6 Asbestos Notification Form 2003 Fif10— 0escnprlon
1. Current Or prior use of facility:
RES./PE/St
2. Is the facility.bwner-occupied residential with 4 units or less? Wes ❑ No
3. Facility Owner: n
i,2nh12, G.recW.es �o Ca.Lvm l;r(asu...
i000 3 -5k -075/7 .
res.
Znt
AoCilthIMRTd0 MA
Cligloon
4. Facility's Owner's On-Site Manager:
N/A
ay/Town
5. General Contractor:
Ace..Asbestos Removal &__Insulation 716 Pine._Mead..W_Rd .
NSW Address
Northfield MA 01360 413 498-0201
w ➢o ca refephone
CryAo
u9c ara37aSi 09/01/03
Granite State Ins . Co .
Contort Workers Comp.Insurer Foley/ Ery.0efe
6. What is the size of the facility? 3Qx2Qso ft) (l of floors)
OWe
&Wren
Lprme renp m
13 Asbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site:
Ace Asbestos Removal & Insulation 716 Pine Meadow Rd .
Mn
Northfield, MA
anon«,
Address
01360
by role
413-498-0201
!elephant
2 Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site:
waste Management of CT, Inc .
Ai Ellen
NbR
Portland
CT
203 Pickering St .
06480 860-342-0667
Zipc+de Telephone
ommonwealth of Massachusetts
Asbestos Notification Form — ANF-001
no s
pl to
ompiecW
iply with
n1 of
al
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1310 CMA
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el Labor
n
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ty
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Its
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02112
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nations
iHAPS(40
Asbestos Abatement Description
1. Facility location.
C7rea✓es resrde.,rcr.-
he 141 CO,1 p± ■ fY)1
c,rynmwn
-8 flemea
Kan the xorale(G a rompNs, I y -
fame
2. Is the facility occupied? $,Yes Nc
3. Asbestos Contractor
Ace Asbestos Remo
Na
Nor.tbf iald..MA.
thy(Tann
AC000006
O:I L✓sna./
Revise ti nrEs
7rrace-.
0/0/nc . L1,3 � 6 7
e � r- '
I _:',4AMPTONBOAND OF HEALTH
TnSUlation 716 Pine Mea'R--
Address
412-40&.-0241...
ZIO care reremkw
Canrm ryrelwnrii& .it')
4. On-Site Project Supervisor/Foreman.
Ed Shearer/Tom Theurer AS70245/AS70066
ou wadn6SU
/taint
5. Project Monitor
RaymQnd 3 ,. Bresnahan A' .31.604
uleemmaeaa
Nom
6. Asbestos Analytical Lao'
Environmental Saririi'l9 S -destiny AA000132
alcmmaew✓
Name 5/5/03 ) /7/03 3c 30
7. Protect start date 5 /31C nd date3/5/4ec'dlc work hours(Mon:Fri 1 u a-7 is (Sat.Sun.)rti 0 to
�moruwCD out fe.wam) Meat
8. What type of protect is this? (circle one). verity/0/ repo 4 'stem
Nml:.lrans/er
Stations must
compfr Nish the
Sorts Waste
Division regula-
tions 310 CMR
18.00
Note:Contractor
must sign this
form for DLI
notification
purposes
3. Refuse transfer station and owner Of applicable):
N/A
vane
ASlat,
Woo Iii rNe Telephone
4. Final Disposal Site:
Turnkey Recycling & Envir . Enterprises, Waste Mgmt of NH, Inc.
