18 1st & 2nd Floor Notification of Deleading 1993 F- -.
In accordance with Chapter 773 of the Acts of 1987, Massachusetts General Laws
C. Ill 5197, 454 CUR 22.00 and L05 CM.R 460.000, notice of the date and method:'
rem val or covering of pa:nc, plaster soil or other accessible material conta c
dangerous levels of lead, is to ne provided to the following persons at least
days prior to the beginning dif deleading.
1. Occupants of the dwelling unit
2. All other occupants of the res'.dentral rremises, if any
3. Director , Childhood Lead Poisoning Prevention Program
Department of Public Health, 305 South Street, Jamaica Plain, MA 22130
4 . Lead Removal Program, Bureau of Technical Services
Department of Labor and Industries, Division of Industrial Safety
100 Cambridge Street, Room 1101, Bontrn, 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 sine has n
and understood the Commonwealth of Massachusetts Deleading Regulations, 454 Of
22.00, and Lead Poisoning Prevention and Control Regulations, 105 CUR 460.00, e
that the information contained in thin notification is true and correct to the
of his/her knowledge and belief.
Date 7/28/93 Signed: ("r`'(y / ( zt":7C
Title: Contractor
Office Use Only
90348/6
Company: Affordable Contracting
rev 11/1
DEPART' OF PUBLIC HPALTO/DEPARTMENT OF FOR & INDUSTRIES
NOTIFICATION OF DELPADING 'WORA
All sections of this form oust be completed in order to comply with
the notification requirements of N.G.L. C. 111 5197
PII.n NUMBER
Lead Paint Inspector Gus Karoubas Dare of imIDection 8/4/92
Contractor performing projec,.Affordable Contracting ( I,_e;,,,e 7 DC000613
Address of Project
Building Name (if any) Floor 1st & 2nd
Street Address 18 Michaelman Ave . Apt. No. Ext .& Common
Areas
City Northampton Zip 01060
Deleadinq Method: DRY SCRAPING HEAT GUN ENCAPSULATION DEMOLZTION
(circle all that apply)
POWER SANDING CAUSTICS REPLAC&9ENT OTHER
If "Other" selected, please explain
Check one: dwelling is Multi-family X single family
Start date 8/ 9/ 93 Completion Data 8/14/93
When will work be done: am X Pm weekends?
Project Supervisor Name Edward Trueha rt IJ cense iDC000613
Property Owner Valley Millbank Limited Partnership
Address 16 Armory St .
City Northampton State MA.
Telephone
(413) 586-5855 (john Dunne owner)
In case of emergency, contact what person:
zip 01060
Pauline Cadiero
Phone: Area code required day ( 508) 249-6332
(OVER)
evening
same
n7nnrr
JUL 2 8 1993
0034B/5 rev 11/16/89