HomeMy WebLinkAbout0039 PEARL STREET - Health 39 PEARL STRE N
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AUG-13-2009 07:35 FROM: TO:15087906304 P.2
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Commonwealth of Massachusetts
t Asbestos Notification Form ANF-001 Deal Number
Important: t t A. Asbestos Abatement Description
When filling out p -
e use
computtr o 1. a.IS this facility fee exempt-city,town,district, municipal housing authority,owner-occupied
only the tab key residence of four units or less?El Yes 'M No
to move your
cursor-do not b,provide blanket decal number if applicable.
use the return Blanket Decal Number
key. 2_ Facility Location:
MARY REAL ESTATE TRUST 39 PEARI,ST,
b
l ►!f "UrAITS 0 02601 = {508)398.4000
G Cityfrown d.State e.'Lip Code T0111PI101110 NumbOr
INSTRUCTIONS 3• Worksite Location:
1.AD sections or this SAME
form must be a.Building Nameleuacling Lomtion D Building q a wing d.Floor e.Room
completed in order
to comply with 4. Is the facility occupied? ❑Yes .❑No
OEP notification
requirements of 310
CMR 7.15 5- Asbestos Contractor
end the Division AIR SAFE INC 61 ENDICOTT STREEY
or Ooculrauonal 'I
Safety,(DOS) A.Namn b.More"
n0tificati0n
reqLdrenumu olA5s NORWOOD 02062 7817823390
CMR a 12 c. � /Town d Code 0.Telephone Number
AC000464
sense umber g•COntrad Type: []Written ®Verbal
h.HOW 0 ontact rson i GOntaCI Retre n-8 Title
0 JAIME'E AMAYA JrSW0847
a Name f WftejumrvlwdForamn b.$upWyiswJForeman D08 Certification Number
NA
7. a.Name of P[*Ct Monitor b.Pro'ect Monitor Dog Brtifica1 on RumM
8.
NA
a.Name of Asbestos AftliCal Ealbn I I r
6211812012 102128=112
p 9' a.Pro oa start Date mmlaa b.Ens data mmld
®fl 7AM-6PM
®N u.Milk hours Mart i d. ours at n.
0 10, a.What type of projecct is this?
c ❑Demolition Renovation
®� Repair ❑Other,please specify: b.describe
11, a.Check abatement procedures:
Glove bag Encapsul2don
o Enclosure Disposal only
Cleanup El Other,specify,
2 ❑Full eontairiment b.ryaeoriba
®d 12. Is the job being conducted: Indoors? Outdoors?" OEM
■ anf001 ap.doc•10/02 Asbestos Notification Form-Page 1 of 3 I(8
RUG-13-2009 07:35 FROM: TO:15087906304 P.3
Commonwealth of Massachusetts
``�± 1Q0142508
a Asbestos Notification Form AW-001 Q"lNumber
B. Facility Description (cgnt.)
a.Name of General Contra_ for h.Address
QN/Town d.ZIR Code a Telephone Number area Code and extensio
f.Contractors Worker's Comp.Insurer Poll Number h.Ex .Dete mnVtld
S. What is the Size of this facility? e,Square Feet b Number of floors
C. Asbestos Transportation and Disposal
1._ Transporter of asbestorreontaining material from site to temporary storage site(if necessary):
z AIR SAFEU
Note:Transfer a.Name of Transporter A dr s
Stations must
Comply with thb c.atyrrown d.Zlp GOde e,Telephone Number
Solid wee
Division 2. Transporter of asbestos-containing waste material from removMemporary site to final disposal site:
Regulations 310
CMR 19,000
a•Name of Transporter b.Address
C,CitylTown - d.zip
a.Tat® none Number
3.
a.Refuse T
ransfer Station and ownerq b.Address
c.CI�i/Town. %i Coda e.T h ne Num r
4. IMINERVA.ENTERPRISES INC
a.FnAI Disposal Site Lotion Name b.Fln is oaal Sita Location Owners Name
9000 MINERVA ROAD WAYNE5SUR
5nil QLgMl aite awns d Cityrrown
IOH 44688
- o.State f.Zip Code g:.Telapho"Number
D. Certification .
The undersigned hereby states,under the DF WALSH
penalties of pod that nersne nas read Ina a.Name b,AutnorizeC Signature
m
�o Comonwgeith of Massachuepttd rogulatione VP
for the Removal,Containment or p /Dori/le Date m d
Encspsulsbon of Asbestos,463 CMR 6.00 and. d.
310 CMR 7.15, and fhat the information 761 762.3390 JAS
contained in this notification is true and corr9Ct e•T®I none Number f R sentin
to the best of his/her knowledge and belief. 61 ENDICOTT ST
-p A.Address
LL NORWOOD 10206
h.Citoown i.Zip Code
0 anf001ap.doc•10102 °Asbestos Notification Form•Pape 3 of 3
RUG-13-2009 07:36 FROM: T0:150e7906304 PA
Commonwealth-of Massachusetts
�,•. 100142508
Asbestos Notification,Form ANF-001 . I""mbe`
A. Asbestos Abatement Description (coat:)
13, Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed, or
ncast e :
40 0
a.Total pipet nr clucm alnear Ki 15—Total Other su Cbe squarB
a Boilor,brwohing,duct,tank � 'd.Inaulatin®cemsnt
aurfaw Coatings :. Li� ft• Lin.
�J S
e.Corrugated or layered Wnr La' f.TrowaUSpraYer roalinDs
pipe insulation Lint-�- ft
g.spray-on fireproofing q. h.Transite board,wal board Lin. s"q R
L Goths,woven fatxi(M 1.Other,please BPWfy: n
k.Thermal.solid Core pipe
insulation un� lsPocify
14, Describe the decontamination systems)to be used:
S CHAMBER DECON
15. Describe the containerizationtdisposal methods to oomply with 310 CMR 7.15 and 463 CMR
6.14(2
6 MIL POLY LABELED BAGS`
16.ffForr'Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency:
IT
.. !a ame OTDEP ORld3lFIT IQ .
c.Oate mmhid of Authorizbton d.DEP Waiver
e.Name of DOS Offiaol TW15 Official TW
g Date 1 Authorization h.D diver#
�0 17. Do prevailing wage rate$as per M G L:'"c`149,§26,27 or 27A—F apply to this project?E]Yes 2 No
B. Facility Description
�N RESIDENTIAL.
Q 1. Current or prior use of facility;
Q
2. Is rho facility owner-occupied residential with 4 units or less? ❑Yes No
SAME
3. b_Address
e. sell Owner Name
p C.CR (town d.zip
oriel® hone Number area coda end extension
emu: 4 JOHN SMEA
a,Name of Facilityowners On-Site Manager b.On 3itw Man erAddraHq --
Q c,Cityrrown d. iD'1 Code e.Telephone Number(area code and axtereion)
anf001apdoc 10102 Asbestos Nottlleation Form•Pa e 2 of 3■