421 Project Revision Notifications mportant:
When filling out
orms on the
computer,use
only the tab key
o move your
cursor-do not
use the return
key.
INSTRUCTIONS
1. This form is
only available for
online filing of
project date
revisions.
2. Enter project
decal number.
3. Validate that
the project
location is correct
for the entered
decal.
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102944
Decal Number
A. Facility Location
DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
4135844040
6.Telephone Number
MA
4 State
5.Zip Code
B. Project Cancelled
Check here if this project is/was cancelled.
C. Project Dates
3/30/2010 J 14/6/2010
1.Odainal Stad Date(mMddlyyyy) 2.Original End Date fmMdd/iWy)
3/29/2010 I r
3.Latest Revised Start Date(mm/dd/yyyy) 4.Latest Revised End Date(mm/dd/yy)/y)
D. Revised Project Dates
3/31/2010
1 Revised Start Date(mm/dd/yyyy)
Z.Revised End Date Date(mMtldlyyyy)
1
E. Other Project Revisions
F. Revision History
EDEP: 03/25/2010 02:32:09 PM
anfO6pdm doc•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102944
Decal Number
G. 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 belief.
!JEAN A KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Ttle
IACCUTECH INSULATION &CONTRACTING
4. Representing
100 STATE STREET
6. Address
LUDLOW
7. City/Town
anf06pdmdoc•rev.215/04
3. Date mm/dc
4135835500
5. Telep_hone_
u4
101056
8. Zip Code
Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102944
Decal Number
A. Facility Location
DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
4135844040
l� 6.Telephone Number
INSTRUCTIONS
1. This form is
only available for
online filing of
project date
revisions.
2. Enter project
decal number.
3. Validate that
the project
location is correct
for the entered
decal.
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
MA
4 State
5 Zip Code
B. Project Cancelled
Check here if this project is/was cancelled.
C. Project Dates
3/30/2010
t Original Start Date(mm/ddlyyyy)
3.Latest Revised Start Date(mm/dd/yyyy)
4/6/2010
2.Onqinal End Date(mm/dd/yyyy)
4.Latest Revised End Date(mMtltllyyyy)
D. Revised Project Dates
13/29/2010
1.Revised Start Date(mm/dd/yyyy) 2.Revised End Date Date(mm/dd/yyyy)
1
E. Other Project Revisions
F. Revision History
anfo6pdrn doc•rev.2/5/04
4.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102944
Decal Number
G. 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 belief.
JEAN A KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Title
ACCUTECH INSULATION &CONTRACTING
4. Representing
100 STATE STREET
6. Address
LUDLOW
1. City/Town
anfO6pdm.doc•rev.2/5/04
J
d Si
3/25/2010
3. Date(mm/dd/yv
4135835500
5 Telephone
01056
8 Zip Code
Important:
When filling out
forms on the
computer.use
only the tab key
to move your
cursor-do not
use the return
key
gul
INSTRUCTIONS
1. This form is
only available for I Check here if this project is/was cancelled.
online filing of
project date
revisions.
2. Enter project
decal number. C. Project Dates
3. Validate that
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AO 06
100102779
Decal Number
A. Facility Location
DEPART VETERANS AFFAIRS MED CTR
1.Name of Facility
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
n
4135844040
6.Telephone Number
MA
4 State
5 Zip Code
B. Project Cancelled
the project
location is correct
for the entered
eta!
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
3/26/2010
1.Original Start Date(mmlddlvyyv)
/9/2010
2.Original End Date(mMdd/yyyy)
3.Latest Revised Start Date(mmldd/yyyy) 4 Latest Revised End Date(mm/ddlyyyy)
D. Revised Project Dates
3/31/2010
1.Revised Start Date(mmlddtyyyy) 2.Revised End Date Date(mmlddlyyyy)
E. Other Project Revisions
F. Revision History
anfO6pdrn.doe•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102779
Decal Number
G. 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 belief.
JEAN A KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Title
ACCUTECH INSULATION S CONTRACTING
4. Representing
100 STATE STREET
6. Address
LUDLOW
7. City/Town
anfO6pdrndoc•rev.2/5/04
A orized Sranature
3/26/2010
3. Date tmm/dd/WW1
4135835500
6Telephone
01056
8 Zip Code
Important:
When filling out
forms on the
computer.use
only the tab key
to move your
cursor-do not
use the return
key.
