77 Project Revision Notification 2007 (2) .i4u
r
'0/It + .
h.
mportanT
When filling out
orms on the
computer,use
only the tab key
o move your
cursor-do not
use the return
key.
INSTRUCTIONS
1. This form is
only available for
online filing of
project date
revisions.
2. Enter project
decal number.
3. Validate that
the project
location is correct
for the entered
decal.
4. Enter your new
project dates.
5. Certify your
notification.
Submit date
changes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100050238
Decal Number
A. Facility Location
VACANT HOUSE
1.Name of Facility
177 MAPLE STREET
2.Street Address
NORTHAMPTON
3.City
6.Telephone Number
MA
4.State
5.Zip Code
B. Project Cancelled
U Check here if this project is/was cancelled.
C. Project Dates
01/24/2007
1.Original Start Date(mm/ddfvwy)
3.Latest Revised Start Date(mm/ddlyyyy)
01/26/2007
2.Original End Date(mm/rid/ I
4.Latest Revised End Date(mm/tld/yyyy)
D. Revised Project Dates
1.Revised Start Date(mm/dd/yyyy)
01/29/2007
Revised End Date Date(mm/tld/yyyy)
E. Other Project Revisions
F. Revision History
anfo6pdm.doc.rev.2/5/04
JAN 262007
NORTHAMPTON BOARD OF HEALTH
oak
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention —Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100050238
Decal Number
G. Certification
The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of
Massachusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310
CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge
and belief.
JUDY CROWLEY
1. Name
OFFICE MANAGER
2. Position/Title
ACCUTECH INSULATION & CONTRACTING
4. Representing
1100 STATE ST. P.O.BOX 376
6. Address
[LUDLOW
.( �. C,h-tt--LLJ
zed ienature
/25/27
3. Date(men/dd/yvyv)
I(413) 583-5500
5. Telephone
01056
7 City/Town 8. Zip Code
anfo6pdm doc•rev.2/5/04