EWR Application

THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
DEPARTMENT OF LABOR STANDARDS

100 Cambridge Street, Suite 500
Boston, MA 02114
Phone: (617) 626-6030 Fax: (617) 626-6965
www.mass.gov/dols

Emergency Waiver Application

DEP Waiver Number:

Job Start Date: *

Job End Date: *

Contact Name:

Contact Phone:

Contact Email:

Name of Business Conducting Abatement:

No AC License?

Asbestos Contractor License Number:

Shift: * Day Evening Night

Reason For Waiver: *

Property Owner:

Property Address:

Specific Worksite (floor #, room #, building #, etc...): *

Abatement Type: *

FT2:

LN FT:

CU YDS:

City:

State:

Zip Code: