HomeMy WebLinkAboutMiscellaneous - 26 HERRICK ROAD 4/30/2018 (2)OVAL
P. O. Box 132
Arlington, MA 02476
(a division of Dudley Services, Inc.)
TeL 781-643-4328 Fax. 781-643-1255
MA Lic. # AC 000112
www. dndleyasbestos. cont
S.EC1A UINGJARESIVEXUALL .SND C0M1_1: U'RIUAL
ASIMS S ; <1Vr
Date. August 30, 2001
To; No. Andover Board of Health
Enclosed, please ftttd copies of the Divislon of Occupational Safely and the Dept. of
Environmental Protection form ANF -001 for nit aisbestos abatement project
to be perforated in voter city/toiwi. Please feel free to call ifyou have arty questions.
Tr wm OF NORTH ANDOVER/
BOARD OF HEALTH�
Sincerely,
Samuel J. Nigro 111
C49
Y
El Facility Description
1. Current or prior use of facility:
2. Is the facility owner -occupied residential with 4 units or less? )1 Yes 1=1 No
3. Facility Owner:
Same _
Nave --- --- — Addess — — _..-- -----
C•ilg7own ----- ;ip code --------- Telephone
4. Facility's Owner's On -Site Manager:
Nanr Ar1Jess
C#Y/Tnwn lip Inde Telephone
5. General Contractor:
Name Address — — --
Citylrnwn Zip code Telephone
American. Interstate Ins_ JIVWCMA1023542001_7/9/02
Contrarmr's Workors Comp. Insurer Pnf ry.I Cxp.Oafrt
6. What is the size of the facility? 2000 (sq ft) 3 (# of floors)
goAsbestos Transportation and Disposal
1. Transporter of asbestos -containing waste material from site to temporary storage site (if necessary) to final disposal site:
Nan,- Address
CiIY/rnnn lip Code Telephone
2. Transporter of asbestos -containing waste material from removal/ temporary storage site to final disposal site:
J-0-B./Rolloff, Inc. _P.O. Box 6037
Nan,- Address
_C_helsea, MA _ 02150 61_7-387-1495
Note: Transfer Civoxn Apcode Telephone
Stations must 3. Refuse transfer station and owner (if applicable):
comply with the
Solid Waste USA Waste of CT 208 Pickering Street
Division regula- Naim Address
tions 310 CMR
i8.00 Portland, CT 06480 860-342-0667
Cilylrnnn Ip Code Telephone
4. Final Disposal Site:
Valley Landfill
I wNion Name Owners Name
Pleasant Valley Road
-----
Irwin, PA 15642 _ 724-744_-7446
CiwoYm tp mde Telephone
Certification
s
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 b net.
Samuel J. Nigro
PrinlN.tme AfAhorizMSignalma Dale
Note: Contractor
must sign this President Dudley Services 781-643-4328
form for DLI Posilinn7ille
notification Representing Telrphone
purposes P.O. Box 132 Arlington, MA 02476
AAdress Cily7nxn Tp mdrt
Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less) ? yes 0 no
Sticker # (from front of form): / G % r