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Miscellaneous - 1 High ST-Bldg 22
CP V- Dear Board Members, I would very much like to attend this meeting but cannot, so I am expressing Iii;% v 1111 Pim lli thisbLlf fah;. I 1Y[ili y'Clt Ii t to g1V2 in to pressure from a vocal group of citizens, to permit the Trash Transfer station to be established, as a way to prevent a Strip Club in our to -o. -n. It will only delay the day when someone builds a Strip Club on another parcel of the Adult Entertainment Toned land and then we would have both. I sincerely believe that the adverse effects of a night club can be more easily controlled than those of a major pollution source. I am already heartily sick of the number of garbage trucks driving through our town on Route 125 to the incinerator. Can we not compel mem to stay on I93 and use I495 and the Ward Hill Connector to get to the incinerator: I can choose not to go to a strip club, but I cannot choose not to breathe the air in my town. Please do not alloTa it to be poisoned further. hours, Hilary Harston 180 High Street phone: 978-682-5638 January 14, 1990 Mr. Robert Nicetta Building Inspector North Andover Town Offices 120 North Main Street North Andover, Massachusetts Brickstone Properties, Inc. 433 N. Camden Drive 200 Brickstone Square Suite 960 Andover, MA 01810 Beverly Hills, CA 90210 Tel. 508 688 9599 Tel. 213 550 1360 (HAND DELIVERED & REGULAR MAIL) 01845 Re: Davis & Furber Mills/North Andover Mills Building #22 Renovations Mechanical Room Enclosure Dear Mr. Nicetta, L JAN 14 1991 BUILDING DEF'IA E, -� Pursuant to our telephone conversation of January 09, 1991, please be advised that by way of a copy of this letter and it's attachments, I am instructing our contractor, V. M. Mirisola Co., Inc., to make the following changes to his contract to ensure that the renovations to Building #22 at North Andover Mills, particularly those that relate to the mechanical room enclosure, adhere to your request for proper fire ratings and protection. 1. Walls shall be constructed of 3-5/8" steel studs with one layer of 5/8" firecode drywall on each side of the wall. 2. The entrance door to this room shall be a "B" lable fire rated door. 3:. A sprinkler line shall be extended from the nearest branch line to a point that is approximately centered in the mechanical room and a new drop and sprinkler head shall be installed at that location. 4. A 165° heat detector shall.be installed, approximately centered within the mechanical room, and shall be provided with an auxiliary relay so that the contacts of the relay can be interlocked through the air handling units' control circuit such that if the heat detector goes into alarm, it will automatically shut off the the air handling unit's fans. 5. Duct smoke detectors shall be installed in each of the two (2) air handlers, on/in the vertical duct section between the top of the unit and the transition to horizontal, which shall also be provided withauxiliary relays so that the contacts of the relays can be interlocked through the air handling units' control circuit such that if the smoke detector(s) goes into alarm, it will automatically.shut off the the air handling units' fans. I have also enclosed a sketch of Building #22, which references the mechanical room and reiterates that the previously addressed items #1 through #5 shall be included in the renovations to this building. 