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17C-224 (15) TATc STREET, BUILDING#119 1-BOO-944-5773 _._.;... �_....__..._..._......... :.._.. . .._ _ ....._. x _ _683',' _.._, _ ..... ___. LUDCOW, MA 0'1055 FAX {413} 58-0-5555 X.R.- WTANT SMOKE RESPIRATOR FIT TEST A. *MPLOYEE INFORMATION ' Test Tama: Qualitative: irritant Smol€e. Rainbow Name of.Employee- Stanley Si sz Date: 06/-?Ii/04 Employees Social Security number 01 R 1 92 1 ?04.2 =_Icarae#: AtZ-7,n&-)2 Company: AccuTech fnsuia4 ion & Conirac'r.ina, Inc. S. RESPIRATOR INFORMATION Respirator Tyne Selected: l2 Fay Negative Pressure Manufacturer: North Model 77 30- Approval #: T C21 01,32 Stz S CM2 L, PAPR: RACAL. Model: Po`er~flaw Approval#. T C2'1 C353 1S1: Model: Tyohoon Approval t— T C21 C492 Name ofTest Conductor, Anthtonv Rov Employee Slgnaira: r t „ • b C. TEST RESULTS lrateral Head MovemerYt Pass x Deep Breathing pass x Stationary Jogging Exercise Pass x Rainbow Passage Reading Pass x Employee Reaction to Agent After. Test Fuss x Proper Performance of Positive and Nagative Pressure halve Check and Fit x Employee Passes Employee Fails Exi:)iration Date: 0£/25/05 Respirator Fit Tast Performed in Accordance Wiith NIOSN and 0SPIA Methods and Procedures. ELH OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES J North fain Street s East Longmeadow, MA 01028 • (413) 525--6003 FAX (41 3) 523-9009 MEDICAL SURVEILLANCE EXAMINATION.AND RESPIRATOR APPROVAL REPORT TO EMPLOYER o� SS#: ra��'T� Date: �mployea Nam � � i �t Le Exposure In accordance with The Department of Labor&Industries, I have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place his/her health at increased risk of impairment due to lead exposure.. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the Increased risk attributable'to the combined effect of smoking and asbestos exposure. In accordance with C?.S.H.A. Standard 29 CFR 1926.58,1 have examined the above named person today and found him/her: Medicaliy qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. { Medically guali;aed with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (see Comment). Medically !.iriosa.ialiied Respirator Clearance The above named employee's relevant health history and physical pxamiinabon results were evaluated. T he reported field conditions of the job were also reviewed. Based on this review,this emplovee is: Cleared for full respirator;use Cleared for restricted respirator vase as follows (Circfed); No SCBA use, No heavy exertion, No exposure to nigh heat stress, Other(See Comment) Not cleared for respirator use COMMENT: r 3 l � 1 �Medical EA _r.....-^ 904.X6 y . ' �y�ti' "�+� � �°'l `y$`' 3 �3�'�' ti3 +Sze' � ��.t�t4•. ,-,p�tN �R�'Q.a��`'�+�,a, a�A"' ^ o- _F .�,,s�.,,� '�-0 L .�'� � 67✓7�4'. 'yd�i�"°tt+° ,, a 4. ,, AY,a.'°Plr f�itN�YEi7'�khO dy�l1 x�,ri ey. k �n,>.q�, ,��20�s�t"�E, ,�5�`ai��Ry°�;ten'. '� �xi �'a��a�wya> a'a m� v1`t1 tY.t+',,b,�,w•"'nf�'31 tY� 5-a i°.s� #tom n-,�. W�°es �,�i:r. 'Mv s°.r:p�ri'�,a�alm����'b r "'✓Ram>�i �11•a '9t�s< �,;'e?�v C�+�,��' �a �'4 y;, + >. ,.� ,.> N „- � w�a��',''sa``r'r c'�;�3� t n. �'� T's�oa7�' ����t�r�"*w: ��g�s",}' t�.�;r,� w+.�� .�a�ro,- �'�aE� �•e ur� �'�` ��'rs � ,fir.ar �� AWRA 9 M OF CHIE E�IE�TT'CERTIFICATE ml> f Y This certz f es that 'h has successfully completed the 40 Hour ,asbestos Abatement Supervisor/Contractor Training Asbestos Accreditation tinder TSCA Title ii 40 CFR Part 763 conducted by ATC associates Inc. • t 4 39 Spruce Street Last Longmeadow, MA 01028 (413) 525-1198 ' Regional r41anage, Principal Instructor I June 24-28,2002 MOSS-247? � Certificate NirmBer Date of Course a' A June 2$,2402 me 28,2003 � Fxpiratlan Date �aurinaf9ass are pf f, '► l�t� _ y+p �. rst rVw '---,Nr +a � i; s�4r ,�4w' a �' k'LA '!a l''tan', a �y�I f• ✓1.G t 5. r'N, p N: '� �f'q?' t y'�$ �� ,4 ��"�i• x44 �i .}Zp p � ..,� +tit9hi •.y ,t •' ,, xyyv � t�swv .s �VI.W, �KDSm>c miq � ��k,' ,mom, Y< 'iF."4� - <�y ;i�" cqy hQ�,?br'4�N'd � '-0�✓tea`aiT `'°r a� a•M ,r ;''.v''mN` �►Y.p 'rrvT;q'"d�' '+ki"9s'�+✓�6 -W �V�,�'1VCN^.` e �(y P+' n a�y"'�T� t .f .t- -1�} .ft a +•.�yM1 'G � �ry�4 ,� �S.�i 1t•1��"L� f'�•Y,p.,..n,s<. ✓ i1. y"yfyl�1 ?�'qw a � sr,.,�¢4 h �¢Y' ° ��\'- 'q+Nm` �' ',F T� yi�j�,(�VLy� L��-A A .4u,.�.iOS' -ALi. �q� � .etays ,��'�`Si ' tJ .G�J�'. •�':�Y3. � .�,.�. a�"*.�a;.t m g Al L" ... ........... 48 -14 lw' �- w Rood ,Fber of C trt s: 8P . auTech I,NSULATION CONTRAMNG,INC. STATE STREET, BUILDING#119 1-800-244-8773 PO, B©Y 376 (413) 583-5500 LUDLOW, MA 01056 FAX (413).583-5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. Employee Information Test Type: Qualitative Irritant Smoke Rainbow Name of Employee: Hector Suarez Date: 11/1/2004 Employee Social Security : 584-73-0968 License#: AS071103 Company: AccuTech Insulation & Contracting, Inc. B. Respirator Information Respirator Type Selected: 1/2 Face Negative Pressure: E Manufacturer: North Model: Approval#: TC21 0152 Size: PAPR: RACAL:'Model: Powergow Approval#: TC21 C152 ISI: Model: Typhoon proval#: TC21 0152 Name of Test Conductor: Les' i w... .... Employee Signature: C. Test Restfs .f Lateral Head Movement Pass Deep Breathing Pass -- -,Stationary Jogging Exercise Pass Rainbow Passage Reading Pass Employee Reaction to Agent aster Test Pass L/ Proper Performance of Positive and Negative Pressure Valve Check and Fit r' Employee Passes Employee Fails Expiration Date: 11/1/2005 Respirator Fit Test Performed in Accordance.with Niosh and OSHA Methods and Procedures. r OCCU--HEALTH OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES 200 North Main Street + East Ldngmeadow, MA 01 028 + (413) 525-6003 + FAX (413) 525--9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Name: G- ff'� sJ U ' ZSS#: `C - `` late: �;2 c� Lead Exposure In accordance with The Department of Labor&Industries,I have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place his/her health at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with O.S.H.A.Standard 29 CFR 1926.58,1 have examined the above named person today and found him/her: Medically qualified With no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically qualified with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). Medically unqualified Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: Medical Examine gaa.as i i t j CERTIFICATE OF ACHIEVEMENT { This certifies that Hector M. Suarez has successfully completed the 40 Hour Asbestos Abatement Supervisor/Contractor Training Asbestos Accreditation finder TSCA Title If 40 CFR Part 763 conducted by ATC Associates Inc. 31 Spruce Street East longmeadoms JWA 01028 (413) 525-1198 P of c(pallnstructor Regiana(Afanager April 14-18. 1.997 40SS--2596 Date of Course Cerltftcate A5rmber April 18, 1998 April 18, 1997 Expiration bate xmrurration ate t 3 , i 1 .�; #� ,mss yam. 'C�' � '�,=x"gip t,.�,� �..'�sB`R�!� 4r `�I»Y7'' ► .... ,4► ��.� � � Y}�.. ,P" 'v�F ,�'� .il a'i F NM w M 00 a.�+ r w ,e ,,,�„r,;,.r .+q� �s,.'f' a ,.,CII�• + .,, „, ,' 4Ue : s< t a<, °” Nero CE r. - .L �. _��, ��1.. .Act TI 1' A_ MENT. l-'i2t,S certifies tllcrt Hector M. Suarez has successfully completed the a 8-Hour Asbestos Supervisor/Contractor Refresher. Training Course Asbestos Accreditation Under TSCA Title- 11 40 C TT. Part 763 +. C01701teted by ATC Associotes Ilxc. 3P Spruce Street ' East I,t�rx;rrrecttlol�=, A-fry t)It028 013) 525-1.198 ell Principal trrstrrrrrar /r€gurnr,..11„rtrgar SAR-6471 Jt nVOIT 9, 2[10=1 --- L?trrG c5coursr f'ertt ctrtc.�`rrrrrher Atrrraty 9, 2005 Jcrnttury 4, 2(I�d f xpirar?tur t)crte lis7nur7T(—,tnrr t cr1e S s� � ' , "”' . Y w °' a VIM< , 'i. JV'pn'.' •a< .{y,� .�yi°i+Qia 1<�4 J."4 � x^'b#{�y ty� y�'iP �M � "�"V Dye ARM 1 �d dNr �iTR.�V A y� q� � 4 M4\T r CL�OJifr w4'O P i { IMP W +aai�" .. .r�+.�" ' ' '. `` �o' �'�,` "+�r�'�: °` ° Gammonwealth oaf M63S chose s Division of Occvpationai safety. _ f?,w J.preaioso,rommissiow Aspestos Supervisor HECTOR M.SUAREZ Elf.pate 03/15105 Exp.Date 03114106 A80711MI J jep aer of CAN E'S. � SP .r RCCUTech I'NSULAMON' &CONTRACtING,INC .STATEE STREET, BUILDING#119 1-800-244-87773 F'O. BOX 375 (4.13) 883-5800 LUDLOW, MA 01066 FAX (4l 3) 583- 8w M RESPIRA*rOR FIT TEST A. EMPLOYEE Wow i ioisl Test Type: Qualitative: Irritant Smoke Rainiacsw ' Name of Employee: Brim Cous neau late: 07/2S/04 =mplavees Soccial Security Number. - '� ! 60 I 21 53 t_icanse AS073338Company: AccuTeoh insulation & Contracting Inc Respir atOr—1 .,"•F'lactted: 1!2'l=aace Negative Pr essur"a Ma;iuFacturer; tooth Model: Approval#: T C21 C1 52 Size: S (M? L PAPP: RACAL: Model: Powerflow Approval# T C21 0353 ISI: Model: Tyohac�n " proval9 TC210492 Marne of Test Conductor: ,�t7l hone Roy Employee Signature: C. TEST r!�SULT'S Lateral Head Movement Pass X Deep Breathing Pass X ' Stationary Jogging E emise Pass 1 rainbow Passage Reading Pass Employee reaction'to Agent after Test Pass Proper P norrr;ance of Positive and Negative Pressure Valve Cheer,, and Fit ' X ' Employee basses employee Pails Expiration Date; 07/23/05 respirator Fit Test Performed in Accordance:lf%fith NIOS'r' and OSHA Methods and Proc=dures. .................... .......... ............ .......... ko")"CCU—HEALT 1-F H -OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES 200 North Main Street * East Longmeadow, MA 01028 - (413) 525-6003 PAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER ate: Employee NaMI&L�A,� n SS#. Lead Exposure In accordance with The Department of Labor&Industries,I have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place his/her health at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditi6ns that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure, In accordance with O.S.H.A.Standard 29 CFR 1926.58,1 have examined the above named person today and found himfher-, Medically qualified with no restrictions: This employee hA no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically qualified with the following restrictions: This following medical condition exists that places this employee at an increased risk of material.health impairment from exposure to asbestos (See Comment). Medically unguallfied Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full respirator use Cieared for restricted resl2irator• se as foliows (Circled): No SCIBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: W1 e d i C a I E X airlr�,i P eft+ X1'�+a�9•►y�'w r i. a+v�a•y4VA't c}a ias tap o w.-.T•a.t{".q�y,>�s7'pv]p'i.r.+.a.•n`'0�gtaOt<p.8W saK+'\iWa'k rt s•'d �+iNiP'a t; ,fit�y��....w'4y�b,� >tt l+.A'wOV+`__l.ttM y MOVE tltC �V,n•t„•wd�1 'P.A �v �i-C 4py TEN Ir nz r CERTIFICATE OF ACHIEVEMENT �t This certifies that Arian Cousineau PP 3 has sziccessf illy completed the , 40 Hour Asbestos Abatement Supervisor/Contractor Training Asbestos Accreditation Under TSCA Title it 40 CFR Part 763 conducted by A TC Associates Inc. 39 Spruce Street Ecal LonSmeado-vi,, A 01028 • (4.13) 525-1198 ;Principal Insfruclor Reglanal Manager Judy 14-18;2003 40ss-2619 j ;Dale Of course Cerll rcate?trrartt6er �t Duty 18, 2009 July 18, 2003 '$xpirallonDale 'tiannnallon Date 9 ` �' �► ' '" t' :+ Ao� ' �� aye=, 17,M",7p.•V 4-4.T -v jj Of OF U1 � a gwo ii' t�J� 1 tYk +' � �W t - j �'Fw.ivaP,5 t�re *yp'Y6M al+r {���n 'Nta •i'c'y .�. ytL•.e'��✓'a.0 fl.'�s.m• 0 .yr+ tl" ,� �"'. ay. v°'ay D�•-va,. qw ' ti s�� s�A r�� .gym �� � .�. .�:�,. -��► �� f � I '�- r '� 1� �,c w 1• yI 4 h«j'xM`M!1"wiM1' a x? '�W"tl 41'�'v�a a 'iM vF" RAW i. ��9• •,� '! 61'~ s <r, .s w., �a v ✓• '711 fT ►M'• 'fNMa"W'Y? L, i' n."n r<t a.,t4s�, �,>i .,y ,W, �y,p "�Pt. �, '�.°y�:. Win• sar• rt uvro-•• .y� alp �*� ,�,, -lit � bx ddb �t+8 e �'D�xae its ^i �+' +kc s e vii, 'ttr�t ,�W VA4 o � $ CERTIFICATE Off` ACHIEVEMENT This certifies that Brian Cousineau has successfully completed the S 8-lour Asbestos Supervisor/Contractor Refresher Training Course I Asbestos Accreditation Under TSCA Title If 40 CFR Part 763 corrr;Ittcled by /I 7"C 4 ssoeiates Inn. �,. . 39 Spr•ttce Street t l i East Lot? i,icrcrc ovv, IA 01028 Prirtciprtl lrrsirara�u Rc�ginr,:7f;Srn�a�rrr' June 19,'OOd r Date qfC Curse Certrttturc'Number t� .111ne 1 2005 June 19, 2004 t rrrtrtin�tk5r? :? r.xj�u'crtintr Data # ,& �s �, �'' w h,t a �fi ` �'` ,. ,• 4. 1�' `. <�,py� y�Nv '> �°'.s+��•, -0�Ib 7r''' ♦<ppy�� ii�b. �,p>{cam Zv.. d� ��w qr � �h � '77ia�V�6~, jYp 'N�4:M�✓"�Ar���4'F.il+tr .j <.'�` iN�Met �l'M y ,� '°Si."tb�c�' .��•rGM> ELM imp' O ,.y,, ��y���� ������ ,�,y����� yam• y��� Vim.`.�N �.� fih �.W�nyYry��, •bM �y� N' `S ��y� , �a �. ��, �T9G* µ �� � (P^�t, 's�o:A*� �°�:�" .v�,::r�. ira:+va! •�� � '71M� a"�4a"s +� *m".�"" .�:f�. �"�.�'� �' a Commonwealth of Massachusetts Division of Occuepitional Safety Robe J.r ezwo,Goat'S.