Ye
3-
01053 e.Tde hlrra lunar one rd becalm
e. wan d, •..Cole
„s _r b. Mew er Addlees
4. e.Name olFera
.....�m...mw and adenean)
d. Cade . ._.
Menthe NoMeelon Fon•Pape 2 of 911
C CtyRaen
■ e1001apdno•1e12
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il4: Asbestos Notification Form ANF-001
ortrrb
n IRV all
net on M flie
'oar.use
yUr lab key
nava your
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i the rein
h
Lu
STRUCDONS
A. Asbestos Abatement Description housing auttamYPietl
1. a u the belay fee exempt-dh�bwn, Strict,municipal
residence of four untie or leas?It Yes ❑No
b.Provide blanket decal number if applicable:
9enket Duval NUnber
Cgrtonn
3. Worksite Location:
pa Sadists of
MT—t.
xnpNled In oast
•amnywa 4.
EP satiation
airman d910
Manes
al u.Dimon
(Ccopacna
Mt/IDDS)
equal
Sl311.12 /MM
,lARe12
a.Makin)Nerneallidklg raraMpn b,Ouliclag
Is the facility occupied? !j]Yes ❑No
MEIN
d.Hoar
a Roam
10. a What type of project is this?
❑Demolition Y
❑Rep k 011, please specify:
11. a.Check abatement procedures:
❑Clew bag Encapsulation
❑EndosLSS 8 or
Cleanup ❑Other,specify:
Fun containment
12. Is the job being conducted: RI Indoors? ❑Outdoors?
b.Deserts
b.Daatbs
•1042
? abed
Asbestos Nalliatan Fan•Peas t 013•
99£££6£SO9 1.433UO3-1.33e xl a Wd64Zl £LOZ OL ^oN
ructions 1.Pa
long or t n torn
t bs conryma n
nta cmTSry oath
sOSP noltruHOn
*mTann of 310
R7.15 and
tartest*of lath
reads(OLS)
NLMIOn
ointments of 453
5.12
IR 5.12
raDEP Use ay
ate Maned
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
A. Asbestos Abatement Description
1.Facility Location:
VAMC
Nang of Facility
Cdfrfaan
IACOALJAPEPa
Facility CaYO Parson Neme
Worksite Location:
100232367
Asbestos Project#
e Project Revision
O Project°mediatior
2. Is the facility occupied?
3. Is this a fee exempt notification(city,ban, district,municipal housing authority,state facility,or
awner-occupied residential property of four units or less)? b Yes a No
4.Blanket Permit Project Approval if applicable:
.Submit Original
om Tar
:emmtrnaa
taWChuseUs of
tta
ear.4052
Iss.to
toaloa.MA02211
b Yes e No
01602 413584010
En Code Tebphaa
VAFYJEMST
Facility CONIC Person Title
(M1CNmEEN
Bulding Mere.Yang.Floor.Room.etc.
pppo+a 10 a
5.Non-Traditional Asbestos Abatement Work Practice Approval,
if spelcable:
6"Asbestos ConlrwtOn
PEROTEC BMRONME TAL
Nara
MORTERCROUGII
Cilyff use
A0000558
DLS Literati!
7. GREGORY W NARDNG
Nana of COr SupanaserFdeman
S. .MESS LAMM.
Name of Prefect Moan
9. ATCGROUP SERVICES PC
Nene of Asbestos Analytical lab
10. 11/18/2015
Protect Mart Dab(MNAO(Gen
tM 7PM
Worn Hass Monday nvouah Friday
1 1.What type of protect is this?
