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HomeMy WebLinkAbout0022 RICHARDSON ROAD - HAZMAT as � -S-on Vocb ZM� TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS 4EZ4 111.4d,141 4CE VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL °mot[ i,l hers /o'o�fBr�for If ,Sske n� (Give same information for.any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS APPito vED Barnstaole Conserva.tio;i Commission Signed Date je commonweaitb of aggac jugettg DEPARTMENT OF PUBLIC SAFETY--DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE. BOSTON J . Centerville 5 12 19 - - (City or Town) )Date - PERMIT In accordance with the provisions of Chapter 148- G. L. as provided in. this permit is granted to Name Centerville Nursing Home _. (Full name of person, firm or corporation granted permit) - to store underground:' 5:00 gallons ofrdieselfuel . for their State clearly emergency generator(Not for Resale) at 22 Richardson R�i� purpose for which permit is granted ¢ Restrictions at 22 Richardson Rd. Centerville, Mass fGiveJt7eafle'by atraet and no.,or describe in such manner as to provide adeouate ' ficaY n ©c Fee Paid 1Si ture of o ial a r tl This permit will expire . 19 f ITjtle) , Fir (THIS PERMIT. MUST BE CONSPICUOUSLY'POSTED UPON THE PREMIS .) 'W-1 i r ., . Commonwealth of Massachusetts FREW r - Asbestos Notification Form— ANF-001 A Asbestos Abatement Description 1. Facility location: (gc11.tta1 x1ff- RSSiS�cd �iyi c, ►1_(E �J : rLv 1 Q INSTRUCTIONS Name ,yam p� Aldme 1.All Win uoIthis form mu;lbecompleted Clry/re"? \ Ilprnk f relenlwm° (� to order to whh �JJ e� ��__'/4i1 L M�a. �4�wNsw (u"�� l�AtaC•i CO X I�ICYrY the ironmntaDepartment of •yry�1,Ale white Auffen7 building nam./7,4. 'nwm Environmental �Q(�c12.\, `'(!�C'V'nr"`q'1 tx¢Ch,n, Ls"r„`^'"' f`•�'vh r iprotection notification 2. Is the facility occupied? ❑Yes Ck �j. +u:^f � V" (� Lon 1"' requirmheds of 310 CMR 7.15(ten working drys prior notification is 3. Asbestos Contractor: requitedofanyahatement Environmental Solutions Inc. �Q GuinatLS.trePt prok.o:and the Name — A krress Department of Labor and Industries notification equi taquiremeres Waltham, MA _02154 617-899-3370 _ — o1453CMR6.12 (ten clynown Ppmle fsl days prior noriGcation is fW NlAr�%requireiofANY �CO00042.., abatement proied greater IX I rkense/ eanlre! .(wdtk a burg Man three linear or square led). 4. 0n-Site*Projec1Supervisor#oieman: - 1.Srbmh Original Form , s....l •�SG�(�k� . .• —.._ _._.._... To: Norma oUfeAllkanon/ Commonwealth of Massachusetts 5. Project Monitor: frebesim ProgramP.O.B.120087 Boston,MA 02 Boston,MA 02112- Name— � al eNerdbn/ 0087 6. Asbestos Analytical Lab: 3.This form may be (1 Q � Pato0aoT _ used for nolifying the �J U.S.Environmental Na"r Pioledion Agency Region / (�1, specilicworkhour n.-Fri. t� D (Sat.Sun. IoIasbestosdemolhionF 7. Project start date3J_�enddate_ ) renovation operations subject to NESHAPS(40 8. Whorl type of project is ibis? (circle one lam orinon rryirlr remnnon olaer(ev*i:n) CFR Subpad M). raoadeueo°s 9• Describe the asbestos abatement procedures to be used (circle): gin„rtoo axwure tuncor/atnned darlw errcaoruraflon dlsrndonly rarchom► v�l; (LQMD�IGQ. 0.6,vdDie 10. Is the job being conducted Indoors ❑outdoors 7 tl� a� �� 11, Total amount of each type o Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear fl.) or other surfaces 5 F r to be removed,enclosed or encapsulated: e )inear/square lee( boiler,breaching,dud,lank surface coatings...—J Moral,solid core pipe Insulation...... corrugated or b)ered ptper pipe insulation...._� insulating cement.................. _� spray-on fire roofs * _/ baveVslaaysreoahnps.:.: .::.::.: _ _-.---- `clottrs.'woven trbrks ftsmileboard.wallboard............. • ogror(please desaibe)..y�'..