-to/W Ast�estos Supervisor �l2FAbF C��Sf tVE,4f1 Eff.Date Qr/20104 Exp.Date 07/19/05 a ASt173338z MFSmt�retG.t'N:E:S. '� �F- E �� � SP=R 3 r ticcuTech € &CONTRACTING,I . °S•TATESTREET, BUILDING#119 1-800-244-8773 P.O. BOX 3761- (413) 583-5500 LUDLOW, MA 01056 FAX (413) 583-5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. EMPLOYEE INFORMATION Test Type: Qualitative: Irritant Smoke, Rainbow Dame of Empiayes: Anthony Roy Date: 10/01/04 Employees Social Security Number: t f 7579 License#: AS71233 Company: AccuTech Insulation &Contractincs, Inc. B. RESPIRIATOR INFORMATION Respirator Type Selected: "/2 Face Negative Pressure Manufacturer: North Model: '7!i't2o Approval #: TC21C152 Size: S t L PAPR: RACAL: Model: Powerflow Approval # TC21 0353 ISI: Model: Tvohoon Approval#:x TC 1 C492 Name of Test Conductor: '^ Employee Signature: i C. TEST RESULTS X Lateral Head Movement Pass X Deep Breathing Pass "X Stationary Jogging Exercise Pass X. Rainbow Passage Reading Pass Employee Reaction to Agent After Test Pass X Proper Performance of Positive and Negative Pressure Valve Check and Fit X Employee Passes Employee Fails Expiration Date: /0/j • r Respirator Fit Test PerfZmed.in Accordance With NIOSH and OSHA Methods and Procedures. OCCU,-HEALTH `CUPATIONAL HEALTH AND COMPLIANCE SERVICES 200 North Main Street a East Longmeadow, MA 01028 a (413) 525-6003 FAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Na SS _ �� ate: Lead xposiure' In accordance with The Department of Labor&Industries,1 have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place his/her health at increased risk of impairment due to lead exposure, Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the'increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with o.S.H.A. Standard 29 CFR 192&58, i have examined the above named person,today and found him/her. Medically qualified with no restrictionS: This employee has no detected medical conditions that would place him/her at an increased risk of material•health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically Qualified with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). Medically unqualified Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: _ Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: Medi I xarrmi(er .. 904.98 E CERTIFICATE OF ACHIEVEMENT c { This certifies that Anthony G. Roy, Sr. n has successfully completed the 40 Ifour Asbestos Abatement Supervisorl+Contractor Training Asbestos Accreditation Under MA Mld II 40 CFR Part .xSJ conducted by ATC Associates Inc. 39 Spruce Street East Longmeadow, OVA 01028 (413)525-1198 ) a ; PrinetpalInstractoy RegionalManager June 16-20, 1997 400-200 Date of Course Certificate Number June 20, 1998 June 20, 1997 apiradon Date Exonfinalion Daye i o a%�Ir a a MOM * �i���pSµµ'J/;�9A;4 1y�»' ►' � x x< *qx t w `y t� +'ra � WIN B Ar > aJw I►sX'o. r.Mo _a>te1-a 4oA v�+�"s, MAa�?w^:.d'a V o ,9 r MEMO,,c•,4 A > ' � � 541T YWy , g BP� �.i s`M a,. ° o?•�Q $� CERTIFICATE OF ACHIEVEM ENT This cor°tife.s that Anthony Roy, Sr. � i has successfully completed the 8-Hour Asbestos Supervisor/Contractor Refresher Training Course Asbestos Accreditation Under TSCA Title 1140 CFR Part 7'83 conducted by ATC Associates Inc. 73 William Franks Drive ` Tf1est S'larinkqfield JWA 01089 (413) 781-0070 , r • i Pegional Mtalager Principal rnStr'rrCtn7 ,Iamlar r 7. 21)05 _ SAR-6924 13atE hf C'tSt1P.S2 Cerd'ncaw Afurntrer January 7 2006 Jatsuayy?, Zt10a" W ; - Examination Date Expirtrtinn CJate ; P& -'P `s y s }I'a�,`�1 r�•. ,++ �., ` Y 1 .i c > i• is �'4 3r�i" 5' +;ass'�,, `aF �y t o } Pp+' xPPo >Y 4ee P•a < t� 4 ail ql rrowkww+ 'yq �wMwt ����rwwy �wa"'�> ff. �uwh F7aY gy'*3o- ,p��• _ � �►44;,� 4.•�tbk':,Pp� 4 +Ny4p+lfi..sJr�'��. �+1�"=.�+'tt ,y�yy � ..�,.� � � �II� �'^Nk�� �,��., "�y�i •!�iq ��y ,��•p� _ +®::a .f�� ti,� �F" � � .�:.w' �ua�au �.:�Y'. •ru:� au'0.".aaa Commonwealth of Massachusetts Division of Occupational Safety Robert J.Prez=o,Commissioner I Asbestos Supervisor ANTHONY G. ROY SR Eff.Date 06/15/04 1 Exp.Date 06;14105 AS071233 + ' Mem�•rn'C.O.N.E.S. SF 11111111 IIN1111111111111 till 1111111111 SPREN r • � AMNGo INC. STATE STREET, BUILDING#113 1-800-244-8773 P.O, BOX 376 (413) 583-5-500 LUDLOW, MA 01056 FAX (413) 583-5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. Employee Information w._. _, bs 2T,ype.... --:.__.; ._.:m...__._....Grr�atitatiV&4 tffhf-5rrioke-Rai"nbow._._.--..,_ Name of Employee- Gilberto Delvaile Date: 11/1/2004 Employee Social Security : 106-60-2399 License#: AS071488 Company: AccuTech Insulation & Contracting, Inc. S. Respirator Information Respirator Type Selected: 1/2 Face Negative Pressure: Manufacturer: North Model Approval#: TC21 C.1 52 Size: PAPR: RACAL: Model: Powerflow Approval#: TC21C152 ISI: Model: Typhoon Approval* TC21C152 Name of Test Conductor: Lesli Atwd Employee Signature: M�14dl C. Test Results ateral Head Movement Pass �eep Breathing Pass stationary Jogging Exercise Pass t./ Rainbow Passage Reading Pass V Employee Reaction to Agent aster Test Pass Proper Performance of Positive and Negative Pressure Valve Check and Fit .r Employee Passes Employee Fails Expiration Date: 11/1/2005 Respirator Fit Test Performed in Accordance with Niosh and OSHA Methods and Procedures. C}C U-`��'H EALTH OCCUPATIONAL. HEALTH AND COMPLIANCE SERVICES ZOOmNp'rth:MairrStreet • East Longmeadow, MA 01028 (413) 525-6003 FAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee N .. . ' `-`� Date Lead Exposure In accordance with The Department of Labor&Industries,I have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place his/ her health at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has beers informed of the resuits'of this'exani nation and any medical conditions that may result from asbestos exposure and has beer'warned'of the Increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with O.S.H.A.Standard 29 CFR 1926.58,1 have examined the above named person today and found him/her: _Medically qualified with no restrictions This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on'the.use of a respirator or personal protective equipment. Medically qualified with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment): Medically unqualified Respirator'Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Rased on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, ,Ao heavy exertion,'No exposure to high heat stress, Other(See Comment) Not cleared for respirator use '':COMMENT: Medical Examiner y 904.98 C vZ�• rf v'y��r ..�ti t��/�tiq.;`t t..lf�' �1''1, v• i. J i �vvt• rr, * y,', V r a �"'' a\, flI r 11 M��`,�r&I—>',� �h S��a. tf '>f �� #�r• F,` ' l�� !y4A v'°S1F._: �r.-7 .�, ..� �.' 'fix. x. .� J'Y„�` � a: E” �` �• �`c' s'� ghis is to certify that } rraa . � +. Defvaffe fins attended anti'passed'the e �nination for the course + � ntractor �,r.. II � 4sfiestos �rf 4 and has completed the requisite training for.Asdestos,Accreditation under�1S�'A �IitCe II. Conducted by � . ' x6ide, ,Inc. Post office Oox 886 F z, East .Longmeadow, WA 01028 800-696-AOID Location of Course: Springfield, MA �{ (Date(s�of Training: March .16-20, _1998 Yours of Training: 40 iration(Date: March 20, 1999v-�'�r� "ran Ttl,(president {r Certificate�VumGer ASG011 k �AA.� '.i •Mb �•�• / �/�.,�,T'^� X84' 4"r R'-��� A�� �� p �� �� •� p� IMn °T 6"yM1 41..0"A 4//•' • M '.MMi T T lO'- Fr0 d="r` �•. ;� �M.`Y' 1�y' R[ 'F.A 'M.t' {�.nsi• '4yT'.+�i�1iCF <. T � This certifies that Gilberts Delvalle, r, has successfully completed the r `8-Hour Asbestos Supervisor/Contractor Refresher Training Course Asbestos Accreditation Under "TSCA, Title Ii 40 CFR Part 763 r Y conducted by A TC Associates.Inc. ' « i 39 Spruce Street � East Longmeadow, JW.4 01028 `+ 1 (413) 525-1198 Principal Ensrr'uctor I�cgrottal'ifi�arra�c�r },r a November 5,2004 SAR-6881 I. vote of Course certf wOkuntber November 5,2005 November 5, 2004 + Expiration Dote x-andrrafio+f Dafe " ,, s d Tel 1�pgrh �ti:� '�i' 't"tj'yR�"� ' t�` R��,v, ►.�jy tip.9�' 1Y' f 6 R.I. �,� .iw�' ��, PRO, tq� �•i � R<`+w. r°"<'�P'bap y��'s<'°��* RI t'g�y�,,, Nfs f . Ji`lL. .� �'!'.y!..R 16`Nr�R+aYA'�!P �Mo'9f�N ,►,¢..oW� �� � .' ;. Y .M*e , ; AP -r I r r Affech. WSWAT � . . SiAi�� ST?REBT, BUILDING -:-I19 -BOO-244-87173 PC). BOX,376 1t} LU7i OYV, MA 61&b FAX(4`€3) 593-5555 I: .. SMOG RESPIRATOR FIT TEST A. EMPLOYES. Il�#FC RMATI€ N ' Test Type: Quslitative: Irritant Smoke, Rainbow game Of Employee: Mi gs1 Retimoso gate: 06125./o4 Employees Social Sec:urity,Number 105 1 78 I 7061 License t� AW2117 Company: ARccuTech insulation & Contracting, Inc. S. RESPIRATOR INFORMATION ION Respirator Type Seleeted: 'lx Face Negative Pressure Manufacturer: Nor ih Model: 7700-39M--= Approval=: T C2'1 CI52 Si? S M L i PAPR: RA Al Model: Powerfiow Approval•�'. TC21 030-3 ISI: Model: Typhoon Approval's —Q21 CA 92 Larne of Teat Conductor: X Anthc nn Ov Embloyes Signat,ge: b C. TEST RESULT S Latar6l iHsad Movement Pass ._x .� Deep Breathing Pass Statio nnary Jogging Exarcise Kass x Rainbow Passage Reading Pass Employee Reacton to Agent After Test Pass Proper Perfdrmarca of Positive and Nagadve Pressure Valve Check and Fit .�..,,x, Employee Passes Employee Fails Expiration Gate: nr,r,)i/n S Respirator Flt Test Pyrfor;ned in Acc*�dance With NIOSH and CSI-IA I'ltr-t` od's and P;ocedurss, i t OCCU—HEALTH OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES 200 North Main Street s East Longmeadow, MA 01028 e (413) 52S-6003 4 FAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Name: ` f �a.ICY ) $S#: Date: c "d Lead Exposure In accordance with The Department of Labor&Industries,I have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which.would place histher health at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with O.S.H.A.Standard 29 CFR 1926.58, 1 have examined the above named person today and found him/her: Medically qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically qualified with the following restrictions: This following medical condition _.. exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). Medically unqualified Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: Medical Exami er 904.98 ' TRITN ING (�OHOOL, IN, 88 Franklin `street, Lawrence, MA 01811 11elephone: (978) 689-7370 Thin i�� to cca'[.il y URAL Miguel A. Reynoso h€ 5 -,,rL€lly c�ompletCd (1 e1 3 -11c Lll' COi`€€e c Asbestos Worker - Spanish pursuant to the requirements l�or asbestos accreditation vf'tlic 'l'SCA, '1'ii.lc 1.1 A10799-16-M€27061 Cerlillcu4.c NumbC1. JUL 13, -JUL 16, 1999 JUL 16, 2000 Datez of Trainin8 . l xPil'ahon DII.C. 7 JUL 16, 1999 _ Jon i�3 W '.T r. ,X� Mpf —,j:, Vt-01 11,ys4 N Q7 'N t alp, Wpm MAN I-M a oil a M ........... k R - AM F—MAEKs MW f Comm,amueallth of US Division of aca�qpafional Safety RO-Irt y'ttea mso,Commissioner '� { Apop s er ' W E WP90 , ! Eff.Date OW- ,5/t4 r _ { Exa bate A 07-2,1417 Moil 1111111 x J . "SU€AI[O &CONTRAMNG,INC. Cir -STATE STREW tl BUILDING#113 1-800-244-8773 P.O. BOX 378 (413) 583-5500 LUDLOW, MA 01056 FAX (413) 583-5555 IRRITANT BESPIRATOREFIT TEST A- EMPLOYEE INFOR-MATION Test Type: Qualitative: Irritant Smoke. Rainbow Dame of Employee: Dale Hardy Date: 1 Employees Social Security Dumber: 7 -1 235 ~� License#: AS71733 Company: AccuTech Insulation & Contracting. Inc. S. RESPIRATOR IDFEDRMA17IO Respirator Type Selected: 1/2 Face Negative Pressure Manufacturer: North Model: 7 700 Approval#: TC21 0152 Size: S. ( L PAPR: RACAL: Model: Powerr"low Atpproval #: TC21 C353 ISL Model Typhoon Approval TC210432 Dame of Test Conductor: ,•.f 4A nv v Employee Signa ire: '' C. TEST RESUL.T S X Lateral Head Movement'Pass X Deep Breathing Pass X Stationary Jogging Exercise Pass X Rainbow Passage Reading'Pass X Employee Reaction to Agent After Test Pass X Proper Performance of Positive and Degalve Pressure Valve Check and Fit X Employee Passes Employee Fails Expiration Date. 10/01/05 Respirator Fit Test Performed in Accordance With DIOSH and OSHA Methods and Procedures. CCU-HEALTH CUPATiONAL HEALTH AND COMPLIANCE SERV€CES 200 North Main Street o East Longmeadow, MA 01028 4 (413) 525-6003 EAX (41 3) 525_ 00 MEDICAL SURVEILLANCE EXAMINATION ACID RESPIRATOR APPROVAL REPORT TO EMPLOYER Em Ic ee Narne:-J,,-z-UL. SS#; � Y J Lead Exposure In accordance with T^e Department of Labor&Industries,1 have examined the above.named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place histher heaittx at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has been info;med of the results of this examination and any medical conditions that may rest;lt from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with O.S'.H.A. Standard 29 C=R :926.58, l hav?examined the above named person today and found himlher: Ki !Medically civalified with no restrictions: This employee has no detected medical conditions `.hatwould place him/her at an increased rsk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medicaliv t7 ualified with the following restrictions: This,`allowing medics!condition 66sts that places this employee at an'increased risk of material health impairment from exposure to asbestos {See Comment). MedicalIV unqualified Respirator Clearance i ne above named employee's relevant health history and physical examination results were evaluated. The reported Reid conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full res irator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other (See C'omrnent) Not cleared for respirator use COMMENT: l'lledical Exaiilh ear 904.98 CERTIFICATE, OF AcutlEVEMENT T'llr.i°crer4fies that Date Hardy has succesq idly completed the 40 Hour Asbestos Abatement Supervisor/Contractor Training Asbestos Accreditation Wider 'TSCA Title 11 40 CFR fart 763 c011(hicled by AZCAssocicites Inc. 39 ASImnce rSireet Bost l,ajtt,>nreadow, A4A 01028 (413) 525-1198 r' �)y' r '�.. rf�7 -- ,,:Y�,'�7, +fit{ 1 ,fir.,.y.;o �{ / $ r a,�.