INSTRUCTIONS
1. This for is
only available for
online filing of
project date
revisions.
2. Enter project
decal number.
3. Validate that
the project
location is correct
for the entered
decal.
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102944
Decal Number
A. Facility Location
DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
4135844040
6.Telephone Number
MA
4.State
5.Zip Code
B. Project Cancelled
Check here if this project is/was cancelled.
C. Project Dates
3/30/2010
1.Original Start Date(mnVddlyyyy)
3/31/2010
3.Latest Revised Start Date(mnVdd/yyyy)
4/6/2010
2.Original End Date(mmkkgy yyl
4.Latest Revised End Date(mm/rid/yyyy)
D. Revised Project Dates
1.Revised Start Date(mnVdd/yyyy)
2.Revised End Date Date(mm/dd/tyyy)
E. Other Project Revisions
7 DAY HOLD
F. Revision History
EDEP:03/25/2010 02:32:09 PM EDEP: 03/26/2010 04:32:20 PM
anfO6pdm.doc•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102944
Decal Number
G. 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 belief.
J ugnafa•
hori;c Signature
4/1/2010
3. Date(mm/dd/ww)
JEAN A KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Title
ACCUTECH INSULATION 8 CONTRACTING
4. Representing
100 STATE STREET
6. Address
4135835500
5. Telephone
LUDLOW
7. City/Town
anf06pdm doc•rev.2/5/04
1056
8. Zip Code
Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
aviC
INSTRUCTIONS
1. This form is
only available for
online filing of
project date
revisions.
2. Enter project
decal number.
3. Validate that
the project
location is correct
for the entered
decal
4. Enter your new
project dates.
5. Certify your
notificatron.
Submit date
changes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102779
Decal Number
A. Facility Location
DEPART VETERANS AFFAIRS MED CTR
1.Name of Fadlity
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
4135844040
6.Telephone Number
MA
4.State
5.Zip Code
B. Project Cancelled
H Check here if this project is/was cancelled.
C. Project Dates
3/26/2010
1.Original Start Date(mmlddlyyyy)
3/31/2010
3.Latest Revised Start Date(mm/dd/yyyy)
4/9/2010
2.Original End Date(mm/dd/vwv)
4.Latest Revised End Date(mm/dd/yyyy)
D. Revised Project Dates
1.Revised Start Date(mm/ddlyyyy)
2.Revised End Date Date(mm/ddyyyy)
E. Other Project Revisions
7 DAY HOLD
F. Revision History
EDEP:03/26/2010 04:02:23 PM
anfo6pdm.doc•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100102779
—Decal Number
G. 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 belief.
JEAN A. KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Title
ACCUTECH INSULATION 8 CONTRACTING
4. Re resentin
100 STATE STREET
horized$innatu
4/1/2010
3. Date Imm/dd/cowl
14135835500
5. Telephone
6. Address
LUDLOW
7. City//own
anf06pdm.doc•rev_2/5/04
01056
6. Zip Cade
tportant
'hen filling out
rms on the
tmputer.use
ily the tab key
move your
ursor-do not
se the return
r
T
tISTRUCTIONS
This form is
only available for
online filing of
'reject date
evisions.
t. Enter project
fecal number.
L Validate that
he project
ocation is correct
or the entered
feral.
1. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
[100101101
Decal Number
A. Facility Location
'DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
1421 MAIN STREET
2.Street Address
'NORTHAMPTON
3.City
4135844040
6.Telephone Number
1MA
4.State
1 5 Zip Code
B. Project Cancelled
J Check here if this project is/was cancelled.
