24 Asbestos Notifications & Project Revision 2006 124 MULBERRY STREET
2.Street Address
NORTHAMPTON
Ci
4135841078
6.Telephone Number
Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
air
YY
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
100038416
Decal Number
A. Facility Location
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.
LEEDS POST OFFICE
1.Name of Facility
MA
4.State
5 Zip Code
-
B. Project Cancelled
C Check here if this project is/was cancelled.
SEP 2 5 2006
OAPO CF_ALTH�
C. Project Dates
109/24/2006
1.Original Start Date(mm/dd/yyw)
3.Latest Revised Start Date(mMdd/yyyy)
09/24/2006
2.Original End Date lmm/dd/vvwl
4.Latest Revised End Date(mmldd/yyyy)
D. Revised Project Dates
1.Revised Start Date(mm/dd/yyyy)
2.Revised End Date Date(mm/dd/yyyy)
E. Other Project Revisions
F. Revision History
anfO6pdm.doc•rev.2/5/04
1100038416
p
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Quality
Project Revision Notification
For Asbestos Notification ANF-001 and AQ 06
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 t ue and correct to the best of his/her knowledge
and belief.
1TRACIE LAFOND
1. Name
ADMINISTRATIVE ASSISTANT
2. Position/Title
IACCUTECH
4. Representing
1100 STATE STREET
6- Address
kith
09/22/2006
3. Date(mink/divvy()
1(413) 583-5500
5. Telephone
1LUDLOW
7. City/Town
enfO6pdm.doc•rev.21984
01056
B. Zip Code
101056
d.Zip Code
U
nportant:
Men filling out
ams on the
omputer,use
only the tab key
a move your
ursor-do not
me the return
ey.
NSTRUCTIONS
Ark Ast..
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001'
•
10004Q203. .
Deml Nurr4ir
SEP 2 5 au
A. Asbestos Abatement Description
1. a. Is this facility fee exempt-citvtown, district, municipal housing authority,owner-occupied
residence of four units or less?u Yes GI No
b. Provide blanket decal number if applicable:
2. Facility Location:
'LEEDS POST OFFICE
a.Name of Faoliw
'NORTHAMPTON
c.City/Town
3. Worksite Location:
1.All sections of this
brm must be
ompleted in order
to comply with 4
DEP notification
requirements of 310 5
CMR 715
and the Division
of Occupational
Safety(DOS)
notification
requirements of 453
CMR 6.12
0
0
N
o 10 a What type of project is this?
BACK ROOM
a.Building Name/Building Location
Is the facility occupied?
Asbestos Contractor:
'MA
d.State
b.Building it
Yes ❑No
ACCUTECH INSULATION &CONTRACTING
a.Name
'LUDLOW
c.City/Town
'AC000005
f.DOS license Number
h.Facility Contact Person
IGILBERTO DELVALLE JR
6 a.Name of On-Site Supervis '-
ATC
7' a.Name of Protect Monitor
'SCILAB
8- a.Name of Asbestos Analytical Lab
110108/2006
9' a.Project Start Date(mmiddlyyyy)
18:00-4:30
c.Work hours Mon-Fri.
O ❑Demolition
❑ Repair
0
Renovation
❑Other, please specify:
11. a. Check abatement procedures:
O ❑Glove bag
Enclosure
Cleanup
Full containment
z
C
•
❑ Encapsulation
❑Disposal only
❑ Other, specify:
Blanket Decal Number
24 MULBERRY STREET
b.Street Address
'01060
e.Zip Code
C.Wing
(413) 584-1078
f.Telephone Number
d.Floor
e.Room
100 STATE STREET
b.Address
4135835500
e.Telephone Number
g.Contract Type:
❑Written
❑Verbal
I.Contact Person's Title
'AS071488
b.Supervisor/Foreman DOS Certification Number
AA000005
b.Project Monitor DOS Certifi
b
AA000162
b.Asbestos Analytical Lab DOS Certification Number
10/09/2006
b.End Date mmldd
8:00-4:30
d.Work hours Sat-Sun.