�' t r;.rlJ 1 /''•'lf .;" t��,j�,�l Iv.I`�{.,7.t.+z.-1 A7 ^mil �/ lr�.�#j.�t' 1 � ttl++y(,y �,. f lt�• �r Y F•✓..«;'+`:..r 1i t 'R l'riitclpel lrrstr++ctnr ReglmuilAk +alter ,Ugust 10-19, 1998 9055-2751 Dale of(at++rse Certificate Nran rer August tit, 1999 . I August 19, 1998 lirpir�tlinr+ .lrrle ,snot tttu3on7airte wo a�N' w . . -d �' .M,„,%'Dw'm ,,..,, K..t,,. ..y "'* CERTIFICATE OF ACHIEVEMENT This certifies that Dale Hardy y. has successfully completed the � 8-Hour Asbestos Supervisor/Contractor Refresher Training' Course Asbestos Accreditation Under TSCA Title 11 40 CFR, mart 763 conducted by' ATC Associates Inc. 39 Spruce Street a East Longmeodoiv, MX 01028 < (413) 525-1198 Principal rrutrnrta Regional Manager i Jute 19, 2004 SAR-6763 Date o Course Certificate Number i� Q> Juna 19,2005 June 19, 2004 $� rp F .&pirvffo tt Date xctmination ate # WIN 1c t9 S eNn,�ti. ci4 ",�i"+• Fn •^' , 3 s't" 'r. `' a p eN" F#' �ta"Tr"t@ ••a:• ,W�' •gy � � �� .ne� ',�, � ,� �p �Y �, �, . e y ,A q�'�c• a, ,�q, 3°,dN'YA,°�u�my� i,.,P..w e�sn+yp�c�+d� 'wn'WV,"� ,�. � <�^'W�a ,e''•.'41G_.y<YI�T��� ���. "'"`Li�"�� � p ��"�'� 6��� '+ate •��`�.. ' r MONO ' r .. ......... +aar. SO 3 RI kN AcCuTech INSULATION CONTRACTING,INC. h -STATE STREET, BUILDING#119 1-800-244-8773 P.O. BOX 376 (413) 583-5500 LUDLOW, MA 01056 FAX (413) 583-5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. :EMPLOYEE INFORIVfATION Test Type: Qualitative: Irritant Smoke, Rainbow Name of Employee: Ne.19Db Bernardes Data: 0 Employees Social Security Dumber: . 018 / 621 1935 License#: AS72621 Company: AccuTech insulation & Contracting Inc B. RESPIRATOR INFORMA T ION Respirator Type Selected: '/ Face Negative Pressure Manufacturer: North Model: ., r Approval#: TC21O152 Size. S M ( L ) PAPR: RACAL: Model: Powerflow Approval#: TC21 C35 `-' IS f: Model: Typhoon Approval#: TC21 C49 Name of Test Conductor: Anthony Employee Signatpre; C. TEST RESULTS S X Lateral Head Movement Pass — Deep Breathing Pass X Stationary Jogging Exercise Pass X Rainbow Passage Reading Pass X Employee Reaction to Agent After Test Pass X Proper Performance of Positive and Negative Pressure Valve Check and Fit X ,. Employee Passes Employee Fails Expiration bate: 04/28/05 Respirator Fit Test Performed in Accordance With NIOSH and OSHA Methods and Procedures. 4 O U-HEA.L TH OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES 200 North Main Street • East Longmeadow, MA 01.028 • (413) 525-6003 FAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Name: : SS#: 3� Qate: �d J Lead Exposure In accordance with The Department of Labor&Industries,1 have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place his/her health at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has been informed of the results of#his examination and any medical conditions that may result from asbestos exposure and has been warned of:the increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with O.S.H.A. Standard 29 CFR 1926.1101, 1'have examined the above named person today and found him/her: Medically qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. r Medically qualified with the followinci restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). Medically unqualified Respirator Clearance T he above named employee's relevant health history and,physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion; No exposure to High heat stress, Other(See Comment) Not cleared for respirator use COMMENT: _. s��.�s Medical Examiner 3 SAFE ENVIRONMENT OF AMERICA INC ENVIRONMENTAL TRAINING O a ° SAFE ,1 t ENVIRONMENT FE STONYRROOK PARK ;- ` 00 MOODY STREET, SUITE 200 - a F A M E n I c A LUDLOW, MASSACHUSE`ITS 01056 "v (413) 589-1882 1 ' NELSON DERNARDES ,S. S. # 018-62-1936 HAS ATTENDED AN 40 HOUR ASBESTOS TRAINING COURSE FOR ASBESTOS SUPERVISOR/FOREMAN ° ON 11/6/00 — 11/11100' AND HAS PASSED A'WRITTEN SEA EXAMINATION a, e 12/22/76 � DOB: Scare: s5� C Serial Number: AST2022 -- Expiration Date: n 11/01 � a - COURSE TOPICS COVERED INCLUDED: �; 4 � * ASBESTOS BACKGROUND INFORMATION, HEALTH HAZARDS,ASBESTOS CONDITION ASSESSMENT, T k PERSONNEL PROTECTIVE EQUIPMENT, PERSONAL HYGIENE, CONTROL METHODS,AIR MONITORING, z REMOVAL PLANNING AND PROCEDURES, FEDERAL, STATE AND LOCAL REGULATORY REQUIREMENTS, �# COURSE INSTRUCTORS U t --_---� IING GO I � TODD SCYOCURKA,PRESIDENT � S': i •t ,a 1' ��"' /ti./. 1 , V' t3 fJ�nl„♦ f �.17 �_ _� 4 ` hl t.r U� `-.'„n :�L? ”„- Q \ ,M1.t..rrw✓tt' _t., Q + ":,1� �_�.� tl. ,. t? --{• C} _ q . . ..� ,() <..7 I j �p�o.a r• a�.�'a. .a �>zy o e... ,,�,�.u.a4�raa +,�"d�`i'°''iw .s�' e';y,o AM +° -� ISO ' A u4a i.W w:ri w.�'rM�• B'+r»'' .r..A CERTIFICATE OF ACHIEVEMENT This certifies that f Nelson Bernardes .r . #� has successfully completed the 8-Hour Asbestos Supervisor/Contractor Refresher E Training Course Asbestos Accreditation Under TSCA Title 11 40 CFR Part 763 conducled by ATC Associates Inc. 39 Spruce Street z East Longmeadow, AIM 01028 (473) 525-119$ 11 principal Instrrrctar - 'Zegtonal A�anager a October 1. 2004 , -6828 Date of Course Certi rcate r'l tuber October 1,200.1 October 1,2004 , i r •xatninatron ate Expiration Date go�M�W NOW'��rt k"yY„��y ..`+i ,yM.�/A`,ii�'�"�. �ti"+a'� `�fCw.r++♦ �llOty � �i �p�y. 'J ' � y ° f 'ra/�' `+lu.�ry�a tFa`y�M" `My�+yw' 't '!y tl�►'a' .y`' °' M� °y'7y�iF.pA" Divisiw apmowo sa Safety. - R.ota�rt�.Frezxiso;lye,�ut�t��ta' nYz Astsestos Supervisor t*-,LSGr4 B�RNARMS i Eff.QBfe Cii (154 AiM6 a 1 Exp.Bate 03f M5 ° A5P72621 0 Watw of c.O.N.ES. SP IN MM 8 A R o,, .................................................................................................... ..... INSULATION& A INC, r ` °S E STREET, BUILDING#119 1-81-800-244-8773 TAT P0.BOX 376 (413) 583-5500 LUDLOW, /VIA 01.0&6 FAX (x'3 3) 583-5555 IRRITANT ASPIRATOR FIT TEST A. E €re'LO`t EE'WFOR A110N Test Type: qualitative: Irritant Smoke. Rainbow Name of Employee: Geraid- Ravi l.a - Date' 03/19/04 Employees Social Security Number: 6 1 5 8 1 7781 Lic6rse#: ASO73387 .Company: AccuTCch Insulation & Contracting Inc. B. RESPIRA T OR INFORMATION Respirator T ype Selected: ,/2 Face Negative Pressure Manufacturer: North#h Mo l l: ,kpproval#: TC21 0152 Size: S M ! PAPR: KCAL: Model: Powerflow Approval Y: TC21 0353 IS[: Model: Tvohoon fipproval int TC21C492 Dame of Test Conductor: pt6tMv Rov Employee Signature: C. TEST RESULTS x Lateral Head Movement Pass x Jeep Breathing Pass x Stationary Jogging E;ercise Pass x Rainbow Passage Reading Pass x Employee.Reaction to Agent.Alter Test Pass x Proper Performance of Positive and Negative Pressure Valve Check and Fit X Employee Passes Employee Fails Expiration Bate: 03/19/05 Respirator Fit Test Performed in Accordance With NIOSH, and OSHA Methods and Procedures. OCCU-HEAUTH r 3UPATIONAL HEAL T H AND COMPLIANCE SERVICES _ ( ,4 I o. h Main Street * East Longmeadow, MA 01028 e (413) 52755-6003 FAX(413) 525-J009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Name: ✓In X SSA: ( ( Date: t, "! Lead Exposure In accordance with The Department of Labor&industries,E have examined the above named person today. Based on the results of my physical examination,there is no evidence of a medical condition which would place histher health at increased risk of impairment due to lead exposure, Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. in accordance with O.S,H.A. Standard 29 Ci=R 1926.38,i have examined the above named person today and found him/her; Medically qualified with no restrictions: This employee.has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically qualified with the€olic:wi'<tci.restrictiorts: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). mow._.. Medically unqualified Respirator Clearance , The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed, used on this review,this employee is: IK _0 Cleared for full resgiratorr use Cleaned for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion,'No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMIVIE:NT: Medical Examin i 904.95 ` ESE' a �^1 �aa drat a v} �i�1`6b y- S �...�'C►L . � ii"NZ<`74 Wx.. a Sfi�2'p i .«Nt n. 'a. '4 y s•s L w+h d ►a .pa '+4. q"••W' m«p;"'�` I#' dy' ' '� > acnN.i�'V" ett s;ate ►t t9�•,i v + �'+ l c, ,�'�•y;,x�;w,a�t, ` ni„� fib�hCnp T;. '� > ' �� g.,. ,�" ��a;�sentJ?' �7a '`' j�"ly�r t. � �',a ' , •�*5����$yy, m sy��� N` hx• �ri � °3oW G•' . ���'' "�iif�v "rah Ifii +�64$� ",� � ,�s?t a t '�* '� A �j 191 S _._ S�� '�_..1�� IFICATE OF, ACHIEVEMENT This certifies that Gerald Davila � has mccessfully completed the 40 Hour Asbestos Abatement 5upervnsvrlContractnr Training Asbestos Accreditation-Under TSCA Title I i 40 CFR Part 763 conducted by i A TC Associates Inc. 39 Spruce Street '' East Longmeadoij, MA 01028 g (413) 525-1198 Princ!pal lastnwor Regfanal dfanagar Z June 16-20,2003 ADSS 2b25 Date ofCorrrse Cartffreate Niauber June 20,2004 June 20,2003 2, piratfon Date �rr�ninataan ale 6wim a WAWA-04 047F UM 01. �� �•'� .r�g�s y ` ltX�e �� •rr'1,1�., 'd.� `.u�f,�• � eS,�s s�.�. .'rte-�' '•�'� i r rN a ¢�tiF Ciy a'ya .yrel+� ,� }.y',a"t t'�y. .m i 5 %,iy�,¢' j• ~ i a .,`°`o-� r/, >s s< �`�.P' ,ype• a �`�dsasK F CERTIFICATE OF ACHIEVEMENT 4r � .yy, s`' .. ''fit!?` >'` .. `-e �• ..rq"°J 7 bt.P.. � C This certifies that Gerald Davila hav succes,sfidly completed the 8-'Hour Asbestos SupervisorlCuntractor Refresher Training Course Asbestos .Accreditation under TSCA Title If 40 CFR Part 763 conducted by ATC Associates Inc. '3 M Spruce Street East Longmeadow, AM 01028 # i (-t 13) 525-119$ t ,� f e - '• tZegiaaa!;Yf:znc+gzr Prinripal Instructor Juste 19,200 f SCR-61764 Uate OJcomse Cerlifcaiz A`untker i� June 19,2405 June 19, 2004 Q �r s* �Ymninatiarr crle F.xnitaiiorz�aie d; 7ii rt - i� 0i�y�J�, 5 �11q���j;+{� '�'>tyRy {s:i . �-+. .«. :mow. �r• w' +.»_,.. 4 ..P ��, �> ��yj� ,TJ, 1q''{L'+7�"4d+1�, l�'�"�'p'H 1 4L,VV }M., ' 'ft'V'y�yc O5 'O'>_ f .J:PCs tsso,cgmmissorw AW st�a .wsssC GIN Ex a i ,SCOSW 05 SP x# 3P:RErit ;J cuTech INSULA 1 _ STATE STREET, BUILDING#113 1-800-244-3773 P.4. BOX 376 (41 a) 583-8500 LUDLOW, MA 01056 FAX (413) 583=5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. Employee Information , Test Type: Qualitative Irritant Smoke Rainbow Name of Employee: Randy Daum Date: 1111/2004 Employee Social Security : 196-52-5111 License#: AS070530 Company: AccuTech insulation & Contracting, Inc. B. Respirator Information Respirator Type Selected: 1/2 Face Negative Pressure: Manufacturer: North Model: Xt 7700 Approval#: TC21C152 Size: PAPR: RACAL: Model: Powerfiow Approval#: TC21C152 ISI: Model: Typhoon Approval##: TC21C152 Name of Test Conductor: Leslie Atwood ' ' Employee Signature: C. Test Results f L"" Lateral Head Movement Pass Deep Breathing Pass `-' Stationary Jogging Exercise Pass �,,°` ,.Rainbow Passage Reading Pass ' .:Employee Reaction to Agent aster Test Pass Proper Performance of Positive and Negative Pressure Valve :Check and Fit Z Employee Passes Employee Fails Expiration Date: 11/1/2005 Respirator Fit Test Performed in Accordance with Niosh and OSHA Methods and Procedures. C U HEALTH ( --CURkEONTAL HEALTH AND UW4°UA SER-0aS 200 Notth Maim meet a Est Lortgrnea4ow, tNIA 01029 0.11-15�°5W3 « FAX(4131 525-90 3 MEDICAL SURVOL,L AIN E EXAMINATION A ND RE iRAT0R APPROVAL REPCIT TO E Pf-OY R E:noloy Na cue �� �3 s} i✓ata: w ' deed Expestre In aecardarrcet `,ht 3z ai si ru axf Lator&lndusfries,i have exat inad'the above riamal person tccday. eased on the results of my,Pt*rsicai W40��'�s is air t#�i ors rT ic�4 cc�?fj��.x�aich a�auid place hisltter heafth at.lrt as6d ffsk of€taxpeitrzaant&U-4 to lead mqposure, This employee has beah informed of ths-results of this examinailtin and any zr e4cai mndihom amt may result froirn asbestos ,-xposure and has hoer.warned of ttie inc ne=ed risk atViibutable to the combine effeat of sm-old tg Ard asbestos expowre, in accardance with C.S,H.A,.Stendar4 29 CF" 1-02.6-5a,t have examined the above—named person tnday and To=d tuimdhec d M cagy c a ffied v*h z .:strii::�m. This,employee has as d-ei ed medicat c:.ncmions that vvvould place Minter at are ihcreased risk of mi at6dej l're:ft inlpat€at nt from wcpasure to,asb oas. There Is;o restrk ons on the czse e a iaspiri s w pa sohar prcttr.ctivs<equipment Mpadi=Hy C uariffo with the'st?4bwtng reStriCSQnS. This f'ctiowing,medical=ndMon exists that places this employee at an)nc;eas©d dsk or materidl heafth impairment from exposure to asbestos (See Comment). Medica!iv IMagailfied ip�s "ifadoj'Clearance The above named ettt*yee-'s seWwartt;t'evaith history and phyidcal exaniiiti ars rem*-.were evaltaled. The reported field conditions of the job were also revlewefi Sw,azed t9vri this t t }ft etnii#6§�i u CIL-ared for futt resnlrat r e No SCt,3A t.'s No heavy a rtlan,, Ni2i,�xprsure to high hea.tstess, Other(SF---Comment) Ntotcl,eamd f6r.