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Home My WebLink AboutMiscellaneous - 12 GARDEN STREET 4/30/2018 (2) 12 GARDEN STREET 1 / 29 0/042.0-009.O-DD00.0 l I i i i � < � )LE Air Quality Experts, Inc . 3 Brentwood Avenue Salem, N.H. 03079 ~-- id 603-894-64G5 JULY 12, 1993 NO. ANDOVER BOARD OF HEALTH 120 MAIN STREET NO. ANDOVER, MA 01845 DEAR SIR: ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN ASBESTOS ABATEMENT PROJECT. THE JOB WILL TAKE PLACE ON JULY 29, 1993. PROJECT: 8IGNAC 012 SARXX STM£T NO. ANDOVER, MA ANY QUESTIONS CONCERNING THIS MATTER SHOULD BE DIRECTED TO MY ATTENTION. SINCERELY, N '/� / ~'-4~^� ,~ / CHRISTOPHERTHOMPSON PRESIDENT � Commonwealth of Massachusetts Asbestos Notification Form— ANF-001 g. t Asbestos Abatement Description 1. Facility location: MRS . GIGNAC 1. GARDEN ST . .................................................................................................... ................................................................................................................................... INSTRUCTIONS Narne Address NO. ANDOVER 07.845 503-688-53;(> 1.All sections of this .......... ....................................................... .......................................................................... .......................................................................................... form must be completed Clry/fown zip a4e Telepha e theDepartmentofr to comply h AS.EMEN.T. theDepartment of ................................................................................................................................................................................................. Environmental Wig is1110worktltelaclion7building rame,/,wing,floor,morn Protection notification 2. Is the facility occupied? es O No requirements of 310 CMR prior(ten working alion i days 3. Asbestos Contractor: prianotificetion k requkedo/anyabatement AIR QUALITY EXPERTS, INC. 349 SO. BROADWAY #8 prolec4:and the .............................................................................................. .......................................»..................»»...................................................._.... ....... .......... Department of Labor Name Address and Induntdea no6lication requirements SALEM, NH'' 03079 603-894-6465 of 453 CMR 6.12 (ten CiryAown Ifp code Teleplane days prior ndibcetion is requkedolANY AC000167 WRITTEN abatement proied grmter . ......... ........................................................................................ ......... ..... . ...... . ....................................................................................................... Bnao tree linear or DU lkanae/ Conlr d Tyle(wdnerWerW) square/ee0. 4. On-Site Project Supervisor/Foreman: 2.Submit Original Form CHRISTOPHER THOMPSON SF07797 To: »................................................................ .................................................................................................................................. Name Dtl Cediliratlon/ Commonwealth of Massachusetts 5. P Qj ct Mo itor: Asbestos Program N A CLEARANCE ANALYSIS AA 0 0 0 8_: P.O.B.120067 Boston MA 02112• K Marne D11 Cedifiratiw�/ 0067 3..This form may be s. Arspe?VAtalytr61J(,1Z'.AR AN.CE ANALYSIS AAO 0 0 8 5 'used for notifying the .................................................................................................... ......................................... U.S.Environmental Name Dtl Cerbrinaliml Protection Agency Region 72993 72993 1-6 1 of asbestos demolition/ 7. Project start dateJ_J_end date_J_J_specfficwork hours(Man:Fri.) (Sat.Sun.) renovation operations subject to NESHAPS(40 t t. What "ion CFR Subpart M). 8type of project is this? (circle one): demoiaw repair 't@,>bDalion otlier(explain) FO,0144 Use 0* 9. Describe the asbestos abatement procedures to be used (circle): glovebag endos ua codalnne deanup encapsulalion disposd only d6er(explaln) raa�oe3>n s PAD"Dale 10. Is the job being conducted O�indoors O outdoors? Hamm 6 Pent„m m 11. Total amount of each type oNbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other surfaces(square ft.) to be removed,enclosed or encapsulated: linear/square feet boiler,breaching,dud,tank surface coatings... 3 0 thermal,solid core pipe insulation.......� corrugated or layered paper pipe insulation.... insuialing cement.................. —J sprayonfireproofing..................... bowel/sprayer coatings.............. cloths,woven kbrks....................._J transile board,wall board............. other(please describe).................... 12. Describe the decontamination system(s)to be used: i .1.....D.E.C.O.N...:_CHAM RER................................................................................................................................................................. .............. ......................................................................................................................................................................................................... 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): KE.T....REMOVAL....I.N.T.0 6MIL....P.OL.Y....ASBESTOS...LABELED....BAGS................................................. ...................................................................................................................................:........................................................................................... ....... 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency: ........................................................................................