51-53 Notification of Deleading Work 2006 Department rblio Health-Childhood Lead Poisoning mo
a tion program
Minding Notification -
alactions our Arcs drilyt csspkteor Illegible has will be returned.
License* ■N\I inspectionDide /*A?
Faint Inspector Tcrl Tyer-h aiJC.
t ry Owne 1 !n OH • ! w ai1S5 - ul t, �wr Ma TAp
arty 0wtar's Address is 5 non RJ Sa w.ye Code O/o73
orimdperson perfarmingwmt Tmof ky L S Lid/Aab s n 9J 6 —Oren
- ! !L_ Zip Code eve)7S
on of aghoriad person
phoneNembcr(4ti) r•47 6Q'!d
x s where the work will be done
ling Name Of any)
*Address 5/ 53 o°-cAopJ S'('
Ner.1i,K..,P�I Zip Code 01040
ge llIS SO
lug Fort intact(high risk)
notion
Ping
!pooenttamov v grtwmest
sing
Floor &Ac)
Agg No._
The property is a 4einalriatally_sl gle Amily.
o Making pair;react(moderate
risk)
o Liquid eecameba
o waving
O Cappsgbasebovds
o Applying Waylaid/mg on aatvior
u Component ra wnl(low risk
camp:mots)
o Other
work sift begin on( J /gaud wilt finish by ij/J j4 The wok bedmea the_ .___pm or �twakeeds.
Sae of smeegaey Carnet y?Stint Evning Phone HII Sin 6o'1
time none 413 "Q-0 testy Owner ant complete rod rigs this frin*g 1n*raratiaa: •
glad only ambor'rad peoaswho have ooapliedwith the twining requirements of the Menee6urea lead Miming
ion sad Cann*ReguWian.105 OAR 460.000,will emir dekadmgnix I furtbaesrrifyOW the arborized
will not eseeed the!cope ofbslbaauthority ad wil l be performing oily thole aetivibes ithliaraid show All of the
lion caseined in this doormat is fluoad coraabethe bet of my knowledge ad belie£
e /04//Od Sigped
!feriowin realdgrdpant be radio*in days before beprag work e
apses of the dwelling tab
Ocr ? 5
olhereeeppms off the raaidaml premises,if arty wodc will be done in the comma areas
ldhaod Lad Poisoning Prevention Proem,DFH Fax(it1)77446700{
1/x110
adolph St,Dawn Building
*on,MA 02011
enrol ad Lead Fmgno,1B.WD
Warhiegson St.,Boron,MA 02108 Fax(617)727-7568.
:N Board of IW WiCOde Haartanai Agency
If globes s at lb:Sore Repliers of BS*Mr"all the MA asmie&rkam ilso a 0717)7274470,