b.Describe
b.Describe
12. Is the job being conducted: N Indoors? ❑Outdoors?
• anf001ap.doc•10102
Go To Top
Asbestos Notification Form•Page 1 of 3•
reek
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
■
1100040203
Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
encapsulated:
0
a.Total pipes or ducts`linear ft)
c.Boiler,breaching,dud,tank
surface coatings
e.Corrugated or layered paper
pipe insulation
g.Spray-on fireproofing
i.Cloths,woven fabrics
k.Thermal,solid core pipe
insulation
1272
b. I dal other surfaces(square ft)
ft. Sq.ft.
Lin.S. Sq.ft.
Lin.b.
Sq.ft
S ft
tl.Insulating cement
f.Trowel/Sprayer coatings
h.Transite board,wall board
j.other,please specify:
Lin.ft
Lin.ft
Lin.ft
Lin.ft.
Sq.ft.
q.
272
VAT&MASTIC
Sgft I.Specify
14. Describe the decontamination system(s)to be used:
ITWO LAYERS OF 6 MIL POLY ON THE WALLS AND FLOOR WITH AN ATTACHED 3 STAGE DO
I
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2)(g):
ACM TO BE DOUBLE BAGGED OR WRAPPED IN 6 MIL POLY AND DELIVERED IN A SEALED CI
16. For Emergency Asbestos Operations.the DEP and DOS officials who evaluated the emergency:
'name of DEP Official
c.Date(mMddlyyyy)of Authorization
e.Name of DOS Official
Ib.Title
d.DEP Waiver#
I If DOS Official Title
g.Date(mmlddlyyyy)of Authorization
17. Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this project?
B. Facility Description
h.DOS Waiver It
0
Yes ❑No
1 Current or prior use of facility:
2. Is the facility owner-occupied residential with 4 units or less?
IP.O.BOX 485
POST OFFICE
3 'BUD HALMER HARTLY,JR
a.Facility Owner Name
o IBELLEVUE,ID
C.City/Town
LL 4 (DAVE LIVINGSTON
a.Name of Facility Owner's On-Site Manager
z
83313
d.Zip Code
c.City/Town
• ant001ap.doc•10(02
d.Zip Code
❑Yes
t7
No
b.Address
e.Telephone Number(area code and extension)
Ib.On-Site Manager Address
1(413)584-1078
e.Telephone Number(area code and extension)
Asbestos Notification Form•Pa ea e 2
(EVERGREEN CONTRACTING
a.Name of General Contra or
2. Transporter of asbestos-containing waste material from removalttemporary site to final disposal site:
110 NORTHWOOD DRIVE
1(413) 583-5500
e.Telephone Number
Li__
Asbestos Notification Form ANF-001
Commonwealth of Massachusetts
lote:Transfer
Rations must
amply with the
aid Waste
livision
regulations 310
;MR 19.000
1100040203
Decal Number
B. Facility Description (cont.)
5.
CHICOPEE
101020
c City/Town d.Zip Code
!GRANITE STATE/ZIMMERMAN INSURANCE 1
f.Contractors Workers Comp.Insurer
6. What is the size of this facility?
71 GARLAND STREET
b.Address
e.Telephone Number(area
'WC6987513
q.Policy Number
800
a.Square Feet
e and extension)
111/04/2006
h.Ex•. Date mmld
b.Number of floo
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site Of necessary):
ACCUTECH INSULATION&CONTRACTING
a.Name of Transporter
!LUDLOW
c.City/Town
101056
d.Zip Code
100 STATE STREET
b.Address
1(413) 583-5500
e.Telephone Number
3.