_......... ............... ...............,...................._...._.......... . .........__................................ Name dQElUtlkial Tftle Dale olAultakation Walser/ i .................................................................................................... Nameaataadat rine .................................................._................................:............... ................................................................................................................................. Dale d Auuxuvaliw, Wafer/ 15. Do prevailing wage rates apply as per M.G.L.c.149.Q 26,27,or 27A•F to this project? O Yes No Rev.6192. lb Facility Description a II 1. Current or prior use of facility: pSld l?ACe, �• .............................................................................................................................. 2. Is the facility owner-occupied residential with 4 units or less? Yes ❑ No 3. Facility Owner: SAME ..................................................................................................... ................................................................................................................................... Name .Iddress _............................................................................................................................................................................................................................... Ciry/rown liv code TelepAone 4. Facility's Owner's On-$Re Manager: N/A .................. .. ..........._ .......... ........ ... Name Address Cirygown rip axle Tele*ne 5. General Contractor: N.4A........................................................ ....:.............................................................................................................................. . Name Address ..................................................................................................... ...................................................... ............................................................................ Gry/Town lip cods A/ephone Contractors Workers Comp.Insurer poky/ Exp.Data 6. What is the size of the facility? 2000 sq ft) (t of floors) 13 Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site: AIR QUALITY EXPERTS, INC. 349 SO. BROADWAY #8 .................................................................................................... .................................................................................................................................... Name Adrl�ess SALEM, NEW HAMPSHIRE 03079 603-894-6465 Ciry/Town 161 tale Teleplate 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site: SAME _................................................................................................... .................................................................................................................................... Nine Address ............................................................................................... ............. . ............................................................................................................. Note:Transfer Gh/r Zinrale Tele/�fwe Stations must 3. Refuse transfer station and owner(if applicable): comply with the Solid Waste Divisionrepula- ......................NT.r'•*.A.......................................................... .arxi�ess......................................................................................................................... tions 310 CMR 18.00 ........................................................:.............................................. ...................................................... ........................................................................... Cirylrown 1u+a* TWO- 4. Final Disposal Site: TURNKEY LANDFILL WASTE MANAGEMENT OF NEW HAMPSHIRE . .............................................................................:....................... .................................................................................................................................... • Lodia�Nine Owners Nxrw 90 ROCHESTER NECK RD. ........................................................................................................................................................................................................................................... Address ROCHESTER, NEW HAMPSHIRE 03867 603-332-2386 ..... ............................................................................................. ................................................ .......................................................................... f CiryAnwn lin arse TeleMone Certification The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this notification is true and correct to the best of his/her knowledge and belie CHRISTOPHER THOMPSON Pdnf Name udxx¢od 3 prulure Dale a Note:Contractor 603-894-6465 must sign this PRESIDENT AIR QUALITY EXPERTS, INC. form for DL _............................................................................................................................................................................. ........................................................ Pbsifion/Tlde Represenfinp leleplane notification purposes 349 SO. BROADWAY #8 SALEM, NH 03079 ............................................................................................................................................................................... ........... ............................................. Address Cify/ruwn lip axle Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?�]yes ❑no Sticker I(from front of form): —I \