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HomeMy WebLinkAboutMiscellaneous - 38 Maple Street---- 1--, FROM (WED)FEB 8 2006 17:41/$T.17:39/No.6820878870 P 1 Department of PubHe Health/ Department of Labor & WorWree Development NOTIVICATtON OF DE[.F.ADING WORK •, ; AN sections of this tau must be completed is order to comply with the ootination requirements orM.G.L. C. 111§147, 454 CMR 2Z mod 105 CMA X160.000, ad most recently amended Contractor performing project ,&Z.0, �. �Q \ License M��Exp Dafe_e ( ��R Lead Point Inspector M � VACA-yLn Date of lospecdoa ' - License *Lh-I p. Dna ADDRICS i QF PRQIECT: ` _ Street Address_g��� S T Apt. Number City "ver zip dk8 ►O PmpertyOwwer Telephone Number . �P� l 1 �` la' t Deleadiug Method:aNDry Sero Rest Coo Liquid Eon of Dame ton Caustics p tomcat over�aQ Iter if "Other" selected. picric expNin fl\ C)C%CC{ Check one: DweWng is ttudti•femWy skate-family—y--21— odor Sort Date a( l � 1 o j_ Completion onto When will work be done. C AM_a 1 PM 5 (Specify tiara as alte) WeekendfdX(N Project Supervi orNdme�\`1�� -&�� Lkeoee N�Csp. Ddtd ( 0 Worker's Compensation Pocky Nwmbor W G WC%5m J- 0 -cm b Carrier t"' fte,C�CA.r^\���eJC'Y�C�1Vi�l` a`� Aso �n 0 ChscD> lw cue of emergeaey eoatact Y� �`�\ AC Qe\ Td tl (Centrattor's Rep rra ntative) The undersigned hereby sates, wader the pains and penalties of perjury, that belshe has read mod understood the ('omatoaweadb of Massachusetts Delmont Regulations, 454 CMR 22.08, and the Lead Falmaiag Prevtollas and Control Regulatiows.105 CMR 40.M, and that the information toptoined in this notification is awe and correct to jiso pest of bWher knowkdo and ballet Company Name tsk � `e,., E= Add Telephone Number. k— ,aLl FROM (FRO FEB 3 2006 16:24/ST. 16:22/No. 6820878844 P 1 Department of Public Hcaltb/ Department of Libor & Workforce Development NOMRCKfION OF DaLOI YG WORK / All sections of this form utast be completed in order to comply with the notification requirements of M.G.L. C, 1111197, 454 CMR 22.00 and 105 CMR 460.000, m mart recently amended Contractor pedbradrtProjecttikon & A. License ll l� Esp-Date Lead Paiat inspector (1(�\kLli atm Date of lnspeetlem '~ Lknm Nf 1�t3� Date Street Aild�reesr \s,1� %�Q p\`� ` Apt. Number City PrapereyOwaerTelephone Number M V"S @A Deleadieg Method: etlDry Scrap Heat Gas , Liquid Lata ulant Demolition Gusties p acetneot ave then If"ONe+ 9c1vated, pksse expldn_ Check one: DwellinS is multi-fWly %glarpniiy _ Other Start Date Maki_ Completion Due )10)bL When will work be done: AM „ PM (Specify times on site) Weekends! M Project SupsnisarNamt_ `�`` L` ``5 l��10. 5 Lieenw # DSQ3V7 Esp. Date worYer s Compensation Polley NwtberW ���D1 5 dokb b Carded' fto—CiC &Y1�[�t�X"Y�CI.�`'tRCt.1 In ease of emergency coatnct b RIA, Mrk���� Tel wt l( 1�1 � \ �.J `"AIC5 (Contractor's Repraeatative) The undersigned bereby data, under the pains and penalties of psrjary, that he/she has read and understood the Commonwealth of Masaebusega Dekediog Regulations, 454 CMR 23.00, sad the Lead Poisoning Preveades and Control Reaaladone,10.4 CMR 460.000, end that the information captained In this nolifiestion is true and correct tollsodest of bk&cr knorrkAp and belieL Company Nasse !"1\© \'( e- eve\ jc-oYN hej&\ -ay • tlephone Number FROM (FRO DEC 30 2005 16:23/ST-16:21/No-6820878751 P 1 Department of Public Health/ Department of Labor & Workforce Development ra 1� a A' NOTIFICATION OF DELEADING WORK ! All sections of this form mutt be completed 1n order to comply with \, !� the notification requirements of M.G.L. C. 1114197, ' 454 CMR 22.00 and 105 CMR 460.000, es most reeendy amended A. P •�oo � Contractor performing project p} QQQ&� �t;, License 0 sp. I ... Lead Pant Iwpedor (fin Onto of laspection a r LicenseiMy�; �Esp Date Street Address : 7� / �u (�\�1'Q _ �►pt. Number city 1L`QC" —ZIP, (Dkg1b Property Owea" Telephone Number o Defending Method:Wat/Dry 5eraplog Bent Cua Liquid Rucappulant Deme tion acemen t+erlag dps Li selected, please explain . _o\Q n i f `moi Check one: OweUbtg is toniti-iLmtly 3iawe4 mily—x— Outer Stan Date Completion bate When will work be done- AM PM `J (Specify dines on site) Weelmad "no Project Supervlaor Name_ O� S� r\ �t3 c a 1_lerme tt(1 �1� a Eap. Dat. �� O Worhar's Compensation Policy Number l 1 Y .1,9,2k ' 1 Cattle" _ � ��• La case of emergency contact Fd. 9CA— Tei. 0 l T1$ 1 (3 J43 Zk) LIC (Contractor's Representative) The undersigned hereby states, ander the pales and penaltln of perjury, that he/she has read mad understood the Commonwealth of Manaachasette Deleading Regulations, 454 CMR 27.000 mod the Lead Poisoning Prevention and Control Regulations,105 CMR 460.000, And that the Information contained In this notification Is Was and est to the best of b knowledge and belief. Date Signed 0-)."""�— %eb_ - &* Company Name 1121ii-k Qs n£. F, Ymi i y Telephone Number. -go -19-2 SC-*� a—)"Q