HomeMy WebLinkAbout1135 SULLIVAN AVE Electric # h It C/►4'� APPLICATION FOR BUILDING PERMIT
Plumbing# Date:
HVAC # 1135 Sullivan Avenue
Sprinkler#
FINAL R - 3 2 2 7 7 - Estimated Cost $ o7v
Peit Fee
Building) 3/ 5� COMPLETE RED BOXED AREAS Occupancy Fee $
Engineelin I
TYPE OR PRINT ONLY En Ins Fee $
Affidavit g' p'
I
Appr. for co. � ► SIGN ON REVERSE SIDE �
Total Fee $ 3 20'
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following: /7(
Applicant "FteaA- Cny,rnr%meiN�m\ Location of Work /i3s-- Lot No.
Applicant's Address ?S' D y r-k A,,o _ CZ��� ; m A t7 Q;t 6. Is, Tel.# 281- B 1.5-- i/oa
Town iZa n d o J_, /,-y A Zip o a 3(12&- Lic.# /6 3 9 -67' nor
Owner CA, Ad„k-V CnrA6 Architect —
Owner's Address 1, Architect's Address -
-!�u (lJ irdso r cT Zip — Zip-
.-Sq. Ft. New Area: 1st FI.�3- oon sF 2nd FI. 3rd FI. Total New Area
Purpose of this permit ��,m0�.�ov. o� �.s �s o��acco Ar`,n 1 A a his
/6ca-ppr��oy% -�10 Vet yno^�-_ r einayq ��t S�JaSck n�d L�-2tet`�s
No �4 NO':�Pr�"ef.
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. ✓ Area Basement Garage
Approved by Date%- dry C/�„ Use Grow Construction Type—�
Revised 6/02
I hereby agree a to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in wZchth* �buil�dKd its �isaed.
Signed
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment
-------------------------------------------------------------------------------
**-32277-B 26,000
B10 FINAL 03/31/08 JFF A STRUCTURE DEMOLISHED AND REMOVED FROM SITE
r
Electric# j I �� APPLICATION FOR BUILDING PERMIT
Plumbing#
3 � D
1135 Sullivan Avenue ate:
HVAC #
Sprinkler# 32671
------------ .i Estimated Cost $1
FINAL APPROVALS -_-_-_ -- - - ----------- ----
Building - %� COMPLETE RED BOXED AREAS Permit Fee $ '
I � Occupancy Fee $
Engineering TYPE OR PRINT ONLY Eng. Insp. Fee
Ar. $
Affidavit ► SIGN ON REVERSE SIDE
for CO. _- Total Fee $ /o
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost)
The undersigned hereby applies to do work according to the following:
Applicant � (, e.- Location of Work 1 ) 3 S,�( (�.i��, Lot No.
Applicant's ddress Is: M 11 ,_ Tel.# KZ o - -7 4 ?dam
Town Zip Lic.# I ?S-G
Owner Architect
Owner's Address I I 1�✓C Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st Fl. 2nd FI. 3rd A. Total New Area
Purpose of this permit o� - //3> u.r
_/dew
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. Area Basement Garage
Approved b Dat �- e Use Group------Construction Type-7, - —�
Revised W02
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in which this building and its use is allowed.
Signed
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment
-------------------------------------------------------------------------------
**-32671-B 13,600
B09 OTHER 06/21/06 CJD
B10 FINAL 03/31/08 JFF A PER CJD BARN DEMOLISHED
r
� y
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
6 Bldg.Permit#
A 44-2511 ext. 230ro38
Dat' e ' Buildi spector
Application must be printed or typed
FEE SCHEDULE Locatio Job:
F
$0-$1,000=$15.00 Street Lot No.Over$1,000=
$15.00 per$1,000
or any fraction thereof ation Apt.No.
