106 Asbestos Notification Form 2001 ate. Transfer
facility Description
1. Current or prior use of facility:
1 ES DEnXE
2 Is the facility owner-occupied residential with 4 units or less? 1 .Yes O No
3 Facility Owner:
Htctael Ras p,er
5IDw _ce MA 0 10(00
Nam
CM/To+,I on We
AXresr
10 (0 ..1-1161-1 S.+
4 Facility's Owner's On-Site Manager:
O In
C lrno»„
A furen
4/3 -58q - 66yj
re/epMm
trod TeleMw,m
5 General Contractor:
Shearer & Snide Inc dba/Ace Asbestos 716 Pine Meadow Rd .
NaMe Address
Northfield MA . 01360 413 498-0201
owes.,
Lp code Telephone
Granite State Ins . Co. wc8540584 09/01/01
Contractors Workers Comp.Insorer Poky &p.0are
6. What is the size of the facility? OX50(sq ft) - (t of floors)
Asbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site (if necessary)to final disposal site:
Shearer & Snide Inc. dba/Ace Asbestos 716 Pine Meadow Rd .
Name
Mr/res.
Northfield MA 01360 413 498-0201
Ofrftaum
Towle
Telephone
2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site
Logano Trucking-Waste Mgmt 209 Pickering Street
Name nnmeeo _..
Portland CT 06480 860-342-0667
STRU CT 10 IM
I senons ol
must be completed
Jet to comply with
'apartment of
tonmental
action notification
itements ot 310 C MP
(len waking days
nOtilkatiOn IS
fired Of any abet!men(
root and the
ailment el Labor
Industries
'canon aqueements
.53 C6.12 (ten
s prior nolthcalion is
!Lured of ANY
atement project g
in three firer or
UWE lee0.
p.
Commonwealth of Massachusetts
Asbestos Notification Form — ANF-001
Asbestos Abatement Description
1. Facilitydooation:
ka5 per rescidertez 106 ACV St
Name Address
rlOg (2QCE li4 4 DIO(4 a
cinam, Illi axle
--bas--Pnefri t
YAW is the ocitsile locaiono imildav name.A wing.lior y.room
Is the facility occupied? p:l Yes al No
3. Asbestos Contractor;
Shearer E. Snide Inc dba/Ace Asbestos 716 Pine Mead-614- Pd:
Nam. Address
Northfield M . 01360 473 498-0201
telepnone
MEM
FEB 2 6 I
Jut.
- astAPTON rOttor)ye 8/
r-
Ciyflowo
AC000006
Oil liaise I
4. On-She Project Supervisor/Foreman:
Subrntt)tainatForm Ed Shea r er/Tom Shearer
• Name DU Carlitiali(M
gnmomvealtb of
as:submits 5. Project Monitor:
tholes Program
A1.120087
aston,MA 02112. Name
DV
6. Asbestos Analytical Lab:
sed la notdang Me 6,00 110 0.1 H FAJTA IC 5 0 ki P I. in_)6" e., A41000 132
1 Ms form may In
.5 Enyuonmental Name 'IF S-71(0 C al i:enilicaDoo I
ol asbestos demolition/ 7. Project start date -3/P60/end date 3/1510i specific work hours(Mon.-Fri.)n2—(Sat.Sun.) in o
elevation°manor's /So 38£2 C.-44-444.7e£ update
:Racoon Agency Remon
.umest to NESHAPS(40
8. What type of project is this? (circle one): *median (*Ill CorTplion °wow) 1neat
system
lip code
12 1/44—
Al
Carat In.(rdienNela)
AS70245, AS70066
DC Centhcatoll I
Stations must
comply with the
Solid Waste
Division regula-
tions 310 CMR
18.00
3. Refuse transfer station and owner Of applicable)'.
N/A
Neale
Adless
GIIyROwI b0 rule reles one
4 Final Disposal Site:
Valley Landfill Waste Management/ Logan° Truckinc
Lnt nNano
Pleasant Valley Rd .
(Amen Na,
AM/ess
Irwin PA 15642
Tdrenle
724 744-7946
•epanee
0
Certification
The undersigned hereby states,under the penalties of penury,that heishe has read the Commonwealth of Massachusetts Regulate
for the Removal.Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7,15.and that the information container
this notification is true and correct to the best of hismer knowledge and belief.
Eduiara )) 5hearer
Print NSlle
Note:Contractor r
must sign this I 10i SI Decor,
form for NI Posweense
notification
purposes 716 Pine Meadow Rd .
Shearer & Snide Inc. dba/
Ace Asbestos Removal
Maim
ReptesenI iu
413 498-0:
Telephone
Northfield , MA. 01360
Cmrnvwn
bp rule
Fee exempt(City,Town,district.municipal housing authority, owner-occupied residential of four units or less)1'�(yes 0 r
Sticker i(from 1 ront of form). , LIF 32
Rev 692
9. Describe the asbestos abatement procedures to be used (circle): glow bag ercbswe mnrawan
manila%on
degoaal only Orne Plain)
set–up variable air
poly work area ,HEPA
filter respirator , w
10. Is the job being conducted ')(indoors O outdoors?
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes
surfaces(square ft.) 3e, to be removed,enclosed or encapsulated:
linear/square feet
boiler,breaching,died,tank surface coatings_ 1,3t thermal,sold rota pipe insulation ___/
corrugated or eye/edpaper pipe lnsulalion. / Insulafvtg cement —/-
spay-on fireproofing _J vowel/wa)b Coatings _/
cloth.woven fabrics _. bamite board,wall board
Ow(please describe)
12. Describe the decontamination systems)to be used:
3 chamber decon unit w/warm water
shower , tyvelc suits ,HEPA vac for clean–up. —
pressure,
vac , HEPA
et asbestos
or ducts(linear tt.) i'10 or other
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g6a s
Rewet asbestos S pack in labeled double sealed poly g
before removal from site.
14. For Emergency Asbestos Abatement Operations,the DEP and DLL officials who evaluated the emergency.
die ofAUNKNi
15. Do prevailing wage rates apply as per M.GI.c. 149, §26, 27,or 27A-F to this project? O yes ri No
me
wawa
here
We ref r