-msWmtw far.-ms use COMMENT: }1r eti2 E�'"ctftiiY M€t:Ttf= RYAN r•�� c�a �Dd.SB ---------------- ............... -T Q IN, &git oil M NA m ,I g'f VP - il} Welfin gtontl`0 U-Se ASSOCIATES CERTIFICATE 4 gii *2201 I —V- 0)889-3722 902 Greensboro Road.,High Point,NC 27260(91 ol. herekli certifies that -52-5111 RANDY DAUM-r 196 requisite has successfully completed thefive day,forij) how traini ng for asbestos accreditation under TSCA Title 11 of the . Toxic Subtances Control Act;for the discipline of "U. 4�-M wining Course Asbestos Ahatement Cott tractorslSupervisors D an d has satisfactorily passed the examination for that discipline. CERTIFICATE TE OF COHN, III I '4LI ETION is hereby presented lit recognition thereof this ............. WN MAY(18-12, MAY 11,1996 hLAY 12, 1995 -12,199A8 -5 Date of Expiration Date of Examination In chaive ilates of instruction DON HARTIG .......... Training Conme A dininistrator Principat Instrucior It D. PHYLLIPS, gm Uml Location of Training: ............ figh Point, 0 -3 10)889 A2 k 902 Greensboro Road NC 2 726 722 T.- lift "g! -W, ia Zt) 7 Et�4-..a� tf,X-1, ou 019 ' f F A Jffi awl F AccuTech wsaxnoN&coti-TRAcTiNG,INC. STATE STREET, BUILDING#119 1-8130-244-8773 P.O.BOX 376 (413) 583-5500 LUDLOW, MA 61056 FAX(413) 583-5555 IRRITANT SMOKE RESPIRATOR FIT T EST A. Employee Information Test Type: Qualitative Irritant Smoke Rainbow Dame of Employee: Bernard McPhaul Date: 12/20/2004 Employee Social Security : 010-58-7176 License##: AS073707 Company: AccuTech Insulation & Contracting, Inc.' B. Respirator Information Respirator Type Selected: 1/2 Face Negative Pressure Manufacturer: North Model: 7700-30 ; Approval#: TC21 C152 Size: � - PAPR: RACAL: Model: Powerfiow Approval#: TC21 C152 ISI: Model: Typhoon Approval#: TC21 C152 Name of Test Conductor: Anthony Roy_ Employee Signature: C. Test results Lateral Head Movement Pass tf ' Deep Breathing Pass _V_-,Stationary Jogging Exercise Pass Rainbow Passage Reading Pass f Employee Reaction to Agent aster Test Pass Proper-Performance of Positive and Negative Pressure Vaive Check and Fit f Z Employee Passes Employee Fails Expiration Date: 12120/2005 Respirator Fit Test Performed in Accordance with NIOSH and OSHA Methods and Procedures. 6 —H, E LT 0CCUPA T IONAL HEALTH AND COMPLIANCE SERVICES ' Ac04 North Main Street e East Lon4meadowt, MA 0:028 * (413) 525-6603 FAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPFUVAL REPORT TO EMPLOYER Employee Nam� ," SSA:�t'� cS��' �J'7 6 Date: Lead Exposure In accordance with The Department of.Labor&Industries,I have examined the above named person today. Based on the results of my physical examination,there is no e`videnc2 of a medical condition which would place his/her health at increased risk of impairment clue to lead exposure. Asbestos Exposure This employes has been informed of the results of this examination and any medical conditions that may result from asbestos' exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. in accordance with O.5.H.A.Standard 28 CFR 1926.58,1 have examined the above named person today and found him/her: Medically qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically cgualified with the-following re:stfttiOnS: This following medical condition r - i exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment), Medicaily unqualified Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: _A/__ Cleared for full resoiretor use Cleared for restricted resuiret€>}r use as follows (Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: Medicirtxami1 e ___ 904.98 �K This is to certify that ; a Bemard McIP"khaul 3 ' f has attended and passed the examination for the course Asbestos /Contractor and has completed the requisite training for Asbestos Accreditation under TSC�, Title U. Conducted by 588 Silver Street Agawam, MA 01001 � r (413) 789-3530 4 3- Visit us on the web at www.ECSConsalt.com jC Hours of Training: 40.0 Dates) of Training: October 4-8,2004 Daniel Knapik,CET VIAM Expiration Date: October 8,2005 Director of Training and Education Services � W Certificate Number: Location of Training: 140'Wilbraham Avenue,Spi°higfleld,MA �r {1 4 q ttt / Commonweafth of Massachaseus } . Division of Occupational SatePy 0.1 I tRCb&f J.Pfeem,Commissr�,n .. As es Supervisor j BERMARD Mqf .PHAWE. I Eff,Date 11/02/04 i Exp.Date 11107/05 i ASf373707 0 -51, M2mb3r of C.D.N,E,S. SP . i i ticcffech N* SULATION&'CONTRAMNQ� INC. -STATE.S T REET, BUILDING#119 1-800-2$4-8773 ~° p 0.0, BOX 370 (413) 583-5500 LUDLOW, IVI.A 01058 FAX (413) 083-5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. EMPLOYEE INFORM €ON Test Type: Qualitative: Irritant Smoke, Rainbow Name of Employee: Andre McClure Date: 05/2504 Employees Social Security Number: pip 769 74013 License#: Company: Accul'ech'insula;ion & Contracting_Inc. B. RESPIRAT OR INFORMATION Respirator Ty pe Selected: 1/2 Face_Negative Pre'ssure Manufacturer: North Model: � Approval#: TC21C152 Size: S m 77 PAPR: RACAL: /Model: Powerflow Approval#: TC21 C35 ISI: Model: Typhoon Approval : T C21 0492 Name of Test Conductor: Anthonv Rov Employee Signatpre: G. TEST RESULTS x Lateral bead Movement Pass x Deep Breathing Pass x Stationary Jogging Exercise Pass x RR&inbow Passage Reading Pass x Employee Reaction to Agent After Test Pass x Proper Performance of Positive and Negative Pressure Valve Check and Fit x Employee Passes Employee Fails Expiration Date; 0525(05 Respirator Fit Test Performed in Accordance With /NOSH and OSHA Methods and Procedures. OCCU-HEATH ( OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES 200 North Main Street * East Longmeadow, MA 01 028 * (413) 525-6003 * FAX (413) 525-900T MEDICAL SURVEILLANCE EXAMINATION'AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Na e' f G� h St ss#.`�"""'�" r Date: Lead Exposure —A In accordance with The,Department of Labor&.Industries,t have examined the above named person today, Based on the results of my physical examination,there is no evidence of a medical condition which would place his/her health at increased risk of impairment due to lead exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. In accordance with O.S.H.A.Standard 29 CFR 1926.58,1 have examined the above named person today and found him/her: x Medically qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of matenai health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. _Medically qualified with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). Medically unqualified . Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: Medical Examiner 904.98 i a ,yI� qa ey .rr a aWr aaw�g. ,tea t +a-, a• > ai3 -• � �, ,y„'b �, 'o ��a.r w+0a V� �` eiawNM�r 44 M' �ofi� a y r<, � M�"Wi, .Y,t. rt & r s•ayyy7lrM.ii -�6�,.,�gp.F{ ) t- r t P CERTIFICATE OF ACHIEVEMENT This certifies that t b Andre McClure has success idly completed the 40 Hour Asbestos Abatement Supervisor/Contractor Training } Asbestos accreditation Under TSCA Title iI 40 CFR Fart 763 conducted by ATC associates Inc. + 39 Spruce Street + East Longmeadow, JVf,1 0.7028 (4-13) .)-25-1.198 4;. Prind.valAsiruefor Pegioncrl,t(arru er .May 17-21, 2004 40,55-2753 Date of Course Cartif:crue A`rntiGer May 21,2Q03 A1cry 21, 2004 f xpiration Dote Examination Dale _ qy� y�v�. 'gyp �'Y< -+�r "n �1 _ r(` y�r Yr<'� d1► '" y sf`�,yy,, - ` + {p, w.avw c-..,q,c. w < {� yy.? ' "�7y."t!+'Y�A+.a. p,, �t �p ''K6$K. �Al � y,�y ' `- .a.��l6a�,r,�yv `�;,°' „��„ a• 'S.� :!iy�as^ '�y?;� as ' '° ��".rV� "ed�.s.. �p'v',a". ° '"�i a d�� •�'fi . �. 4 ry•. �,�ra•s p•*k .y,� aan, ,> �prl nr+°.idg. '�' a� ' +p• a� v �`q' a�"^a.`1d a.•a hh..w`"' " w6wry' a m�M y, "yi3spt<+ a' °'.r' ,,� >..a ow � W CERTIFICATE OF ACHIEVEMENT This cep°t�fies that Andre McClure fi has successfjlly completed the fill S-Ho rr Asbestos SupervisorlC©ntractor Refresher � Training Course . Asbestos Accreditation Under TSCA Title 1140 CPR Fart 763 conducted by � A7C Associates b7c. 73 T3illiam I'iT Drive alest S'hringfield MA 01089 (413) 181-0070 L ,rr �a r -----------r^" r A';:riotzl.Y9 ir7�gerr'' x n•',nr L di ('artjt ak rirsi ," j Date AfCourse iii AI ,27,2006 1,Vk—2'200 - --- -----° kxutturafia r Ihtt f.:Ypirwion Dare e� �, ��: ,��-�.� ��'r��.�.s�.Nr �� w� ,o,,� yar `�•,o�,�yy,a ,r-+ .♦ w ay�a"a +may ' f Commonwealth cat,Massachusetts &ivisiot,of'Occupa€iona/Safety 2o3er!J.Frazim,Commissioner X1 hestos We rkei r off.EJate f15/25'70� Ex .Rate 05t24105 1 AW073566 wemb,of C 0.N.E.S. SP 5?•NEVJ } 1 F iccuTOc'h I'NSU ATION &CONTRACTING,INS. a, -STATE STREET, BUILDING 7#119 1-800-244-8773 P.0, BOX 376 (413):883-5500 LUDLOW, MA 01056 FAX (413) 683-5555 I T T SMOKE RESPIRATOR F17V TEST A EMPLOYEE INFORMATION t`est.Type: Qualitative: Irritant Smoke. 'Rainbow Name of Employee: Eroid3'Patrick Date: 7/06/04 E mployees Social Security Number 117 / 74 1 2186 License : AS71981 Company: AccuTsch Insulation &Contractina. Inc. E. RESPIRATOR INFORMATION - Respirator Type Selected: 1/2 Pace Negative Pressure Manufacturer North Modet: _ M7700 Approval : TC21 C152 Size: S / MI)?_ PAPR: RACAL: Model: Powers Iow A.pprpval#: TC21 G353 ISk Model: TXDhoon Approval ;ff- TC21C492 Dame of Test Conn v Roy Employee SignatWr;. ` cy- . C. TEST RESULTS X Lateral Head Movement Pass X Deep Breathing Pass X 'Stationary Jogging Exercise Mass X Rainbow Massage Reading Pass X Employee Reaction to Agent After Test Fars X.. Proper Per or rnance of Positive and Negative Pressure Valve Check and Pit x Employee Passes Employee Fails Expiration Date: 07/04/05 Respirator Fit Test.Performed in AcCo danca With NIQSH and OSHA Methods and Procedures. ccuTech , � .. - ,INC. ST TZ s T REE T, BUILDING#119 1-800-244-8773 %RO. BOX 376 (413):683 LLJ'DLOW, PIA 01056 FAX (413) 5s�-6=56 IRRITANT SMOKE SPIEL OR FIT TEST A EMPLOYEE INFOPti AT]ON Test.T ype: Qualitative: Irritant Smoke, Rainbow Name of EmployeY: Eroida Patrick Cale: 7=6-05 =mployees Social Security lumber. 117 i 74 1 2186 License T -AS71981 Company: AccuTech Insulation &Contracting, Inc. I ' IS. E PIRATOR It�l~I'�E�MATi0 Respirator Type Selected: "/ Face Negative Pressure manufacturer: North Mod,6l; M7700 Approval#: T C21 C1 52 Size: _S I NI L PAPP: RACAL: Model: Powerflow Approval TC2'; 353 £ Isi. Modal: Tvohoon provel;�: T C210492 Marne of Test Cend v Pov Employee Signature�, O e Mfl ` C. TEST RESULTS X Lateral Head Movement Pass X Deep Sre ati-iing Pass X Stationary Jogging E.cercise Pass X Rainbow Passage Rsadirig Pass X E.mployea Reaction to Agent Ai erest Pass X. Proper Pei formance of Positive and NegaTive Pressure''halve Check and Fit =mploysa Passes =rni ployee Falls r--piration Date: 7-6-06. .. Resplrator Flt Test Performed in Acco,•dance With 1\11 0Si k and OSHA Methods and Procedures. """._•`..�/' ,^�../. —��`•• '�'�./'. •.,•�'�.. ./""` '"'\..../'� /fir'�'� ..\ ;';�.a r S Ft` `.'-i°:f• /F,, � , 4\/� 2` �S V i l SSlS ''t S'�is+i.:{ S,S ✓�t,-s S t ✓ •!t:t.�r `'p S Si,i,y ,>iJ s fS S d F[m:'tt S 1 f i l NINA , MEN"" t n'Ir§`as` .�a$4iNi;- r'y",;.�,..4� 2f r��it f�CY 5,L r.,,1iI ii,y�= ✓r 1+i y'' al ;SSl:irr`�i t r - a'.FNtt!r i�' �-J'� 't•��sln.1? `fig•. �i, P}J rr }litxSS* `3._ ,r#s -•'rk -r 'rt�li�.:::,. fiJ ti i{rr ,5r Y r i. q KKR Iii f iS1l �� 1 iS ,a':•1'Su' .,[ ,r«`[ ,•iR'P•r... r aP �.,ul i- °'id�, -.va r+l�l�n$ r'v.,Tili .,.;-ar..r ti4.,ls:f!#J '` dp• r(t. 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S v.•Y, r ,r\ {,y c:., i ,�"- ���CCz'�,�it'�u°t.�fc�;� tnt 1qq 4�`•�Z.�_�.�CN"3((a?,e'�"'�r'`}''��`�.,�„,. a�.• .o`lia�.-�-�';+.'��•,.'•��1�.�• 4�a ;01 rw at J,�',�r r"�s<#"�,,ft,�' .ii.a`t t�H��_.'-r,:•4E'f�"y"��a.L,�VY'.s.�..(f c,•x"t z afl,,':�,`�C c x-a l�4�Y,i c��.:s,'y�'''"'�i,�,✓;�it's pr- � AO ml Q,. m_ ;r y�4..tA trta6..?."r�".t'f J,,c}):�..,y�.:1?.i't e'"i''j�,�t',;nv.�.''1�-t���r3 7(�`+fi 4rr.'