APPLICANT V
APPLICANT DRESS CYC _
Pt-E Ilk 1v I le Lt 61066 '31-
APPLICANT PHONE# 1960 /4/- F d(o Fz
1%O W N S F-4 OWNER
OWNER ADDRESS
o OWNER PHONE
C = ESTIMATED COST$ d4,Oro
IS THIS A CONTRACT COST? t/Ires —No
FEE ENCLOSED$ 3Io ayn O
TYPE OF JOB: (f
SOR•CO -New Installation U
Alteration/Addition/Repair
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF S STEM: TYPE OF BUILDING:
ATING ❑RESIDENTIAL
MMERCIAL
VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC ❑ WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL^HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
❑91L--GPM OIL TANK LOCATION :❑ INSIDE❑ OUTSIDE CAPACITY
GAS-INPUT LPG TANK CAPACITY ELECTRIC-KW
AIR CONDITIONING
DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
CLZ a� �
TONNAGE COOLING CAPACITY(BTUH)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
-raj ALCLI V 412- . l4 liat'd
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
sr- 3 �(-s s 1 0�t
CONTRACTORS LICENSE NO TAPE STATE
SIGNATURE OF APPLICANT DATE /�'
r-�
$ m3c
000"
40,
,�
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La
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in
low—
(o z�0.2y Ac, Mtn f
115
Ail
JUN2.. 51996
South Windsor
BUILDING DEPARTMENT
CERTIFICATION OF ZONING COMPLIANCE
Proposed building(s), use(s) and/or structure(s)
as shown on this plan appears) to be in
•:onformance with current Sollth Wind:.,.-
::gulations. Variances and special exception
i-my apply.
Date 9L
Enfo ent Off;cerQ���
6e j a /�4-c -
TO TN'.
't•�s crrt:." I .'i]t tint plan and
,epics �f the proposed building or ell.r..!• t
rcc/It,d
together with amendments stated in apP1lc•lioa
,led with plan and I agree to comply with all zor••
..nlding and stele laws and such orders as sh-r.
,ssucd by the Building Department during pendr,
i this application and final issuance of a build",
permit.
Signed
this plan is approved subject to the condition that
orders and ordinances regulating building shall be
complied with.
Conditionally Approved These filed with
In I pert Clark
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CONNECTICUT Department of Public Safety,
Division of Fire & Building Safety
DEMOLITION CONTRACTORS CERTIFICATE
NO 1356 CLASS:B
DATE ISSUED 2006/01/01 EXPIRES:2006/12/31
Certification as a Demolition Contractor is hereby granted
to the person or firm named hereon
Name of Design e_d Technical Expert John Pizzimenti SIGNED '
(DTE) ,,,� ,-.A
it Class 8 Limited to Demolition
ISSUED TO: F & G Realty Recycling of Buiidmgs Not to Exceed 2•1/2
9 shorham Road Stories Nor AAoi�7fleitt135' In
Ea t dsor, T 6088_ H
AUTHORIZED B �C� SP-981-C
J
o�N Srq
'!'t SOR'C:V�.W
Comm erciaUlndustrial Site Compliance Checklist
Date Submitted: •/ 06
Applicant: Applicant Address:
Applicant Phone: to
Job Location: r ". . GIS PIN
Prior to the issuance of a building permit, the following_items shall be addressed:
APPROVED DENIED N/A
Planning and Zoning
complete set of final plans submitted, including
landscaping plan and architectural elevations
Mylars filed
P &Z bond
r IWA/CC bond
Deeds ands easements
Other
Pre-construction meeting held (date)
Architectural elevations submitted to Building Dept
are as approved by PZC
WPCA approval received (date)
WPCA fees received $
Fire Marshal
Construction drawings/specs submitted (date)
Site plan with location of hydrants and water mains
a Flow test completed
Plan review completed (date)
Response received from architect for Plan Review
Sign-offs: Date
IWA/CC
Comment:
Zoning 4 d
Comment: c r
D
Engineering
Comment:
WPCA
7
Comment: i1�,'I-fie,, 2 ,�..�.e _ 0% 4A,4_A�� h,_,,.P
Public Works
Comment:
Fire Marshal
Comment:
Building Permit # assigned
06 07: 52a josh 648-1531 p. 2
The Connecticut Water Company
North Road P.
