50 Asbestos Notification Form 2002 fatldtyDessdption
1. Current or prior use of facility:
2 Is the facility'owner-occupied residential with 4 units or less? AI Yes 0 No
3 Facility Owner:
same ICh ?.uc hats ki ALUMS
so Si d 0 hoc
r rex,c_q_ ma
0.1 .o 6.0
c/a/Tom
4 Facility's Owners On-Site Manager
N/n
Nene
Cia/Toae
5. General Cbntiador:
Shearer & Snide Inc dba/Ace Asbestos
Name
laude rdMaSee
. . a3- 93s- 093g
Zip ate
Northfield MA .
Croenoan
Granite State Ins . Co.
comxtors worms coop.Nsux
pony,
Melon
01350
rehMrve
716 Pine Meadow Rd.
Zip coca
WO8540594
6. What is the size of the facility/SOX-56(sg h) a (t of floors)
Asbestos Transportation and Disposal
1. Transporter of asbestos-containing
Shearer & Snide Inc.
Name.... .._........
Northfield
covroym
413 498-0201
reopia e
09/01/01
E p.Date
waste material from site to temporary storage site(if necessary)to final disposal site:
dba/Ace Asbestos 716 Pine Meadow Rd .
Adares5 __......_.._...._.
MA 01360 413 498-0201
lm arrt INpoop
2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site:
Logano Trucking-Waste Mgmt 209 Pickering Street
Nome
amre»
Portland CT 06480
Note: Transfer cgnnm 860-342-0667
lip We rw.mN.
01C110116
tons ol this
be completed
I comply with
rtment ot
venial
on notification
en ts ol 310 OMR
WJrking day;
Mahon is
I of any abatement
and the
ment ot(Abu
patties
yon imuirements
1MII 6 12 (Mn
Jar noldication Is
of ANY
en!prole greater
wee‚wear or
led)
)n1 Original Form
oorno.alth at
;salmons
stag Program
1.1200V
on,MA02112.
CommonwealthoilWassachusetts
Asbestos Notification Form — ANF-001
Asbestos Abatement Description
-Rich&ski les tn S+ra,(a) int
I. Facility location:
ri re ) k, A-4 A 010 g
Cily/Foo lip rade !A b
his Ion may be
for ncrMing the
Environmental
action Agency Region
asbestos demolition/
ovation operations
iirm to NESHAPS(40
Warne Wen
iD CA-5-e-rne,nt 11
WW1 5 Ihe ov431M ovum?Iwildiag mat i.wing.!bor.scam I
, . MAR 44002,
..
2. Is the tacility occupied? AlYes 0 No
3. Asbestos Conttactor:
Shearer S. Snide Inc dba/Ace ,Asbestos 716 Pine Meadow Rd .
Name ea ill9VAL 6 IPS titt41746A) &4,m'
Northfield MA. 01360
Telepnone
413 498-020
City/Iv" Isp wit -
AC000006
OLI License I CM(X)To e(ivritteafterbar)
4. On-She Project Supervisor/Foreman:
Ed Shearer/Tom Shearer
OtiCeraricalime/
AS70245, AS70066
7591.11
0 9 3 F
11 '1
Name
5, Project Monitor;
lelq1M0A)1) 3gESA)41-141‘.)
Name
6. Asbestos Analytical Lab:
(A) . ..NWrilt .5AmFG006 & 0
132_
Nan. -TE S-1)r‘DG Warticalion I
7. Project start datelji_t/44nddatel/i2/122specif ic work hours(Mon.-Fri.) 341_.L3c1(Sat.Sun.) 0
update
out(expo) heat
system
144 31661
Old Cellthcaoll/
What type of project is this? (circle one).
aemomon
AM/
.i.awanwsi
campy with the
Solid Waste
Division regula-
tions 310 CMR
18.00
Nola:Contractor
must sign this
form for 0(I
notification
purposes
3. Refuse transfer station and owner if applicable:
N/A
Mme
Address
wow/
4 Final Disposal Site:
valley Landfill Waste Management/ Logano Trucking
Lot*m One amens Name
Pleasant Valley Rd .
D
PA
15642 724 744-7446
Certification:
The undersigned hereby states,under the penalties of penury,!hal hNShe has read the Commonwealth'of Massachusetts Regulations
for the Removal,Containment or.Encapsulation of Asbestos 453 CMR 6.00 and 310CMR 7.15.and that the information contained in
this notification is true and correct to the best of hismer knowledge ayd_yelief.
al.ulard Shearer ' .a /a7/oa
Pm,!Name AuffNed&wMU2
Shearer S Snide Inc. dba/
-Prtsidfune Ace Asbestos Removal 413 498-020]
Rottem
716 Pine Meadow Rd.
Add/13%
lap"SenlMM-
TNepae
Northfield , MA. 01360
CiryAUrm &mm
Fee exempt(City,Town,district,municipal housing authority, owner-occupied residential of four units or less)? {yes ❑ no
Sticker#(from front of form): 75 9 4/ 7
Rev.6192.
9. Describe the asbestos abatement procedures to be used (circle): glove eaa encwrwe ( ull[un19nlmnl ) ukwau
set—up variable 3rr pressure,
ezysulylm disposal oily wner(wpam) poly work area ,HEPA vac ,HEPA
filter respirator ,wet asbestos
10. Is the job being conducted $l indoors O outdoors? •�
11. Total amount of each type of Asbestos Containing Materials to
oreaandldolntpiippes or ducts(linear It)iQ_or other
♦70 to be removed,
surfaces(square ft.) linear/square feet
_ IMrma(solid core pipe insulation. ..
.
boiler.rugated oor la edpapv pwlace ulano9f_./D / insWatinp anwnL__...._, �-
corannfirr6ofing .pw p'ce —J— eowelhpaYerCoerirge...... .... ..
spray-on fireproofing -- varsile bond,wall board__.
cloths,woven tabrla —— .... .
one/(please desnbe)
12. Describe the decontamination system(s)to be used: 3 chamber de con unit w/n'a rm water
shower ,tyve'< .suits , HEPA vac for clean—up. _...._
13. Describe the containerization/disposal methods to comply with 3W CMR 7.15 and 453 CMR 5.14(2)(g)
Re wet._asbestos & pack in labeled double sealed poly bags
before removal from site .
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency'.
nee
Win deer OAitial --.
.._.._.._.._
..._.._.._....._.._.
.._.._.._.._...._...._.
.._.__........._.
no.
new ysuaawl
..._.......
Oil OI4iiIIWYwaal
15. Do prevailing wage rates apply as per M .L.c. 149.§26,27.or 27A-F tothis project? O Yes S,No