C. Project Dates
2/18/2010 , 311/2010
1.Original Start Date(mm/dd/vyyy) 2.Original End Date tmmldd/yyyvl
12126/2010 1 13/10/2010
3.Latest Revised Start Date(mm/dd/yyyy) 4.Latest Revised End Date(mm/dd/yyyy)
D. Revised Project Dates
12/23/2010
1.Revised Start Date(mm/dd/yyyy)
L2.Revised End Date Date(mm/dd/yyyy)
E. Other Project Revisions
F. Revision History
EDEP: 02/17/2010 01:40:36 PM
anfo6pdm dog•rev.2/5/04
0
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
G. 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 belief.
'JEAN A KUMIEGA
1. Name
'ADMINISTRATIVE ASSISTANT
2. Position/Title
1ACCUTECH INSULATION S CONTRACTING
4. Representing 1100 STATE STREET
6 Address
(LUDLOW
7 city/Town
anfo6pdm.doc•rev.215/04
t<umieta k L/n .r> z
thorized Synature /�
2/22/2010
3. Date mm/d
14135635500
5 Telephone_
01056
8. Zip Code
I11 i
1 F
X11 1 f � � 1 1 t f ,
•
1
1
•
•
r
1<JUDITH BEREZANSKY
1 Name
'OFFICE MANAGER
2. Positonfite
'ASAP,INC.
4 Representing
k WILDER DRIVE,STE 12
8. Address
29/2010 12:44 FAX 8033780610 ASAP, LOU.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100118168
Decal Number
G. Certification
The undersigned hereby states,under the penelges of penury,that ht/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 hest of Masher Pam/ledge
and belief.
'PLAISTOW, NH
7. Ctyfioan
anf08ddm.doc-rev.2/51134
AuXprised Sionretro
1212912010
3 Datalm4Mddtenen
1(603)378-0600
5. Telechore
1
103865
6.
To Code
1421 NORTH MAIN STREET
2.Street Address
29/2010 12:44 1•.0 Duda/500'u
•
LI
Important:
When fining out
forms co Wa
computer.use
only at tab key
to move your
cursor-do nOt
use the return
key.
INSTRUCTIONS
1. This form is
only avafatae for
onrne filing or
project dale
revisions.
2 Enter lintel
decal number.
3. validate that
tarotiont 1.Otginal SIait Data(mmPoNwW)
fa the en credal ,
for ai.entered
decal.
4. Enter your new
project dates.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-0D1 and AQ 06
110011814B
Decal winner
A. Facility Location
IYA MEDICAL CENTER
1.Name of Facility
'NORTHAMPTON
3.City
5.TeleMma Number
MA
• State
5.Bp Code
B. Project Cancelled
['Check here it this project ishuas cancelled.
C. Project Dates
11213012010 1
5. Certify your
notification.
Submit date
changes.
10110512011
2 Or$3nat End Deb?fmm/de/Wet
11
3.Latest Revised Start Omer ImMddyyyy)
4.Latest Revised End Data(mnJ4dyyyy)
D. Revised Project Dates
10110412011
1.Revised Start Date(mmlddlyyyy)
1Ov0412011
2.Retried End Date Date InsrdddNyyT)
1
E. Other Project Revisions
F. Revision History
anINpdm.dw•rev.2/5/04
1/2010 tz:44 r,,..
1
All State Abatement Professionals, Inc.
866-565-ASAP
Fax:603.376.0610
4 Wilder Drive, Salle 12
Plaistow,NH 03865
December 2010
Northampton Health Department
212 Main Street
Northampton,MA 01060
Phone#: (413)587-1214
Fax 4: (413) 587-1221
Re; Asbestos Abatement a VA Medical Center,421 North Main Street
To whom it may concern:
AU State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the
above referenced project on the following dates:
Start Date: 4il3ORB 01\°4\11
End Date: 04,2454-1— O l l en 11
All appropriate agencies have been notified for the above referenced project. if you have
any questions or need additional information,please do not hesitate to contact me.
Sincerely,
l,./J. Scott Curley
President/CEO
JSC:jab
Enclosures
Asbestos•Masonry Cleaning•Selective Demolition•Shot/Sand Blasting •Mold Remediation
1100118146
Daal Hater
101/0512011
2,Oiovgl End Dale rnmryddkvw%
10310&2011
4.latest Revised End Data(mmlettryryyl
)4/2011 lb:UU rss oudorovosu
Important
When rdh'ng out
forms on the
computer,use
only the tab key
to maw your
cursor-Oa and
use the return
key.
INSTRUCTIONS
1. This Corm is
anyavaltede for
at*aeng of
Voted date
revisions.
2. Enter project
dew minter.
a Valiate thet
She Prgvp
location is correct
for Po entered
decal.
4. Enter your nBa
project dates-
a. Sealy your
Subfication.