P.O.Box 957
East Windsor,CT 06088-0857
O.Tzc ;860.6 "355
Fee$60.654.1903
C Wnwr Service;100.2863700
I
June 13,2006 I
Connecticut Development Group
1135 Sullivan Ave.
South Windsor, CT.06074
Attention: Josh
Re:Water Service Abandonment—1135 Sullivan Ave.(Balm),South Windsor,CT.
A Connecticut Water representative witnessed the temporary abandonment of the
water service at the above referenced. This was done per your request to allow for the
demolition of the misting structure.The service needs to be abandon at the water main at
a later date.
Please contact me if I can be of further assistance at 1-860-623-3355 ext.3309. ,
Sincerely,
Paul C.Lowry
Field Service Supervisor
i 'd SH 'ON 03 UiVA 101103NN00 AV61 It 900t 'El 11f
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Rpr 18 06 O9: 56a josh 648-1531 p. 1
1135 Sullivan Avenue
South Windsor,CT. 06074 CT DEVELOPMENT
860.W.2691 •
8W.648.2708 Fax
Fax
To: � � From: e-/015
Fam (�O -.��� 1 Pages:
Phone: Rate:
Re: cc:
❑Urgent 0 For Review 0 Please Comment ❑Please Reply ❑Please Recycle
• Comments: �j/�',
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Apr_ 18 _06_ 09: 57a josh 648-1531 p. 2
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ASBESTOS
COMPLIANCE REPORT
FOR
THE RED BARN
1135 SULLIVAN AVE.
SOUTH WIND SOR, CT
Apr 18 06 09: 57a josh 648-1531 p. 3
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ENVIRONMENTAL CONSULTING & CONTRACTING LLC
dw P.O. BOX 1337 NAUGATUCK, CT 06770
tow M (203) 754-5959
_,
Date: November 09,2005
Client: Connecticut Development Group
344 Washington Drive
Middlebary,CT 06762
Project: 1135 Sullivan Ave,Soutb W-indsor,CT
Subject.... Pre-Demolition Asbestos Investigation -Tbe.Sarn"
Report No: 110405-ASBINV
1.0 INTRODUCTION
On Friday,November 04,2005 ENCO conducted sore-deMo61iae asbestos investigation of the existing bam
located at 1135 Sullivan Ave,South Windsor,CT. The Asbestos Investigation was conducted in order to
satisfy the U.S_EPA National Emissions Standards for hazardous Air Pollutants Ad(NESHAP)as amended
November 20,1990. The U.S.EPA NESHAP requires that the ideatifucalion and removal of any regulated
Asbestos Containing BwUng Materials(ACM),which may be impacted during selective or complete
demolition of the building.
2-0 BUILD(NG DESCRIPTEON[EXISTING CONDITIONS
The building is a singie-story,one room wood 62=building built in the mid 1800's The roof is asphalt
shingle_ There are several windows in The s mcuM no any heart,no water. The building escompasses
app=dmate1y5,750 square feet
ASBESTOS CONTAINT4G MATERIALS
On November 04,2005,a State of Connecticut licensed asbestos iispector was dispatched to the site to perform
an asbestos investigation and identify and collect samples of suspect building materials for asbestos analysis.
Tag the sampling process,suspect ACM was separated into three U.S.EPA categories. These categories are:
Tberwal Systems Insulation,Surfacing ACM and Miscellaneous ACM. TSl includes all materials used to
prevent heal loss or gain or water condensation of mechanical systems. 'These include pipe covering,boiler
insulation,duct wrap and heating supply components. Surfacing ACM includes aD spray,troweled on or
otherwise applied surface materials that could contain asbestos. Tlie applications are most commonly used in
fireproofing,acoustic applications,and to a kmcr extern wan and ceiling plaster and sheetrocic compound.
Miscellaneous materials include ail ACM not included in a thermal or surfacing category listed above,and
inchule such material as linolcu rn,vinyl asbestos tiles,caging Wes and ductwork vibration dampers. (Note:
This category has recently been expanded to include wallboard.)
