Loading...
HomeMy WebLinkAbout0010 TOWER HILL ROAD - HAZMAT Cl f 1 ma i r1 5- yw+P h lkzcn lq T i i f i 02/09/2007 10:12 19786920311 EAGLE ENVIRONMENTAL PAGE 02/04 Commonwealth of Massachusetts _ 100061"It Asbestos Notification Form ANF-001 Decal Number Important:Wien filling out A. � .Asbestos Abatement De cri taon farms on the computer,use 1. a.Is this facility fee exempt-city,town,district, municipal housing authority,owner-occupied only the tab key residence Df four units or less?]Yes 0 No to move your marsor-do not b.Provide blanket decal number If applicable; use the return Bldnket Decal Number key, 2. Facility Location; 41AL FOR-Eft RETAIL STORE � -� 10 TOWER HILL FAD Nr�mi.,.—.-.-ir F dolt� .-�,....—_--,.,� �M _ s' w �.. 7 t'&_dress DARNSTABLE !NR�r�_.._._... l r0�• 6 5 � F_ &M C. rtyrrown d,SYate e.Zip Code f.Telephone Wurnber INSTRUCTIONS 3. Worksite Location_ THROU511OUT _ 1.All sections of this �•. .� �_ farm must be a.Building NarnalBuiiding Location b.Building# c.IMng d.Floor e.Room eompletea In order t000mplyWith 4. Is the Facility occupied? F1 Yes [✓I No DEP notif=cin requirements of 310 CM 7.1$ 5. Asbestos Contractor: and the atio on EAGLE ABATEMENT SERVICES INC -J 1150 HAYDEN ROAD y ofOtx�petianal �...�-...., �.� t�.�.,.,.�.�.r _J Safety(DOS) a.Name "�"—`"`�_�_,__.._,..�..._._�, b.Address_ notification CROTONrequirements of 453 .. � , � --_— f$O07631026 GIV1R 5.12 c ciWrrown e.Telephone Number AC000443 g. Contract Type: I Written Verbal TEVE LEE -� ADMINISTRATION Faoh onk�erson""`�— ""- _�""" {L ontact Persarl's_Title _ - t3. IaANIEL LORA _.: 4AS030359 a-Name of n-site S perviao�tForemon _ _ b,SUp®MborlFareman DOS certif_caUon Number _ 7. N!A .._. �_ _ i _._. e.Ntlme rode Mounitorr— _r_ b Pict M_ on�tor DOS Certiriretion Number t3 �ItOSCIENCE ANALYTICAL AAO00156 � a.Name of A�btos Anai iasl Lab �_� _ b.A na iCn!aydb DOS Certjon N r .�— ffiwffl�_V. Q 9. 02/09/2007 -- 02/0912007 a.Pratt Dette »mild - `_�. •-•"__.. ,... . „_ _-•, -�---- - —�. b.mod.Date fmmfddtyyyyl 0 8AM-4PM N G.IlNork ours Wton s^r _ ,,..�._..- „_.___... ld..Wo*houls7Sat Sun: - 0 10. a.What type of project is this? 0 Demolition [{] Renovation .- C] Repair Other, please specify: b.Describe Mom �- 11. a.Check abatement procedures: ° Glove bag Encapsulation MWOEMMo Enclosure ❑Disposal only --_- Cleanup ]Other,specify: V1lET METHODS A� z ED Full containment b.Describe ME 12. Is the job being conducted; 7J Indoors? L Outdoors? M snfWlap.doo•10102 Asbestos NotilkAllon Form-Page 1 of 3 02/09/2007 10:12 19796920311 EAGLE ENVIRONMENTAL PAGE 03/04 Commonwealth of Massachusetts 1.. 100051443 _..,....._.. .. Asbestos Notification Form ANF-001 DecatNumber A. Asbestos Abatement Description (cant.) 13. 'dotal amours of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or eincapsufated._M .I a, ot�ta per of duck ineat fij`I -15-a a7:otTier'b aes square C.Boiler,broactiing,duct,tank �� ._. Lin surface coatlnps Lin.ft _ gift. d•Insulating cement ft e.Corrugated or layered paper L_ - I.v Pipe insulation _Lin ft. (3 _--j� f,TrowellSPrayer coatings tin.ftn. "` Sq. g.Spray-on tireprvofng Lin J t 1 h,Transite board,wall board � .] 3� Lin,ft. t __ Lin.ft, r. _— I._ I.Cloths,woven fabrics L---�- j,Other, lease s Q Jn,tt. S P apt �. LT ..La ._ S k.Ttiermat,solid core pipe L LIL!`,OLDAUD __,_ r Insulation min`.ft._ Sq,ft. "'. 1.SpeGty 14. Describe the decontarttination system(s)to be used: DOUBLE SUITIHEPA VAC _-- � 15. Describe the containerization/disposal methods to comply with 310 CMR 7.16 and 463 CMIl 6.14(2)(g): DOUBLE Q(MIL POLY BAGS 16. For Emergency Asbestos Operations,the DEP and DOS C)fficials who OValuated the emergency: ANDiE a. ENVIRONMENTAL.