5 Notification of Deleading 1994 In accordance with Chapter 77] of the Acts of :98 . , Massachusetts General Laws
C. :11 5197, 454 CMR 22.00 and 105 CMR 460.000, notice of the date and method ;:
removal or covering of paint, plaster soil or outer accessible materLal contain,_
dangerous levels of lead, is to be provided to the following persons at least_ '.
days prior to the beginning pi deLeadiny.
1. Occupants of the dwelling unit
2. ALL ocher occupants of the residential. premises, if any
J. Director , Childhood Lead Poisoning Prevention Program
Department of Public Health, 305 South Street, Jamaica Plain, PA 72110
4. Lead Removal Program, Bureau of Technical Services
Department of Labor and Industries, Division of Industrial Safety
100 Cambridge Street, Room 1101, Bostpn, MA 02202
5. Local Board of Health/Code Enforcement Agency
6. Massachusetts Historical Commission
(if premises is listed on the State Register of Historic Places(
The undersigned hereby states, under the penalties of perjury, that s/he has rev'
and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CIF
22.00, and Lead Poisoning Prevention and Control Regulations, 105 CMR 460.00 , an:
that the information contained in this notification is true and correct to the rh
of his/her knowledge and belief.
Date 9/16/94
Signed: &cit l4// (` .oL
Title: Contractor
Company: Affordable Contracting
Office Use On1y
00342/6
rev 11/16/'.
rr,r—I nei er'Jr DEPARTMENTAF PUBLIC aEALTR/DEPARTMENT OF LAWA6 INDUSTRIES
NOTIFICATION OF DELEADING WORK
SEP 211994
f� A1L sections of this form must be completed in order to comply with
the notification requirements of M.G.L. C. III 5197
FILE NUMBER
Lead Paint Inspector Environment Insp. , Inc . Date of Inspection 9/7/94
Contractor performing projectAf fordable Contracting License 1DC000613
Address of Project
Building Name (if any) Floor _2nd
Street. Address 5 Michleman St. Apt. No._ 5
City Northampton Zip 01060
DeLeading Method: DRY SCRAPING HEAT GUN ENCAPSULATION DEMOLITION
(circle all that apply)
POWER SANDING CAUSTICS REPLACEMENT) OTHER
if "Other" selected, please explain
Check one: dwelling is Multi-family y single Gamily
Start date 9/26/94 completion Date 9J7n/gq
when will work be done: an x pm weekends?
Project Supervisor Name Edward Truehart License IDC000613
Property Owner Marken Properties
Address 667 Main St .
City Holyoke
Telephone (413 ) 256-1720
State MA zip
In case of emergency, contact what parson: Pauline Cadiero
Phone: Area code required day ( 508) 249-6332 evening same
(OVER)
0034D/5
rev 1l/1s/39