While performing the inspection,the inspect"identified all rooms and areas where representative samples of
suspect ACM can be identified and co6ed ed. The y tif areas idened correspond to any identification/room
numbers observed on site during our investigation. All ACM quantified in linear and square footage depending
upon the nature of the material. The quantities identified of ACM confirmed by bulk sample analysis are listed
Apr 18 06 09: 57a josh 648- 1531 p. 5
in the following sections of this report Destructive investigation techniques were utilized during the sampling
process. This included carttiIIg through various layers of wall material to inspect the inner structure,flooring
materials down to the wood deck,as well as cutting through all layers of roofing down to the wooden sub roof.
A minimum of three samples of each material were collected for analysis by Polarized Light Microscopy(PLIvI)
and a minimum of 5 samples of wallboardroint compound were collected to satisfy the sampling requirements
for this materiaL The U.S.EPA accepted method of analysis for identification of asbestos in bulk samples may
exist_ Each set of tree samples was systematically analysed until one sample was determined to contain
asbestos. Upon determination of the sample set,no subsequent samples in the set were analysed_ This method
is called a positive stop. If no asbestos was observed during analyses of the samples within the set,the suspect
material was determined to be negative for asbestos content The U.S.EPA recommends that three samples
form each homogeneous area be collected and analyzed prior to determining that material is negative for
asbestos content
3.0 DISCUSSION
Sample analyses molts are reported in percentages of asbestos and non-asbestos components. The U.S.EPA
defines any material that contains in excess of l%of asbestos utilizing PL A as being asbestos-containing.
Sample results indication no asbestos detected(NAAD)is specified as nowasbestos containing rmtaials. Any
materials that were found tocontain asbestos in percentages less than 1%were Sather analyzed by the point
cow3ting. This method is accepted as providing statistically reliable results when analyzing bulk samples with
very low asbestos concentrations. If these low asbestos concentrations are found to contain less than 1%by the
point counting methods,than these samples are also determined to be non-asbestos containing. Each suspect
bomogeneous samprrng material had 3,5,or 7 sampks collected of it,depending upon the nature and quantity
of each mattriat This is the currently accepted U.S.EPA and OSHA sampling requirement to determine
confirming asbestos concentration-
4-0 ASBESTOS CONTAINING MATERIAL INVENTORY
LOCATION MATERIAL TYPE SAMPLE# RESULTS UANTITY
THERE WAS NO ASBESTOS CONTAINING MATERIALS DISCOVERED_
(Quantities are estimates only and should be verified by the abaternent contractor)
Apr 18 06 09: 58a josh 648- 1531 p. 6
5.0 CONCLUSION
Samples of all suspect material were sent to an acarodited laboratory for analysis to detect any asbestos. These
samples were a representation of the bomogenons groups of suspect materials as defined by the U.S. E.P.A.and
the State of Connecticut Department of icalth Services;Asbestos Di vision_ It is suggested that a state of
Connecticut licensed abatement contractor be retained m monitor the demolition so that any suspect material
uncovered can be tested when found,and if positive,then the appropriate action can be taken.
THIS BUILDING IS SUITABLE FOR DEMOLITION.
SPECIAL NOTE-Although this investigations focus is only for asbestos containing building materials,it
should also be noted that there are regu6Yons regarding the proper disposal of other materials that may be
present such as storm chemcals and oils,lead based paint,mercray thermostats and fight bulbs,PCB
containing ballasts and b=sformers,fuel oil tanks,sod refrigerant eorrtaining compressor units(frrtzers,
refrigerators,and air cooditiouets)etc.
If any of these are present on site,they must be identified for proper classification and disposal of the
demolition debris as per federal,state,and local laws,regulations and codes prior bo any subsequent activity.
Respectfully ;tied,
Edmond L_Robichaud
State of Connecticut
Licensed Asbestos Irtspector
License#000024
C:1Docurnents and SettingsU,ouwy DotaanentAinspectionsAsbll 135 Sullivan Ave S Windsor bam DEV GRP
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Apr 18 06 09: 58a josh 648- lS31 p. 8
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E0VlR6NII!ElNTAL HAZE S.SERViC.ES -L:L.C.
