10 CEDARVIEW ROAD - ASBESTOS & PEST CONTROL DOCUMENTS CORE CONTRACTING SERVICES, INC. Invoice
ENVIRONMENTAL SPECIALISTS Date Invoice#
195 Massachusetts Avenue
Lexington,MA 02420 2/20/2020 14504
Bill To
Brenna McNiff
37 Woodbury St
Beverly,MA 01915
P.O. No. Terms Project
Quantity Description Rate Amount
Asbestos Abatement at 10 Cedarview Rd,Salem 1,720.00 1,720.00
Asbestos Air Test 350.00 350.00
Asbestos Abatement Notification Fee 100.00 100.00
Generator/Gas Usage 100.00 100.00
Portable Water Usage 100.00 100.00
I
Phone# Fax# Total $2,370.00
781-721-4540
LlMassachusetts Department of Environmental Protection
eDEP Transaction Copy
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Username: JJMAHONEY
Transaction ID: 1171736
Document: AQ 04-Asbestos Removal Notification Form ANF-001
Size of File: 230.77K
Status of Transaction: In Process
Date and Time Created: 21412020:6:28:34 PM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
IMM Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF-001)PreForm
Asbestos Notification Form
I` This is a revision to an existing form.
Project 1D for existing form to be revised:
This job is being conducted under a Blanket Permit.
MassDEP assigned Blanket Authorization 1D:
r This job is being conducted under a Non Traditional Abatement Work Practice Pen-nit.
MassDEP assigned Non Traditional Work Practice Authorization 1D:
I This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards
because(please check one box below):
F This job involves breaking,shearing or slicing of non-friable asbestos-containing material only(e.g.cement
shingles/panels,cement pipe,asphalt roofing or siding,vinyl floor tiles,etc.)in a manner that does not generate
asbestos dust or render the material friable,as allowed by the Department of Labor Standards(DLS)at 453 CMR
6.13(2)(a)5.All work must be done in compliance with the applicable regulations at 310 CMR 7.15;or
r This job involves work on asbestos containing material that is classified by the Department of Labor Standards
(DLS)as a`Small-Scale Asbestos Project,'an`Asbestos-Associated Project',or an`Asbestos Response Action'
by qualified'in-house' personnel as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.00,and
will be performed in accordance with all the requirements of 453 CMR 6.13(1)(a),453 CMR 6.13(2)(a)l.and 3.,
and 453 CMR 6.14(1)(a),as applicable. All work must be done in compliance with the applicable regulations at
310 CMR 7.15,
G None of the above conditions apply,generate a new form.
Revised: 11/13/2013 Page 1 of 1
Massachusetts Department of Environmental Protection i 100323551
` BWP AQ 04 (ANF-001) Asbestos Project#
r Asbestos Notification Form f— Project Revision
T` f` Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
10 CEDARVIEW RD 10 CEDARVIEW RD
Instructions 1.All a.Name of Facility b.Street Address
sections of this form SALEM MA 01915 9784739655
must be completed in
order to comply with c.City/Town d.State W.Zip Code f.Telephone
MassDEP notification BRENNAMCNIFF PROJECTMANAGER
requirements of 310 9 Facility Contact Person Name h.Facil'ity Contact Person Title
CMR 715 and
Department of Labor Work-site Location: 10 CEDARMEW RD
Standards(DLS) i.Building Name,Wing,Floor,Room,etc,
notification
requirements of 453 2. Is the facility occupied? rV a.Yes r 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)? W a.Yes I— b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Nun-1'raditional Asbestos Abatement Work Practice Approval;
if applicable: Approval ID#
6.Asbestos Contractor:
CORE CONTRACTING 3 OAKLAND STREEM
a.Name b.Address
WOBURN MA 01801 7817214540
C.City/Town d.State e.Zip Cade f.Telephone
AC000754 h.Contract Type:P 1.Witten 1-2.Veibal
g.DLS License#
7. ALGELISM.CAMPUSANO AS901676
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
EDWIN G.MORGAN JR. AM051114
$ a.Name of Project Morritw b.DLS Certification#
9. ASBESTOS NOTIFICATION LABORATORY AA00208
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
2/14/2020 3/14/2020
a.Project Start Date(MM/DDA r") b.End Date(MMIDWYYYY)
7AM-7PM 7AM-7PM
c.Work Hours-Monday Through Friday d,Work Hours-Saturday 8 Sunday
11.What type of project is this"
r a.Demolition rw-o b.Renovation I— c.Repair r- d.Other-Please Spccify:
Remised: 11/13/2013 Page 1 of
Massachusetts Department of Environmental Protection 100323551 _
' BWP AQ 04 (ANF-001)
Asbestos Project#
Asbestos Notification Form r Project Revision
I— Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
r a.Glove Bag I- b.Encapsulation T_ c.Enclosure I— d.Disposal Only r e.Cleanup
V f.Full Containment r g.Other-Please Specify:
13.Job is being conducted: IV a.Indoors 'I— b.Outdoors
14 a. Total amount of each type of asbestos Containing materials(AGM)to be removed,enclosed,or
encapsulated:
120
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
1'.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 TLEF LINOLEUM 120
1.Lin.Ft 2,Sq.Ft. 1.Lin.Ft 2.Sq.Ft
15.Describe the decontamination system(s)to be used:
THREE CHA ABERDECON
16.Describe the containerizationldisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
wEf TO DOUBLE BAG
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/DDNYYY) d.Waiver#
e.Name of DLS Official f.Title of DLS Official
g.Date of Authorization(MM/DDNYYY) h.Waiver,#
18.Do prevailing wage rates as per M.G.L.c. 149,§26.27 or 27A—F apply to this f- a.Yes W b.No
project?