/RED TECHNOLOGIES, LLC
a.Name of Transporter
'BLOOMFIELD
c.City/Town
06002
d.Zip Code
a.Refuse Transfer Station and Owner
c CRy/Town
4. !MINERVA ENTERPRISES INC
a.Final Disposal Site Location Name
d.Zip Code
9000 MINERVA ROAD
c.Final Disposal Site Address
!OH
e.State
44688
L Zip Code
b.Address
(860)218-2428
e.Telephone Number
b.Address
I
e Telephone Number
b.Final Disposal Site Location Owners Name
WAYNESBURG
d.City/Town
g.Telephone Number
D. 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.
anf001apdoc•10/02
ITRACIE LAFOND
a.Name
'ADMINISTRATIVE ASST.'
c.Posifon/rille
9/ 2/20,06
d Date(mm/ddJy ,y)
'ACCUTECH
f.Representing
100 STATE STREET
q Address
'LUDLOW
h.City/Town
101056
i.Zip Code
Go To Top
Asbestos Notification Form•Page 3 of 3•
ACCUTECH INSULATION &CONTRACTING'A
mportant.
Men filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
INSTRUCTIONS
Commonwealth of Massachusetts
•
100038416
Asbestos Notification Form ANF-001 ijr `
SEP - 62006
1.All sections of this
form must be
completed in order
to comply with
DEP notification
requirements of 310
CMR 7.15
and the Division
of Occupational
Safety(DOS)
notification
requirements of 453
CMR 6.12
0
0
0
0
A. Asbestos Abatement Description
1. a.Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied
residence of four units or less? ❑Yes 12 No
b Provide blanket decal number if applicable:
2. Facility Location:
LEEDS POST OFFICE
a.Name of Facility
NORTHAMPTON
c.City/Town
3. Worksite Location:
BACK ROOM
a.Building Name/Building Location
4. Is the facility occupied?
5. Asbestos Contractor
6.
7
8
9
F1
MA
d.State
b.Building#
Yes ❑No
a.Name
LUDLOW
c.City/Town
01056
d.Zio Code
AC000005
f.DOS License Number
h.Facility Contact Person
GILBERTO DELVALLE JR
a.Name of On-Site Supervisor/Foreman
ATC
a.Name of Prated Monitor
1SCILAB
a.Name of Asbestos Analytical Lab
09/24/2006
a.Project Start Date(mmlddlyyyy)
IN/A
c.Work hours Mon-Fri.
10 a What type of project is this?
❑ Demolition 0 Renovation
❑ Repair ❑ Other, please specify:
11. a. Check abatement procedures:
° D Glove bag
❑ Enclosure
▪ ❑Cleanup
❑Full containment
Z
12 Is the job being conducted:
❑ Encapsulation
❑ Disposal only
• ❑Other, specify:
• anf001ap.doc•10/02
12
Indoors?
Blanket Decal Number
24 MULBERRY STREET
b.Street Address
01060
e.Zip Code
c.Wing
(413) 584-1078
f.Telephone Number
d.Floor
e.Room
100 STATE STREET
b.Address
4135835500
e.Telephone Number
g. Contract Type:
❑Written
❑Verbal
i.Contact Person's Title
AS071488
b.Supervisor/Foreman DOS C
tfication Number
AA000005
b.Project Monitor DOS Certification Number
AA000162
b.Asbestos Analytical Lab DOS Certification Number
09/24/2006
b.End Date(mmldd/yyyy)
8:00-1:00
d Work hours Sat-Sun.
b.Describe
b.Describe
Outdoors?
Go To Top
Asbestos Notification Form•Page 1 of 3 •
Al ilk
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
■
100038416
Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials (ACM)to be removed,enclosed,or
encapsulated:
0
a.Total pipes or ducts(linear ft)
c.Boiler,breathing,duct,tank
surface coatings
e Corrugated or layered paper
pipe insulation
g.Spray-on fireproofing
i.Cloths,woven fabrics
k.Thermal,solid core pipe.
insulation
6
otal other surfaces(square ft)
Lin.ft.
Lin.fl.