Loan,Nn
97 Rochester Neck Rd .
Demers Nam
.Wm
Conic
clnnpon
NH—
03839 603-330-0217
7 i role relmhoire
Certlficatlon,
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Reguk
for the Removal.Containment or Encapsulation of Asbestos.453 CMR 6.00 and 310 CMS)7.15,and that the information confab this notification is true and correct to the best of his/her knowledge and belief. F, evi Secs al19 /0%
(deva✓d D Shcare( e � 2 /1/03
MM ' Aveiaved Sienaere On
Ace Asbestos Removal
Yr'es, /4pr & Insulation 413-498-0201
NMoMne
716 Pine Meadow Rd
AMm
kpetenling felephone
Northfield, MA 01360
ally/raven 4 tale
Fee exempt(CIy;Town,"dlstdct,municipal housing authority,owner-occupied residential of four units or less)? yes 0
Sticker (from from of form): %(n3 7 93
tie
592
9. Describe the asbestos abatement procedures to be used (circle)- oure aa; eztume full eM renI m"
set–up variable air pressure ,
erclppwnv
d15m5a1oR, purer Wind") poly work area ,HEPA vac ,HEPA
filter respirator , 4et asbestos
10. Is the lob being conducted JC
indoors II outdoors p
11. Total amount of each type of Asbestos Containng to
ore encapsulated es or ducts(linear ft.) lac archer
pupates(square h-) nC n linear be/square feet
_ thermal sole core pipe irsulalion _ /-
botrug2tea[ding.duC.lperpupa�e elation msutIng p�rwpl... 1111.._.—
sprrugneE erbofing paper pipe rnsWanm fi r_ ucweVSpafei coatings 1111 _1
spray-On
iof w venrabncs pansile board,well board —J--
clorrts.woven bbria
ape((pease describe, -
12. Describe the decontamination systemic)to be used 3 obambero decoea unit •;Li tn,
water shower , tYve1 suits , ..
in labelled double sealed poly 's 5s
13. Dee we the containerization/disposal be cetnotlsm laibell,ed 7.15 453 poly Eev:2t asbestos & pace
before removal from site.
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency.
me
Neel/
Odle d/vnduewn
15. Do prevailing wage rates apply as per M G.L c 149. §26,27,or 27A-F to this project? le Yes K No
AMA
ANKs.,
1. Current dr prior use of facility:
RESIDeCCE
. .
2. Is the facility Owner-occupied residential with 4 units or less? $.Yes 0 No
3. Facility Owner
AcT/4-02- Graves t enlv5n rrerracc_
Address
IUCen/414211)0 0/06,0 ---5"g6-075/2
City/Then Zip rode Telephone
4. Facilitys Owners On-Site Manager:
Name
k?/Teen
AdIress
2w rile MED/Sone
5. General Contractor:
Ace Asbestos. Removal & Insulation 716 Pine Meadow Rd
Hr. Address
Northfield MA 01360 413 498-0201
Cily/town
fl Telephape
'CC W07370?
Granite State Ins . Co. WC8510581 09/01/03
Contra-lords Workers Comp Insurer Poky/ fergDele
6. what is the size of the facility? (12,KOso ft) c2 (0 of floors)
121 Asbestos Transportatlan and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal sit
Ace Asbestos Removal & Insulation 716 Pine Meadow Rd.
Name
Address
Northfield, MA 01360 413-498-0201
Waive
Zip code Tempt,.
2. Transporter of asbestos-containing waste maturel from removal/temporary storage site to final disposal site:
Waste Management of CT, Inc . 203 Pickering St .
