0075 NORTH STREET - ASBESTOS ABATEMENT ' s
i
i
AT I ON A L
ABATEMENT
MAU
P.O. BOX 4386 Peabody, MA 01960
(781) 589-3161, Fax (781) 231-5780
Email: jnet@a-abatement.com
July 29, 2019
To: Salem Inspectional Services / Fire Dept.
RE: Asbestos Abatement at
Start Date's: August 7th-10, 2019 2 Lf
Sam-4 a ,
National Abatement, Inc.
Jimmy Net
Massachusetts Department of Environmental Protection 100312734
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form r Project Revision
17- Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
CATALDO AMBULANCE 74 NORTH ST
Instructions 1.All a.Name of Facility b.Street Address
sections of this form SALEM
must be completed in MA 01970 7812330062
order to comply with c.City/town d.State e.Zip Code f.Telephone
MassDEP notification STEVE AGGANIS CONTRACTOR
requirements of 310
CMR 7.15 and g•Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: ROOF FLASHING
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. Is the facility occupied? r a.Yes l✓b.No
CMR 6.12
3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility, or
owner-occupied residential property of four units or less)? t— a.Yes r b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
if applicable: Approval ID#
6.Asbestos Contractor:
NATIONAL ABATEMENT INC 98 LINCOLN AVENUE
a.Name b.Address
SAUGUS MA 01906 7815893161
c.City/Town d.State e.Zip Code f.Telephone
AC000511 h.Contract Type: r 1.Written f 2.Verbal
g.DLS License#
7. JIMMY MAO NET OWNER AS000339
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 FU ENVIRONMENTAL INC AA000144
a.Name of Project Monitor b.DLS Certification#
9. N/A
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
8/7/2019 8/17/2019
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
8AM-4 8AM-4
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
I— a.Demolition I— b.Renovation I— c.Repair r d.Other-Please Specify: ASBESTOS REMOVAL
Revised: 11/13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection 100312734
r BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form r Project Revision
r Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
r a.Glove Bag r b.Encapsulation r c. Enclosure r d.Disposal Only r e.Cleanup
r f.Full Containment r g.Other-Please Specify: WET REMOVAL
13.Job is being conducted: r a.Indoors r b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
600
1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft)
b.Boiler,Breaching,Duct, c.Transite Pipe
Tank Surface Coatings 1.Lin.Ft 2.Sq.Ft 1.Lin.Ft. 2.Sq.Ft.
d.Pipe Insulation e.Transite Shingles
1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
f.Spray-On Fireproofing g.Transite Panels
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft. 2.Sq.Ft.
h.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft 2.Sq.Ft.
j.Insulating Cement ROOF FLASHING 600
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft. 2.Sq.Ft.
15.Describe the decontamination system(s)to be used:
WET REMOVAL
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g)
ALL METHODS WALL COMPLY
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
a.Name of MassDEP Official b.Title of MassDEP Official
c.Date of Authorization(MM/DD/YYYY) d.Waiver#
e.Name of DLS Official f.Title of DLS Official
g.Date of Authorization(MMIDD/YYYY) h.Waiver#
18.Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this r a-Yes I✓ b.No
project?
Revised: 11/13/2013 Page 2 of 4
Massachusetts Department of Environmental Protection 100312734
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form
I— Project Revision
r Project Cancellation
B. Facility Description
1.Current or prior use of facility: FORMER CAR WASH
2.Is the facility owner-occupied residential with 4 units or less? r a.Yes r b.No
3.SAME SAME
a.Facility Owner Name b.Address
SAME MA 01970 7812330062
c.City/Town d.State e.Zip Code f.Telephone
STEVE AGGANIS CONTRACTOR
a.Name of Facility Owner's On-Site Manager b.Address
SAUGUS MA 01906 7812330062
c.City/Town d.State e.Zip Code f.Telephone
5'SAME SAME
a.Name of General Contractor b.Address
SAME MA 01970 7812330062
c.Citylrown d.State e.Zip Code f.Telephone
TRAVELERS
g.Contractor's Worker's Compensation Insurer
4484P107 12/23/2019
h.Policy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility? 5000 1
a.Square Feet b.#of Floors
Note:Temporary storage of Asbestos C. Asbestos Transportation & Disposal
containing waste 1.Transporter of asbestos-containing waste material from site of generation:
material is only
allowed at the place r a.Directly to Landfill or r b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer NATIONAL ABATEMENT PO BOX 4386
station that is c.Name of Transporter d.Address
permitted by
MassDEP and PEABODY MA 01906 7815893161
operated in e.City/Town f.State g.Zip Code h.Telephone
compliance with Solid
Waste Regulations
310 CMR 19.000 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing
waste material from temporary storage location/transfer station to final disposal site:
JOB/ROLL OFF PO BOX 907
a.Name of Transporter b.Address
HEAMSTEAD Ni 03841 6173871495
c.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
Massachusetts Department of Environmental Protection 1100312734
BWF AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form r Project Revision
Le r Project Cancellation
C.Asbestos Transportation&Disposal:(cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
229 LYNNWAY SAME
a.Temporary Storage Location Name b.Address
LYNN MA 01905 7815893161
c.City/town d.State e.Zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
WASTE MANAGEMENT OF NH TURNKEY LAND FILL
a.Final Disposal Site Name b.Final Disposal Site Owner Name
97 ROCHESTER NECK RD
c.Address
ROCHESTER NH 03839 6033302165
d.City/Town e.State f.Zip Code g.Telephone
Note:Contractor must
sign this form for DLS
notification purposes D. Certification
AM NET JNA NET
"I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am SUPERVISOR 7/24/2019
familiar with the information
contained in this document and 3.PositionTtle 4.Date(MM/DD/YYY`r)
all attachments and that, based 7815893161 NA,INC
on my inquiry of those 5.Telephone 6.Representing
individuals immediately PO BOX4386 PEABODY
responsible for obtaining the 7.Address 8.City/Town
information,I believe that the MA 01960
information is true, accurate,and
complete. I am aware that there 9•State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 4 of 4