HomeMy WebLinkAboutMiscellaneous - 37 BRADSTREET ROAD 4/30/2018 (2)LL
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ABATEMENT CONTROL SWUM$, INC.
ASBESTOS REMOVAL & MAINTENANCE
May 8, 2000
NORTH ANDOVER BOARD OF HEALTH
27 Charles Street
North Andover, MA 01845
DEAR SIR/MADAM
MAY TO
w
ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE
FOR AN ASBESTOS ABATEMENT PROJECT.
THE JOB WILL TAKE PLACE ON May 22, 2000
LOCATION: 37 Bradstreet, North Andover, MA
ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY
ATTENTION.
SINCERLY,
C&I �
CHRIS CHRETIEN III
PROJECT ESTIMATOR
2 INDUSTRIAL WAY • SALEM, NH 03079 • NH (603) 898-9472 • MA (888) 870-9292 • FAX (603) 898-1846
Commonwea/�/rolMassachusens
� EXEMPT',
AsdeslosAoffffcal%Ufo/M--af-001 -
AsbesrosAbatemeo�0esci/,vdan •- . _ .. _ �. _
1. Facility location:
UMUCTIONS
1. All sections of this
form must be
competed In order to
comply with the
Department of
Environmental
Protection
notification
requirements of 310
CMR 7.1S (lee ratv*Ov
dais P'> Fa' /a o �p (na0 qv
afew4wofwy
aArte7eatpojnV0
and the Department
ofuborand
Industries
notification
requirements of 453
CMR 6.12 (Mr days
paw1VA*a&V&
aya/red dANY
ymaterman okfw
*xW WJgWm fer0
2. Submit Original
Form To:
Commonwealth of
Asbestos Program
P.o.B.120087.0067
3. This Form may be
used for notifying the
U.S. Environmental
Protection Agency
Region 1 of asbestos
demolltion/renovabon
operations subject to
NES1,M (40 CFR
Subpart M).
Tom Koken 37 Rradctraat.
Name Address .
North Andover, MA 01845 978-685-3624
cry/r_ zip ad--
Basement
afeBasemen
Wnatcr poo naatvte 10CJ&W,'AVhft AWA, r, nv/rq, Naw, rrzvn -
2. Is the facility occupied? }] Yes ❑ No
3. Asbestos Contractor:
ABATEMENT CONTROL SVC,INC. 2 INDUSTRIAL WAY
SALEM, NH 03079 603-898-9472
Cnl//avn z/P code TekpMan e
AC000362 Written
uJilreme r Cmbad 7jpe (Wiittm or ✓eIWV
4. On -Site Project Supervisor/Foreman:
Nolberto Galcia AS32348
Nang IXlCerd/Araobn /
5. Project Monitor:
NA
Name &I Cerp7kddon if
6. Asbestos Analytical Lab:
7.
FW Omdal Use
9.
Nocrrauon s.
9.
Race* date
Renew
10. Is the job being conducted @ Indoors ❑ outdoors?
vamp AonoWoerwed
11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.)1.0.5— or other
surfaces (square ft.) 0 to be removed, enclosed or encapsulated:
Unear SQ.ra feet u_r — feet
dtArneaaft 04 GratWf"avow 7h"* AtefaveRwkwWw
a'i/a'nfAion'FNeil7leaaW7105 kwolavmnw
•� $7Y'a9��WZIY T/�NL'i�itra/D'ai%Gtpr
0A% amen fabY 7r"Noarst mebow
offirr(pbwaksvdei 0001(NIAW0.a W
NA
Acme all Cno7kaaa, r
Project start date _L/2 'enavate 5� 2 spearlPwork hours (Mon. -Fri.) 7 am 4 mm (Sat. -Sun.)
What type of project Is this? deltVftr rep7if renovation oder ep�/ain) y pVQY
Describe the asbestos abatement procedures to be used: /o✓e ba endawre At
CWAMmarlt dewilp awapsNadon dWaw/on/y other(exp/aiy
12. Describe the decontamination system(s) to be used:
Glove Baa
13. Describe the caltainerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9):
Wet removal into 6 mil Poly Asbestos Labeled Bags.
14. For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency:
NAM dDEi a7/au/
77W
alta WAW)alradty,
WaAtrr
Afa cfALJ0M60/
r*
Gale CfA✓Cafradfav
WaACrr
15. Do prevailing wage rates apply as per M.G.L c. 149, § 26, 27, or 27A -F to this project? ❑ Yes ® No
Rev. 6192
Note. r="
SYaormMa
comp* wid) die
Solid waste
,DKQ v regrda-
ANW3100W
law
faci/sascilpaoa
1. Current or prior use of facility:
Residence
2. Is the facility owner -occupied residential with 4 units or less? E] Yes ❑ No
3. Facility Owner:
Tom Kok R+ 37
Name
North Andover, MA 01845 978-685-3624
Ory/r— Zo mole rnha�aoe
4. Fadlity's Owner's On -Ste Manager: r
NA
� AafSe�t
�e
DQ fiddle rebp'e
5. General Contractor:
NA
AWW
0Y?— I(° code reArp'v-
Cowwak' wcvkers cwp IAsmei
6. What Is the size of the facility? a 4"(sq R) 2 (x floors)
As,usfosftafflefudomwalsvosw
1. Transporter of asbestos-cwtaining waste material from site to temporary storage site (if necessary) to final disposal site?
ABATEMENT CONTROL SERVICES,INC. 2 INDUSTRIAL WAY
AMW AOWW
SALEM, NH 03079 603-898-9472
aw— oto carie Te/edrare
2. Transporter of asbestos-wntaining waste materials from removal/temporary storage site to final disposal site:
AWne
Gy?own
3. Refuse harrier station and owner (If applicable):
NA
AWx
ov/rowa
zo code rN*h-
4. Final Disposal Site:
.TURNKEY LANDFILL WASTE MGMT OF NH
1=010AWree 0*7)MN&W
90 ROCHESTER NECK RD
Ad&W
ROCHESTER, NH 03067 603-332-2386
Oty/rown code radga—
� Ce�ti/Iddoa .
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 gest of his/her knowledge and belief.
FRANK BALOGH 5/8/00
F"AWra
GNre
PRESIDENT ABATEMENT CONTROL SVC,INC. 603-898-9472
r0 9
2 INDUSTRIAL WAY SALEM, NH
AaOw OWT— �Ocrob
Fee exempt (City, Town, district, municipal housing authority, owner-aacupied residential of four units or less)?Jo Yes ❑ No
Sticker r (from front of form): N 8 9
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