�.._—. ;PECIAt.SS_.�Ta cl o21e7/2007 -- c.bate mm/dtlZafAuthurizaUon-- � d,DEP GAR'Y GAS PAR INSp+E&OR ®.Name of D59 �L1i iaT'� N 6 Dste(mmWd/YYYY)aYf Authoillaiion __ fi.Dbs W ver i 0 17. 40 prevailing wage rates as per NIM+G.L. c. 149,§26,27 or 27A 1=apply to this project? C]Yes®No S. FaCiiity Description •.lV e 1, Current or prior use of facility: 2. Is the facility owner-occupied residential with 4 units or less? 0 Yes ✓ No 3. HOSTETTEIR(REALTY CORP 770 MtAINt ST e.Facility Owner rdame _ _ 6.Addrers o OSTERVYILLE,lVIA o c Gt,Mown 561.575-4567 u ADAM HOSE ETTER -� e.Te_ lephone Nurnbarr rea code and extension __ �1 ISAM E AS AB®VE 4' a.Name of Ffsc_/s9 _ `—it y Owner s on Sfte Mansger _— ' b.O� its AAana Fr A dro aS L �_ d.21p Code e.Telsphune Number(area cRe and extension) anfoolep.doc•10102 Asbestos Notir"Con Form P 02/09/2007 10:12 19786920311 EAGLE ENVIRONPIENTAL PAGE 04/04 Commonwealth of Massachusetts 4 t. .. 100051 d43 Asbestos Notification Form ANF-001 ©oWlNumber B. Facility Description (cont.) a.Name of General Contra4tor�_ _ —'� `y�"'""�-"• b.Address _ ade a.Teiephane Number area code and ) f,ContradoNs Workers Comp.insuror r%-,Pollc�r Number h.EJT.Qata mm/dd 00 1 8: IM�at is the size of this f2Citity? 100�..�Y____,� a.Squbre Feet b.Number of floors C. Asbestos Transportation and Dispfaaal 1, Transporter of asbestos-containing material from site to temporary storage site(if necessary): ACLa_ABATEMENT SERVICE$, yY [T 13AX CAR RLVD Note-Tranafer a.Name of Tran^,snorter b.Address Stations must TEWKSBURY,MAMA rrdi876 -- � �9?® 858-Q551 __w__ � j comply with the ---.. _J [— � �." ) _. __. Solid Waste c.Cityrfuwn d•Zip Code e,Te lephone Number OMslon 2- Transporter of asbestos-containin waste material from removal/temporary ra site to final disposal site: RegulatlonaVO 9 po ry CMR 1e,000 RECOVERY EXPRESS _Y _� 180 CANAL ST a..--,ame of TM2M2 ter _ ' -� w b.Address aOsrON eviA {OTT 523-7i Q.- _. ,.-_�..N,..^ � _._ Cam. Cit (Town - 3. N/a a,Refusa Transfer Station and Owner c.Gityrrown d, .W Cede e.Telephone Number a. IMINERVA ENTERPRISES INC _J e.Final pis opal Site Looatian Name _ b.Final Qisposal Site vocation Location s Nam 9000 MINERVA ROAD --' _ � �WAYNESIBURG �.! 061 Di 15rig rests d.brit !Town e.State f,Zip Code I g..Telephone Number D. Certification N __ The undersigned hereby states, under the rSAM MCGUIRE Q penalties of perjury,that he/she has read the a." a Commonwealth of Massachusetts regulations at4�— —"""` b.Authorized Sisnatura for the Removal,Containment or 9 �PRIrSIt)ENT L C2/0er2o07 C.Positionll'itie d.o to m Encapsulation of Asbestos, �153 CMR 6.00 and rr{g71�s�51# t15S1 310 CMR T.15,and that,the Information l..,,w ' _ EAGLE ABATEMENT SE oohtained in this notification is true and correct a•T.. elenhorra Number f.Reoresentina mod ° to the bust of hisrher knowledge and belief. $O —CAR ELVCI _ Address LL TE"WKS8UR_Y,MA [L0%1"878 h,Cityfrown i.Zip Code 4 P00131ap.doc 10102 Asbestos Notification Form•Page 3 of 3 U 1:/G0/zutl I CI7:00 171007GCJ.311 tHULt tINV 1KU1 Wr-IY I HL 1"HUC tJl Eagle Abatement Serv- ices, Inc. Friend to tree Bnvi;onment- Asbestos and Lead Abatement Demolition Site Cleanups Monday,February 12,2007 Andrew Cooney MA DEP Re: 14 Tower Mill.Road,Osterville,'MA Decal# 100051443 Dear Mr.Cooney This letter is to inforru you that on Friday,February 09,2007 Eagle Abatement Services,inc.completed its Gleam-up at the above referenced sito.We HEpA vacuumed the entire floor area,in doing so we Found several small pieces of red tile which we bagged as asbestos and ttw mported to our Ivaste trailer.We also removed intact a trawiw board at