4 January 14, 1991 Mr. Robert Nicetta Re: Building #22 Renovations - Page 2 Based on our agreement to undertake the additional work as described in this letter, Brickstone Properties, Inc., on behalf on North Andover Mills Realty, requests that the Town of North Andover, Massachusetts issues V. M. Mirisola Co., Inc. a "Permit to Build" in conjunction with the renovations to Building #22 at North Andover Mills. If you have any questions regarding this matter, do not hesitate to contact me at (508) 749-3000. Very truly yours, Daniel P. Schevis, Jr. Brickstone Properties, Inc. for North Andover Mills Realty enclosure cc: Martin Spagat John G. Baker V.M. Mirisola Co., Inc. File z Zo''' M�lm ■I© O N D I Zo''' M�lm ■I© O �zr N ro Ula r,(n �� o 0 �3 ::j ft to w v r- I y \ I O .t--- co Ln =co Fl (t td cn ¢0 (D �r O �� _ O r N(D (D � � D� 0 � � � -- I �-- �" IL Iv p)—i- rt J1 r r rt O Ap rr (D ti r r �j F. rt O r i - t7 �3' O cn (D (D O ri (D rt rt rt O (D rt rt �r ::j mm m C) F1 m L=am " ' __ Y a .,• r c�D in N F- id 1A r� i MITT ROMNEY Governor KERRY HEALEY Lieutenant Governor COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston — Northeast Regional Office Town of North Andover Department of Public Works 384 Osgood Street North Andover, MA 01845 Attention: William Hmurciak, Director Dear: Mr. Hmurciak: ELLEN ROY HERZFELDER MAR 0 3 200 Secretary EDWARD P. KUNCE Acting Commissioner RE: North Andover 1 High Street RTN: 3-22625 PERFORMING UTILITY RELATED ABATEMENT MEASURES PURSUANT TO MGL c. 21E & 310 CMR 40.0000 On February 25, 2003 at 10:30 AM, the Department of Environmental Protection (the Department) received, a notification of a release/threat of release of oil/hazardous material at the above referenced location. The Department has reason to believe that the location for which the release/threat of release was reported is or may be a disposal site requiring the performance of one or more response actions pursuant to the Massachusetts Contingency Plan (MCP), 310 CMR 40.0000. At the time of notification, you also informed the Department of your intention to perform assessment, containment and/or removal actions at the subject location, as a Utility -related Abatement Measure (DRAM), in accordance with 310 CMR 40.0460. The purpose of this letter is to inform you of the minimum requirements for conducting Utility -related Abatement Measures as described in 310 CMR 40.0460. Persons conducting Utility -related Abatement Measures must comply with the following. minimum performance standards and all other applicable provisions set forth in 310 CMR 40.0460: (1) URAMs shall (a) be limited to only those assessment, containment or removal actions that are necessary for the completion of utility -related activities, (b) shall not prevent or impede the implementation of likely future response actions, and (c) shall not include the construction of residential, commercial, or industrial buildings; (2) Persons conducting a DRAM shall engage or employ a .Licensed Site Professional (LSP) to manage, supervise, oversee or actually perform the necessary response actions at This information is available in alternate format. Call Aprel McCabe, ADA Coordinator at 1-617-556-1171. 205A Lowell St. Wilmington, MA 01887 . Phone (978) 661-7600 . Fax (978) 661-7615 . TTD# (978) 661-7679 DEP on the World Wide Web: http:/Avww.mass.gov/dep Za Printed on Recycled Paper North Andover RTN#3-22625 K (2) Persons conducting a DRAM shall engage or employ a Licensed Site Professional (LSP) to manage, supervise, oversee or actually perform the necessary response actions at this site, unless the response actions consist solely of the excavation and/or handling of: (a) not more than one hundred cubic yards of soil contaminated with oil or waste oil; or (b) not more than twenty cubic yards of soil contaminated with hazardous materials, or a mixture of oil and hazardous materials as outlined in 310 CMR 40.0462(4); (3) URAMs shall neither be initiated nor continued at any site where a "Two Hour" or 72 Hour" release or threat of release has been identified, as described in 310 CMR 40.0311 through 40.0314, until such time as an Immediate Response Action Completion Report has been submitted to the Department; (4) Contaminant conditions shall not be exacerbated as a result of the URAM or as a result of structures placed within an area of identified contamination; (5) Construction workers, surrounding human populations, and environmental receptors