�.1:.�.�k_�.�►{'�D 12. Describe the decontamination system(s)to be used: Tlie aecon- i nat L'used as appropriate. 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): Asbestos west-ew_;11 Ile We-tbed & double_baggPd in a;x mi t 1 abut a hanS---The;r w-U1 be ant ac ed bv_EST;i n a 40—cu-yd.--dosed_locked--contaiAer--f=--disposal-- 14, f�St rh ge I s�YsTo31J3C€r1&& bFer3lfWsd,1 )AP and DLI officials whho�evaluatedd the emergency: 4 � ► 1i' ICJ �. 7y Name albEPoaklar DateofAulhortl f—kvr Gro,U,' &MOti X 11cS�caL� (Lflu yv c�5t' wmrda►a al rifle Oak onNdhorbafrnn warner/ 15. Do prevailing wage tales apply as per M.G.L.c.149,§26,27,or 27A-F to this project? Dyes No Rev.02 Facility Description 1. Current or i fact prior use of p �Q.CO..w"li X11�'tr�-•2°v 1Jw y�.u`tiw-s_. 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes A. 3. Facility Owner. Clry/Town lip rode Telmhonee 4. Facility's Owner's On-Site Manager: �� ,�t���.•�i� _ ` ' _lL\L �(• u� 'emu s l.OW1.{' �e •1al�n�w.1.J'l Name � _-4�.�— o zz��—_ G t•�,alp 1-S�,do CI flown Ilpark Trap&_ 5. General Contractor: ` Name f_ --- Address ---- - — -- .------ - --- - ---- ----Cl ofm '` yy—�— II code Ab one N 11'1 — Contractor's Workers C D.Insurer Policy/ DOife 6. What is the size of the facility?31.3, I(sa ft)_ V of Iloors) 13 Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste malmial from site to temporary storage site(if necessary)to final disposal site: Environmentai Solutions Inc. 50 Guinan Street Nacre Waltham, MA 02154 617-899-3370 Clfy/laxn --- lip ark Iff"au 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site: Lo.qano Truckin�cl Co•, Inc.. ____-._ P. 0.-Box 144 Name Address PQrtland�GT -- 0698t).--._--.—.___1_203-342_0667_- - rte:Transfer elN/r_ lip a0. lerelow ations must 3. Refuse transfer station and owner(H applicable): mply with the jy did Waste N / A ds/on repula- Name Address. . .- --- ----- ns 3fOCMR .00 ------- Ciry/ro" 70 aak /region 4. Final Disposal Site: u _Qo4Ln4JL2 - -- - - ._ ..-..- ---- ----- ------ ----- loraf m Name O�ners Nane AIUrU�r Addfm Crrypoan Certification The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulations for the Removal.Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the Information contained In this notification is true and correct to the best of his/her knowledge and belief. S���' erg c. _CJU:�e --- �--. - •���, - _ 3�a��_ Mnl Nana l — Avffo&ed S nafure W! r;Contractor l sJpn this —Envi.-ronmental-Solutions-Ing 617_899-3370- f for DU PoOkWnee K. fr#— ication oses 50 Guinan Street Waltham, MA 02154 Address C107— lip M* Fee exempt(City.Town,district,municipal housing authority,owner-occupied residential of four units or less)7❑yes[51 no Sticker/(from front of form): �'� Commonwealth of Massachusetts i° b Asbestos Notification Form— ANF-001 . j _IWK ' 1=' Asbestos Abatement Description -- ESI Job # L 1. Facility location: �z�tiCC•'v�1�L �y>>�'-�kz� �y�,`u�r �/iC�l}� .?Z....E' ( Sef�......._.....p 5........................_...... INSTRUCTIONS Na/me Address L 1.All sections of this (('V\1!U0i0f_ k`klk D._1 �:. ................._.. ............................................ lorm must be completed' C,iwown i T......... ill aWe Telephone in order to comply with akVWOo 1 r CG < SIN�C1A \6 (0 0✓ C �C�A the Department of .......................... Environmental Wlral is llie wnrlafle loralion?building narrm,/wing,floor,room w VAXV1S ••k 44-QU5 Protection notification ke f VG011� requirements 2. Is the facility occupied? ❑Yes &No 1���CY.e-%A ��w.�r�a t�ov. 7.15(left working days prior notification is 3. Asbestos Contractor: requiredolanyabatemenl 50 Guinan Street projecp:and the E.n.vIr.o.nmen.t.a.1....Solu.ti.ons....I.fic............................................................................................................................