7 Asbestos Notification Form 2001 6. What is the size of the facility755Xqs2 ft) a (rot floors)
Asbestos Transportation and Disposal
Facility Descoption
Current or prior use of facility'
Enic€
2. Is the facilily owner-occupied residential with 4 units or less? >I Yes 0 No
3 Facility Owner:
NJme
0.,01.22-e-r) Cal nal-- 7 r chard St
z
Cilynoen k774 Pr11 P xi Ad if O��o
bp cove 537- 9'7175
teleplhene
4 Facility's Owners On-Site Manager:
/4
Name
GeWroep
5 Genera!Contractor:
Apleees
Denule
relephOne
Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow Rd .
Nme
Address
Northfield MA. 01360 413 498-0201
COrner
OpCode
Granite State Ins . Co. wc8540584 nlepame
'Cowmen Workers Cmp Mauler 09/01/01
Pak yee
hp Date
Transpo of asbestos.containjng waste material from sjte to tempora storage site(II neessa )to fnal disposal site:
Shearer & Snide Inc. dba/Ace Asbestos 716 Pine Meadow Rd .
Name
Address
Northfield MA 01360 413 498-0201
liji Wow',
ac4e
reeephOne
2 Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site:
Logano Trucking—Waste Mgmt 209 Pickering Street
Nape
Adoeee
Portland CT 06480 860-342-0667
Ci /Town
bp rude
Commonwealth of Massachusetts
Asbestos Notification Form — ANF•001
Asbestos Abatement Description
UCTIOMS
or of toe
be completed
comply wits
tment al
instal
n nalthcason
n6 of 310 CMR
working days
rY2lion rs
Many abatement
MI the
tent of Libor
!SHIN
leave,omens
MR612 (len
nwdirallm is
of AMY
ni poled 4'e31&
e hrear or
rep.
nn plc final Farm
awnith of
chusatts
ton Program
.12004/
n.MA 02112-
s lorm may be
of notii 1ng the
nvume Fit it
lion Agency Region
peslm dmnolinonl
soon eperauons
et to NESHAPS(40
1 Facility loc lo;
Connor"
%/e5f�e u _ I 0KcwAgb
Adorar
Name
Oe..gni wro � M A
C 7/fowr,
briers eint
41 l ie the Kab Ie:GC M)aunmuo name e wow.floor.Wee
Is the facility occupied? Yes EL No
Zip rule
S
JUL 2 nib"
2.
NQ1:�:tMAPfON BOARD OFHFALTN
3. Asbestos Contractor: 716 Pillne ea Ow ° ' _ _.
Shearer & Snide Inc dba/Ace odres.Asbestos
413 see
Nam 0201
MA . 01360 _..
Northfield N wig rNeplloe
._.._.._ .__
ciry/rowr
AC000006
alfiense,
c ZJf/ft if en
4. On-Site Project Supervisor/Foreman: pS70245 , A570056
Teln Shearer _.._.._.
..............
0..
Ed Shearer/Tom -- - -�- N❑cmJnuunr
Now
5. Project Monitor:
Name
6
IX16eni cato/
Asbestos Analytical Lab'. y( �p / �
SA TI-IPok% / l A-
�/IUIKOPIM (--. 5"no3e pufemramw,, 30 a
Q Y o
8 /15/°)end date 8/fib/°Specific workhours(Mon.-Fn.)✓ 0. (Sat-Sung ate
update
7. Project statldale--- heat
Name
R What type of proleat is this? (circle one). demoltoo
relief relloealtln,
onurlam,nlr
Stations must
comply with the
Solid Waste
Division regula-
tions 310 CMR
1800
Note:Contractor
must sign this
form for OLl
notification
purposes
1 Refuse transfer station and owner(if applicable):
N/A
Name
4 Final Disposal Site:
Valley Landfill waste Management/ Lugano Trucking
D
Aeoress
lip rate Telephone
IVXgO Name (toners Natne
Pleasant Valley Rd .
Address
Irwin PA 15642 724 744-7446
Certification
ri,w,pne
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulatic
for the Removal.Containment or Encapsulation of Asbestos.453 CMR 6.00 and 310 CMR 7.15.and that the information contained
this notification is true and correct to the best of his/her knowledge and belief.
FaiWa rd D. ShearercaGp J... 00101__ .
Pons Name
Authorized Signauee
R �/� ��-i Shearer & Snide Inc. dba/
CS/del-it Ace Asbestos Removal 413 498-02
Represenlino Telephone
716 Pine Meadow Rd . Northfield , MA. 01360
ArWren Ciry/lVwi -
Lnrule
Fee exempt(City,Town,district.municipal housing authority,owner-occupied residential of four units or less) 7 yes ❑ no
Sticker I(from front of form): 7 S/ 77.5
v 592.
9. Describe the asbestos abatement procedures to be used (circle):set—up saws
variables air pressure,
e wa:a CRry521010 omerluryaml poly work area , HEPA vac ,HEPA
filter respirator , wet asbestos
10. Is the job being conducted 14,1
indoors ❑outdoors?
11. Total amount of each type at Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear f.)
oreNer
surfaces(square ft.) (1to be removed.enclosed or encapsulated:
linear/souare feel
Nermal solid core pipe imulalion__ �-
cor,ugaedoor yeredpper bps insulation /00 Insulating cement
sprmgalMeprooT Qpapupipe insulation 7✓ � bowel/sprayer coatings
cloths,woven tablmp. transits board,wallboard
_J-
dolhs.wortn hD/Ia
one/(please describe)
12. Describe the decontamination system(s)to be used 3 chamber decon unit w/warm water
shower , tyve' . suits ,HEPA vac for clean—up.
ack in labeled double sealed poly bags
13. Describe the containersationldisp0sal methods to comply with 310 CMR 7.15 and 453 CMR 614(2)(9
escr
asbestos S p --
before removal from site .
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency.
•
Name 0101Pelgelf f , ,
Ohs d Avinaniabon
Mae or XI wear
nne
nee
Oates w tsocann
15. Do prevailing wage rates apply as per M.G.L.c. 149, §26. 27.or 27A F to this project? ❑ Yes X No