28 Asbestos Notification Form 2000 H
frdrmomeeah7D el Massachusetts
Asbestos Notification Form— ANF•001
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Asbestos Abasement Description
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2. Is the Denny occupied, ki4.ss C No
S. Asbestos Soigne!
Building Renovation Services
Owe AMC.
Springfield Ma 01101
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4. On-See Prefect Supnnornoreman:
Michael Moore
S. Pmjeci Monitor.
Nina Inchardi.
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Po Box 5942
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Plole<1Nddney��ndnle lff‘LDee6ic work hours(Mon-Fri tit Sun)
1. What type of rimiest is this/ (circle one): (emw1o') lier /��.n�m,e\u
9 Describe the She slot abatement procedures m be used (circle). gents//rtAM IM,mn+n.m
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10. Is the job being conducted Vedoars Oeetdeort7
11. ivubmount of each type oe Asbestos Conleieing MNerials(ACM)to be handled on pion or ducts(liner tiI a Other
mdres(satire II) / ,Th0 Is bl umov.d,enclosed or ens apaulat.d:
Surhenre feel
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12. Describe the decmhminstion systems)to be used:
Three Stage
11 Describe the containeriztiNdiapoul methods to amply%Ma 310 CMR 1.15 and 153 CMR 6.11(21(01:
Amended Water; 2 6mil bags; Covered Vehicle;
-Licensed Landfill
II. pet Emerging Asbestos Abatement Opdnuane.1k.DEP and DU clIkka who mYUled the mmergers:
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15. Do r ono mars tilts apply at per M.GA.c.149.5 26.21.or 21A P le Ms Dm1W7 CTn Ix Mo
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Mile Transfer
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pone 110 CAM
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2 IS the facility owner-o:eurnee respemLal anal onus or kit, 4n _ No
3 Sanity Owner
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5. General Conlrador.
Building Renovation Services
NAM
Springfield Ma 01101
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PO Box....59.42....._..-
( 41 3 ) 788-095..5__..,_
6. What is the site of the facility?(11nOete M)1(I 01 lbws)
Asbestos Transportation and Disposal
Is On
I. Transporter of as kilos-containing waste muaul fmm site to temporary swage site(it necessary)to liMI dmosai Mc
Building Renovation Services
Mn ..m. - __._ PO Box. .5942......_
Springfield Ma 01101 (413 ) 788-0955_
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ome
2 Lamponer of as benm.conlaining wale material from removal/Iempoary sloppetite lolinal Oifooul silt:
Building Renovation Services
cow Mew .. P0. .Box....59.42..__._
a Springfield MA )gp7707 (13 ) 788-0955. . .
J. Reline lanna nation and owner(ilappbeabfa):
new
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4. Final Disposal Silt:
_Conn Valley ..Sanitary United Waste
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New Lombard Rd
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785-1581
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Certification
The undersigned hereby slices underthe nmAhs d per uiy the hNM Ms rod the Commonwudh of Mauehvent,RpuSfom
to.the Remem,Cominmml w FnunuIliea WASbeao.451 CMR 6.00 and 5 CM' .IS,sad lhume MmmaliommfdWntl le
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Building Renovation Services
Michael Moore
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PD t5o1c 5942 Springfield Ma 01101
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