shall be reasonably protected from exposure to oil and/or hazardous material during and following construction activities; and (6) Contaminated soil, contaminated groundwater, and other Remediation Wastes removed from the disposal site and construction area shall be managed and transported in compliance with the provisions of 310 CMR 40.0030, 310 CMR 30.000, and all applicable federal, state and local laws. The following submittals must be provided to DEP within specific regulatory timeframes: (1) If an oral notification of your intent to conduct a Utility -related Abatement Measure was provided to DEP, written confinnation of such notice, as described in 310 CMR 40.0462(2), should have been provided to DEP within seven calendar days of this oral notification. If you have failed to provide this written notice within the required timeframe, the Department reserves the right to initiate appropriate enforcement actions to obtain full compliance with the MCP. (2) Except for limited projects exempted pursuant to 310 CMR 40.0462(4), one of the following documents/reports must be submitted to DEP within 120 days of the date of notification of your intent to conduct a Utility -related Abatement Measure: a. a Utility -related Abatement Measure Completion Report, accompanied by a URAM Completion Statement Form (form BWSC-106) as specified in 310 CMR 40.0466, in cases where the proposed response actions have been completed; or b. a Utility -related Abatement Measure Status Report, accompanied by a Supplemental Risk Reduction Transmittal Form (form BWSC-106), as specified in 310 CMR 40.0465, if the proposed response actions are ongoing. f North Andover RTN#3-22625 3 Reports concerning Utility -related Abatement Measures should be addressed to DEP, Bureau of Waste Site Cleanup, Risk Reduction Section, 205A Lowell St., Wilmington, MA 01887. The following is provided to advise you (as used in this letter, "you" refers to the Town of North Andover, Department of Public Works) of the liability. provisions of M.G.L. c. 21E for assessing and remediating releases of oil and/or hazardous materials to the environment. You are advised to review the following section and determine if you are a Responsible Party for the subject release. If, after reading this section, you do not know if you are a Responsible Party, you are advised to seek legal counsel to help you in making this determination. M.G.L. c. 21E, Section 5 makes the following parties liable to the Commonwealth of Massachusetts for response action costs: current owners or operators of a site from or at which there is or has been a release/threat of release of oil or hazardous material; any person who owned or operated a site at the time hazardous material was stored or disposed of; any person who arranged for the transport, disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport, disposal, storage or treatment site from which there is .or has been a release/threat of release of such material; and any person who otherwise caused or is legally responsible for a release/threat of release of oil or hazardous material at a site. This liability is "strict", meaning it is not based on fault, but solely on a party's status as an owner, operator, generator, transporter or disposer. It is also joint and several; meaning that a party may be liable for all response action costs incurred at the site, regardless of the existence of any other liable parties. The MCP requires Responsible Parties to take necessary response actions at properties where there is or has been a release or threat of release of oil and/or hazardous material. If Responsible Parties do not take the necessary response actions, or fail to perform them in an appropriate and timely manner, the Department is authorized by M.G.L. c. 21E to have the work performed by its contractors. By taking such actions, a Responsible Party can avoid liability for response action costs incurred by the