Demolition b Renovation a Repair c Other Please Specify:
e
ypprea110 a
163RICEAVBtIE
Address
MA 01532 9753rd
Slab ZV Code Telprere
Contract Type: b Wri¢en a Verbal
AS000278
O 1.5 Certification*
MA073784
O SCataratbn•
AA800005
OLS Cons
12120/201 5 �����N
Ertl oats(MMIODPCNY)
Work Noss-Saturday a Sunday
Revised:11/132013
Z abed
Raga 1 of 4
S9£££6£80S leluawxulau3 Dal waV Wd80:Z SIOZ 5050=a0
W iavw
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
Asbestos Project#
e Project Revision
e Project Cancellation
C.Asbestos Transportation&Disposal:(cont.)
a location/transfer station for the asbestos containing waste
3.Name and address often pp rery storag
NP.
Tempcgary Location
NA
NA
re
AddresS
MA 00ggg 0000690003
Stem To Code Tie
Cltpwrawn
4.Name and locaiun of final disposal site(asbestos landfill):
Bd1E taNIRVAEKTEFFRSE
Hrel Dip Finn Deposal Site Owner Name
prat ptrposa Staten*
900n MINERVA RD
Address
WAYNESBURG
Cipfrevm
D. Certification
I certify Mat I have personally m
baamalad the foregoing
familiar with the information
contained in this document and
all attachments and that,based
on Ply inquiry of atria
individuals immediately
responsible for obtaining the
information,I estrus Vatthe
information a true,accurate,and
complete.I am aware that there
are significant penalties far
submitting false information,
Includng passible fines and
imprisonment.states that I have reread the
hereby elate®
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR E99 promulgated by
the Department of Labor
Standards and 310 Department
promulgated Environmental try the
Protection),
of I aaware and that I l cat or notification
shall application
tb
anew nos be deemed valid
unless payment of the
applicable fee is made"
Revised;11/13/2013
g abed
CH 44eari 3a0Massas
See TO Cede Telephone
GREGORY WONG ppl)^rORYl Dell
Authorized Signature
Nina 11INP01&
Osison pate Mpam roM�
0783759534 pp1EG
163R10E AVE reDIMMCHOuGH
City/Town
Address 01532
MA
210 Code
Sate
Page 4 of 4
59£££6ES05 leWawww03 say 0-PV 14dg6Z S IOZ 50 ”Cl
ICommonwealth of Massachusetts
Asbestos Notification Form ANF-001
B.Facility Description
t.Current or prior use of facility.
HOSPWAL ----
2.1s the facility ovmer-oocupied residential with4 units or less?
421 N MNN ST
Address
MA 01802 4133564040
State zip Telecoms
3 VV
Facility Omer Name
NORTHAMPTON
City/Town
4.NA
Name of sera Owns?*On Sr M asseer
Asbestos Project#
e project Revision
c Project Cancellation
e Yes
NA
Address
MA OOOOe
NA State p Cyder
Oay roan
183 RICEAI+E
Mdmn
01532 9783759514
State Zip Code TeleNerla
S A9dDlf3
Name oTOenaei Coarsen
Ili 1
ea:Temcorery
ype d Patinae
mawrywva•
Medal is ono
hawed et the pace
I busmen of a DLS
Demme Asbestos
oniaWr or a:rmafer
awn that la
minded by
aeanDEP end
,wand In
xmcdaem With Solid
Waste Re1ulaoom
echo CMR19 W0
Cayffoem
ACE
Cotta*"Worker's ComPe^ne6°^mum
688206
P01w#
6.What is the size of this facility?
0000000000
TeleAMe
3
grrare Feet
C. Asbestos Transportation & Disposal
tier of asbestos-containing waste material from site of generation:
1.Transco
e Directly to Landfill or b To Temporary Storage Location/Transfer Station
� �
1031:WEAVE
�
Ad
dress Name orTraspaeer MA 01532 9763159534
NCftmen OJC�1 rate In Cole Teapeore
C8a temp es of asbestos containing
waste material storage m temporary a station is her station to final disposal site:
waste material from teorporsry storage location/transfer
173PI01a3ST
RR Mdresn
Marne PORTLAND Paaar a 06480 6603421042
f�RiL19✓D State Z9 fade Telecncae
b No
5/1712016
Brennan oate MMIDOfYY?Y)
*of Floors
Ca fI'own
Notts Connecter must-�
rip et form ler OLS Revised: 11!132013
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Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
Asbestos Project 0
a Project Revision
e Project Cancelladmt
A.Asbestos Description:(coat.)
