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ABATEMENT CONTROL SERF/CES, INC.
ASBESTOS REMOVAL & MAINTENANCE
Jun. 21, 00
NORTH ANDOVER BOARD OF HEALTH
27 Charles Street
North Andover, MA 01845
DEAR SIR/MADAM
ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE
FOR AN ASBESTOS ABATEMENT PROJECT.
THE JOB WILL TAKE PLACE ON JULY 17, 2000
LOCATION: 79 JOHNSON STREET
ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY
ATTENTION.
SINCERLY,
FRANK BALOGH
PRESIDENT
2 INDUSTRIAL WAY SALEM, NH 03079 • NH (603) 898-9472 • MA (888) 870-9292 • FAX (603) 898-1846
UMUCTIOYS
1. All Sections of this
form ust be
Complmeted In order to
comply with the
Department of
Environmattal
Protecdon
nookAtion
requiranents d 310
0011t 7.15 (!M wa*Aq
dryspd 140 Waa,
tr fflVdredo -y
Atalef""AM,,OW-
ano me Department
oflaborand
Industries
notification
regWernents of 453
CMR 6.12 (099 ddYY
mVubed e/ANY
AwtbmwAwiecr
Rooter Ow arae
*7AV0f4tWV revµ
2. Subrtdt Original
Form To:
commonwealth of
Asb"t" Program
P.OJL 120087=7
3. This Form may be
used for nooly" the
U.S. Environmental
Protection Agen(Y
Region 1 of asbestos
danoiitlon/ratovatlon
operations subject to
NL9 APS (40 CFR
Subpart M).
For offioal use
Nourration r
aerare date
sews
PWffA APpeve/D&w d
Dusan mte
Rev. 6/92
commonwealtbolN,#ssacbasetts
AsbestosNotilicationfo�m—NiV�00>
! EXEMPT
13
Asd�estosAD�a�emeo�oesciwdon
1. Facility location:
BILL POGOR 79 JOHNSON STREET
Aldine Address'
N ANnQZER 'MA 01845 978-258-3199
TNeXNaR
00/1r-00/1r—zip CWL-
BASEMENT
lyhdt d Ohe txvks/te AxaLbwTAvhV sty twm4 11 W* ttoo5 roan
2. Is the facility occupied? Q Yes ❑ No ~�
3. Asbestos Contractor:
ABATEMENT CONTROL SM INC. 2 INDUSTRIAL WAY
AOrrae Address
SALEM, NH 03079 603-898-9472
01y1T0_ IJp code TefephcrK
AC000362 Written
U14tow / Con" WWt ow (Wr/tten A' VcvAr/J
4. On -Site Project Supervisor/Foreman:
NOLBERTO GALACIA
Marne
S. Project Monitor:
NA
AAW
6. Asbestos Analytical lab:
AS32348
aueerWcdObn r
ac/Cerr//kR&"1 #
FINAL CLEARENCE ANALYSIS AA000085
NAM
7-17-00 7-17-00 7 4
7. Project start date end date specific work hours (Mon. -Fd.) am om (Sat. -Sun.)
ASBESTOS
8. What type of project is this? obnWWW repair renovation 06"r(e'Od"7) REMOVAL
9. Describe the asbestos abatement procedures to be used: g/ove trag endawre
awtammeat deanup encapwiation do w-1 only other(ep(am)
10. Is the job being conducted P Indoors ❑ outdoors?
11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 3 5 0 or otter
surfaces (square ft.) 0 to be removed, enclosed or encapsulated:
unear sQuam feet Unear Kara feN
e2b'.dlea004 dad G,M'w9,%C-tow MwAg SOW ctmAorrurl Wn
Carey+ddaHre'edRWe'Pperttunab/350 tWA11tV7vMOW
.t"r- +civ r/VMW4"A rCW*W
Claft "MW Ab* rran arA-r4 gourd
Wykr(pkueaimate) OMe-(P '1
12. Describe the decontamination system(s) to be used:
t•
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
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 LYRIP 01150W nae
Date 9rAoo4olmdae WaAcr At
I&WO(Au6Ylklwa/ ride
Date VfAeaiR WW7 WaArr/
15. Do prevailing wage rates apply as per M.G.L c. 149, § 26, 27, or 27A -F to this project? ❑ Yes K No
.*
farawOP,sezza m
1. Current or prior use of facility: HOME .
2. Is the facility owner -occupied residential with 4 units or less? ® Yes ❑ No
3. Facility Owner:
BILL AGER 79 JOHNSON ST
AWW N.ANDOVER OA1845 978-258-3199
OY/T— zoCade TeAW-
4. Facilitys Owner's On -Site Manager:
ay/Ta- uoawe Tex
S. General Contractor:
NA
/"W AafZesr
dY/r— Zocrov TefNA k
CmOacra� Wakens Cara Insurer 7 0 ��
6. What Is the ON of the facility? 2,000 (sq R) 2 Ur floors)
.4sUSIAST"Soloda/Ioosod0lsposa/
1. Transporter of asbestos-contalning waste material from site to temporary storage site (if necessary) W final disposal site?
ABATEMENT CONTROL SERVICES,INC. 2 INDUSTRIAL WAY
/"M Address
SALEM, NH 03079 603-898-9472
Gq/Tam zo code TeAgWav
2. Transporter of asbestos-oontalning waste materials from removal/temporary storage site to final disposal site:
Address
Tip code Tekphau
Z47 Cade reA*W-x
4. Final Disom Site:
TURNKEY LANDFILL WASTE MGMT OF NH
LPCOAVA yK Owners Name
90 ROCHESTER°NECK RD
Addis'
ROCHESTER, NH 03067 603-332-2386
UY/Tam Dp code TNe�ahaae
13
Ceilifice/Ioo
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 know ge an ief.
FRANK BALOGH
gy�rNy,N Authadr /9nahae Qile
PRESIDENT ABATEMENT CONTROL SVC,INC. 603-898-9472
AVOO U& RepesenGny TO 9
2 INDUSTRIAL WAY SALEM, NH
AOWW Ory/Town IW W*
Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less)?Z Yes ❑ No
Sticker # (from front of form): -7 -4 R n R R
CAY/loon.
3• Refuse "Wer station and owner (if applicable):
Note. ;rWARIer
2aD'o7tsMa
c9fiwy wityr 09
,Yater
Said Waste
aKsionngcrra- .
0cvts310ONR
00/7own
1B.x
Address
Tip code Tekphau
Z47 Cade reA*W-x
4. Final Disom Site:
TURNKEY LANDFILL WASTE MGMT OF NH
LPCOAVA yK Owners Name
90 ROCHESTER°NECK RD
Addis'
ROCHESTER, NH 03067 603-332-2386
UY/Tam Dp code TNe�ahaae
13
Ceilifice/Ioo
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 know ge an ief.
FRANK BALOGH
gy�rNy,N Authadr /9nahae Qile
PRESIDENT ABATEMENT CONTROL SVC,INC. 603-898-9472
AVOO U& RepesenGny TO 9
2 INDUSTRIAL WAY SALEM, NH
AOWW Ory/Town IW W*
Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less)?Z Yes ❑ No
Sticker # (from front of form): -7 -4 R n R R