the electric panel,will adhesive around rear windows and we packed for disposal a trash barrel full of tMoite board. Wbile we were there the owner transferred waste from the two eonstntction debris containers into.empty- coutainers.Eagle's site supervisor,Dan Lora,instructed the owner's employees for what to look for as suspect asbestos materials and periodically checked material.The transfer of waste has beets completed and. the two newly filled containers are still on site waiting for your approval before they are removed. "'YOU need any more information please call, Sine ely. �f Nia11 Mc(}ulrc 7 Box Car Blvd. • Tev*sbury,NtA 0 1876 • Tel:(g7g)858-0551 • Fax:(978)858-0553 wO/WCagleabatement,Gorr. GL/Lb/LGG! G7:Oh 17lbb7LG311 tHULL UIVINUIllyr-YIHL r'HUL GL r - FORM— 1: ASBESTOS WASTE MANIFEST See InstruetiO)nS,.Of,Back) F. Wa3tt Site None and Madli ns Address ower H 1.1 Rd (JOB# A 7 0 0 8) Owner's Name,Address:Phone No stab >ie, MA 02566 Hostetter Realty .Corp Adam Hostetter pets ville MA 02 55 aCtpl s Name,Address,Phone No.(4pe;ator) 770 Main aiII St. 6 5 5-4567., e Abatement Services, Inc .Box Car B1v sbury, MA 0 676 Dimosal Site( S)Name,I.00adon,Address,and Phone No. 851 rva Enterpprises,esburrvaoHd99688 and Addteas'of Responiibls NESHA.PS Agency 86 6-3 4 3 5 s EPAReqio 1 0 .Congress tit Boston, MA 02114 t4 5. Description of Materials (See LLttructions) 6.& 7. W to Contairura and W . , n TYitsNurn Otfikntity Quanti r,_:,_ N M DP BA S. Special Handling Instructions and Additional Information rq ASBESTOS 9, NA 2212 P611 L14Y4 23724 9, OPPRATOti'S CERTIFICATION: I het ereby declare that the contents of this.waste corisignment are fully and accurately described above by proper shipping name and'are classified, packaged,marked, and labeled;and are in all respects in proper condition for transport by highway according to applicable international and government regulations. PrintedfCyped Name R Title Si I•crTLiz t ZZ ' 10. TrallsPOfter 1 Aclrnowled ement.of Recei of Materials y 2' Company Name&Address Signature: Ile REICQvery Express 180 Canal St. Printed Name: HBoston, MA 02114 Title: N11. Transporter 2(Acknowledgement of Receipt of Materials Company Name&Address Signature' ale a No F Printed Name: itlr; t 2. Discrepancy Indication Spacer w H H 13. Waste Dis sa! Site Owner or U rators Certification Recci t of above Waste Except as Noted trt l2 Company Name&Address Signature: v ,Te a ne N cI Minerva Site 9000 Minerva Rd Printed Name: r-; Waynesburg, OH 44688 Title: Project No. Project Manager: Forrn_.gf �— Witte&Blue—Transporter's Copy Green—Disposal Facility Copy Yellow—Generator's Co Goldenrod—Generator's Co py Pink—Generator's Copy py(to be Isft a!job site on pick-up) Massachusetts Department of Environmental Protection LlBureau of Waste Prevention •Air Quality 100051716 B W P 46 Decal Number Notification Prior to Construction or Demolition General , � (cont.)Statement.It B. General Project Description cant.) asbestos is found during a 4. General Contractor: Construction or Demolition West Say Management operation,all a.Name reeporsible parties must wm ply with 770 A Main Street 310 CMR 7.00. b,Address and Chapter osterville Ma 02655 Chapterter 21E of the . General Laws of c.Clhr,Town d.State e.Zip Code the Commonwealth. (774)836-3098 ah@broform.corn This would include, f.Telephone Number(area code and extension) p.E-mail Address(optional) out would not be Adam Hostetter Bmited to,filing an asbestos removal h.On-site Manager Name notification with the Department and/or a notice of releaseofa of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor Department,If applicable. Same as Above