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'fie undersigned hereby states; under the penalties of perjury, that he/she has
read and understood the Ca-mnwealth of Vssachusetts Regulations for the
Rival, Containment or Encapsulation of Asbestos, -451 CIS 5.00, and that the
information contained in this notification is true and correct to the best of
his/her }aioledge and belief.
Date Uct 12, 1y)88 Signed by: do
41
Title: Hresiaent
Of: Abatement Specialists, in
Return to:
asbestos Control tical Service :
t of Labor and Indust-ries
Division of i�strial Safety
severe tt Saltonstall ,f�ildir g
k . 100 :Camkirl d n Street
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Add 8 U C-IQ �,c,� /��, Title of Fiie
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Date f=ile open: Date file closed: ,
Doc Document/Action Title Date of Refer to other Purpose of pocurnent/Action and notes
action Document/ document/
Num. Action Department
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Board of Appeals - Board of Health Planning Board _ servation Commission - B
oildin Departr.ent
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