_rY isr••J;.Y.•,k�,i<<.r.,�,-n'�F.•�4w"{ y-. f i z� ��'!? ''�'z��� ,•s,� �1�i,-``„--T��$ �£���t � "�?e'ptF';��a�+.k� ,i i k t `,,a ri �. `•I y t a Ny r f 3 r S t i 3 3t ('.'+ {J+� ,! Y.Itlf�,:+ t� # S,�t( j i�t+�L--/"X "”' av'r•"\�,✓•' \_✓'.^, � Rr'/�``` �'^� `^- `` �'• 3�' ...................._... . .. ."eiaY 'C•�J 'c'�% �v'Y/ Offim `�";,"°'r�>aa, - +a�y" .2 1 $x� F t 3,�r ,`mac i UERTIFICATE OF ACHIEVEMENT F .l his cei rt e theft Erich Patrick has successfully completed the 6-Flour Asbestos Supervisorltlnntractar Refresher 1 Training! Course ,asbestos accreditation Under TSCA Title 1140 CFR Part 763 conducted by � A:I'C'Associates Inc. 73 William Franks Drive 11,'e.st.Springfield X114 01089 (413) 7<S�1-0070 8 r• v Region al t f t;lagv- f'rincizxrl;rzrrrrrctczr a .; 200.E _ 4tLtZ 7170 Cate of C'ozrrsc �er4lfrtnfe 11n;ber Xfo7.27,2006 11117127,2005 F:rizf;rtiatz Date l vowination Fate - i Nf►'y.��{��'((...��+��.i.°+A" 'r'� ',, �.'� '° �y.Sy� �„_�yY �d4�, �y� ' M Y. � , r.,,,'.�1.p .s+�' .!�f,. .~4;pA�' ,7' 'W'4'A'9'M`' '+�' y , aF'yPN Y` �' r ate``` .,��,�a► ,a�,� x ,:.. • d.�ia.. .. ..fix," .,, r ' U- 004 hS El�lqp: N-"x . x � Tr.+el ', x Y'�i`<+::'•• Je ^tin 3 is 1 affech 'NSL ON 8. —. WIWI.& E" STREET, BUILDING#119 :_800-244- 77a Po BOX 3,76 LUEbLC'W, 1IA 01056 � t4 3} 683-5555 X-RRITANT SMOKE' RESPIRATOR T TEST Test T ypa: Qualitative: Irritant male, Rainbow Name of Empioyee: Manuel Casiano Date• 03/221/05 ;ployeas Social Securitv dumber: -03? i 1011 License#: kW7296Compa'n' y:: AccuTech lnsulaticn „C- E inc . . REZRP�'FIA T OR INFORMATION Respirator Type SVlaw ad: 1/2 Face Necatiye Pressure Approvai#: TC'210152 Size: PXPR-: RACAL: Model: Powerflow Approval ,": T.C1 iC35 lSf: Mcc ei: ` a� T 21 C 92 Name r Test Conductor: An Employee Sig atur x C. TEST RESULTS Deep ran-Unincr lass . St a liJr "r Jogging Exercise Pa : Rai -oaw Passage Reading peas x Cmp cy -Reaction tc , ant After Test Pass ProDer Parljorn ance of Positive ar'stz ieg 'i35da r , u. Valve Check at"C� 1"'it _. Empioyes 7—asses ptow i a'la f^ Di atD s t >.!t . F itorma in a c�.o ca;)w � , h i'tiYC� S`� an, D� A a � <fi 3 � i �ra , ............. _.._.._._ ................................ . . .C3CCU H EARTH CCUPATIONAL: HEALTH'AND COMPLIANCE SERVICES ``2100 North Main Street East Longmeadow, MA 01028 • (413) 525-6003 FAX (413) 525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Name)- - � ^' 1 Date: '' Lead Exposure In accordance with The:Repartment of Labor&Industries,I have examined the above named person today. Based on the results of my,physical examination.there is no evidence of a medical condition which would p ace�hislner t ieaith at increased risk of impa:rrnent due to-lead exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and.has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. In Accordance.with"O S.H.A.Standard 29 CFR'1926.58;1 have examined the above named person today and found him/her: Medically _qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically qualified-with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment).. Medically unqualified Resptrator Clearance The above named-employee's relevant health history and physical examination results were evaluated. The reported feld conditions'of the iob were also reviewed.'Based on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as follows (Circled): No SCBA use, No heavy exertion, 'No exposure to high heat stress, Other(See Comment) Not cleared for respirator use COMMENT: :—, ,/Medical Examiner 904.98 f i x a wit n �x �{g yg 4�!'a 'C4,`w•b 1 7x Y:��ad•a'''4`ay{I a qi.....+.•.1,Q*.NN y V''J�Jak'iW77wau�lya`is+8•,>N<..•;.�rn w.kw'"�``.;�i`,,.�gu�s:V`+.i�'��qW,,.".e b,_ > w��'N3,t w'i,e�i`y�+g�os�K+..`,'G 7. N"i�+NN'`y"'�».."�``u;'A�.x'A;gt 4„m am'•Mt b r''k,t.t N y��Ko ry By'A.4 2>ri•:'Ty r d d�°W y�µ'�d�a".t i7k'd 91,�,y 2 uµ,ySt>d D t.�\ 1 S*��+P iat yk j'S>✓'.•!"'�t>^'�t'�.1Kx�>.-+4,^A`t.R,y�s'.��`,;�akqi�_.�>'S.,:}r.�,y,v4lk`w�p.9 k`.�.....,.,.N s W�4�w�+�r,Z'O H.3k J.''�x/y''Y s s T`Sifa�+,a,T;�t e Oy,+a>�S�..Vv.��^,,,ro `i H'ri. " d a ^" XM m H3,^C ` &a Mw ,'•e"{:W�;Uuatt'�a??�,"�u°{:.y$Y d.n i.'yi O^,iMf��t fL�cr W v k".�.x` o�,.6r' 4 q3 Y XkP $ ,. ' CERTIFICATE OF ACHIEVEMENT f This certifies that tA Manuel Casiano � s has successfully completed the e `r 32 Hour Asbestos Abatement Worker Training Asbestos Accreditation Under TSCA Title H 40 CFR Part 763 conducted by ATC Associates Inc. { 39 Spnice Street �e East Longmeadow, I114 01028 � �+ (413) 525-1198 f + Princip��lnstructor Regionalrtfanager ? Alfarch 19-22,2002 32-4696 Daie of Course Certificate Number a� March 22. 2402 March 2?2003 $ �f Expiraiion Date, tn+nrnation ate `}�k ; _— �T .._._�__.'�A 'T•'!.°i > f".zS'f r$'jk a�ir.Cf,,Z� 4��' i y. � �,iy�3 i� C�x�"J ry�Fa� (4 j 6a"3 ip'�1:"•; ...�T a,� .5:&��,_�y^ _.�t..�'�t�� .K.•..L"" � H r� �•,��'! �fi�'-ti.�;•. #� t�.tr..� t,�;:sY,� ,i"ra ti. �r;lR� a c�a rG d �.w l i,�t � s nc A�} ,�y '{y�_ .. ANN.m' Z•i v, a yyti; 6 t"p�•J�h,NgPa' y'�'.''�'u p1. •,SS': j q,.Y, w t :i'r• . rtri n•@; d"CR , ,. sa"J•. ,r y Jr- 9h, ,>a`TF, � ,p " �r�..s"° •.. �,•aw�5+� „: a ` ct�2..mri •tt, i �r..r s:�. - I + +M4 Rx to ,� •aa'4� , .. � � °'�..` "«.,tc¢` r'a"s3'1P, tr 5• ;.t3 ur.. awcryr�N,•,., Au t 4 ;..,. e +xo >r >< r >1 >r ♦ ttGi a40Y ;i. RCka- a4gi} `Dr. K• gN,v^tcks D<s,7y�i ,,,�:v.+t!�,,sx #.raw.V;V,W-- 'Mw w o- e�ta.� a mot.a d i b •p' 9bw�' .� Z' L . 1yr y4 >r !� >i ty.r- s�R {aiy^#b�' +o R.`�too• a, t�"i+{�l '�b�itNa +a °'°nwss, Yw .•„+, 4 a--1V as-, sm 1 , r9. iJ�:'.'ab a>� y. P_4xi11�•'@'• 5"n. , r• 9"-C. p ,:A!l�" r8r.rd�.a:T'!b ru%.,' ,fin`1-M� dihb �Na"•��'6 Wip.ayp s i ;v. a Asa'r a. *#w. a dst a; fit' ;Na.. �y¢pyowa+ tr,. ,qa`r ra 4 ,�p,,+ a•.F a x �o� N g s• •��i 47'r#� "`w,n c��.. *T.sw" "r'n:�?�,�!y a,�w;r �fia. 'dn:.+r¢ '�. s7X' m �o, ETii><�C,, o N. '°� aM!'P •{���n �k't¢�°}�`�,wr�+lHnf� �S> P�`to NIR ¢ a+ '.yf'�b >t� 'R >tnA P �' n'�RFt�!" trisar'` "c9tGSf? 11`•i� ... °b r rzs ••'gay, r� ..��tq. a *x7 td E�k4ti Nab i-s'. '���s ter. .. CERTIFICATE OF A-a-TIEVEMENT e Thl S (,°e t yles thca Manuel Casiano + has-successfillly coil,leted the f ' 8 Hour Asbestos Worker/Handler Refresher Training Course ."asbestos accreditation Under TSC A Title 11 40 C FR Part 763 conducted ky, A A.,As.s•oeiates Inc. a 39,Spruce Street East Lonc Meadoiv, A4A 01028 t-113i 525-1195a ; I t!'Ch 2-! 2004 t Ali-l,a� _ a} I7 trz of Course C rtific:tNa^ \,r!u(!e, i kfarch 24, 2005 Hurch 2-4.2004 tYETrrut;or!L?crtcr ;xcn+tincr,inrr Date ai' x '`r' y q 4 ray' s / atd +. 'k �'{; e,`U�; w� •`' r e '3�,°"" �.�t ;�; i > a > '1!0' j*4&I iw i'4 t �y rb 4 M*�.., r " fi �j:ry •Fie`f,t' i ).i >t Y'FjV. sr t ,+�'>F ,A 'y asp�3•�R— Fyn.s mtea'8�� p,•',ki.°8'.,p4'.ry y. q,• y. t , �a%w '0kr a•�B".[F' •sb " W+wpb• M"�-01tley Y 4ti - ` - � .'A'yN 7$.�bA!h,�ti'�N� $�'gN�4Q.�'�w'.�dttl• � `m.'n,4�a"a_,,,Ae•�c.'A'.aW,,� ,-°"?,8t. a� may`'}P• 6 �' - �fi e116A��-w 'tr,`'ca•+ `+yy a4 ,G ��a.'dx w �.� .at�A •n' '�'�F" _ ........__��r____ COrrtMC)nweal;th of is Massachusef oivision of Occupational Safety Rcbert J.f-rezioso,Commissioner Asbestos Worker MAN4lEL CASIANO Eff,Date 03/15/05 Exp.Date 03+14/06 ¢ s AW0729M Phar�erotC.4.N.lS. � r' SP 11 44 RREN lil�lll�lll�llll4ll�l�ll�l�1 l , eauTech. t,. FE STET, BUILDING 9 1-800-244-8773 PO. BOX 373 (413) 583-5580 LUDLONN, MA 010.55, FAX (413) 583-5555 I ,r T SMOKE PZ- SPIRATOR FIT TEST A. =MPLOYEE INFORMATION ' ��Test Type: Qualitative: Irritant Smoke, Rainbow L / Name of Employee: 0-=P an. TP-1;.-=T1 j a- Date: 061 11/01, Employees Social Sec��riiy Number: o2g 1 1 iz7 License 4: Company: Rceu T egh lnsulation 8 Contractina, iric. S. RESPIRATOR INFORMATION Respirator Type Select-ad,. '!,-2 Face Negative Pressure Manufacturer: North Model: Approval ° T C21 C1 52 Sig.-6- S iil L PAPR PACA : Model: Powgrflow Approval TC �53 isl hfiodel: Tvohoorr Approval 4: T C 2'1 C492 Marne of Test Conductor: Ant! 20�� Employee Sias aipre: / .k C. TEST RESULTS x Lateral bead Movement Pass x Deep Breathing Pass Stationary ,dogging Exercise Pass x Rainbow Passage R;�iadirlg Pass _ �mOsloyee. R' Radio l to Agent.After Test PASS Propsr Performance of Positive and Negative Pressure Valve Check and Fit Employee Pisses tmp oyBve r aiis Expiration Date: Pesplrator Fit Test Periornmed in Accoruaincs With N1CSH and OSHA Miath.ods and lc ooedures. r I i OCCU—HEALTH OCCUPATIONAL HEALTH AND COMPLIANCE SERVICES -200 North Main Street last Longmeadow, MA 01028 a (413) 525-5003 m FAX (413) 525-9009 y MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER Employee Na &? SS#: Lead Exposure In accordance with The Department of Labor&Industries;I have examined the above named person today. Based on the results of my.physical examination,there is no evidence of a medical condition which would place his!her health at ii .caased rir>t of Impair'enf due to/Gad exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. in accordance with O.S.H.A.Standard 29 CFR 1826.58, l have examined the above named person today and found him/her: Medically qualified with no restrictions: This employee has no detected medical conditions that would place him/her at an increased risk of material health impairment from exposure to asbestos. There r is no restrictions on the use of a respirator or personal protective equipment. Medically qualified with the following reStrietionS: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comment). l edically unqualified Respirator Clearance The above named employee's relevant health history and physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: Cleared for full respirator use Cleared for restricted respirator use as~~o1Iovvs.(Circled): No SCBA use, No heavy exertion, No exposure to high heat stress, Other(See Comment) Not cleared for resoirator use COMMENT: �1 ,Vdlc . a. JIM'! a x �3' ai• '>,-k^6 e1" adfa►'A. a :if►�`s�. � a +f� dk a+ wr,,►'."fir"'q, 4' +`Xv, �` _� s ttt��,ap"� 7 .•iiP�'Y. "':gi6l t alTN' >F.Awpr }<_�� >t �; �j >tMtlRPIP Y" p � �'}I'R90s 'Nmb ,s CERTIFICAT E? OF,ACHIEVEM E NT i This certifies that Stephen Tavernier has successfully con pleted the } 4f • 40 Hour ,Asbestos Abatement Supervisor/Contractor Training Asbestos Accreditation Under T'SCA Title II ' 40 CFR fart 763 conducted by ATCAssociates Inc. # 39 Spruce Street .l ast Lon�"ecrdaw, 11/1 0.1028 (413) 525-11.98 Prineipalltrstructar Re iorrai bf ger June 1 fi-20,2603 40S,72636 .r a-le Of eo-I Se C.erti fcate Number June 20,2004 June 20,2003 Exyiratian Dateaminatian Zral, jS t l �Y >.<'�p�. ir WORKS. <taO �• s_�^y'4t '91F'8 1. 'FN {�gMfpp A�`.!"'>"'�s' v�� �4.'�7Y'�`1%a 4. � M{y'7r?�.uw4 '�tlnW,A�a`�l.!`+Yr' �f4►. J�< ' &���O$ � '��'.. `µeP'. _. ,py� a i1Cts a' 'd+'.�na,(Ais a a rota a a4ff��va ad�h4.•g•,�, ,�-'•'��Ta.�,�ia ���, p flr a ,yes t q�SY�' 11 m ,p�.,_„ W. .aN' �„ .w' a ♦ 7 sM� ♦_.°,r.y ,��i>�k'�y-rib s�:r"+t F4t ry fi� Jw�4fs�a aM t` e 4 nv �. >. �'.` ��e',,�i, 'ymm�d�a;�x��,��7.?. "�+►' "• �`° 'M1r `'" , CERTIFICATE off` ACHIEV EMENT, This certVies that � Steven Tavernier has successfully comjpletecl the $ 8-1-lour Asbestos Supervisor/Contractor Refresher "raining Course Asbestos Accreditation Under TSCA Title 1140 CFlt Part .763 conducted by ATC'Associates Inc. 39 Spruce Street a r East Longtneaclow, Ift 01028 � (413) 525-1198 Principal Instrixfor. Regional Atannger June 19, 2004 � AR-6765 -_rt .[late q(Course L'erfrra:7te:4'uu+ber _ +} ne 19,2005 June ne 19, 2004 ,lo Ex�it'aflOn Gale _xtutrinafion ttfc x { 4b � �'f Sy(�;" - ♦,�y> (y��j�t4'•"'W 1 ,, ,.�p'i f 1 t {. 1 t1 7 i y�,Y ( N.b 4� ' � IQ�1./+J30'�Lv 4• Cam,, V,Y�y HIS�s •�LSy y'°'L41�� t�>'�4i,>n'�y�� T'�TJ'1"e O-0t.�j� mdJ"ya.1r.^v.W' �Na'L1Vr y�� MIj.MwFY� `ICpCY�i/dw �'W.'r�¢S 4.,y2a�f:;_Q, .�•�e�y;4,��',lM �i��„Myy�W[V u�,�tR.xh PjP' �, �`�.l_4$6}a. �O„{.�'._i: �'4_,�f'ffi64', ' �,:K���++ �^W.'g'd, p' »pyq•Q''. �y'���'��u5¢ f Trfra�rsu�esi��k�a�r � t a Wit:.