904.-VS-AM FAX-04.05407
BUtAM9*5 0S SAW EAHM-Y816$ILlMe+MY
CLIgNTi ENCO Envi==OMW Coasnitiug&COnUlcting UATIE OF RECEIPT: 07 NOV 3W5
P.O.Bat 1337 DATE OF ANALYSIS: 07 NOV 2005
Naugatuck.CT 06770 DATE OF REPORT: 07 NOV 2005
CUENT NUMElat:- 7-1742 A
EKG PROJECT 9: 200641-0779
PROJECT: Barg L135 Sullivan Avw.;Bo.Rtindeor,CP
ENS CLEhiT SMVLE V. %A38ESTOa OTHER MATERIALS
9AMPLE A LA2,2IORY C3MU MCRIPTIDN
01 12S5-Il Trace.-cl% M%Fibrous Glass
Mack Brit Black F5b,;Orecal -a%Total Asbestas SOX Non-Fibrous
Off•V�hitsAggregata
02 118b?I NAD 20%Fibrous rlsas
Bladc�8uttle�Blw*-Mb� 8094 Non=l?5brous
Off-White Aegregabe
08 S 1135-8/ MAD 20*5 Collalose
Black-Brittle;Mack]nb.; 80%Non-Fibrous
Grern(Off-Whits Aggreeatr
04 1185=sJ NAD 85%colhtka's�. - 5596 Nou-Fibrous
05 1185 b! NAD- 65%Celhloaa
. 81ae]ca'Sb. = a6x Naa•Fibrws
06 1195-6( NAD 65%ccuuloie
BliclrFSb.. 35%Non-Fibrous
07 11g5 fi! MAD 1%Cenaloee Off-White Brittle 99%IZoa-�brovu
08 1185 g► NAD 100%Non Itibrc�ss
. Off-mite�ritlie
09 1185-9� _ HAD 1%Cellulose
Off whits Brittle- 9Bx Nan-F9brow
PAGE 01 of 02—
Apr 18 06 09: 58a josh 648- 1531 P. 9
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ENVIRO MTAL HAZARDS.SERVICES •L.CC.
74"MOTE PrOg VIA -
904.27&4M PAX-W4-2"-"V7
�i!lJf 70$SA8IPLE�N/1LY81S SIIILY_MY
CLIENT: ENCO M vitotw atal Consulting h Coates�nr DATE OF RECEIPT: 07 NOV 2005
P.O.Bow;887 DATE OF AMALY819c 07 NOV 2005
NaiiBat Wk.CT 00.770 DATE OF REPORT: 07 NOV 2D08
CLUM NUMB: 71T1Y A
am$PROJeCT F. pWrp,;11.07-M
PROJe=:- M&rW 1135 Sonoran Ave.;So.Wbulmv,CT
ENS CLIENT>1/4NPIERI. 'K AMEBWS- OTHER K'ATERJALIS .
BAMPLE� _- LABORATORY BROSS DEBC�ttPTION .
01 1195-11 Trw% q%Cbrym*de M)%Fibrous Glaw
Me*Brittle;Black 1%,:Umnf <1%Total Ambestw 80%Nea-mroas
O�WMte'A�regats -
02 NAD 20%Fibrous Gla"
' - •Blscic$r�t1e;�r.ica4b:; - 8M4 Non:Plbi+ons .