Department and its contractors in performing these actions, and any sanctions which may be imposed for failure to perform response actions under the MCP. Please refer to M.G.L. c. 21E for further information regarding liabilities. The subject site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the site have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 21E and the MCP. In addition, the MCP requires persons undertaking response actions at disposal sites to perform Immediate Response Actions (IRAs) in response to "sudden releases", Imminent Hazards and Substantial Release Migration. Such persons must continue to evaluate the need for IRAs and notify the Department immediately if such a need exists. a ^y r North Andover RTN#3-22625 4 Depending on your status under M.G.L. c. 21E Section 5, you may be responsible for conducting additional response actions at the subject site. However, regardless of your status under M.G.L. c. 21E, Section 5, you may be named a Potentially Responsible Party if actions conducted by you at this site contribute to and/or exacerbate contaminant conditions. If you are a Responsible Party, required by the MCP to undertake additional response actions at the subject site, you must provide the proper release notification information to the Department as described in 310 CMR 40.0300, and you must also employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions. In addition, the MCP requires persons undertaking response actions at a disposal site to submit to the Department a Response Action Outcome (RAO) Statement prepared by an LSP in accordance with 310 CMR 40. 1000, upon determining that a level of No Significant Risk already exists or has been achieved at a disposal site or a portion thereof. [You may obtain a list of the names and addresses of these Licensed Site Professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1091.] Thank you for your anticipated cooperation in this matter. If you have any questions relative to this notice, you should contact Iris Davis at the letterhead address or at (978) 661-7724. All future communications and/or submittals regarding this release should be directed to the Bureau of Waste Site Cleanup (BWSC) and must reference the Release Tracking Number (RTN 3-22625) contained in the subject block of this letter. Very ly yours, 4L Iris W. Davis Section Chief, Risk Reduction Branch Bureau of Waste Site Cleanup cc: North Andover Board of Health DEP data entry/file Pricing Breakdown Building #22 n...l��!,3�#�ii 12/18/90 EXHIBIT "A" 1) Demolition: Existing offices, restroans, and remove wood shelves. Remove debris including that at exterior of building. Total - $3,000.00 2) Construct: Steel stud & drywall partitions around HVAC Units; install door with hardware, acoustically insulate walls; install one light i fixture with wall switch, paint exposed surfaces. Total - $2,700..00 3) Clean: Oil off floor, off north half of west wall, power wash concrete floor. Total - $1,200.00 4) Sandblast: Paint from interior face of exterior walls at old office. Awo cEXL4Ncs,zc, r-- a.o ovr;%c.Q A �, Total - $1,700.00 5) Construct: 2 Restroams one mens and one womans with handicapped capability each consisting of steel stud & drywall partitions full height to roof deck. Paint all exposed surfaces, ceramic tile on floor and 4 ft. up walls ( $4.00 Sq. Ft. Budget) one laminet top over 2'x4' surface mount light. Total - $7,900.00 6) Install: New steel stud & drywall enclosure around basement steps. Price includes paint, door & hardware complete with ceiling. Total - $2,100.00 **Price includes 8% Profit & Overhead. Total Job Price - $18,600.00** ...... 'I�'�vr. " Ll Jy,.F; k4f� 1�4?Lie }r� m�'rti Gti V}s#�ly r. �.-4� •�D. .�': f 7 ! I f f( f I - s1f- 1f flr 6 y. �r iT x r t ){ +"'s a3 hF I.h i� r .Nf Ff,�cr l_ rq # S� r ri�Y'i �y4r°,s }A r ) Tylnu..'