„�re7.ggsa.,Gbrntr'r5�ior� r a • f ,4 tap 05' ' NOUN , 1 r (4vauTech � C °�I ,INC. STATE STREET, BUILDING #119 1-800-244-8773 PO,BOX 376 (413) 583-5500 LUDLOW, MA 01056 FAX (413) 583-5555 IRRITANT SMOKE RESPIRATOR FIT TEST A. Employee Information Test Type: Qualitative Irritant Smoke Rainbow Name of Employee: Daryle Dunlap Date: 1212/2004 Employee Social Security : 265-27-4525 License#: AS070009 Company. AccuTech Insulation & Contracting, Inc. B. Respirator Information Respirator Type Selected: 112 Pace Negative Pressure Manufacturer: North Mo'del: '7'700 ­301K Approval#: TC21 CI 52 Size. I� _ PAPR: RACAL: Model: Powerflow Approval #: TC21 0152 ISI: Model: Typhoon Approval#: TC21 C152 Name of Test Conductor: L .Iie Atwood Employee Signature: C. Test Results r Dateral Head Movement Pass eep Breathing Pass ,Stationary Jogging Exercise'Pass Rainbow Passage Reading Pass _.,`tl�, Employee Reaction to Agent aster Test Pass Proper Performance of Positive and Negative Pressure Valve Check and Fit V! Employee Passes Employee Fails Expiration Date: 12/212005 Respirator Fit Test Performed in Accordance with NIG SH and OSHA Methods and Procedures. OCCU-HEALTH4 '-ICCUPATIONAL HEALTH AND COMPLIANCE.SERVICES �s 00 North Main street a East Longmeadow;MA'01028 (413) 525-5003 a FAX(413)525-9009 MEDICAL SURVEILLANCE EXAMINATION AND RESPIRATOR APPROVAL REPORT TO EMPLOYER : SS#;, Employee Name ` TS Date: r y � - - Le €f exposure l/ In accordance with°The Department,of Labor&Industries,i have examined the above named person today. Based on the results of my physical examination';there is no evidence of a medical condition which would place his/her health.at increased risk of Impairment due to lead exposure. Asbestos Exposure This employee has been informed of the results of this examination and any medical conditions that may result from asbestos exposure and has been warned of the increased risk attributable to the combined effect of smoking and asbestos exposure. in accordance with O.&H.A.Standard 29 CFR 1926.1101,l have'examined the above named person today and found him/her: 1/ Medically gdalified With no restTictions; This employee has no detected medical conditions that would place him/her at an increased risk`of material health impairment from exposure to asbestos. There is no restrictions on the use of a respirator or personal protective equipment. Medically g6alified with the following restrictions: This following medical condition exists that places this employee at an increased risk of material health impairment from exposure to asbestos (See Comm6nt). Medically uncivalified Respiraitor Clearance The above named employee's releyant health history and,physical examination results were evaluated. The reported field conditions of the job were also reviewed. Based on this review,this employee is: L� Cleared for, ease Cleared for restricted respirator use as follows (Circled): No SOBA use, No heavy exertion; No exposure to high heat stress, Other(See Comment) Not cleared for resoiratar drse COMMENT: �.- Medical Examiner _ _ 0,04.98 v2 �• •.,y /�' '•: •.,,.'l iir Hi• •,t,,N t•'r< � t+tr+ t:j,�. irh+' t , j � t`fs r��' �i r f .+- r,nr..,t ,,�t••• t'". �}i ,4 .aAtta Rt••• • ,„+' +�,it v; rS +r.. 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X Y � r .,i, tkii NOW • .t X c ,..,,`1,W L�+ t .dN j s /i�a.' 1,j t p+t titu 51k. „ i.ie ! • ,+.t•� h.i. .1 +. { Sy�'+ ' V .#%`t ' .f t'.}!t d 1 'IL ii tl ''i i ''yihi �t �. ,:.+,''•' } t`< .t7 u• '1 ',yt f� •,.It•+ tA7, it+;41 �,rT. /..,./x7 p��!;tliy fl.i+ � F,4 +,;'1 j i' :1•:1 ^!'� 1 tl a f , trit`�t`1iti4t�'a` _,'t�i,t'11,s`'� s'�4��••w yisjyf�V �`'tktt�����1's'' '�i+•€k:ri'Ji y, ...t Y ,,,, ^nez'mm s a ro dAa'Y�'r�•`a�'a, �fr,-.,,.;a'ros�. aro. '*ao°a�� p U'swa y�.;'<�.dw"k�w�'y,��+ . .��;.° , �¢a 'Ka. .yaw'' �e.;r°w"�,°4a ai'°�p mm°�+"4 '°ii*Y r7''s�''yrroN:a a;r•fume Scn'�'s�''.'.`'t >t?� x:< w�hi �93Dq;'y Cr` �Y'Wj " y' �� c {:. � CER-TIFICAT , OF Aa r` This certifies that Dairyle Dunlap �. � has succe.s.sfitlly completed the � , .r• (J-Hour Asbestos Supervisor/Coutra ctior Refresher Y 4 1 Training Course Asbestos Accreditation Under TSC.A Title 11 40 CFR Part 763 conducted by ATC associates Inc. 39 Spt•t.tce.S'tI•eet East Longmeadoi'v, AdA. 01 028 (413) 525-1198 y ' ltiegraxxat arra �:� r/ � PrMcrpal Instructor September 3, 2004 M SAR-6802 5rtlfiaate M-R I Dare of Course ' i - September 3, 2003 September 3,200 .zanxinntion crte &,pirafion Date itTAT"10.5 AMM y pp N3 �1 ' ii �Y3 I W}�p �6'! W < Wn ,26 iw° �CS�,�.dW <"S 'V1tS —'-> Y.i. sY lyAy. � - Y ! R ra y i wr�i' v. t t y 'V1h99�r arLLw w �� po-na �'t• :rwur�;� M f I F f S ' f f - i R n I Y r ATE I A CO t CERTIFICATE OF LIABILITY INSURANCE 02/23/2005) =UCER (413)586-0111 FAX (413)586-6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION lebber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3 North King Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. R,-n. Box 538 hampton, MA 01061-0538 INSURERS AFFORDING COVERAGE NAIC# 'SURED Accutech Insulation & Contracting, Inc. INSURERA: American Intl Specialty PO Box 376 INSURERS: Pilgrim Insurance Co. Ludlow, MA 01056 INSURERc: Granite State Insurance Co. INSURER D: INSURER E: :OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR DD' TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY PROP9342961 11/04/2004 11/04/2005 EACH OCCURRENCE $ 5,000,000, X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50�000 CLAIMS MADE FX]OCCUR MED EXP(Any one person) $ 51 000 A PERSONAL&ADV INJURY $ S,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 5,000,000 POLICY PRO JECT LOC AUTOMOBILE LIABILITY PMC7123414 02/01/2005 02/01/2006 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) B X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC6929778/NYR 11/04/2004 11/04/2005 WC LIM T X OTH- EMPLOYERS'LIABILITY E.L EACH ACCIDENT $ 1,000,00C C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 OTjjjution for PROP9342961 11/04/2004 11/04/2005 $5,000,000 Occurrence Pol Abatement Contractors $5,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PROOF OF INSURANCE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1Pi(a"&1 '� � ~ Q„ Richard Webber/SMP 1��j�(� ACORD 25(2001108) ©ACORD CORPORATION 1988 ................. ............. Control No: W. 10111 ¢T I WP THE COAMONNVEALTH OF MASSACHUSETTS E' Department of Labor and Workforce Development Division of Occupational Safety 399 Washington Street, 5th Floor,Boston,Massachusetts 02108 ASBESTOS CONTRACTOR LICENSE ACLU TF,CRi'i,SULATiOi-,'&Cb ,TRACT I G, 1NIC.- C 'N J-00 STATE STREET LUDLOW MA 01056 LICENSE: AC000005 EXPIRES: Friday,April 22,2005 IN ACCORDANCE WITH MOL CH. 149§6B AND 453 CMR 6.04 THIS CERTIFICATE IS ISSUED BY THE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT,DIVISION OF OCCUPATIONAL SAFETY FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN ASBESTOS WORK. THIS LICENSE IS VALID FOR A PERIOD OF ONE(1)YEAR. Rot ert J.Prezi(fso,Deputi-136c tor EN IV R'iMMENTAL HAZARDS SERA ICES, L.L.C. 7469 WHITE PINE ROAD -RICHMOND, VA 23237 804-275-4788 FAX 804-275-4907 FIBER COUNT ANALYSIS SUMMARY CLIENT: AccuTech Insulation& Contracting, Inc. DATE OF RECEIPT: 04 MAR 2005 100 State Street, Bldg.#119 DATE OF ANALYSIS: 05 MAR 2005 P. O. Box 376 DATE OF REPORT: 06 MAR.2005 Ludlow,MA 01056 CLIENT NUMBER: 22-1056 A EHS PROJECT#: 03-05-0683 PROJECT: 24-5267; Go West Building EHS CLIENT VOLUME SAMPLE# SAMPLE# LITERS(L) FIBERS/FIELDS FIBERSICC 01 24-5267-15 60.00 17.0/100 0.14 02 24-5267-16 180.00 4.5/100 <0.017 METHOD: NIOSH 7400, Issue 2, 08/15/94 Intralaboratory Sr=0.205 Interlaboratory Sr=0.450 ANALYST: Mark Case - Reviewed By Authorized Signatory: '°" tlmc�� Howard Varner, Laboratory Director Irma Faszewski, Quality Assurance Coordinator David Xu, MS, Senior Chemist Feng Jiang, MS, Senior Geologist Michael A. Mueller, Quality Assurance Manager NOTE: The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report. Results represent the analysis of samples submitted by the client. Sample location,description, area, volume, etc.,was provided by the client. The submission of blank samples is required by sampling methodologies. EHS sample results (fibers/cc)are blank corrected, per NIOSH 7400,when the client submits blank samples. If the report does not contain the result for a field blank, it is due to the fact that the client did not include a field blank with their samples. This report cannot be used by the client to claim product endorsement by NVLAP or any agency of the U.S. Government. This report shall not be reproduced except in full without the written consent of Environmental Hazards Services, L.L.C. California Certification#2319 NY ELAP#11714 Method Level of Detection: Estimated at 7 fibers/mm2. LEGEND L= liters fibers/mm2 =fibers per square millimeter fibers/cc=fibers per cubic centimeter pcm3.dot/29OCT2004/MR -- PAGE 01 of 01 -- END OF REPORT -- ENVIRONMENTAL HAZARDS SERVICES, L.L.C. 7469 WHITE PINE ROAD -RICHMOND,VA 23237 804-275-4788 FAX 804-275-4907 ( FIBER COUNT ANALYSIS SUMMARY CLIENT: AccuTech Insulation & Contracting, Inc. DATE OF RECEIPT: 04 MAR 2005 100 State Street, Bldg.#119 DATE OF ANALYSIS: 05 MAR,2005 P. 0. Box 376 DATE OF REPORT: 06 MAR 2005 Ludlow, MA 01056 CLIENT NUMBER: 22-1056 A EHS PROJECT#: 03-05-0682 PROJECT: 24-5267; Go West Building EHS CLIENT VOLUME SAMPLE# SAMPLE# LITERS(L) FIBERS/FIELDS FIBERS/CC 01 24-5267-17 69.00 7.0/100 0.05 02 24-5267-18 957.00 5.0/100 <0.005 METHOD: NIOSH 7400, Issue 2, 08/15/94 Intralaboratory Sr=0.205 Interlaboratory Sr=0.450 ANALYST: Mark Case Reviewed By Authorized Signatory: Cam. Howard Varner, Laboratory Director Irma Faszewski, Quality Assurance Coordinator David Xu, MS, Senior Chemist Feng Jiang, MS, Senior Geologist Michael A. Mueller, Quality Assurance Manager NOTE: The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report. Results represent the analysis of samples submitted by the client. Sample location,description,area,volume,etc.,was provided by the client. The submission of blank samples is required by sampling methodologies. EHS sample results (fibers/cc)are blank corrected, per NIOSH 7400,when the client submits blank samples. If the report does not contain the result for a field blank, it is due to the fact that the client did not include a field blank with their samples. This report cannot be used by the client to claim product endorsement by NVLAP or any agency of the U.S. Government. This report shall not be reproduced except in full without the written consent of Environmental Hazards Services,L.L.C. California Certification#2319 NY ELAP#11714 Method Level of Detection: Estimated at 7 fibers/mm2. LEGEND L= liters fibers/mm2 =fibers per square millimeter fibers/cc=fibers per cubic centimeter pcm3.dot/290CT2004/MR -- PAGE 01 of 01 -- END OF REPORT -- ENVIRONMENTAL HAZARD Fax:8042754907 Feb 25 2005 11 :10 P. 19 ENVIRONMENTAL .HAZARDS SERVICES,' L.L.C. rTE PI E• LJ- ' 804.273.4788 FAX 80 •4- -4907 ABER•COUNT ANALYSIS.SUMMARY CLIENT; AvcuTecir Itiirulation.&Contracting,Inc. DATE OF RECEIPT: 24 FEE 2005 100 State s.txeet,.Bldg.#119 : . DATE OF ANALYSIS: 24 VRB 2005 P.:0.Box.376 DATE OF REPORT: 25 FEB 2005 Ludlow,MAR 61056 CLIENT NUMBER: 224056 ...A I+HS PROJECT#. 02-05-8174 4 PROJECT', 24-5267; Go Nest Building . EHS CLIENT . VOLUME fiAMPLE# SAMPLE# LITERS(L). FIBERWFIELDS FIBER$12Q _r(t) 01 '24-52..67-01 60.00 1.01100 X0.05 G •G'G� 02 24-5267-02 15040 2.01100 <0.028 GG k 4 METHOD:- r 1410SH7400,,Issue.2,08/15/94 F Interlaboratory Sr=0.205 ' Interlaboratory 9,;E!0.450 ANALYST: Mark Case Reviewed By Authorized Slonatoty: , Howard,Varner,Laboratory Director rrm.d Fatzei saki,Quality'Assurance Coordinator k David Zu,MS,Senior Chemist brig Jiang,Ms, senior Geologial . Mlchael'A Mueller, Quality Assurance Manager. E NOTE: The conditi6n of the samples ari�lyzed was acceptable upon receipt per laboratory protocol unless otherwise rioted on this report,''Results represent the analysis of samples submitted by the client.'Sample location,description,area,volume,etc.,was provided by the client The submission of blank samples is required by sampling methodologies. EHS'sample results.(fibers/cc)are blank oorra6ted•,por N10S.H.7400,when the client submits blank samples. If the report does not contain the result for a field blank,it is due to the fact that the client did not include a field blank•with their samples. This report cannot be used by the client to claim product endorsement,by NVLAP or any agend' of the U.S.Government: This report.shall not be reproduced except in full without the written consent of.Environ entai ktazards-Setvldes,L.L.G. California Ce:tlficaWn.M. 19.NY.ELAP#1 714 Method Level of Detection: Estlmated,atC7 flherslmm2, LEGEND L=titers E fibers/mm2=fibers per square millimeter Qerdfcc- to pcm3:dat12Q0CT2G04/MR? PAGE 01 of 01 --END OF REPORT-- K ENVIRONMENTAL HAZARD Fax:8042754907 Feb 25 2005 13:03 P. 01 i ENVIRON EN7AL HAZARD .SERVICES L.L.C.VA 23237 804275.4788 FAX 8 3 0 -275-4907 SULK EtSTOS SAMPLE AN&X,516 SUMMARY F CLIENT: :AccuTsch Insillation& Contractiat.g,Inc; i DATE OF RECEIPT: 24 FEB 2005 100 State.Stre6t,Bldg.#119 DATE OF ANALYSIS; 24 FEB 2005 F. 0.Box 876 DATE OF REPORT: 25 FEB 2005 Ludlow,MA 41056 CLIENT NUMBER:. 