- Og W#sita Aegrep�ete - - -
-08 MAD' 20%Celluloaa
Black-Brltft Black R%.: 80%14004%iom
GYeen/Oif W}iits Agpecaft
04 1136i/ MAD 85%QsAvlo�et
-
05 HAD. 95%C M%iloee-
B7aekFib. 8ti%Nvn-PSbroai
06 L13b 6/ HAD 66%OrSiuloee
B]aelrl�5b.. 35%I�iea:lFYbr6us
07 11SS- / NAI! 1%Cellulose
Off-White$tittle 99%Non-Mbrous
MAD 100SG Noa-PS'broIIs
Off Vftkke$r3tde
09 11>IS-BI MAD 1%Cellulose
Om Vhkite Brfetle• 99%-Noa-Fibrous
—PAGE 01 of 02—
Apr 18 06 09: 58a josh 648-1531 p. 10
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Cuma MJMs6R. 177Z A
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PRWEGT: 'Birn;11W.SWEvanAve.;Bo.Windsor.CT
QC SAMPLf*- :- M1=199961
t2C BLANK: _ BIiM I988>�be;dads
REPORTING LIMIT: 1%Asbestos
METHOD: Polarized Idgta!AS-v—o".EPA Method GDO(R-M11s•
AIiALYBT: D+(ert Cans
Reviewed By AuthorbLad Wanatwr.
Nct cr r vim,Ga&W Afawnr�er
Irma POWMrK.QsRTAutuw.ce Cbords,.ator
Fag Jiar+p.W 2'ichnkaf Arsitur
The coeediion'of the saarpfes SmVned was acceptable upon face"pertabon"psoboal unless otherwbe noted an we report
Reserl[s Pbpraesnt the astitl3ala d asarosa abnttlod by 1!s denL �bcsto .dwabCwr,red,voYsne,No.,star pn wided by
ttea stint.Thin ro cit stud be used by Ow rient to cWm imd+d cndsrseueent by WVLAP a �
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sd WOW wpm shal not be MWOMAoOW in fug.w*=4 the wi ken eoasent of Em mnfmvtW Hoards SerWam. L.LC. Csetomis
CertlSos6on M19 MY EIAIFP 0177U; AN hfosaiaW oorAWr*V Sampkv toca data, rnd thm can to%und on CWn-0t-
Cudwy.fnvhorsnsrAai Hai**Senboes;L.I..C,doss rat PORN,u mmyes"Vie collection.
Envtaninenhd Hazards Seabee. L.L.C. moaarnenes n►snat m br/Dirt count (for mots scorats QwaSfieafmO or Trananeisslon
EJec bw NovocM(TEhr, for en wood deleda%-c*vsb9*m) for iaabMak regrrtato try the EPA NESHAP (Naftn* EA*S;on
Slmdwdi for Hawdevia Air Pokilords)and foesed&contain iesa thee ton pereoret(<to%) "hest" by pond pgnf mkmscopy
(PLM). Bath servkm we dmlia-Ole Ior an admimal lEe.
AN C*WofniamanW6w anakwed by Pdrtad L*M Namaw.EPA U*Vwd 80WM4-82w=.Oec.JWL
OEW HAD-no"DeaOos deieded
SCF�■ ' cw
plm7. ldpb
PAGE 02 of C2—END(W REPORT—
I
tHs 20111-114774. .741'
69 Whilepine Road Richmond,VUglnfa 23237 Phcphe(904)27t�478e Fox(804)275,4907
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Co+r►pany Name: ENCO Environmental Consulting &Contracting Datg:
Address: P.O. Box 1337 Contact Name:
City,S&N Zip: Naugatuck,CT 06770 SampferName: ,' Chrh�lC.r
EHsC.fenf Account It: 7-1171 A pr,oa
Rhona A:(203)757-5979 Fax fit:(203)757-5979 �I3�f u/�s1AJ A!,c
P.O.9. /'dSi fl S' e if*Jr W/w6solt, 6"17
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Asbestos Lead Other Metals Peripuiale: Tow Nulaance(NIOSH 0500)
m .. Spedfy mete)e twatow) Reephtle(NIOSH 0800) []
Sample � b � � °° � •
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Sample Number Date& p '>> a cn ,� ,c U- OR Comments
Time _o a . v . y I Wipe Aroa(R�)
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Dp wipe samples submitted meet ASTM E1792 requirements? Yes 0Li
"' Released by: 5 nature: QetelTirne: �s`
Received by. 5i�nabirv. „ Nfef ime' !/! ss/,p
Released by: Signature: Date/Tune:
Received b : Si nature: Date/Time: .-