{fly �r� '�)L6y 1f 1;4Sq k;� 's r f ! i' Y sI 1 ,��.sr�. ¢ t , J 1 ie f`}t. fr r2 j'li..iy �3Pef t)t�{ { 9tj 1C `i.. 9Fr l f f``tC'Yr r} { t F h l j } d 3 I 7� t }Yta i ,y�liy SS:Y m`.H3ia`VR1;§T`e�+yjy° . Li L COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY I f y } a ! OF ' 1010 COMMONWEALTH AVE. $ a BOSTON, MASS. 02215 1 MASSACHUSETTS ,t, { LICENSE EXPIRATION DATE CONSTRUCTION SUPERVISOR 06-30-92 T'. RESTRICTIONS $ EFFECTIVE DATE 1 i LIC -NO. 4 07-01-87 045374 Vincent M. Mirisola 52 Federal St. PHOTO (BLASTING OPR ONIVI FEE: $150.00 Wilmington, MA 01887 - I HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY DOB' STAMPED - OR - SIGNATURE OF THE COMMISSIONER( - COMMISSIONER u, ! i i � I 1 lil I I � I I - I' ! Ii JJ O tll ji i i Z I 'II I V. M. Mirisola Company, Inc. General Contractor 120 Arlington Street Dracut, MA 01826 (508) 459-0965 �kP-WMI CA'L goDN` - N EW - 51 c, ,'6 --up --/5 it FflI3�VF- /7 M�t�►s � Lwin s Rp IN ( D`` C� -_---- �� I fJ Earl STL 5TU r7 S/8u Flfe-coD,,e— (nU►ili Q�UUND PJAh�M X Haab s TL.S-rtfD � S�Q,�trecoDeGjW�j AF o 10,"j 6eant> �o.rl�l��F�f IaN�U�T`�te Location/ KI r-), W. (2LU _ TOWN OF NORTH ANDOVER Certificate of Occupancy $ t;�) 13? Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee C 4_:�ewer, onnection Fee t., water onnection Fee %0jrAL Building Inspector Div. Public Works PER111T NO. o z / '.APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. _f PAd1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK '.PAGE ZONE SUB DIV. LOT NO. I LOCATION 3�- 6 `-w 2Z 1 N�►+ LtNOu.l .r MtL.L J »� �.0 �;az��r PURPOSE OF BUILDING _ oFF1G5 �iC-I:,:: NAME 6 s NO. OF STORIES SIZE ONE: 00Xeo /4 Z c; )O . OWNER'S ADDRESS ` abbe ,I VV BASEMENT OR SLAB ``•�� ARCHITECT'S NAME .�^ -, t�7e..A p SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME v, M, IYIIf` )%- IA A w- ! 1�+ - c _ SPAN _ e DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT IS BUILDING NEW�1(/ FRONTAGE ry L r- A44 HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER Yds BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 7 IS BUILDING CONNECTED TO NATURAL GAS LINE yo INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 /�f✓I.iv v PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED 19 OWNER TEL # 6-816-C1599 CONTRACTOR TEL # 45%6�66- CONTRACTOR LIC # 045737 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 1 c BUILDING INSPECTOR 'NV -1.1 101d SA0V1d3U SIHl 'a3SOdWlU3df1S '013 'S30VU -VE)'S3H0H0cl HHIM'SVNIO11f18 dO.SNOISN3Wld lOVX3 C3NV S3N17 101 WOUA 30NV1Sia dNV 10"1 JOSNOISN3Wla lOVX3 MOHS1Sf1W N01103S SIHl . _ P"L 1.W.8 - JIa1J313 ON 110 PSE i:1 Sd0 SN31V3H 11N11 i`JNIIV3H 1NVIOVd `JNINOI110NpJ aIV aOdVA a0 a.1.M lOH WV31S _ 1 S631dV8 DOOM SIOJ 4 'SW9 1331S 'S10J 8 "SW9 a39Wli 'Nana a1V lOH 03JaO3 3JVNand SS313d1d iSlor 000M DNIIV3H L L I 0NIWM 9 'NV -1.1 101d SA0V1d3U SIHl 'a3SOdWlU3df1S '013 'S30VU -VE)'S3H0H0cl HHIM'SVNIO11f18 dO.SNOISN3Wld lOVX3 C3NV S3N17 101 WOUA 30NV1Sia dNV 10"1 JOSNOISN3Wla lOVX3 MOHS1Sf1W N01103S SIHl Z L AON V d (1000 L OV033H JNIG71A9 . _ P"L 1.W.8 - JIa1J313 110 SWOON d0 Sd0 SN31V3H 11N11 1NVIOVd `JNINOI110NpJ aIV aOdVA a0 a.1.M lOH WV31S _ 1 S631dV8 DOOM SIOJ 4 'SW9 1331S 'S10J 8 "SW9 a39Wli 'Nana a1V lOH 03JaO3 3JVNand SS313d1d iSlor 000M DNIIV3H L L I 0NIWM 9 00V0 3111 aOOld 3111 —0. S3an1X13-Na300W `JNHOOa 1108 _ a3MOHS 11V1S ONI9Wnld ON 13AVa9 8 aVl 31V1S ANIS N3HJIIA S30NIHS DOOM ' - QOIVAV1 S310NIHS 11VHdSV 13SOID 831VM 03HS 1V13 1383 wVO I"Xld L) 131101 OaVSNVVVdIH ('XIIaEI HIV13 19VO ONI9Wnld - OL. dOOM S 3 good I I a01�doS ON181M 3WVdl NO 3NO1S ABNOSVW NO 3NO1S 'A19 a30NIJ a0 "JNOJ _I a001d 8 S81S JI11V 3WV84 NO AJI89 ABNOSVW NO A)la9 —� E _ 9 3WVad NO omnis ABNOSVW NO OJJMIn1S `JN101S 'MA 3111 'HdSV N7VVWOD ONIOIS SOIS313SV 0tj\OaVH ONIOIS 11VHdSV HidV3 S310NIHS DOOM 313aJNOJ ONICIS SO4VO9dV1J 580071 6 II S71VM v N3HJ11A Na300W WOOa OVf� �S37V1'd' 3813 1.W.9 ON d'3aV.3111V"NIA 'V3aV .1.W.9 "Nld llnd V3aV 1N3W3SV8 fi — E Z _ I _ 9 NIANn 11VM AIG • — Sa3ld a31SVld O.M(aVH '7'1 3NO1S a0 AJIa9 3NId 'A.19 3138DNOD 313dDNOJ HSINIJ NOIN31NI 8 NOI1VONnO4 Z N0u:)nZ11SN00 SiN3W1aVdV S3JI3do Allwvd 111nw _— S311f0!S kIIWV4 316NIS Z L AON V d (1000 L OV033H JNIG71A9 CA m m m YI m N m CD CA C � O d CACD MZ h CD o F 90 o CL =• y aCo -0 �� CD o p CD o CL CD CD o CD C CD y CL. p y CD I C2 CA O CD Z� o� CD 0 000or- 0 b m cn rn cn _ =r cs _ Q Go norm y -i m m 'Cot c) Z to t =C2 3 '�A vi -4 �.w .