a.Name b.Address c.City/Town d.State e.Zip Code f.Telephone Number(area coda and extension) g.E-mail Address(optional) h.On-site Manager Name 2. On-Site Supervisor: AW'( Ht 140 S T�TTF� On-Site Supervisor Name 3. Is the entire facility to be demolished? I Yes No tv ra 4. Describe the area(s)to be demolished: o We are removing all Interior walls,and sheetrock N Q c) 5. If this is a construction project,describe the building(s)or additiort(s)to be constructed: We will doing a build out for an offiee building �o O Q ® agM.doc•10412 SVdP AQ 06•Page 2 of 3 R -cI /_QC4r CI.0 7QQ .JDaaaa50u TaTULrr dcT _ten in o� ria_s i Massachusetts Department of Environmental Protection j Bureau of Waste Prevention •Air Quality 100051715 i BWS AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (corgi.) ®. a. if this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material(ACM)? Yes No If yes,who conducted the survey? Envirote>st Laboratory b.Surveyor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: a. 04/4112007 a.Start Date(mrWddlyyM b.End Dale(MWddlyyyy) S. a.For demolition and construction projects, indicate dust suppression techniques to be used: seeding paving b. if other, please specify: wetting shrouding covering other 9. For Emergency Demolition operations,who Is the DEP official who evaluated the emergency? Andrew Cooney a.Name of DEP Official b.Title c.Date(mmld&My)of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the Daniel Hostetter o above and that to the best of my a.Print Name o knowledge it is true and complete. The signature below subjects the b.Authonz d Signature a signer to the general statutes Owner 0 . regarding a false and misleading c.PosMonrntla 0 statement(s). Hostetter Realty Inc. d.Representing P Ae6. 1,5� 07 fL e.Date(mmlddly& �O a _ Q agMdoc•1 D/02 BVVP AQ 06•Page 3 of 3 . .r -- Massachusetts Department of Environmental Protection o i Bureau of Waste Prevention•Air Quality 100051716 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When forms on the computer,use only the tab key A Construction or Demolition operation of an industrial,commercial,or institutional building,or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor•do not use the return ( )DEP , Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09.Notification of key. Construction or Demolition operations is required under 310 CMR 7.09(2)ter!(10)days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. WE] B. General Project Description 1. a. is this facility fee exempt-city,town,district. municipal housing authority,owner-occupied Instructions residence of four units or less? Yes V No 1.All sections of b.Provide blanket decal number if applicable: Blanket Decal Number this form must be completed In order Z Facility Information: to comply with the Department of Hostetter Realty Environmental Protection a.Name notification 10 Tower Hill Road requirements of b.Address 310 CMR 7.09 Osterville MA 02655 a Cltvfrown d.State e.Zia Code (508)420.0644 danh42@aol.com f.Teleohone Number(area code and extension) g.E-man Address(optional) 12,000 1 h.Size of Facility in Square Feet 1.Number of Floors j.Was the facility built prior to 1980? V Yes No k.Describe the current or prior use of the facility: grocery store 1. is the facility a residential facility? Yes No 0 m. If yes,how many units? Number of Units 0 3. Facility Owner: N HostaUer Realty 0 a.Name 0 770 A Main Street b.Address T Ostervitle Ma 02655 tD c.Cftv,Town d.State e•Zic Code c (508)420-0644 danh42@aol.com f.Teleohone Number(area code and extension) a.E-mall Address(optional) Adam Hostetter a( h.Onsite Manager Name ag06,doc•10102 BWP AQ 06•Page 1 of 3