1271086 'A EHS.PROJFmCT #: ,02-05-8184 PROJECT: ' 25-5267;Go. st Binding EHS CLIENT SAMPLE Iff, °16/t,SBESTOS OTHER MATERIALS SAMPLE# ORATORY ORt 58 DESCRIPTION OI 25-5267-011 NA) 100%Noia-Fibrous Brown Cementitioud t i , I QC SAMPLE: '= Ml-1999-2 GtCLANFK:. : ARM'1866 Fiberglas REPORTIHG,11M1T: 1%Asbestos • i METHODr Polarised Light Mier�iscopy,EPA Method 600fR-981116 ANALYST' Christian Id. Schaibl,6 Reviewed qY Authorled;3i�>7atc►ry: aounid Varner,Labc ory Director Irma Faasewski, Qualr y Assurance Coordinator David Xu,M�9,Senior dhe mist Fong Jiang;MS,Senior geologist Michael A,Mueller,Quality Assurance Manager The condition of the samples analyzed'wa acceptable upon receipt per lahpratory protocol unless otherwise noted on this report. Results represent the analysis'of samples`submitted by the client. Sample bcation, description,area,volume.e.the U.S. Govern sift the client. This report cannot be used by ithe client to claim product endo Bement by NVLAP or any agency This report shall not be:reproducQd exoet in full, without the written co sent of Environmental Hazards Services, L.L.C. California C®rtificetioh #2319 • NY.ELAP #1171.4. Alt information conceming sstpling location, date, and time can be found.0 , Chain-of- custody.Environmental Hazards Servicest L.L.C.does not perform any safnple collection, Envir'nmentst Hazards'Services, L,L.C. 1wommends reanalysis by point count•(for,more accurate quantification) or Transmission Electron Microscopy (TEM), for enhance, detection capabilities) for materials regulated by the EPA NESHA li I ht$mlc ml n Standards for.HaZ rdous Air Pollutants) brad found to contain less than den percent ( 10%) asbestos by polarized 8 (PLM). Both'services are aysllable for an®dditional fee. . *All Californla samples Analyzed by Pol,#sd Light Microscopy,EPA Method 60OW-82-020,Dec.1982. i LEGEND NAD=no'•asbestos detected ni fibera p1ml,d6tt280CT20041 PAGE 01 of 0.1 ••END 16F REPORT-- • i j ENVIRONMENTAL HAZARD Fax:8042754907 Fab 15 2005 10:54 P. 01 ENVIRONMENTAL,HAZARDS. SERVICES L.L.C. 746 1 WWFE AQ.-RIERMON0,VA 23237 :804-215-4-788 FAX 804.276.4907 ' ER COUNT N LYSIS SUMM CLIENT: AccuTeeh tion&Contracting,1nc. DATE OF RECEIPT: 14 FEB 2005 100 State Sim ieC Bldg.#119 RATE OF ANALYSIS: 14 FEB 2005 P.O. Box 876 DATE OF REPORT: 15 FEB 2005 Ludlow,MA 1056 CLIENT NUMBER: . 22-1056 A EH6 PROJECT#:' . 02=05-1781 PROJECT: 24-5267;Go N 7est Building EHS' CLIENT VOLUME SAMPLE# S LITE F gR ?Il)� 01 24-5267-05 60.00 1.0/100 60,05 d3 02 24-5267.06 700.00 .4.0/100 . <0.405 <.6.6 METHOD;' N10SH-7400,Issue 2,08115/94 Intralaboratory Sr R 0.205 Interlaboratory Sr=0" ANALYST: Mark Case Rt3Vlewed By Authorized SI nifory: Froward Varner,laboratory Director Irma Faasewah4 Quality.Assurance Coordinator David Xu,•MS,Senior Chemist Feng Jiang,MS,Senior Geologist Michael A,Mueller,.Quality Assurance Manager NOTE: The condition of the samples an lyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report. Results represent the analysis of amples submitted by the client. Sample location,description,area,volume,eta.,was provided by the client The submission o blank samples is required by sampling rhethodologies. EHS sample resulta(fibers/cc)are blank corrected,per NI68H 7400;when 9 client submits blank samples. If the report does not contain the result for a field blank,it is due 0 the fact that the chord did not Inclu e a field blank with their samples. This report cannot be used•by the client to claim product endorsement by NVLAP or any agency o the U,S.{government. This report shall not be reproduced except in full without the written consent of Etivironrnentel Hazards Seffil es,U.C. California Certification 02319 NY ELAP 11714 Method Level of Detection: Estlmated p 7 fibers/mrn LEGEND L liters fiberslmm2l=fiber's per square millimeter e per a e to pern3.dot128DCT20W.MR^ --PAGE 01 of 01 END OF REPORT-- ENVIRONMENTAL HAZARD Fax:$042754907 Feb 25 2005 11 :10 P. 17 ENVI.RQ 914TAL ,HAZARDSIERVIGES, L.L.C. 7469 WHITE PIN p,VA23237 804.275-4788 . FAX 8044754907 tIBE COU T AN PSIS SUMMARY t CLIENT: AcouTech Iiis*lation&C=trdcting,Inc. DATE=OF REGFIP'T: 24 FEB 2005 100 state Street;Bldg.#118 DATE OF ANALYSIS: 24 FEB 2005 P, C,.Box 376 DATE OF REPORT: 25 FEB•2605 ;.Ludlow,X& 61056 CLIENT NUMBER 2Q-Y056 A . EHS PROJECT#: 02-0-5,3282 PROJECT: 24.5267; Go Vilest Building ENS CLIENT VOLUME SAMPLE 0 ;5&MRLE# l LITER U FIBERS IELDS FIBERSlCC � 01 24-547-07 60.00 2.01100 e,0.05 Z- ,043 02 24-5267-08 741.00 5.01100 .-,0,005 4 METHOD" NIOSH 7400,.Issue 2,08/15/94 Xntralabozatory Sr=0,205 Interlaboratory Er=0.450 ANALYST: ' Mark Case RevieWod By Authorizid.,$i jhatdry: ' Howard Varner,laboratory Director Irma Faezewski;`.Quality Assurance Coordinator David Xu,1S,Senior Chemist, Feng Jiang,MA Senior t7eologist Michael A.Mueller,Quality Assurance Manger NOTE: The condition of the samples an�lyaed was acceptable upon receipt per laboratory protocol unless otherwise no4ed an this area,volume,etc. report. Results represent the analysis of,samples submitted by the client. isarnple lacaron,description,, ,was provided by the client.,The submistiod of blank samples Is required by sampling methodologies. ENS sample results(fiberstce)are 'blank corisoted,per'NIOSH 7400,when the client submits blank samples, if the report does not contain the result for a field blank,it is due to the fact that the client did natlnGlude;a geld blank with their samples. This report cannot be used by the client to cla'�m product endorsement by'NVLAP.or shy egency'oO tho W.S.Government, This report shall not be reproduced except in full without the written consent of Environmental;HaZOMs Sett'i4es.;L,L.C. Calrtbrniatertifl 0on•0a319' NY EIAP#11714 Mefhad Level of Detection: Estimated. Tfiberslmm?. LEGEND . L-liters 1ibers/mm2=fibers per square millimeter ti °fi pern1dot/290C3200a/.Moi PAGE 0 i of QTi--END OF REPORT=- • I: I f• ENVIRONMENTAL HAZARD Fax:8042754907 Feb 25 2005 11 :09 P. 15 f ENVIRONMONTAL HAZARDS SERVICES L.L.C. 7440�s WHITE Pi 237 004.275-4780 FAX$044754907 FIBER COUNT ANALYS_ 6MMMARY CLIENT: 'AccuTeeh Ina�Iation&Contracting,Inc. DATE OF RECEIPT: 24 FEB 2005 . 100 State Strelet;Bldg.#118 DATE OF/ANALYSIS: .24 FEB 2005. F, 0.Boas:$76' DATE OF REPORT: 25 FEB 2005 ..Ludlow,MA 91056 CL I-ENT NUMBER: 12-1058' .A E14S PkOJECT PROJECT, 244267; Cho West Bltiidin6 EHS CLIENT VOLUME SAMPLE ff sWELEO, L L) EA RS/C 1P 01 24.5267-09 r 60.00 4.01100 <0.05 d 02. 24=5287=10' 684A 1110/100 0.008 i METHOD. NIOSR 7400,Xaeue 2,0$/15/94 Intralaboratory Sr=0.205 k Tnteriaboratory Sr=0.450 "r f ANALYST: Mark Ckse Reviewed By�Atlthorlaed SlOnatory Howard garner,Laboratory Director Irma Faaaeu,ski, Quality Assurance Coordinator Daum Xu,MS, Senior Chemist E Fang Jiang,MS,Senior[geologist I. Michael A,Mueller,Quality Assurance Manager NOTE-, The condition of the samples an®iyzed was acceptable upon receipt.per laboratory protocol unless otherwise noted on this report. Results represent the analysis of 6amples-submitted by the client. Sample location,deectiption,area,volume,eto.,Wes provided by.the client. The submisslon of blank samples is'required by sampling methodologies. EH5 sample results(fibers/cc)are blank Corrected,per NiDBH'7400,when tie client submits blank samples, if the report does not contain the result for a field blank,it is due to the fact th9t thei client diii-not inclutle a field blank with their samples. This report cannot be used by tho client to claim product endomementby NVLO'6i'ariy agertCy.vf the U,S:Govemnterit This report shall not be reproduced except in full without the written consent of,enoronmental Ha4ardn Servlaes,L.L.G. Califosnla Certification#2319' NY ELAP 1,1714 . Method Level of Detection: Estimated a0 fibers/mM LEGEND L=liters f+beralmm2=fliers par square millimeter fibers cc fibers aer c�bw aentim�t� - pcm3.daU g0CT2004/.MR ; PAGF 01 of 01 --END OF REPORT-- a ' ENVIRONMENTAL HAZARD Fax:6042754907 Feb 25 2005 11 :11 P. 23 i { E.N1/[RO'NMgKTAL.HAZ4RDS,'$ERVICES, L.L.G. 40. � A -RICHMOND 2 ; { 8o4-x75-4788 PAX 80'4.275.49'01 EA COUNT a,NLY&IS SUM XAARY CLIENT: AccuTech Iusul4tion&Contracting,Inc. DATE.OF RECEIPT: 24 FEB 2005 I00 State street,.,Bldg,#119 DATE OF ANALYSIS: 24 FEB 2005 P'. a,Sox 376• DATE OF REPORT: 25 FEB 2005 Ludlow,'MA 01056 CLIENT NUMBER: 12-105.6 A I EM PROJECT#: 42-05.3177 PROJECT: 24.6267; Go Building Building EHS . CLIENT, VOLUME E # LR L 18E F1E Fig S!C Iq Ol 24.5267-11 60,00 2.0 1100 X0.05 G Q 3 i 02 24-5267.12 250,00 1,01100 s0.01Z G . 0 j METHOD: NIOSH 7400,Issue 2,08115104 Intralaboratoxy gr=0.205 Interl6orat6Ty Sr=0.450 ANALYST: Mark Case Reviewed ey Authorized SiS story: fl .-- Howw�d Vdrne'r,Laboratory Director Irma Fasxeweki,'Quality Assurance Codrdinaior i Dabid Xu,•MS;Senior Chemist Ferrg.Jidng,M5,Senior Geologist Michael A.Mueller,.Quality Assurance 10anager NOTE: The condition of the sampies analyzed was'acceptable upon receipt per laboratory protocol unless otherwise noted on this report. Results represent the analysis of s8imples submitted by the client. Sample location,description,area,volume,etc„was provided by the client, 'The submission pf.biank samples is regiAr by sampling methodologies, EHS sample results(fibers/00)are blank corrected,per NIdSH 7400,when t ie client submits blank samples. if th®report does not contain the result for a field blank,it is due to the.faot that the.clieni did not lnaluile a field blank with their samples. This report cannot be used by the client to claim product endorsement by NVt.Ap or-any agerioy,of the U.S.Government This report shall not be reproduced except in full without the written consent of Environmental Hazards$ery&s,L.L.C. California Certlfic6lon#2319 NY FLAP#11714 Method Level of Detection: Estimated atj"1 fibers/mm2. . LEGEND L r!liars fibers/mm2=fibers per square millimeter jog&s r r °b .c i r pcm3.dotl290C120041 MR t -:PAGE.01 of.01 --END OF REPORT ENVIRONMENTAL HAZARD Fax:8042754907 Mar 2 2005 13:25 P. 01 , NVIRO MENTAL. HAZARDS SERVICES, L.L.C. R ,. 804-2754788 FAX 804.275.-4907 FIBER COU S RY CLIENT: AecuTech Insulation 80: Contracting,Inc. DATE OF RECEIPT: 01 MAR 20 05 100 State StrOet,'Bldg.#119 DATE OP ANALYSIS: 01 MAR 2005 P..O.Box 37Ei DATE OF REPORT: 02 MAR 2005 Ludlow,MA(IM56 CLIENT NUMBER: 22.1056 A' EMS PROJECT M, 03-05-0138 PROJECT: '24..5267. EMS CLIENT VOLUME l) SAMPLE# t AMgLgg LITERS(L)' FIgERS1 lELD$ FIBERS/ 01 24.5267.13. . 70.50 19101100 d.ia '60F 02 24-5267-14 1069.50 91.(1100 0.042 'LA METHOD: NIOSH 7400,Issue 2,'08/15194 Intralaboratory,Sr=0:205 Tnterlabaratory Sr 0.450 ANALYST:, Mark'Cae Reviewed Sy=Authorized,St natory: 7> fj:!! 99ward Varner;xiuboratory.Zlirector Irma Fagxewaki, Qualify Assurance CPordinator Dauid)'u,MS,.Seriibr Chemist Fong jkuw&MS,Senior Ueologist. Michael.A.Mueller,Quality Assurance Manager NOTE: The.condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report, Results represerit1he analysis of samples submitted by the client. Sample location,description,area,volume,etc.,was provided by the client: The.submission of blank samples is required by sampling methodologies..EHS sample results(flbers/cc)are blank corrected,per NIOSH 7400,when the client submits blank samples. If the report does notcontain the result for a field blank,it is due'to the fact that the client did riot Include afield blank with their samples. This report cannot be used by the client to claim product endorsement by NVLAP.ar any ageney of.ft U.S.Govemment. This report shall not be reproduced except in full without the written consent of.Environmental Hazards Services,L.L.C. California Certification#12319 MY EtAP#17744 Method Level of Detection: F-stirhated at I Rberslmm2, LEGEND L=liters flbers/mm2-fibers per square millimeter =Me Ubid centim pcm3,dot/260CT2004/d0b ..PAGE 01 of 01,-END OF REPORT ENVIRONMENTAL HAZARD F2x:8042754907 Feb 28 2005 9: 47 P. 01 ENV Fita1 MENTAL HA7ARDS �§.ERVICES L.L.C. -F . , HIT .. O -7 RICHMOND,VA 2323-f f 804-2754788 FAX 004-2754907 . IB R CO NT.ANALYSIS SU. MARIE CLIENT: AocuTech Insulation&Contracting,Inc. DINE OF RECEIPT: 25 FEB 2005 100 State I3tre t,Bldg.#119 DATE OF ANALYSIS: 25 FEb 2005, F.0.Box$76 DATE OF REPORT: 28 FEB 2005 Ludlow,MA 61056 CLIENT NUMBER: ,.22.1056 .A EHS PROJECT#; ;02.05=8419 PROJECT: ;24.5247,; Go West'Building EHS CLIENT VOLUME SAMP EL # SA P L Et # LaERS&I FIBERSlFIELDS FIBERSlCC /W 1� 01 . 24.5267 719 69.00 X.0/160 {0.05 C.dG3 02 '24-5267-20 a 726.00 2.01100 .