HomeMy WebLinkAbout0089 PLEASANT STREET - Health fIRS
89 Pleasant St. H a0zWER
i
A=
1
e e �
�� a
05/14/2001 11:31 5088217684 HAMMOND DELEADING - PAGE 01
MtiK. 9 rwt" . ice. ,. _ - -"
Department of Public HwIthl D epsftment el Labot'&Workforce DeveluP scat
N0"i'IBitC-&&ION OF DLUAID G WORJK
An sections of tilt form must be completed-in order to comply with
theaotiYiti40n requiromentsoflVL(j.L C.111§197,
1 454 Cl 22,ti0 d I05 C1ti1R 4ftU,4tl0:as Meg recently ameud.W
I '
• Hammond Deleading 'eense#f DC1068 Exp,Date 6-09-01
Contractor performing pxagect �
Lead Faint Imspetfar Date of Insp�on i Iaeense# l xu-Date
AlD1 RB§S 01!PIZ0 CIr:
street 1lddresa� �Y�� �1 �pt.:+igmber� l�� Nl� i,
c:ty 2r+, t ° _ zap
Property user "l j V C. Address_
Telephone Noinkerj
8
xat Gun Liquid EacapwIfi Ft
DeleadiD�M�atitoiE: etLnr�Ser3pi�
coo rtiaa Caustics Repgaoement•
Cw—ring
Cheek onc; Dwelling is multi-(amity Single-
Start Da4e Complefi m.Date_ —
W)ten wffi work be dcme: A►VI_ PbI '' atkends?
Pro�ert B�erri9ar ATaato
Mark Harrington XWgnsa� DS3229 Exp,Date 3-1.9-02
555X774 Carrier Reliance
workwS Compew"fibn Polley Number
In Casa of aw"Ieney contact
John Hammond Tel, —7684
# 5� O8 821
(Contractor's$epreseatative) Cell# (5 0 8) 2 4 3—16 6 8 1
I)ELIg"INCI trONI13A DI; I
The 4ndw9iV ed hereby states,modertAe psins and Landtho
rjury, N
sh I:as read apd mWerstaod tbo Canunonweaith of
bdassacbnsetts Deleadian Itagplationa,454 C 22. ad Foie entiou and Coatroi P.egulatdons,105 CMR
460.OSi0,and 1Ast the ind`ormsitfe�a eo�atain®d in this e r to
the best of 4iFs{tler knowledge and betscf,
Compaay Hammond Deleading
Addxess 19 Orchard Street Berkle MA 02779
Telephone Numb (508) 821-7684 Cell# (508) 243-1668
OVER-0
05/14/2001 11:30 5088217664 HAMMOND DELEADING PAGE 01
MHh- --- _-..
tgPairrment of Publie Healthl Department of Labor&Workforce Development
NtyrMc.A.TI'ON OF DEL]EADING WORK
4
j AD sections oftbis forpt must bt eotxplctod j•order to comply witb
the Aotirmafton requi mmenU of C.1111197,
4S4 cN.W noo and=05 CM 460.000,as most recently amended
Contractor performing projwt Hammond De l e adi n g �,icease D C 10 6 8 lysp.Date 6-0 9-O 1
s.
Lead Paint Inspector F� i1 -QW11�A Sate of Inspection / o� � 7Licen3e#& 7 4 txp.Date
i
am0](�SS of PRE:r:
s
Strect Address f _S?" Apt:Number
-propferty Otrger � Address
Telephone Nn r r" (// �
Delcading Method: Tema
tlDzp Scraping Rest Gun Liquid BucaysulaM
'ion Caustios Iteplace>nont
Csveritim
zf"�OtbeP'seleot�,please explaan, /^.,�,�� ��;
Check one-, Dwel tg is multi-family S4IIgi¢-fauu4y (�cs+ Osbar
Start Date Coo edon te
pl Da --'—
-
Wh4b wf work be dame, saM (Sp VG*times on site) 'oleekendc't i
ProSe'ct8umervisorNaate Mark Harrin ton nae# DS3229 r,xp�Date 3-1.9-02 `I
555X774 Reliance '
worker's Coa pew*d6n Policy
Number Carirerr
Yea Case o£emergeary eontaef John Hammond Tel.# { 508
} 8 21-7 6 8 4
(Contractor's Itep&`utesitive) Ce 11(k (5 0 8) 2 4 3-16 6 8 �— f
DVXV:AAING CONTRACTOR—
The undersigned hereby stunts,under the pains and penapties afp VrJury, t elslie has read amd understood the CemmoatWesDfh of
Massaehnsetts Dglesding Pegpiaitous,454 Cs' M 22.00,and On Lead Pois nation and Control Regulations,105 CMR
}WOO,and that the WormatiOn conmined ill this uadfe2tion i a to the best o6 h"er 6wowiudge and belief
Date 7 ^i1 SiP4
Company Name
Hammond Del.eading t i
A,dezess 19 Orchard Street Berkley MA 02779
TelephvneNumbar (508) 821-7684 Cell' (508) 243-1668
OVF.R�► t