Mn
Arelress
Portland CT 06480 860-342-0RA7
OMS
d this
mpleted
dy with
n of
Akation
310 CMA
Mg Eats
n is
abatement
e
al Libor
n
2
1Ligament
(len
12 Ie0
KdI1 P'm l5
ly
a,Of;realer
y0/
ginal Form
pith of
rtb
O9la1P
187
02112-
may be
lying the
mental
,envy Region
demolition/
petabons
:SNAPS(40
ommonwealth of Massachusetts
Asbestos Notification Form — ANF-001
flAsbestos Abatement Description
1. Facility location'.
Greg VCS reSidU
A c6J- 1CaCi-Mpion al
mw ms me(ronla ile lalalM w1W 1afre./,wing,llrol,rom
2. Is the taciRty occupied? 231,Yes Li No
Name
7Aowe
3. Asbestos Contractor nlpgrd6^Ah1Aa'(1N BOARD pptfEAL7M�.
Ace Asbestos Removal & In=ulation 716 Pine
AEdleta
Name
013_60._ 417_4 ra0-024:
V,arm field M.A.-. hp code releptae
�fl T u,
AC 00e6 LON, I bey(wnheA4tAM)
(Mara SIA
4. On-Site Project Supervisor/Foreman.
Ed nearer/Tom Shearer
AS70245/AS700016
Ou CMDnOWm/
CP _Cat 11if1 retrace, _.
dr
01060 /3 .5gt- )5i7
Nil axle rnep'1le
it itu1 --9 d
I .1511 FEB - 4 2003
Name
5. Project Monitor
Raymond and 7 • .Pxesnahan . A7.01604 a16ed✓iaup'✓
Nam
6. Asbestos Analytical Lab.
Environmental Sampling Testing AA000132
of ang IXI .emmrlw/ -
Name �
(Sat Sun.) n
7 Prajxdclad date=l /Dnddzte.�sl=1pecificwork hours(Mon Fri) ' update
omely heat
leptir rerovaian system
8. What type of project is this? (circle one)i. cempcoon eWain)
Note:Transfer
Stations must
compy with the
Sofid Waste
Division regula-
tions 310 CMR
I8.X
Note:Contractor
must sign this
form for DLI
notification
purposes
crhaoen
3. Refuse transfer station and owner(if applicable):
N/A
Name
tip Tux
cirynown move Telephone
4. Final Disposal Site:
Turnkey Recycling & Envir. Enterprises, Waste Mgmt of NH, Inc
foram Nfl
97 Rochester Neck Rd .
O nrs Name
conic -
Ciry/Tum
NH—
03839 603-330-0217
no awe Telephone
D
Certification ,
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Re
for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information con
this notification is true and correct to the best of his/her knowledge and belief.
rcQwa✓d Shearer a 4,t.� a /1/03
PmV i Aueuve)Siinaw, Care
Ace Asbestos Removal
_ ?res,c%rrr & Insulation 413-498-020
kbvnar na,e,enrn! Teleplay
716, Pine Meadow Rd. Northfield, MA 01360
ideas Warm zei code
Fee exempt(City;Town,-district municipal housing authority,owner-occupied residential of four units or less)?Ryes
Stickers(from front of form): '7t,3 7 93
92.
them
9. Describe the asbestos abatement procedures to be used (circle): glove
—u on lullbleeair pressure,
ercaoladn disposal omy omniexam) poly work area,HEPA vac,HEPA
filter respirator ,wet asbestos
10. Is the job being conducted X indoors ❑outdoors?
11. Total amount of each type of Asbestos Containg Materials(ACM)A )t or e handled on
nlpiipes or ducts(linear ft.) Sao oedher
surfaces(square ft.)
linear/square feet
thermal,sold ore pipe irtulation.
botrug leadring.dud.tank pipe �nsudlin9Cemeel
corrugated o/Wofing paper pipe usulalron. aowedsptayer coatings
spray-on breirooln9. garage board,nil board... . —�
dotes.woven dents
obwr(please descnbei —�-
12. Describe the decontamination system(s)to be used. ? chamber d e con unit with warm
water . shower,. tyvelz suits ,HEPA vac for clean—uP. _.-.....
13. Describe the containerization/disposal methods to comply wi O and CM 14(2 (g).
Eewet asbestos & paw in double labelled poly *cogs
before removal from site.
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officals who evaluated the emergency:
Narrz 010 r pevul
(➢a MAtJWflon
wrr.dal Ultra
tie
we reN
Oat vlAleuvaal4n
15. Do prevailing wage rates apply as per M.G.L.c. 149,§26,27,or 27A-F to this project? O Yes )(No