12 Notification of Deleading 1990 DEPART ME.. _ OF PUBLIC Di:ALTF/DEPAR'TME.NT ON :.ABOR & INDUSTRIES
NOTIFICATION OF DELEAD::dc WORK
All sections of this form must be completed in order to comply with
the notification requirements of M.G.L. C. 111 S197
UMBRR
Lead Paint Inspector Iter DC
—__Da _ of Ins e :Fan 9/6/90
Contractor perforr:ing project " n
Address of Project
Building Name (if any)
Floor
Street Address I .' .. . .
City RorL amcto:1, 111 .
Deleading Method: DRY SCRAPING
(circle all that apply)
Apt. No.
aip O : OGn
■.HEAT G6N1 (-'N'CAPSULATION
) DEMOLImION
POWER SANDING CAUSTICS
CREPLACEMP:N16) OTHER
If "Other" selected, please explain
Check one: dwelling is Multi-family
Start date : 0 /66791
When will work be done:
Project Supervisor Name
Property Owner
Address 9iv
am
Fs
single family
.ule, i!,e ..- fl/)H/r.H .
City 'adl
Telephone (413) ;61-6160
State
In case of emergency, contact what person:
Phone: Area code required day ( =.PY -
0034 B/L
(OVER)
License Si lO661 3
D DI ^"1r
evening same
rev 11/16/09
DEPARTMEN. OF PUBLIC HEALTH/DEPARTMENT OF s.aBOR 6 INDUSTRIES
NOTIFICATION OF DELEADING WORK
All sections of this form must be completed in order to comply `-ith
the notification requirements of M.G.L. C. 111 5197
FILE NUMBER
Lead Paint_ Inspector Waite Dernheck
Contractor performing project Afford:h e ✓,n
Date of Inspection
an frog
9/6/90
I:cense gDC (100 613
Address of Project
Building Name (if any) Floor
Street Address 12 Viii :C- Apt. No.
City Northampton. MN . yip 01060
Deleading Method: DRY SCRAPING ■HEAT GUN) ( ENCAPSULATION) DEMOLITION
(circle all that apply) --
POWER SANDING CAUSTICS cREPLACEMENTI OTHER
If "Other" selected, please explain
Check one: dwelling is Multi-family single family X
Start date
10/25/91
When will work be done: am Y am
Completion Date 10/211/91
Project Supervisor Name Edward E . 'Pruchart
weekends?
Property Owner Holly lrtzerounian
License gDC 000613
Address 3B West St .
City
Hp l cv
State vi zip 01015
Telephone ( 713) 536-6100
In case of emergency, contact what person:
Phone: Area code required day ( HOB ) 219 6
n nc
(OVER)
evening 5350e
0034B/5 rev 11/16/89