123 Deleading Notification 2003 a b i d e
Abide Inc Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: I- /6 - 03
ATTENTION: FAX #:
[v"Director,CLPPP(Boston) 617-284-8410
[L4". Director,LEAD PROGRAM(Boston) 617-727-7568
IA Town/City of 44/3 - 5g 7- /aa
(Local Board of Health)
[ ] Massachusetts Historical Commission 617-727.5128
FROM: FRANK TILLDABIDE,INC.
REGARDING:
[✓f PROJECT NOTIFICATION
[ ] REVISED NOTIFICATION
[ [ OTHER:
NUMBER OF PAGES (including this one): 3
COMMENTS:
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CONFIDENTIALITY NOTICE: The documents accompanying this tdcoopy transmission may contain confidential and privikgcd
infor alioo from Abide,Inc. This in/unmade is intended for the use of the addressed individual or
entity. Ifycu art not the intended recipient,be await that any disclosure,copying.distribution.or
use ofihe contents of Nis tremmIsskn uprohtbiiM Wynn have ueceived this transmission in nor,
pre sc noun/us by telephone(413-525-0644)immediately. Thank you.
P.O. Box 886 East Longmeadow, MA 01028
Phone 413-525-0644 • Fax 413-525-0678 - E-mail ABIDE I @aol.com
• r
ABIDE, INC. PROJECT IP 03031
a .
COMMONWEALTH OF MASSACHUSETTS
Department of Labor Industries and Department of Public Health
NOTIFICATION OF D£LEADING WORK
All section. of tAle fobs wet be completed in ordoct9-comply
with the notification fapiSr .nt. of N.O.L. c.111 j 191,
454 sat 22.00 and 105 Oa 460.000 an most raenntly mended
PILE NUMenl'
(Am.:cY OSe)
Contradorperlonningprojed ABIDE, INC. (Frank Ti11i) licensed DC001 (119
Exp.date70//03
Lead Paint Inspector NeiI She era flail License M 2170
Date of Inspection 9- Q-021
If low-risk deleading work is being performed, complete the following line:
Property owner Agent(s)
Address of Project
Building Name (if any) Floor
Street Address IA3 Me4Qnw 5f Apt. No.
City (IOYeil/e ,UA zip 0l06,Y
Deleading Method: et/Dry Scraping Heat Gun Caustics
Liquid Encapsulant Covering Demolition epl acemen Other
If "Other" selected, please explain
check ow:
Start date
welling ie multi-family scnale family V/
A,- 17 -03
when will work be done:
Completion date
A.H. TOO P.H. 5:00
,S- /4- 03
Weekends?
Project Supervisor's name Robert P. LaMountain License 0 D53605
Property Owner WAOhl fAYh/NAV/uAnit
Address /Al3 Meadow 6#.
city Elorenros J44 State j1AA zip
Te)ephone L413) 5-fl -58th 7
In case of emergency contact
Frank Tali, President
Phone: day 413-525-0644 evening 413-525-0644
(over)
In accordance with Mall"Xhasetts General Laws c. 111 4 197 Qh 22-L Id 105 CAM 460.000 notice
of the date and n.etha al of removal or covering of paint, plaster .,r other aceesal :1e materials
containing dangerous levels of lead is to bee+provviided ands must be received by the following must
persons, at least ten f101 dap prior to be g.
Occupants of the dwelling unit
All other occupants of the residential premises, if any
Director, Childhood Leading Poisoning Prevention Program
Department of Public Health, 470 Atlantic Avenue, Boston, HA 02130
Director, Asbestos 4 Lead Program
Department of Labor r Industries
Room 11006, 100 Cambridge Street
Boston, MA 02202
Local Board of Healtn/Code Enforcement Agency
Massachusetts Historical Commission
220 Morrissey Blvd.
Boston, MA 02125
Fax i6f7) 284-8410
tax 16171 127-7568
GIfy fax dr 4/13-5g1- I
11f premises is listed on the State Register
of Historic Places, this notification must be
made upon receipt of an Order to Correct
violations or at least 30 days prior to
initiating preventive deleadinol
Fax 16171 727-5129
➢Weeding Coateactes
The undersigned hereby states, under the pains and penalties of perjury, that
he/she has read and understood the Commonwealth of Massachusetts Deleading
Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control
Regulations, 105 CMR 460.000, and that the information contained in this
notification is true and correct to the best of his/her knowledge and belief.
Date
11 16/0 3
Signed:
ank
Title: President
Company: ABIDE, INC.
Property Owner Iff owner or unlicensed owner's agent will be performing low-risk daleading work)
I certify that I have complied with the training requirements of the
Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations,
105 CMR 460.175, for owner/agent low-risk abatement and containment. I
further certify that I or my agent will be performing
the following low-tisk activities (I have circled all that apply :
applying liquid encapsulant
applying exterior vinyl siding
removing doors, f tinet doors, spotters
capping baseboards
covering suetaces
I certify that all the information contained In this notification is true and correct c the
best of my knowledge Lltl belief.
Date: Signed:
ABIDE, INC. PROJECT # 0303"9
REV 10/12/95