62-64 Notification of Deleading 2000 :YINILM So'eu.
4.
a
COMMONWEALTH OF MASSACHUSETTS
Department of Labor 6 Industries and Department of Publ
NOTIFICATION OF DELEADING WORK
All sections of this form must be completed in order to c
with the notification requirements of H.G.L. c.111 S 197,
454 04R 22.00 and 105 0191 460.000 as most recently amend
OOIC3
FILE NUMBER:
L)
NORn4aIONICOF HEALTH
Contractor performing project Abide, Inc. (Frank Tilli) License # D0001619
Lead Paint Inspector
ly /tKIC 14R4NEs
Exp.date 8/30/00
(E CS) License #
Date of Inspection
If low-risk deleading work is being performed, complete the following line:
Property owner Agent(s)
Address of Project
Building Name (if any)
62 (04 /4kwL -i
Street Address
Floor
S'I Apt. No.
City k/06171tRMY1 DO Zip olb(oO
Deleading Method: i@Vet/Dry Scraping Heat Gun Caustics
Liquid Encapsulant Covering Demolition Replacement
If "Other" selected, please explain $ L 1ZC.MW/#i--
Check One:
dwelling is multi-family V single family
Start date .3/2../ /CO Completion date 3/L4/00
When will work be done: A.M. .j P.M. Weekends?
Project Supervisor's name
1 013.zrz-r I A111,c.i4JTA tn.) License #
A/C
Property owner CHUCC 3cwL -c. bowtu-r Etc ERPR 1S ES
Address
City
237 MAx , s
A)OR-r-1-)A MPV)N
State
MA-
Telephone
In case of emergency contact Frank Tilli
Phone: day 413-525-0644 evening 413-2631146
(over)
Zip ) Clop
of paint, 4Ra 22'e�[ `o Other accessible materials
In accordance di mh Massa. of t rs General Lams i 111 4 191 QpR ster and 105 OBI 460.000 notice
of the date and rousole(e)so of removal or covering o must be received by the following
containing dangerous levels of lead rstaabeginning e provided ff deleading.
persons, at least ten (10) days prior
Occupants of the dwelling unit
All other occupants of the residential premises, if any
Fax (617) 753-0436
rogram
Director, Childhood Leading Poisoning tic Avenue,PBoston, MA 02110
Department of Public Health, 470 Atlan
Fax (617) 727-7568
et) Director, Asbestos 6 Lead Program
llll Roos r c 11006 of Labor fi Industries
Room 11006, 100 Cambridge Street
Boston, MA 02202
Local Board of Health/Code Enforcement Agency
6. Massachusetts Historical Commission
220 Morrissey Blvd.
Boston, MA 02125
1•) `r in,.vro•• iiekt nt 9cT-
210 MAW TJ fLR"tn M OTON L1.VlaC
(If premises is listed on tnotification gister be
of on eceiptr c Places of an Order to Correct
upon at least
prior to
initiating preventive deleading)
(611)
727-512b
eel ading Contractor
The he/shedhasr read and e understood the e
Commonwealth aof Massachusettsp that
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
3/s /Do
Signed:
Title:
Company: Abide, Inc
ty Ownar or(If owner o unlicensed owner's agent will be performing low-risk deleading work)
I certify that I have complied with the training requirements of the
105 monwalth of Lead
low-risk9abatement andnc Regulations,
ntainment. I
further certify that I or my agent will be performing
the following low-risk activities (I have circled all that apply) :
capping baseboards
covering surfaces
applying liquid encapsulant
applying exterior vinyl siding
removing doors, cabinet door's, shutters
I certify that all the information contained in this notification is true and correct to the
Pest of my knowledge and belief.