Submit data
granges.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
A. Facility Location
IVA MEDICAL CENTER
1.Name of Fay
1421 NORTH MAIN STREET
2.Sheet Address
`NORTHAMPTON
3.Cay
T4bpnro Nrmtus
IMA
4.am
S.$Code
B. Project Cancelled
0 Cheek here if this project is/was cancelled.
C. Project Dates
11213012010
1.DNS Stan Der(ri&dd'yywl
10110412011
9.LSI R.%SSed Stan Oak(nm'dd'yyyy)
D. Revised Project Dates
1.RMSed Start bate(mmrddyyyy)
(
2.Revised end beta Date(mrWdd/yyW)
E. Other Project Revisions
1
1
F. Revision History
EDEP:12/29)201011:30:50 AM
EDEP: 12130)201010:00:54 AM OTHERPROREV:CREW WILL BE ON WE ON 01104,01105,
02107,03/07 AND 03108111.
4
04;2011 15:1.1U PM owaorowe.o
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
1180118118
G. Certification
The undersigned hereby states.under the pitman*of penury.that he/she has read the Commonwealth of
Massachusetts regulations for tt the Removal,Containment or encapsulation of Asbestos.453 CMR 6.00 and 318
CMR 7.15,and that the information contained In Nis notification is true and coned to the best Of hSNher knc*ledge
and belief.
Nam
2. PoeibonfTeis
Aadmdied Swneture
3. tlete(mmkWwr1
II
4. Raeesentine
6. McKeon
7. Cityacren
e t0epdm.doc•rev.715N+
s. 97,Code
04/2011 15:UU me OUOOIOOOlu
All State Abatement Professionals, inc.
4 Wilder Drive,Suite 12 86&565-ASAP
Plaistow,NH 03865 Fax!603.378.0610
re-6oat,61 y, aolr
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:
End Date: nI^_-1.s/11
01404
4 4/I
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 nte.
Sincerely,
i
IL/J. Scott Curley
President/CEO
JSC:jab
Enclosures
Asbestos•Masonry Cleaning•Selective Demolition•Shot/Sand Blasting•Mold Renlediation
/U4/Cull ia:oa rite O1.1O010VOLU An! 101..
All State Abatement Professionals, Inc.
4 Wlider DrNe,Suite 12
Plaistow,NH 03865
666-565-ASAP
Fax 603-378-0610
Vti
FAX
To:
A)of4LCtnl on Health beet
Phone:
Fax phone: Ill,3- 5-$2-42*i
CC
Date: C>21.51 A
Is/wither of pages including cover sheet
y
From:
All State Abatement Professionals,Inc.
Phone: (603)378.0600
Fax phone: (603)378.0610
REMARKS: ❑ Urgent
® For your review
❑ Reply ASAP ❑ Please comment
Asbestos•Masonry Cleaning•Selective Demolition•Shot/Sand Blasting•Mold Remediation
mportant:
Then filling out
'bans on the
computer,use
anly the tab key
to move your
:ursor-do not
use the return
Key.
atC
INSTRUCTIONS
1. This farm is
only available for
online fling of
project date
revisions.
2. Enter project
decal number.
3. Validate that
the project
location is coned
for the entered
decal
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
A. Facility Location
DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
[4135844040
6.Telephone Number
MA
4.State
5.Zip Code
B. Project Cancelled
H Check here if this project is/was cancelled.
C. Project Dates
2/18/2010
1.Original Start Date(mMdd/yyyy)
2/23/2010
3.Latest Revised Start Date(mm/dd/yyyy)
3/1/2010
2-Original End Date(mm/ddNwv)
3/10/2010
4.Latest Revised End Date(mmidd/yyyy)
D. Revised Project Dates
2/26/2010
1.Revised Start Date(mm/dd/yyyy)
3/12/2010
2.Revised End Date Date(min/dd/MO
E. Other Project Revisions
F. Revision History
EDEP: 02/17/2010 01:40:36 PM EDEP: 02/22/2010 11:40:08 AM
AM OTHERPROREV: 7 DAY HOLD
EDEP: 02/25/2010 10:09:37
anfo6pdrn doc•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
G. 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 belief.
JEAN A KUMIEGA
1 Name
(ADMINISTRATIVE ASSISTANT
2. Position/Title
ACCUTECH INSULATION&CONTRACTING
4. Representing
100 STATE STREET
Qnemega
onze nature
2/26/2010
3. Date tmm/dd/ww1
4135835500
5. Telephone
6 Address
LUDLOW
7. City/Town
anfo6pdmdoc•rev.2/5/04
01056
8. Zip Code
mportant:
Moen filling out
orms on the
amputer,use
lnly the tab key
o move your
ursor-do not
ise the return
:ey.
niviL
LAI
NSTRUCTIONS
I. This form is
mly available for
online filing of
woject date
evisions.
