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7 HIGH STREET - BUILDING INSPECTION 74520 400P4 mppnm Commonwealth of Massachusetts [ Asbestos Notification Form ANF-001 Decal Number A.Asbestos Abatement Description Man filling out Fame on t"' 1. a.Is this facility fee exem t ci town, district, municipal housin authority,owner-occu ad computer,uge h P a Pa 4 Y. Pi only me tffi my residence of four until or Paas? Yea ©No to move your cursor-do not D,Provide blanket decal number if applicable: �i-' use the return 91ankM Deoal Num4er key. 2. Facility Location: HOUSE _ T HIGH ST AOI1316 � — SALEM ^� MiA 01970 (�L8'78)�821 0000 C,C{ty�j'pawn d.State d.Zip Cale mm f,Taiepnuro—�tuinbii�."' NsraucnoNs 3. Workske Location: t.aiseabnsord,is HOUSE bno moot be e,Sullollry Narroiaulldi g Location b.Building a.Floor a.Rcxm oompbted In onpr to cornWy 41h 4. Is the facility occupied? (..-j Yes n No DEP"WI Mor CMR[ nfR 7 1erss of 310 t5 5. Asbestos Contractor. �"'_ arld Dly,si RO TECH EHVIRONM ENVIRONMENTAL 36 MAIN STREET Safety(DOST _ b teas n' SAarm NORTHSCRO 01532 x9.79933759534 raqulnmier"Of 45$ i i�.�. .,._------ ��...., CMR 5.12 A Cl own —Z Coda e.Tatepnorro Numb iACOUAGOAA 0icenee"i1'umf�{ __._. g.Contract Type: C�',Wr'tten [7 Verbal MILES GANSY PROJECT MANAGER 8. GREGORY W HARDING . AS0002711 ..._� N C I 1Foraman .� b�Sunet`�isof/Fo_;+�,rr+,gA_�S�erLYcatan Nienhe_�,� 7. ROS GRAVILLESE b Profg—fit�,MCr,Lb_or.DSy_Curtit,es00n Numcei �_„� All SPECTRUMO. AAW0132 ,N OTASU t AnelVtke4 { 02/23/2607 _ [0312312007 0 9. a. 1firt PSita„yreim'k vrftei..... _ -- .9rd care reddellyyyX) —i 0 OAM 6PM 6AM OPM a C a nouns"f,]ofF"i- 0 10. a.What type of project is this? o [�Demolition 0 Renovation r (�]Repair ❑Other,please specify: b.Desonbe 11. a. Check abatement procedures: ° Glove begQ Encapsulation MERAIWO Enclosure H Disposal only { -- u. Cleanup 0 Other, specify: L�....�.�.�......_,.... t[�Full containment It.DeWAbe i 4 12. Is the job being oonducted; L'IIndoors? 4.]outdoors? l0 anlgOfep.doc 1W02 Asbeatoo Nolfcodmi Form Page 1 of 3 td S•d S9EEE6£90S 181W3WW081AW3 331 0838 81191 L002 22 Qa3 Commonwealth of Massachusetts _■ IL i l000s�sas Asbestos Notification Form ANF-001 Oecsi Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials,ACM) to be removed,enclosed, or encaosu 4 ! 401) aW pes a 'MInear 6.T'oteTdthar aces square j C.Boller•broaahing.duct,tank _.--_ `--- ^---1 c. Insulaoament auAaoe coatings L_:�''��''II Sb:tt._ dng s,9 N_ e.Corrugated or layered paper C�..,...1 __�j f.TmweU9prayer ooalinge •1 IT I pipe iroulanat Vin.rt. rS ft._ un k 1sa�il.' _ g.Spraycn firepfoofing C—� �: " h.Transits,board,wall board I.Cloths,women fabrics �q-i�-� j.Other,please spec+fy: Lam: J 140_p --� " k Thermal,solid sae pipe (FLOOR TILEinsulation 14. Describe the decontamination systemic)to be used: is CHAMBER WASH BUCKET 15. Describe the containerizatlonldisposel methods to comply with 310 CMR 7.15 and 453 CMR 0 MILL DOUBL BAG 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: aCama-- m of ere ,) f Author@s,t on_-- d.OEP Ner s l r e. a�A mato Z`s, dal �N a. sial 0f hariratlon - h.60 WaiVero, — _1 ®0 17. Do preva01rtg wage rates as per M.O.L.c. 149, §26,27 or27A–F apply to this project?❑Yes 0 No ®° B. Facility Description �o 1. Current or prior use of facility: HOUSING ®o ®r 2. Is the facility owner-occupied residential with 4 units or less? O Yes {�No 3 SEEDS OF HOPE HOUSING INC L7 NIGH ST e.Fedlity Owner None — Jb..A Address ° aAL.EM 01970 �� �o c.CIV/Tam _. d.Zip Coat � e.Telephone Number ere9 wde srrJ extenaieN a 4 SAME m Name of Fscl&Ownees On- te Manager _-T__ b.OhSite Manager Addross 6 c.CIty/rown tl.215 Code e.Telephone Number(area codeand extension) •� ■ anl00loodec•10102 Asbestos Nwirodan Form•PULAALLON g•d S9EEf.6E909 1H1W3WW0b1AN3 331 Oa316 sitst L002 za Clad Oommonwoelth of Massachusfilts Asbestos Notification Form ANF-001 Decol Number B. Facility Description (cont.) _j 110— ICE AVE a PA!M of Tbf,AA gr" 41ii— f9i3959 l 4 C.CWTOM I zlp Galea.TellplA2LM-hlumft S_Kta=0 aMl OXMISIMI GRAMTE STATE f,contulctors workers comp-insurer j; ".Pd- NWrbe to.�.DMir mmxl 6. What IS the Size of this faCility9 a.saus's Feet b,Numlow of 1mrs C. Asbestos Transportation and Disposal 1. Transporter ofalsoestos-containing material from site to temporary storage site(if necessary): (AERO TEC Nate:Trarver Stations must comply VA01aste th.9 0.ORYfrown 0.Zp0cdo e.79*phoms Number Soso W Division 2. Transporter of asbestos-containing waste niatensl from rernovaltemportary site to final disposal sitte; Regulathors 310 OMR 19.000 rj�7EPCC7KkR!N__ __q§T cN A"Itas— C.7 [Qjk:4=80 = ;860 842.1022 PORTLAND cChtTzw� a.7eleptiorv-Nunwoor 3. 1 ......I a.Refuse Transfer Station and Omer do a.TerepMan N ber_ ' 4, MINERVAANTERPRISIES INC ...... F[qgj RilRosal att p,Final OrsooseI site 9600 FA ROADIWAYNESSURG ftmgms p,Ojilyf Town ON G.Sate t zp Coolie 9 7ehtpphorm Number 0 D. Certification The undersigned hereby states,under the GREGORY HARDING penalties of per ury,that he/she has read the b,Author"d nature Commonwealth of MasSaChuseft regulations [92112YLOCI for the Removal,Containmert or --1dd4,-1 Encapsulation of Asbestos,463 CMR 6,00 andcnP[ 2iltfl t 310 OMR 7.15, and that the information 3759534 AELRq.MC oonlained in this notification is tAis and correct Tetq�Kunnhle Ftwemlft to the beet of his1her knoevedge and tellef. RICE AVE U. eNORTHBORO Z It Cty)Toetn 1.Vp'-Ode arMandoc-IOM2 Asbestos Notifloatloft Form,Pege 3 of 3 t. c! 99CCES6809 -jUjW3WWO?11AW3 331 OM3H ST *91 1.,002 212 qa--i