Revised: 11/13/2013 Page 2 of 4
Massachusetts Department of Environmental Protection `100323551
sb A BWP AQ 04 (ANF-001) Asbestos-_._-_-- _estos Project#
Asbestos Notification Form 1" Project Revision
Project Cancellation
B. Facility Description HONE
1.Current or prior use of facility.-
2. is the facility owner-occupied residential with 4 units or less?9— a.Yes b.No
BRENNAMCNIFF 1 o CEDARVIEW RD
a.Facility Owner Name b.Address
SALpyl MA 01915 9784739655
c.City/rown d.State e.Zip Code f.Telephone
4
BRENNA MCNIFF 10 CEUARVIEW RD
a.Name of Facility Owner's On-Site Manager b.Address
SALEM MA 01915 9784739655
c.Cityrrown d.State e.Zip Code #.Telephone
CORE CONTRACTING 3 OAKLAND ST
5.a.Name of General Contractor b.Address
WOBURN MA 01801 7817214540
c.City/Town d.State e.Zip Code t Telephone
TRAVELERS
g.Contractor's Worker's Compensation Insurer
4/20/2020
1 K32069
h.Policy# i.Expiration Date(MMIDONYYY)
2000 2
6.What is the size of this facility? a.Square Feet b.#of Floors
Note:Temporary C. asbestos Transportation & Disposal
storage of Asbestos
containing waste 1.Transporter of asbestos-containing paste material from site of generation:
material is only
allowed at the place r a.Directly to Landfill or W 1 ' Storage Location/l'ransfer Station
of business of a DLS
licensed Asbestos 3 OAKLAND ST
contractor or a transfer CORE�C'
station that is c.Name of Transporter d.Address
permitted by MA 01801 78172'14540
MassDEP and WOBU�1
operated in e.City/Town f.State g.Zip Code h.Telephone
compliance with Solid
Waste Regulations
310 CMR 19.000 2.if a temporagl%olage lvcation:transfer station is used.list name of transporter of asbestos containing
waste material from temporary storage location/transfer station to final disposal site:
TRANSWASTE 3 BARKER DRIVE
a.Name of Transporter b.Address
WALLINGFORD Cr 06492 2032698300
c.City7rown d.State a Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
`71 Massachusetts Department of Environmental Protection 100323551
L BWP AQ 04 (ANF-001) Asbestos Project#
Project Revision
Asbestos Notification Form f
F Project Cancellation
C.Asbestos Transportation&Disposal: (cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
MINERVA 9M MINERVA RD
a Temporary Storage -ocation Name b.Addr ms
WAYNESBURG OH 44688 3308663435
c.Cityfrown �State -�.-bp—Cod.
4.Name and location of final disposal site(asbestos landfill):
MINERVA FRANK STUFANO
a.Final Disposal Site Name b.Final Disposal Site Owner Name
9000 MINERVA RD
c.Address
WAYNESBURG CH 44688 3308663435
T— —
d.City[Town State FZip Cod. g.Telephone
Note:Contractor must
sign this form for DLS
notification purposes D. Certification joHN MAHONEY JOHN MAHONEY
"I certify that I have personally 1.Name 2.Au rized Signature
examined the foregoing and am PRESIDENT 2/4/2020
familiar with the information 3.Positionfritle 4.Date(MMIDD/YYYY)
contained in this document and 7817214540 CORECONTRACTING
all attachments and that,based 6.Representing
on my inquiry of those 5.Telephone
individuals immediately 3 OAKLAND ST WOBURN
responsible for obtaining the 7.Address 8.C own
information,I believe that the MA 01801
information is true,accurate,and 9.state 10.Zip Code
complete.I am aware that there
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: 11/1312013 Page 4 of 4
Dennis the Mennis
"The King of Pest Control"
Termite and Pest Control Specialists
MAIN OFFICE AND LABS
29 Locust Street
Lynn, Ma. 01904
Boston Lynn Lowell Woburn Newton Peabody Lawrence
567-1038 592-0023 459-2950 935-DEAD 332-5853 532-3443 689-0697
PEST 1 PET2
Date: December 13, 2019
Location: 10 Cedarview Street, Salem,Ma
Service Date: Our men serviced here on December 13, 2019.
General Comments:
We serviced the above location for demo baiting per State and Federal regulations. All baiting stations
are in place.
Conditions/Observations:N/A
Materials utilized: Contrac Soft Baiting Packets—EPA# 12455-146 Al%@ 0.005 Bromadiolone
Please call if you need anything thing additional.
Thank you,
Dennis Mastrolia
James Duffy
Mark Hudson.
781-592-0023
800-649-3028