_..... Deparlment of Labor Name Address and Industries notilicalionrequirements Waltham, MA. ......................................................... ..0.2.1.54................................. ..7.8.1.-.0..9.9.-.3..3.7.0...................... ^.... of 453 CMR 6.12 (ten City/Tdwn Dp code Telephone days prior notification is requiiedolANY AC000042 1�J�rC�Cv\.... ..... ................... ..........._......._.__:............ abatement project greater p(llicerrse/ fdnlfXJ lyle(wrilfen/vedral) Man three linear or square feel). 4. On-Site Project Supervisor/Foreman: c 2.Submit Original Form U.l. ..........�r:�C:(i` ........................................_..... ............................................... ........� c7...�.c?...1.. Lk . To: Name DLI Cediliralion/ Commonwealth of 00 Massachusetts 5. Project Monitor: J �y Asbestos Program D 0 O L P.O.9.120087 ...Q.1.vMr5��,ed.... ... �yov�rmun ...Cora....... ....lkl ..................t......................................................................_. Boston,MA 02112- Name DLI cediaraliun/ 0087 6. Asbestos Analytical Lab: 3.This form maybe ,(� �kc p U t(51- used for notify ng the 1✓.�U..e J S v.Y".C .......j` .vo!�cA� v�10 Y.................. .......................................................................... U.S.Environmental Name DUGeniliraliun/ Pdo[ection Agency Region )i (i 1 OC ):3� Sat.Sun. Iofasbestosdemolition/ 7. Project start date_/A_kLenddate�/��specificworkhours(Mon.-Fri.) ( )� renovation operations —� subject to NESHAPS(40 CFR Subpar[M). 8. What type of project is this? (circle one): demolition repair renovation orher(explain) 9. Describe the asbestos abatement procedures to be used (circle): grove Ira? enclosure lull containment cleanup Fd official Use Oey encapsulation disposal only olher(explainJ 5��� �d�� �J G�L'r v Cc S rrAavauon r \ �o v neahed Dale 10. Is the job being conducted 0 indoors ❑outdoors? �ervH w Pe1e1 AVWedlDmd 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other surfaces(square ft.) o D i to be removed,enclosed or encapsulated: sro� aw linear/square feet boiler•breaching,dud,lank surface coatings..._/ thermal,solid core pipe insulation...... corrugated or layared paper pipe insulation...._/ insulating cement.................. spray-on fireproofing....................._/ bowel/sprayer coatings.............. cloths,woven Fabrics.... ..... ......... hansile board,wall board..,.......... other(pleasedescribe).Jr4T. �. 5 n + or 12. Describe the decontamination system(s)to be used: The decont:am.ina_t.ion._.sys.tem...de.s.c.rl.be.d....i.n....45.3..._CMR....6...1.4....wi.l.l....be......... used..as. .appropriate.. .... .... ... .... ... . ........ ..... ...................................................................... 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): Asbestos waste wi.11_...be,,,.we.tted.„.& d.o.u..bl.e....ba.g.ge.d.....in....s.ix.+mll..............._....... ................ labelled.bags.! Tbey will be.. placed..in...a._.ctl,.osed...container..... . 14. Fo Emerg�nCy Asbestos Aatemenl�pera�ions,the D6 an�pot�ialswho evalUafe��h� ne�gf i 11. Name o to EP Dairial Tine t ..................f Date of Authorization Waiver/ Na of oil O/liriai Title cre f . - ._.....:.._...._............_.._......................... ....... ..................... . Dale of Aulhurizaliun Waiver/ 15. Do prevailing wage revailin rates appl,y as per M.G.L.c.149,§26,27,or 27A-F to this project? 0 Yes No 9 CC: Local Health Department Rev.6/92. Facility Description 1. Current or prior use of facility: ...................................................... .......................................................... 