217-221 Essex St. Asbestos Notification Form RECEIVED
DEC -2 T 2019
CITY OF SALEM
E & F EPMRC BOARD OF HEALTH
Environmental/Demolition Contractors
Commercial/Industrial/Residential
December 19, 2019
Salem Health Department
120 Washington Street,#4
Salem, MA 01970
RE: 217-221 Essex Street, Salem, MA
Dear Sir/Madam:
Please be advised that we will be at the above captioned property for Asbestos
Abatement on December 28, 2019. 1 have enclosed both notifications filed with the
MASS DEP.
Kindly contact us with any questions or comments you may have.
Very truly yours,
Susan A. Pappalardo
E & F Environmental Services, LLC
/Enclosures
7 PUZZLE LANE, UNIT 2, NEWTON, NH 03858
(603)974r2503 FAx: (603)974-2471
Massachusetts Department of EnvironmentREIDEi VED 100321346
BWP AQ 04 (ANF-001)
Asbestos Notification Form DEC 2 7 2019 Asbestos Project#
I— Project Revision
�.
CITY OF SALEM r Project Cancellation
BOARD OF HEALTH
A. Asbestos Abatement Description
1.Facility Location:
OFFICE BUILDING 217-222 ESSEX STREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form' SALEM MA 01970 0000000000
must be completed in
order to comply with c.City/Town d.State e.Zip Code f.Telephone
MassDEP notification N/A N/A
requirements of 310
CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: THROUGHOUT THE BUILDING
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2, Is the facility occupied? r a.Yes W 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)? r a.Yes T 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:
E&F ENVIRONMENTAL CORPORATION 300 BRICKSTONE SQ UNIT 252
a.Name b.Address
ANDOVER MA 01810 6039742503
c.City/Town d.State e.Zip Code f.Telephone
AC000971 h. Contract Type: W 1.Written 2.Verbal
g.DLS License#
7. GUILLERMO A MARGARIN FRIAS AS032500
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 N/A
a.Name of Project Monitor b.DLS Certification#
9 ASBESTOS NOTIFICATION LABORATORY AA00208
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
12/28/2019 1/31/2020
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
7-4 7-4
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
r a.Demolition r b.Renovation r c.Repair I~ d. Other-Please Specify: REMOVAL
Revised: 11/13/2013 Pnop t „fA
Massachusetts Department of Environmental Protection 100321346 --I
BWP AQ 04 (ANF-001)7, - �-1
Asbestos Notification Form Asbestos Project#
r Project Revision
r Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
T` a.Glove Bag r b.Encapsulation r c.Enclosure r` d.Disposal Only r e.Cleanup
S-0 f.Full Containment r g.Other-Please Specify:
13.Job is being conducted: W a.Indoors r b. Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
500 22000
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 500 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 22000
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
15.Describe the decontamination system(s)to be used:
FULL CONTAINMENT
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
ALL METHODS WILL COMPLY
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
a.Name of MassDEP Official b.ride 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(MM/DD/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 170 b.No
project?
RPviri-d- 1 1 11)-__'f ._l A
Massachusetts Department of Environmental Protection 1100321346
-;�- BWP AQ 04 (ANF-001) Asbestos Project#
`, Asbestos Notification Form 1 ' Project Revision
T- Project Cancellation
B. Facility Description
1.Current or prior use of facility: OFFICE BUILDING
2.Is the facility owner-occupied residential with 4 units or less? r a.Yes r b.No
3 ESSEX DERBY,LLC 50 FRANKLIN STREET,SUITE 400
a.Facility Owner Name b.Address
BOSTON MA 02110 0000000000
c.Cityl-own d.State e.Zip Code f.Telephone
4.N/A N/A
a.Name of Facility Owner's On-Site Manager b.Address
N/A MA 00000 0000000000
c.City/Town d.State e.Zip Code f.Telephone
5 ACS GROUP 26A SHEAF STREET
a.Name of General Contractor b.Address
MALDEN MA 02148 0000000000
c.City/Town d.State e.Zip Code f.Telephone
STAR INSURANCE COMPANY
g.Contractor's Worker's Compensation Insurer
00000000000000000 12/4/2020
h.Policy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility?
32076 5
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 T b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer E&F ENVIRONMENTAL CORPORATION 300 BRICKSTONE SQUARE
station that is c.Name of Transporter d.Address
permitted by
MassDEP and ANDOVER MA 01810 6039742603
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:
SERVICE TRANSPORT GROUP,INC. 301 OXFORD VALLEY RD,SUITE 803B
a.Name of Transporter b.Address
YARDLEY PA 19067 8779999559
C.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Pare 3 of 4
Massachusetts Department of Environmental Protection 100321346
BWP AQ 04 (ANF-001)
Asbestos Project#
Asbestos Notification Form r- Project Revision
` k
r Project Cancellation
C.Asbestos Transportation&Disposal: (cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
N/A N/A
a.Temporary Storage Location Name b.Address
N/A MA 00000 0000000000
c.Citylrown d.State e.Zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA LANDFILL N/A
a.Final Disposal Site Name b.Final Disposal Site Owner Name
8955 MINERVA ROAD
c.Address
WAYNESBURG CH 44688 3308663435
d.Cityfrown e.State f.Zip Code g.Telephone
Note:Contractor must
sign this form for DLS
notification purposes D. Certification
FRANK BALOGH FRANK BALOGH
"I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am PRESIDENT 12/17/2019
familiar with the information
contained in this document and 3.PositionlTiffe 4.Date(MM/DD/YYYY)
all attachments and that,based 6039742503 E&F ENVIRO
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 300 BRICKSTONE SQUARE, ANDOVER
responsible for obtaining the 7.Address 8.City/Town
information, I believe that the MA 01810
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- 1 1/1 1001 1 D,,. n ,.r e