� d O T CD d� O O y C y --1 S' �mmCD C a o : e� m 0' o = : , o Z �.a -coo � c ? ca COL �m s C gr �o CD CD C 1 C o . CL t4H p O1 y C a Q N ru C r m � IE m H H H m� O .di. H ca CD m� o0 m g y 1-0 dd a� o� �o t r cn o En o To i 7N% S� r ;J n m n D r � m I n i q F A O r cn o En o d ro r ° d � C/) O O y 0 9 .41 0 IM b �s APPLICATION FOR LICENSE TO MANUFACTURE FROZEN DESSERTS AND/OR ICE CREAM MIX To the Board of Health of North Andover in accordance with the provisions of Section 65H of Chapter94 of the General Laws, as most recently amended and the regulations made thereunder, the undersigned hereby applies for a license for the WHOLESALE/RETAIL manufacture of frozen desserts and or ice cream mix and submits the following information: Name of Establish __e"t•.... �C�� .P...�.�....�.....1..�... .... .00 .. .... Location:.... ....... ...:... . .?: ........................Telephone #.�t� : OCA Name of firm:...... 00SAi:1,()......... .. Address of firm:..7. i�'!!:! e one Owner (s) / Operator(s).... :!;?.........:'LX ............................ Type of business: Corporation (t� Partnership O Owner O Please list licenses, permits, or registrations issued by other municipal, state or 1 federal agencies: ...... i?�..,.•;M�. ........................................... .......................................................................................................... Names of brands and trade or corporation name, if any under which the products are to be sold ...... C -0W. ^ Rc).... �?a.�?::`:..`1e?9:.................................. Number and capacity of freezers ......... 3jo�-S . ...............:40 ................................. Make and Model of mixing equipment.(c�of: iia .......... Age .....�..:���.. Is the mix purchased?......... ..................If so, from whom purchased?......... .............. l:�4�Vyx!-�:�:�:..S�i,S.L®........ K)0,('ion.....M` ........................... Is the mix pasteurized?........�� :.............................................................. Number of gallons of frozen desserts and/or ice cream mix sold as such in Massachusetts, manufactured during last calendar year ..... S.S?.�0. ................. Have you received a copy of the regulation?...... . AS ........................................ Is the plant constructed and equipped as provided in the regulations?:: Are you manufacturing dairy products? ......%%L)..... Please note. Non- dairy frozen desserts no longer require bacterial testing What is the approved laboratory which will conduct monthly bacteria testing? Name ......�?Ue.-Ak..............Address. ...M.l 4)A... �R!&........... oto c�005c__) Do you understand that the laboratory must submit copies of the results to the Board of Health and the MI)PH upon completion of the analysis?........ .... J�� ...... ............................................................................................................ Bacteriological limits for frozen desserts are: 10 coliform colonies per gram 50,000 standard plate count per gram 1 hereby certify that the frozen desserts and/or ice cream mix 1 sell in Massachusetts will be manufactured in compliance with all laws of the Commonwealth of Massachusetts pertaining thereto and all rules and regulations promulgated by the Massachusetts Department of Public Health made thereunder and will be m�jfactured under sanitary conditions 1 1 Kignature 7 NOW 0 C) z ONO I I . f I Q) a) -n m -n cn M 21 m 21 0 w 0 0(D CD CD "'C) m 0 > FA m 0 CD 0 c to =r ('iC) M m 0 0 Uc 3 =r z :7 j, :3 0 C (a =r C) 0 > 0 m > 721, F� �D p I.