-00.ou METHOD: N, IOSH 7400,Issue 2,08/15194 Intralabaratory 6r=0.205 r Imterlaboratory Sr=0,450 ANALYST: Fang Jiang,M.S. Reviewed B y A uthofad Signatory; Roward'Varner.,Laboratory Director IrmaOrrasewski,Quality Assurance Coordinator David Xu,MS,.Senior Chemist Fong Jiang,MS,Senior GeotogW MiohaelA.Mueller; QualWAseuranee Manager NOTE: The condition ofthe'eampiea anlyae<i was acoeptBble upon receipt per labor®tort'protocol unless otherwise noted an thin report, Results.represent the analysis of samples submitted by fire client Sample location,description,Brea,volume;etc.,was provided by the client. The submissioh o blank samples is required by sampling methodalopies. EHS sample results(fiberslcc)are blank corrected,per NIOSH 7406,wfi®n tlie,c{ient submit3 l�enk samples. If the report does not contain the easult for a field blank,it Is due to the fact that the.dlent did not include B field blank with their sBrnples. This report Cannot tie used by the client to p{aim product endorsement by NVLAp.or,ariY agehaY the W.S.Gavemment. This.report shall oat reproduced except in full Vthaut the wriden consent of'Envirohmental Hatards Servi s,L.L.G. California COrtificatlon.42'3i9 M'EL 411714 Method Level of Deteed6n,' Estimated fit 7 tlbers/rrrm2. E LEGEND L,=liters ffibers/=2=fibers per square mtllimetet - tlb nti pern3,dot/290CT2Q04?'MR .:PAGE 01 of 01 ENO OF REPORT-- ENVIRONMENTAL HAZARD Fax:0042754907 Feb 15 2005 10:54 P. 03 E:NVIRON ENTAL HAZARDS $ERVICES . L.L.C. T 'WHITE N ,VA 23zs-7 804=275-4788' .FAX 804.275-4907 FI$ER CQUNTMALY$IS SUMMARY CLIENT: AccuTech Itts: lion&Contracting,Inc. DATE OF RECEIPT: 14 FEB 2005 100 State S'' et,:Bldg.4119 DATE OF ANALYSIS; 14 FES.2005 P.Q. 80X,876 DATE OF REPORT: 15 FEB 2005 Ludlow,MA.. 1056 CLIENT NUMBER; 824056 'A EH8 PROJECT#: 02.05.1782 PROJECT: 24.5267; Go est Building EH8 CLIENT VOLUME LE SAM L $L F RS LD lrR C 01 2475267-03 60.00 3,01100 O.Ob G .063 02 24-526704 740,00 16.5/100 0.011 d d b METHOD, NIQSFI 7400,Issue 2,08/15/94 Iutralaboratory Sr=0,205 Interlaboratory Sr=0.450 ANALYST- Mark Case Reviewed B Y.Authorized Sig ataxy: / Howard.Varner,Laboratory Director. , Irma Faaawaki,Quaff*Assurance Coordinator David Xu,'MS;Senior Chemist peng Jiang,MS,Senior Qeologist Michael A.Mueller,Quality Assurance Manager Nt3TE: The condition of the samples era! ed was acceptable upon receipt per laboratory protocol unless atheruYrse noted�on this report. Results represent the analysis of sa ples submitted by the client. Sample location,description,area,volume,ett:,,was provided by the clienL The subrnisslan of bl nk samples is.repuired by sampling methodologies. EHS sampla results(libersloc)are . . blank corrected,per NI,OSH 7400;when the Bent submits blank samples. If the report does not contann the result for a geld blank,it is due to the fact that the client did not include field.blank with their samples, This report cannot be used by the client to claim product endorsement by NVLAP or any agency of th, U.S. Government, This report shall not be reproduced'except in full without the written consent of Enuironmentat Hazards Services L.L.C. California Car-OpE(Wn#2319 NY EIAP#t1 14 Method Level of Detections-Estimatsd at 7 ers/mma. LEGEND I_=Iltera fibers/=2=fibers per square millimeter hers per pcm3,doV29QCT20041 MR --PAGE 611 of 011 --E=ND OF REPORT-- VV -a N•E•E�T• E.P.A. AGENCY # 99 110260 MA,RI,VT,NH,ME NY GENEP, 9S WASTE MANAGEMENT NERATORS New England Environmental Transport,Inc. EPA Region 2 EPA New England V53061 290 Broadway,26th Floor EMERGENCY RESPONSE P.O.Box 144•Portland,CT 06480 1 Congress Street New York,NY 10007-1866 (860)342-0667 • Fax:(860)342-4866 Boston,MA 02114-2023 (212)264-6770 TELEPHONE 'State 1-800-272-3867 (617)918-1111 #1-800-272-3867 TK# ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # 24-.5267 GENERATOR/BUILDING OWNER Contractor AccuTech Insulation & Contracting, Inc. Valley CDC Address 100 State Street, P.O. Box 376 Add61arket Street IiA City Ludlow State Zip 01056 C' orthampton e 010p60 Telephone Number (413) 553-5500 Phone Number ;413 586-5855 Date Container Del. 11-30-04 Date of Pickup?-14-05 GENERATING LOCATION Type of Container 100 CY Go West Building VOLUME5.56 CY Friable jg Non-Friable❑ A dr North Main street MUST BE IN CUBIC YARDS City State Z Ba Drum T-Pack Wrapped Other Florence MA 0160 9�] 270 ❑ ❑ pp ❑ ❑ Phone Number RO, ASBESTOS, 9, NA2212, PG III None certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law,is not a hazardous waste as defined by 40 CFR part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150. Shipper's Certification: I hereby declare that the contents of this con g ment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarde , nd are ' r p is in proper condition for transport according to applicable international and national government regulations. '- 'THORIZED SIGNATURE Transport 1: AccuTec ulation & Contracting, P.Q. Box 376, Ludlow, MA 01056 (413) 583-5500 Name Address Telephone# Driver: Registration #: MA/F22-384 Date: Signatu State/# Acknowledge, t of receipt of material Transporter t N.E.E.T., Inc., PO Wx 144 Portlar nd CT 06480 1-800-272-3867 Driver: Registration#: Date: `® Signature State/# Acknowledgement of receipt of materials. WASTE MANAGEMENT N.E.E.T.,INC. • 203 PICKERIN (EE RTL D,CT 06480•PH E: 00)272-3867 P R IT#1130559-PO Transfer Date: 02118/05 By: Discrepancy: Certification of transfer of materials covered by this manifest. Transporter& WASTE Ga= INC. 9 PICKERING ST. -ORTLAND, Cr 06480 860-342-0667 Name / Address Telephone#4r Driver: Registration #: `� Date: ignature State/ Acknowledgement of receipt of materials. Landfill Name: Turnkey Recycling & Environmental Ent. Phone No: (603) 330-0217 1 -tion: 97 Rochester Neck Road, Gonic, NH Permit#: DES-SW-SP-95-001 Approximate Volume of Asbestos Received: Discrepancy If A Received by: ` Date: Certification of receipt of materials covered by this manifest. COPY 1 -GENERATOR Commonwealth,,, Massachusetts ( 777440 Please Enter Decal# Asbestos Notification Form ANF-001 i D. Facility Description (cont.) 5 Western Builders PO Box 587 Name of General Contractor Address Granby 01033 413-467-9171 City/Town Zip Code Telephone Granite State Insurance WC481-49-86 11/04/04 Contractor's Worker's Comp.Insurer Policy# Exp.Date 6. What is the size of this facility? 8,400 3 Square Feet #of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary)to final disposal site: AccuTech Insulation & Contracting, Inc. 100 State Street, P.O. Box 376 Note:Transfer Name of transporter Address Stations must Ludlow, MA 01056 (413) 583-5500 comply with the City/Town Zip Code Telephone Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 Waste Management N.E.E.T., Inc. 25 Silver Street Name of transporter Address Portland, CT 06480 (860)342-0667 City/Town Zip Code Telephone 3. N/A Refuse transfer station and owner Address City/Town Zip Code Telephone 4. Turnkey Recycling & Environmental Enterprise Turnkey Recycling & Environmental Enterprise Final Disposal Site location name Owner's Name 97 Rochester Neck Road Gonic Address City/Town NH 03839 (603) 330-0217 State Zip Code Telephone D. Certification The undersigned hereby states, under the Grace Mitchell penalties of perjury,that he/she has read Name ytKorized Signat a and Date the Commonwealth of Massachusetts Office Manager AccuTech Insulation & Note:Contractor regulations for the Removal, Containment must sign this form Position/Title Contracting, Inc. for DOS notification or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15, and that the (413) 583-5500 100 State St, P.O. Box 376 purposes information contained in this notification is Telephone Address true and correct to the best of his/her Ludlow, MA 01056 knowledge and belief. City/Town Zip Code Fee exempt(city,Town,district,municipal housing authority,owner-occupied residential of four units or less?) ®Yes ❑ No Notification.9/02 Asbestos Notification Form^Page 3 of 4 r , I Commonwealth( Massachusetts 777440 Please Enter Decal# Asbestos Notification Form AN -001 f A. Asbestos Abatement Descripti®n (cont.) 11. Total amount of each type of Asbestos Containing Materials (ACM)to be removed, enclosed, or encapsulated: 515 16,660 pipes or ducts(linear ft) other surfaces(square ft) Boiler,breaching,duct,tank surface / Insulating cement coatings lin.ft sq.ft Ifn.ft sq.ft Corrugated or layered paper pipe insulation 5,n.ft sq.ft Trowel/Sprayer coatings lin.ft / 5 q.ft Spray-on fireproofing fin.ft /sq.ft Transite board,wall board lin.ft /sq.ft Cloths,woven fabrics fin.ft sq.ft Other,please specify: Thermal,solid core pipe insulation lin.ft /sq.ft 4,375 sq.ft.VAT&Mastic 21 sq. lin.ft /sq.ft ft aink r_nn inn 12. Describe the decontamination system(s)to be used: Two layers of 6 mil poly on the walls and floor(where applicable)with an attach. 3 stage decon unit. Seal critical with 6 mil poly pre-clean, lay drop cloth & remove using neg press glovebag method. 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): ACM to be double bagged or wrapped in 6 mil poly and delivered in a sealed company vehicle to rii imn citp 14. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: N/A Name of DEP official Title Date of Authorization Waiver# N/A Name of DOS official Title Date of Authorization Waiver# 15. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑Yes 0 No B. Facility Description 1. Current or prior use of facility: Retail & Residential 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes 0 No Valley CDC 30 Market Street 3. Facility Owner Name Address Northampton 01060 413-586-5855 City/Town Zip Code Telephone 4 Joanne Campbell same as above Name of Facility Owner's On-Site Manager Address City(Town Zip Code Telephone Notification•9/02 Asbestos Notification Form•Page 2 of 4 Commonwealth( Massachusetts ? 777440 Please Enter Decal# Asbestos Notification Form A F-001 Revised #7 1-7-05 Revised #7 2-2-05 ` Revised #7 1-28-05 Revised #7 2-24-05 A. Asbestos Abatement Description Important: When filling out 1. Facility Location: forms on the computer,use Go West Building 1 North Main Street only the tab key Name of Facility Street Address to move your Florence MA 01060 _ N/A cursor-do not use the return City/Town State Zip Code Telephone key. Worksite Location: Basement- 3rd Floor Building name,#,wing,floor, room. 2. Is the facility occupied? ❑Yes ® No 3. Asbestos Contractor: AccuTech Insulation & Contracting, 100 State St., P.O. Box 376 Name Address INSTRUCTIONS Ludlow, MA 01056 (413) 583-5500 1.All sections of City/Town Zip Code Telephone this form must be AC000005 completed in order DOS License# Contract Type: Written Verbal ❑ to comply with Joanne Campbell I� DEP notification Facility Contact Person Contact person's title requirements of 310 CMR 7.15 4 Dale Hardy AS71733 and the Division Name of On-Site Supervisor/Foreman DOS Certification# of Occupational Safety(DOS) 5 To be determined notification Name of Project Monitor DOS Certification# requirements of To be determined 453 CMR 6.12 6. Name of Asbestos Analytical Lab DOS Certification# 2. Submit Original Form to: Commonwealth of jr n�i1��gr � ���f���' 2-24-05 Massachusetts 7. Project Start Date End Date Asbestos Program PO Box 120087 Boston MA 02112-0087 7 AM to 4 PM N/A Work hours Mon-Fri. Work hours Sat-Sun. 8. What type of project is this? ❑ Demolition ® Renovation ❑ Repair ❑ Other, please specify: 9. Check abatement procedures: ® Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup ❑ Other, specify: ® Full containment 10. Is the job being conducted: ® Indoors? ❑ Outdoors? Notification-9/02 Asbestos Notification Form•Page 1 of 4 a + AccuTech INSULATION & CONTRACTING, INC. 1 111F STATE STREET, BUILDING #119 1-800-244-8773 P.O. BOX 376 (413) 583-5500 LUDLOW, MA 01056 FAX (413) 583-5555 FINAL DOCUMENTATION Asbestos Abatement for: Go West Building 1 North Main Street Florence, MA 01060 Basement-3rd Floor prepared by: AccuTech Insulation & Contracting, Inc. P.O. Box 376 100 State Street, Building #119 Ludlow, Massachusetts 01056 (413) 583-5500 0ii tqccuTech INSULATION & CONTRACTING, INC. STATE STREET, BUILDING #119 1-800-244-8773 P.O. BOX 376 (413) 583-5500 LUDLOW, MA 01056 FAX (413) 583-5555 July 27, 2005 Western Builders P.O. Box 587 Granby, MA 01033 RE: Go West Building Thank you for selecting AccuTech Insulation & Contracting, Inc. to service your environmental needs. Enclosed please find final documentation for the above referenced project. This documentation package should be retained as part of your permanent records. Included you will find: Westem Builders, tnc. 1. Regulatory Notification 2. Personal Air Monitoring Renewed to OM,ral Cmtomurao 3. Documented Waste Manifest to nespsdecekm 4. Contractor's License 5. Contractor's Certificate of Insurance 6. Worker Certifications Please call if you should have any questions or require additional information. Sincerely, AccuTech Insulation & Contracting, Inc. RECEIVE G� JUL 2 onica Alessi Administrative Assistant WESTERN BUILDERS •,� ,� T I 107 C AVG 11 2005 Ford - - - Gillen DEPT OF BUILDING IN SPEC)IOVS NOR'N"'�"TON.FAA 01060 Architects, Inc. TRANSMITTAL 409 Main Street Amherst, MA 01002 DATE: August 8, 2005 Tel 413-253-2528 g Fax 413-256-1553 fgaoffice @fordgillen.com Kathleen E. Ford,AIA William V.Gillen,AIA TO: Valley CDC RE: Go West, Florence, MA JOB NO.: 2226 Urgent X By KB For Your Quote Under Separate Cover By Express Mail Per Your Signature Review and Comment By Messenger X. For Your Use Other Enclosed: Asbestos disposal record and close-out information. <U4,�&M-1— Krista Benoit