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes (YNo 3. Facility Owner: r.vv.......... �Aer 1" C..'yj 1`1�;C;,1. t.� .....` ........:....... J Name Address .................................... C.. >�.�.4............................. .......... ........................................................... .................................:.. ......1...... . Cirypuxtl Zip awlc telephone 4. Facility's Owner's On-Site Manager: Dv\ 1 � ' �Yi-1,\�k,,Aao 6bl c.& . trW1 R tmuww.SC Naine Address �.d............. . 1... �.� ....Ca.a..............................:....... o ............................. . rier,own i ZiP tale re/epfroue 5. General Contractor: Co �. l�J u 1 c c>t S�vec� ..... V,�\� ......... ............... Name Address C, ` .... � d.1Y..��..........v...... .b............................................ ............................................... ...:... ........ l.k..� .......... Ci(y/,Totwi Z%o CodB relaphone Contractor's Workers Comp.insurer Policy 1 Exp.Dale 6. What is the size of the facility?3 iTi (sq ft) 2— (k of floors) Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site: Environmental Solutions Inc. 50 Guinan Street ....................... _. nrirlress ..._. 781-899-3 i70 .....,... ..__,...._... Name Waltham, MA. 02154 filyZTowo Zip awle Telephone 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disp:sal site: Logano Trucicing Company, Inc. P.O.... Box.. ...149.. .. .................................... .........................................................-...................-.................. .......................................... ............ ..... . .. .. Nam Address Portland, CT. 06480 1-203-342-06 1.67 ' Note:Transfer firyiTdwn - lit,wle Telephone Stations must 3. Refuse transfer station and owner(if applicable): comply With the �n ...... SolidWaste ?`� YCNl.L1............................................................. Division regula Na,ae n:9rlress 1111 tions 310 CMR 18.00 ..................................:........................... .................................................................................................... Viry,'lown Zip awle Telephone 4. Final Disposal Site: Meadowfill Landfill .. ......................................................................................................... .. .................................................. ............................. ............. .... (rx811D11'Wine — -0,4a"s Name Route 2, Box 68 ............................................................................................................................................................................................................... Address 1-304-842-2784 Bridgeport, WV. 26330 ..................................................................... 607bwn Zip tale relephone Certification The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the Information contained in this notification is true and correct to the best of his/her knowledge,and belief. -) 1 /I t i r]............... ........ �_..AullioritnlSipn3fm pal Print Name 1 � 1 Note:Contractor J/c � Environmental Solutions Iric 781—...... 70 must sign this t�_S'�1�!!...... ...... . `. � `1% ..... .....:..:.......:,....... ,i.... - ....--i� - Telephone lDfm for D(I Pa;ifionpille � nepresenhnrl ... notification It purposes 50 Guinan Street Waltham, MA. 02154 . ...........................................:........................................................ .....................................:................................... ...................................................... / Address City/Town " ' All awle . FEe exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?Cl yes is no Sticker i(from front of form):