12.Abatement procedures(check all that apply):
Glove daB a Encapsulation a Enclosure e
Disposal Only a Cleanup b Fa Cyrmimn ent
e
c Other-Please Speedy
14.Job is being conducted:of each t b
Indoors a Outdoors
14.Total amoLmt of each typo of asbestos Containing materials(ACM)to be removed,enclosed,or
enpapwlalad. 1800
Spurn Feet(Sq.Ft)
Linear Feet
ng Transitt Pipe
Tank,HreachCS•Duct, Ui.Ft — un.R 5n.FL
Tank Surface Coatings Lin.R Sp Ft.
Transits Shingles Lisa Si.Ft
Pipe Insulation
Lin-R. L
Transits Panels .
Spray-On Fireproofing R 39
Lin Fl. S4 Fl
FL
Other-Please Specify.
Clothes,Wov®Fabrics
al ft 1600
R MONASTIC Uri 180R'
hnsulmunB Cement ,__,..__p FL
LnR. Sp FL
15.Describe the decontamination system(s)to be used'
SCHPNEtRSVOtekR
methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):16.Descrbe the contai0eri�tiDt✓�y Pond
ORUMSOOUBLE LINED
17.For Emergency
Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
nra atawcEP Mai
Waiver*
kte re DLS DladBl
Name ottAaaeDEe COOP
Dare me m+vir•uan otwoorcrrn
Nate or DLS Official
waiver#
Dato revili glita M.G.L.mC49.��,2710RX7A—F apply to this
1 B.�olprara li n9Nra0e�
Prefect?
Revised: 11/132013
e Yes b No
1Page 2 of 4
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LVI Environmental Services Inc.
401-S Second Street
Everett, MA 02149
Phone:(617) 389-8880
Fax (617) 389-9502
www.lviservices.corn
boston @Iviservices.com
March 18,2010
NOTIFICATION OF ASBESTOS ABATEMENT
ATTENTION: Northampton Health Department
212 Main Street
Northampton,MA 01060
LVI Environmental Services Inc.will be conducting an asbestos abatement
the ment being roje t at the to
ment project at the e
following location. Please note the site and dates listed below,
changes. Do not hesitate to contact our office for more detailed scheduling information at 617-
389-8880.
BUILDING LOCATION:
START DATE: 04/08/10
END DATE:
VA Hospital—Northampton
421 North Main Street
Northampton,MA 01053
Throughout Bldg.
04/01/10
necessary Asbestos signs util be in the clearly posted in all areas when work is being conducted Please e take the
nec precautions in the event you are required to enter the building d�do not hesitate to
much for your attention
contact you a hove officer at any time att( respect 7) -8 this abatement hank you please
our office at any time at(617) 389-8880. Thank you very
regarding this matter.
Very truly yours,
LVI ENVIRONMENTAL SERVICES INC.
Wandyeatiaa
Wendy Carias
Projects Coordinator
All State Abatement Professionals, inc.
866-565-ASAP
Fax: 603-378-0610
4 Wilder Drive, Suite 12
Plaistow, NH 03865
December 15, 2010
Northampton Health Department
212 Main Street
Northampton, MA 01060
Phone#: (413) 587-1214
Fax#: (413) 587-1221
Re: Asbestos Abatement @ VA Medical Center, 421 North Main Street
To whom it may concern:
All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the
above referenced project on the following dates:
Start Date: 12/30/10
End Date: 01/05/11
All appropriate agencies have been notified for the above referenced project. If you have
any questions or need additional information,please do not hesitate to contact me.
Sincerely,
lx"J. Scott Curley
President/CEO
JSC:jab
Enclosures
Asbestos •Masonry Cleaning •Selective Demolition •Shot/Sand Blasting •Mold Remediation