109 Asbestos notification Form 1999 facie. , Oescrlpllen
1. Cadent or prior use of facility:
Residence
2. Is the facility uwneroccupled residential wilh 4 units or loss? rt Yes ❑ No
3. facility Owner:
Leda Mahmoodi
Name
Northampton, MA
ironodd-----.-___-
4. facility's Owner's UnSite Manager:
Same as above
Asno
109 South Street
Armen
01060 413-247-9313
lip rule -- -- telephone
A6
cllffimin -_—
lip cafe rpepMnn
5. General Contractor:
N/A
Name Menus
C/p91mm by cods _. . - hb00one
Reliance Nat lonAl NWA1795179-00 11/04/99
conform}IVWAen Como.morn Poky/ Etc aye
•
G. What is the size of the lacllily7 (so II) (/of floors)
Ashes!us Transportation and Illsposal
1. Lmisporler ul asbestos-conlalnhig waste material hum site lu temporary storage site(il necessary)to final disposal slle:
AccuTech Insulation 6 Contracting, Inc. Depot Street, Delta_Parb
Name Athhr
Chicopee, MA
01013 (413) 592-5326
hp ails lerphine
2. Transporter of asbeslos-conlaluing waste maletlal train remaval/temporary sloiage site to final disposal silo:
Logano Trucking Company, Inc. 25 Silver Street
INSINUC110PS
I. All seiner this
01111 must be commpbled
n alley to comply wdli
In Pop rlmenl of
i',Irnnmenlor
'aotecllml notification
eeuiranenb ol3W CMU
'.15 (fm wonting dap
nix notification Is
eeuber ofinyabalenent
voles*:and the
'upsllmn0 of labor
and Indumlee
mlilicallonnemuilenelas
X1453 CMN 6.12 (len
lays pia nolilialiuu is
evuded ol AM'
Gatemen(pm(ec greater
Ian three larea,or
qua's led).
Suhmil U iulnal Fos
o:
:ommonwsallh of
flenavhusetts
bbeslot Program
e.0.B;120087
lotion,MA 02112•
IUSI
I.INs lam may be
iseJ lot notifying Joe
IS.Envhomnental
'loledion Agency Region
ol asbestos demolition/
enonlial operations
Iubiedto NESVIAPS(1U
:111 Suboan M.
Culnamnweal tt'f Massachusetts
Asbestos Notification Fowl— ANF-11u1
Asbestos Abatement Description
1. , Facility location:
Residence
None
Northampton, MA
ell)4OM
Basement
'U)ania Ua eolblle.trtJeenl Mittel naive/Ida,riot,worn
2. Is the facility occupied? IH Yes ❑No
109 South Street
n✓hess
01060
a✓e
413-247-9313
'Neptune
3. Asbestos Connador:
AccuTech insulation & Contracting, Inc.
Mot Mines
01U13
)Ipavre
Chicopee, MA
Cn}Amnr —
AC000005
unterse/
4. Uo-Site Pr jeci Supervisor/Fineman:
Randy Daum
Nino
5. Project Monitor:
N/A
Name
Depot Street, Delta Park
(413) 592-5326
lelepmau
Written
nlal lfeeMarnennll P ( �,
AS70530
UIILnlllbfloat
--1
i 1 CC J y __.____
0.l Certigokw/
6. Asbestos Analytical Lab:
N/A
Nina 0.l eefaalloaf
7.
a.
8AM-4PM Sa1.Sull.
Project slalldate�?77 9k°d dalej�99 specific workbuul s(Mon.FIi.) ( )
Mint type ol project Is this? (circle one): dempmeeo Tit mane (On 1wealn,,
Note:Transfer
Stations must
comply nith the
Solid Waste
Division regula-
tions 310 CAM
18.00
Hats:Contractor
must sign this
form for DLI
notification
purposes
Portland, CT
C/&him
3. Refuse transfer station and owner(il applicable):
N/A
Nine
Mins
06480
(860) 342-0667
Lp ore 6lrphom
A
Clq/foen
4. Final Disposal Site:
Souehern All.eghanies Landfill
Imam Ni,,,
843 Miller Picking Road
Mktg
Davidsvillc, PA
Dptole lelNee
USA Waste Services Inc.
NMr'en Mug
C10/10n
•
15928 (81) 479-2537
mepnni
rows
Certification
The undersigned hereby stales,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulations
for the Removal.Containment or Encapsulation of Asbestos 53 CMR 6.00 and 310 CMR 7.15,and that the hi?orntalion contained In
This notification Is true and correct to the best of his/her*no Plipo and belief.
Laurie Croteau
Aid Mune
Administrative Assistant
1le1ArylM t
Depot Street, Delta Park
Addicts
OLIJAd
.Au ced S
Acc'utech Insulation &
Contracting, Inc.
lapeunlhq
Chicopee, MA
Clly/lomi
7/12/99
LIM
(413) 592-5326
lerephne
01013
Iq code
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of our wills of less)7 a yes O no
Slicker/ (horn trout of Iann): 13b'a
Dev.6N2
9. Describe the asbestos abatement procedures to be used (cliclq: glow tag wwkeuw lull confirmed damp
encasuleon dbpoel only
oPgl(tpl+ls)
10. Is the job being conducted 2d Indoors ()outdoors 7
11. Total amount al each type oh Asbestos Containing oaedialeuAl M)t or e handled onpipes or ducts(linear It.)
,unlaces(square IL) ((hear/square feet
boiler,breaching,duct,kith surf ace coaling,... tlemlaIsolN core pipe Insulalion _J
L+�S kuula@rp cement —J
sarugandmkofing paper pipe bwulalion.... bonetlspe)W coaling, -J
dolls,,wbntalyks J IWire board,wall board J-
oiner wmm ks ib —/
otlw(pkasedesniDe)
12. Describe the decontamination syslem(s)to be used:
Seal criticals with 6 mil poly, pre—clean, lay dro cloth and re
using the negative pressure glovebag method.
13. Describe the containerization/disposal methods to cmnpN with 310 CMR 7.15 and 453 CMrt 6.14(2)(9):
ACM to be double bagged or wrapped in 6 mil poly and delivered in a
sealed company vehic a to dum. site.
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
210
or other
N+me cell?nehll
WwolAulhoWlen
WOeMRltlrlrl+I
----------- Ml
bale bale VIMftLebllw
15. Do pi evening wage tales apply as per M.G.L.c.149,§26,27,or 2TA•F to lids protect? ❑Yes Ell No
hiker/
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