?. Enter project
fecal number.
3. Validate that
he project
ocation is correct
or the entered
1 ecal.
1. Enter your new
project dates.
3. Certify your
iotlfication.
Submit date
hanged.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
A. Facility Location
DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
14135844040
6.Telephone Number
MA
4.State
5.Zip Code
B. Project Cancelled
j Check here if this project is/was cancelled.
C. Project Dates
2/18/2010
1.Original Start Date(mmrdd/yyyy)
2/26/2010
3.Latest Revised Start Date(mm/dd/yyyy)
3/1/2010
2.Original End Date(mm/dd/ywvl
3/12/2010
4.Latest Revised End Date(mm/dd/yyyy)
D. Revised Project Dates
1.Revised Start Date(mm/dd/yyyy)
Revised End Date Date(mm/dd/yyyy)
E. Other Project Revisions
WORK INCLUDES RM 119 IN BLDG 2 WHICH WAS OMITTED FROM INITIAL NOTIFICATION
F. Revision History
EDEP: 02/17/2010 01:40:36 PM EDEP: 02/22/2010 11:40:08 AM EDEP:02/25/2010 10:09:37
AM OTHERPROREV: 7 DAY HOLD EDEP: 02/26/2010 12:49:49 PM
anlo6pdm.doc•rev.2/5/04
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
G. 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 belief.
JEAN A KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Title
ACCUTECH INSULATION &CONTRACTING
4. RegreseMinq
100 STATE STREET
6. Address
Je iffDl4lFumi
/A oimorrzed Signature
2/26/2010
3. Date(mm/dd/yyyy)
ezzi
4135835500
5. Tele bone
LUDLOW
7. City/Town
an(06pdmdoc•rev.215/04
01056
8. Zip Cade
t.
aperient:
/hen filling out
rms on the
mputer.use
nly the tab key
r move your
ursor-do not
se the return
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
A. Facility Location
DEPT VETERAN AFFAIRS MEDICAL CTR
1.Name of Facility
1421 MAIN STREET
2.Street Address
NORTHAMPTON
3.City
14135844040
6.Telephone Number
MA
4 State
5 Zip Code
VSTRUCTIONS B. Project Cancelled
. This form is
nly available for
Inline filing of
aojed date
evisions.
I. Enter project
fecal number.
1. Validate that
he project
oration is coned
or the entered
fecal.
I. Enter your new
'reject dates.
5. Certify your
totification.
Submit date
iianges.
Check here if this project is/ as cancelled.
C. Project Dates
12/18/2010
1.Original Start Date(mm/tld/yyvy)
12/23/2010
3.Latest Revised Start Date(mmfdd/yyyy)
3/1/2010
2.Original End Date Imm/dd/vwv1
3/10/2010
4 Latest Revised End Date(mm/dd/yyyy)
D. Revised Project Dates
1.Revised Start Date(mmldd/yyyy)
2.Revised End Date Date(mn ddlyyyy)
E. Other Project Revisions
7 DAY HOLD
F. Revision History
EDEP:02/17/2010 01:40:36 PM EDEP: 02/22/2010 11:40:08 AM
anfO6pdrn.doc•rev.2/5/04
t.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100101101
Decal Number
G. 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 belief.
JEAN A KUMIEGA
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/T'dle
ACCUTECH INSULATION &CONTRACTING
4. Representing.
1100 STATE STREET
6. Address
Je
a
era
oozed Signature
2/2512010
3 Date(mm/dd/ww)
4135835500
5. Telephone
LUDLOW
7. City/fown
anfO6pdm.doc•rev.2/5/04
01056
8. Zip Code