61 Asbestos Notification Form 2000 (2) Y Tacit fescriplion
1. Current or prior use ul facility:
Telecommunications
3. radii&Owner,
Y. Is the facility owner-occupied residential with 4 units or less
................ .
Yes 1>?j No
8e.L1._Atlant is
Nnnr
Milton
corn's, _._..._............._..
4. facility's Owner's On-Sile Manager:
rr Mike Carrigan
5 General COMrrac lot
Catamount
M1 Mrr Environmental, Inc . P. O. Box
Address 160
Wilmington, Vermont
otstom 05363
802-4
zr0 code -- 64-275
Reliance Insurance rr/rnndl,. . . '4'° ..
YAi tom dlonn'one/rommmrn Com an NWA-1795107
G. What is the size of the facility? Polar ---�1 676/00
(,aeon e��----
'- Y' — (so II) 4 (I of floors)
Asbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary slorage site(if necessary)
Catamount Environmental , Inc .
Na -- ry)lo hnaldbpoul
P.O. Box 160
Wilmington, 'V
Wilmin Amrress .- ._
ermont - '
rrrynn+r' .05363
by woe 802-464-2754
2. Transporter of asbestos-containing waste feeler
material from removal/temporary storage site to final disposal silts:
Waste hlanagemen t/Logano Trucking Trucki .
twat
.._P. 0. Bow are/.
114 Adams Street
Arkin s
. .. ..
.......................................
02186
r„e;,H ---. 617-696-411
telephone
................
114 Adams Street
de.
02186 rrlmi'�rs.... .... ........
61 )_6964112
h
Oa h of Massachusetts 4.
Comm -
Ashe tos Notification Form — ANF•001
16100C1101e
I sections of this
must be tompkled
do lo comply nab
ley Omen]el
Ilonmenal
Mellon',Minutiae
Menem o1310 CMR
Ilrn i.wkin0 days
fr ndllkefion is
vired of soy sbtlen'enl
rpKrl.srdlhe
gmlmen'el Labor
rl IndusltMt
Aillcetiommoue enrtnms
153 CMR 617 ben
aes prior ndificolim is
!INS°,ANY pester
behnrn inject P
ben lhee liner or
loons lnA
o Submil Oioinel Fnm
t0
Commonwealth el
FAemebosellt
Asbestos Prelrem
P.0.1.120062
1 Won,Mk 01110•
on?
s
REVISED WORK DATES
Asbestos Abatement Description
I, Facility location:
61 Masonic
Bell Atlantic _. -........ Awns.
xarm 01060..................... FeleMane
Ply MIMI Northampton_.. zip r� Firs a_
Basement_Hall and Water .Room,
in Lobby__. - - Floor Toll Area
Nail Room.... pn,rro
Nhar is ine enrbileerrAimJ IvrlJrre ra re I•rnp.
2. Is the Willi)/occupied? U Yes Na
3 this loim may be
used In n0161113 the
V5 tnnioi rental on
rioledIon Arne'/ 0'
I of nbestoe demolition/
imoeetion olan ions An
50 FIFTY
sTst
3. Asbestoseonbacloc Inc P .O,_._DQ?L-1�0" '"' """'
Was Catamount Environmental m_._. . 802-464-2754. ,.,,
Nes _. 05363 .,._.. ___... feiemwne..rR�
Wilmington , Vermont -._- 7n R ^.
rinnn^^ Written
AC0001 erpm f Written
n es.ee o � aDOD •
ervlsodForeman'. � 70816 .._.. .CCY"� '
q. .
Tony Pl a Sup AS
Mact in --.. '_..."..... ow naMaronl ONMOOFNEUM
'long JNOOTNMAFFON
One
......... ..
5. Protect Monitor. AM 71094 ........_ -
Marchant .. pl lemflMIJ1
Gary _..
None .........
.............
6. Asbestos Analytical Lath
AA000107
CorP • ....... grunnraerve
Diversified Env ,,.. Bem 12 m(SetSunl
xmre OQpeeilic work hours(Mon:Fri.)�
7. Proleclslad dates 30/00enddaleJ3/—
hail.ni oolec is this? Wide one): dmp n rcpt rmvalbn
aengeMn)
Role: Transfer
Stations must
comply with the
Solid Waste
Division regun.
Irons 310 CMR
18 00
Note:Contractor
must sign this
form(or DLI
notification
purposes
Portland , Connecticut 06480 203-342-0667
Cnennm, LPrxk Selatre
3. Refuse transfer station and owner Of applicable):
N/A
Nene
cares
Tpvnk rrlaUUin
4. Final Disposal Sile.
Valley Landfill
(naieri Vrua
D
R U 02 , P.O. Box 282A
A4Uro3 _.....
Wren Name
Irwin , Pennsylvania 15642 724-744-7446.
CV/0m hp mite .....
telephone
Certification
The undersigned hereby slates,under the penalties of perjury,Thal he/she has read the Commonwealth of Massachusetts R
for the Removal.Containment or Encapsulation of Asbeslos,453 CMR 6.00 and 310 CMR 7,15,and that tie Information cc
this nc'mkalioa, is lilts aiJ coi red io the besi of his/her knowiedge;nd b 'el,
Donald Yanke
President -
Osnem/lme
P.O. Box 160
AafJ^'UelSRnPure
5/5/00
par
Catamount Env. , Inc . 802-464-2;
Representing
remnant
Wilmingtlu , Vermont 05363
_ AnAre's elly/luw, 7Nnale
Fee exempt (City,Town,district,municipal housing authority,owner-occupied residential of lour units or less)?D ys
536784
Slicker a (horn Iron'of form):
Rev GI92
9. Describe the asbestos abatement procedures to be used (circle): epee aaa enclosure leaeonameol denvp
Jiffuselonly of her fnplain)
em-arsvlalnw
10. Is the job being conducted ;Lt Indoors 0 outdoors 7
11. Total amount of each type of Asbestos Containing Malerialss(ACM)t ore handled on
nlppes or ducts(linear ft.)
surfaces(equate It.) ,)ineat/sunare feet
/
/ Ihermaf sold nee pipe insulation =/
coupled edor la dud Mal make in ration. ...��/ insulating cement........... /
spay-on Ma roofin paper pipe irrsulahvn..._ _ DoneiIspfa)e Goslings . —
_/
sprapon Drepmvlinp. _ .,..,, __/ bamile board,nallbwrd
cloths.woven RDrks . ..._.... —/
other(please describe) _._._. -
12. Describe the decontamination system(s)to be used:
3—Chamber decon_unit and portable ..shower
13. Describe the
cntarali comply with R M
prope r 6milpolyethylene bgswith asbestos materials
.._
properly wetted inside
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
. lure
Nan.el IMP Nnicial
..................................._..............................................
e..__.__................. Waive,/
one olAvllnupaliun
Na flu
We M e
rail Meat
.......... ......._
Wk M AUtlirfUaliur
15. Do pievailing wage rates apply as per M.G.L.c. 149,§26,27.or 27A Flo Ihis project? 0 Yes )Q No