Si Led:
Date:
REV 10/12/95
deer
Pet/Dry Scrapingi,
'2000 WED 09:57 FAX 410 020 MHO Alert a .,
'X CAPmcELLAT1on/ * �°
COMMONWEALTH OF MASSACHUSETTS
Department of Labor I Industries and Department of Publi
NOTIFICATION OF DELEADING NORA
# DD103
11 E
lal section. of this form net be completed an order to aosplt L1L I
with the notifioation ragidreseenta of N.O.L. c.111 5 197,
451 001 21.00 and 105 on 460.000 as east recently •vended
ORTHAMPFON BOARD OF HEA11W
FILL )almf:
Contractor pedonnetg pr*d Abides Inc. (Frank Till!) license(' D0001619
Lead Paint Inspector
Exp.date 8/30/00
M* K WrIkc-S LEGS) License e
Date of Inspection
If low-risk deleading work is being performed, complete the following line:
Property owner Agent(s)
Address of Project
Building Name (i£ any)
Street Address 62-Cot PAWn GY
city k)o2'c'3trin-vr"De )
Deleading Hotbed:
Liquid Encapsulant
If "other" selected, please explain SOIL
s
Floor
Apt. No. -
Zip 0tOfo0
Heat Gun Caustics
Replacement
20w1,0✓n0-
Covering Demolition
Check M":
dwelling in multi-family V
Start date
single family
Completion date
When will work be done: A.N. V
RO6v'eT AritarrAvO License it ..953L0.5
Sowtes etate2PR )$ES
Project Supervisor's name
CHOUL 3owlr-$
Weekends?
No
Property Owner
Address 237
MA-1A-I
ST -
City a)O0.'M1IA MrfM
Telephone
State
MA-
In case of emergency contact Frank Tilli
Phone: day 413-525-0644
Zip 0 ) D/oo
evening 413-2631146
(over)
/2000 WED 09:57 FAX 413 520 00(0 Manic i...,
In accordance with Ma,noseCts General Lava C. lit S 197 CMR 22. ,nd 105 CM11 460.000 notice
of the date and emthodara) of removal Cr covering of paint, plaster or other accessible materiels be containi�gtdannet us IvelsJOf lead
ead isktobbel provided and<must
stgbe received by the n following tom persons, at
Occupants of the dwelling unit
2. All other occupants of the residential pcemiees, if ally
Directly Childhood Leading Poisoning Prevention Program
Department of Public Health, 170 Atlantic Avenue, Beaton, MA 02110
(9 Director, Asbestos a Lead Program
Department of Labor c Industries
Room 11006, 100 Cambridge Street
Boston, MA 02202
Local Board of Health/Code Enforcement Agency
6. Massachusetts ahusetts Blvd.
Commission
220
Boston, MA 02125
Fax (6171 753-8436
Fax (611) 727-7566
�1� 'et Ceri) Stir-vital
a0etaaA,Aeteea s een.,11t P�f.
24 poky-) S-r. a A702c+rra rim& 040bb
(If premises is listed on the State Register
of Historic Places, this notification most be
made upon receipt of an Order to Cotrect
Violations or at least 30 days prior to
initiating preventive deleeding) 121-5120
Fax
Delaad{t{g Contractor
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 beat of his/he; knowledge and belief.
Date
3/8 /oo
oi Ls
4
Title: +�r�/r/f%1=.1/S��
Company: Abide, Inc.
Property Owner (If owner. or unlicensed owners agent will be performing low-risk deleading work)
I certify that I have complied with the training requirements of the
Commonwealth of Massachusetts Lead Poising Prevention and Control
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-risk activities tl have circled all that apply) :
applying liquid cncaNUlanc
capping baseboards
applying exterior vinyl siding covering surfaces
removing doors, cabinet drabs, snot{era
I cettity that all the inturmat ion ront•ined in this notification is true and cot ter o, the
nest of my 'knowledge and belief.
Dale; :i goad:
REV 10/19/94
72000 WED 09:57 FAA 41J 0z0 00,o ADLUL ....
a
a b i d e
Abide,Inc,Environmental Contracting
FAX COVER SHEET
DATE: 3)2214)
ATTENTION:
FAX NUMBER:
FROM:
REGARDING: Lead Ar4-kine^J Prune-1- Can tr1144hQN
NUMBER OF PAGES(Including this one): 3
SE
13C WW)
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COMMENTS:
FAnt
rlrecite Ct-Per
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D,recess- Lead Drone Al
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Nar#Nee_nplvel Ssars4 n-F H4V l tin
'If; 5237 12-21
If there are any problems receiving this transmission,please call 413-525-0644.
Ce.WWYay Notice:The Ammo scanqrsnihn Ws tel'M/IrmagnIen m9'contain miWmasl W privacy'
bkmaam from AMA;Inc.MY lafemstlab Sad d bhe fee the a.ed as dtvd SISALS read!-Urn on
net the'Swam ealplml,be mare that••y ashen,<spying.amlbam ram of the cams et deb saamlimb
pol:hed,line Wee.ttl•eJ ale tenn■aiso in ester,place.db m by senses W.dWly.
P.O. Box 886 East Longmeadow,MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • E-mail ABIDE @aol.com