Lin.ft
Lin.ft
Sq.ft.
d.Insulating cement
S ft f.Trowel/Sprayer coatings
Sq if h.Transite board,wall board
S .ft.
Lin.ft.
j.Other,please specify':
Lin.ft.
Lin.ft.
Sq.ft.
Sq.ft.
6
Sq ft
Lin ft
VAT
Sq.X. I.Specify
14. Describe the decontamination system(s)to be used
SEAL CRITICALS WITH 6 MIL POLY,PRE-CLEAN LAY DROP CLOTH AND REMOVE USING TH
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
ACM TO BE DOUBLE BAGGED OR WRAPPED IN 6 MIL POLY AND DELIVERED IN A SEALED
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
N/A
a.Name of DEP Officia
c Date(mm/dd/yyyy)of Au
rization
N/A
e Name of DOS Officia
b.Title
d.DEP Waiver#
L DOS Official Title
g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver#
o 17. Do prevailing wage rates as per M.G.L. a 149, §26, 27 or 27A—F apply to this project? rill Yes❑No
o B. Facility Description
O 1 Current or prior use of facility:
POST OFFICE
0
2. Is the facility owner-occupied residential with 4 units or less?
0
0
Z
3. a.Facility Owner Name
BUD HALMER HARTLY,JR
4
BELLEVUE,ID
c.City/Town
83313
d.Zip Code
DAVE
a.Name of Faality Owner's On-Site Manag r
anf001ap.doc•10/02
c.City/Town
d.Zip Code
❑Yes
No
P.O.BOX 485
b.Address
e.Telephone Number(area code and extension)
b.On-Site Manager Address
e.Telephone Number(area code and extension)
Asbestos Notification Form•Pa ea a 2
Note:Transfer
Stations must
comply with the
Solid Waste
Division
Regulations 310
CMR 19.000
0
O
N
0
0
0
0
LL
Z
C
oak
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
100038416
Decal Number
B. Facility Description (cont.)
5.
EVERGREEN CONTRACTING
a.Name of General Contractor
CHICOPEE
C.GiN/Town
01020
d ZFp Code
GRANITE STATE/ZIMMERMAN INSURANCE
f.Contractors Worker's Comp.Insurer
6. What is the size of this facility?
71 GARLAND STREET
b.Address
e.Telephone Number(area code and extension)
WC6987513
q.Policy Number
800
a.Square Feet
11/04/2006
h.Exp.Date(mm/dd/yfYV)
b.Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
ACCUTECH INSULATION 8 CONTRACTING
a.Name of Transporter
LUDLOW
01056
100 STATE ST. P.O.BOX 376
b.Address
(413)583-5500
c.City/Town d.Zip Code e.Telephone Number
2. Transporter of asbestos-containing waste material from removal/temporary site to
RED TECHNOLOGIES, LLC
a.Name of Transporter
BLOOMFIELD
c.City/Town
3. I
a.Refuse Transfer Station and Owner
4.
06002
d.Zip Code
c.Citv/Town
d.Zip Code
MINERVA ENTERPRISES INC
a.Final Disposal Site Location Name
nal disposal site:
10 NORTHWOOD DRIVE
b.Address
(860)218-2428
e.Telephone Number
b.Address
9000 MINERVA ROAD
c.Final Disposal Site Address
OH
e.State
44688
f.Zip Code
e.Telephone Number
b.Final Disposal Site Location Owner's Name
WAYNESBURG
d.City/Town
g.Telephone Number
D. 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.
anf001ap.doe•10/02
JUDY CROWLEY
a.Name
OFFICE MANAGER
c.Position/Title
(413)583-5500
haired Si•nature
d.Date(mm/dd/W W)
ACCUTECH INSULATIO
e.Telephone Number f.Representing
100 STATE ST. P.O.BOX 376
q Address
LUDLOW
h.City/Town
01056
i.Zip Code
Go To Top
Asbestos Notification Form•Page 3 of 3