Attachment_5_IG_Pumphouses_Asbestos_and_LBP_Report_092816.pdf

Asbestos and Lead-Based

Paint Sampling Report

Grand Canyon Indian Gardens Campground

Pumphouses

National Park Service

Grand Canyon, Arizona

September 2016

Prepared for:

National Park Service

Grand Canyon, AZ

GRCA 182403

HDR

419 Canyon Ave, Suite 316

Fort Collins, CO HDR Project No. 10041212

This page intentionally left blank

Asbestos and Lead-based Paint Sampling Report

Grand Canyon Indian Gardens Campground Pumphouses

September 2016 | i

Contents

Acronyms and Abbreviations ................................................................................................. ii

1 Introduction

2 ACM Regulations and Sampling Survey Procedures

3 LBP Regulations and Sampling Survey Procedures

4 Sample Results

5 Conclusions

5.1 Asbestos

5.2 Lead-based Paint

Tables

Table 1. Asbestos Sampling Results

Table 2. LBP Sampling Results

Appendices

Attachment 1. Asbestos Inspector and Lead-Based Paint Inspector Certifications

Attachment 2. Sample Locations

Attachment 3. Representative Photos of Sampled Materials

Attachment 4. Laboratory Reports

Attachment 5. ADEQ Notification Forms and Inspection Checklist ii | September 2016

Acronyms and Abbreviations ACM asbestos-containing material

ADEQ Arizona Department of Environmental Quality

AHERA Asbestos Hazard Emergency Response Act

ASHARA Asbestos School Hazards Abatement Reauthorization Act

BRL below reporting limit

CFR Code of Federal Regulations

COC chain-of-custody

EPA Environmental Protection Agency

HDR HDR Environmental, Operations and Construction, Inc.

LBP lead-based paint mg/cm milligrams per centimeter squared

ND none detected

NESHAP National Emission Standards for Hazardous Air Pollutants

OSHA Occupational Safety and Health Administration

P.L. Public Law

PLM Polarized Light Microscopy

RACM Regulated Asbestos Containing Material

TR trace (<1%)

TSI thermal system insulation

% percent

September 2016 | 1

1 Introduction HDR Environmental, Operations and Construction, Inc. (HDR) has prepared the following Asbestos and Lead-Based Paint (LBP) Sampling Report for the North and South Pumphouses located at the

Indian Gardens Campground, Grand Canyon National Park. The asbestos and LBP surveys were performed in anticipation of pump station equipment updates in each pumphouse. The surveys were not full demolition surveys; only accessible areas were sampled. Mr. Todd Wickert, an Asbestos

Hazard Emergency Response Act (AHERA), State of Colorado Certified Asbestos Inspector; and

Environmental Protection Agency (EPA), State of Colorado Certified LBP Inspector, performed the surveys on August 24, 2016. Copies of certifications are included as Attachment 1. In addition, National Park Service personnel collected roofing material samples on September 1, 2016. The

Arizona Department of Environmental Quality (ADEQ) does not have separate state regulations and therefore, refers to the applicable federal regulations. ADEQ does however, maintain notification forms for asbestos-containing material (ACM) renovation and demolition activities.

The pumphouses are situated side by side north to south. The exterior walls are rock and concrete with some wood framing; however, the south exterior wall of the north pumphouse contains a cementitious stucco-like material. The interior floors are concrete and the north pumphouse includes a concrete trench in the floor. The majority of the walls and ceilings of both pumphouses are covered with fiberglass insulation. According to as-built construction drawings, dated 1985, the pumphouse walls also contain different variations of layers of rock, concrete, plaster, wood, vapor barrier, and various sealants. In addition, the north pumphouse walls were identified in the 1985 drawings to contain asbestos wallboard, and variations of layers of gypsum board and plywood.

The north pumphouse membrane roof system contains layers of white styrofoam-like material

(underlayment), brown fibrous material (¾” fiberboard), and grey/tan fibrous material (top layer/membrane). The south pumphouse membrane roof system contains black tar (underlayment over concrete), tan/brown fibrous material (1/2” fiberboard), and grey/tan fibrous material (top layer/membrane).

2 ACM Regulations and Sampling Survey

Procedures The inspector conducted an ACM inspection of the pumphouses pursuant to the procedures and protocols set forth in the National Emission Standards for Hazardous Air Pollutants (NESHAPs), as amended in 40 Code of Federal Regulations (CFR) Part 61 Subpart M; AHERA. Survey and sampling procedures were also performed in accordance with applicable sections of the following regulatory requirements:

Public Works Technical Bulletin 420-70-8, Chapter 8-3, “Bulk Sample Collection”;

Section I of the EPA “Model EPA Curriculum for Training Building Inspectors”;

Occupational Safety and Health Administration (OSHA) section 1910.1001 pursuant to the requirements of 763.86 of 40 CFR Part 763;

AHERA, P.L. 99-519; and

2 | September 2016

Asbestos School Hazards Abatement Reauthorization Act of 1992 (ASHARA, [P.L. 101-

637]).

The asbestos inspector conducted a thorough inspection of each pumphouse to identify all surfacing material, thermal system insulation (TSI), and miscellaneous materials that potentially contain asbestos. The asbestos survey included accessible exterior building surfaces, and all accessible interior areas. Areas of the buildings such as pipe chases and other areas behind walls, or not otherwise readily accessible, were not sampled. Roofing materials also were not sampled due to the possibility of causing leaks (National Park Service personnel sampled the roofs at a later date). The inspector identified “homogenous areas” and “functional spaces”. Homogenous areas refer to materials that are similar in color, composition, date of manufacture/application, texture, or other characteristics. Functional spaces are those areas of a building delineated by their use; such as offices, hallways, etc. Suspect ACM samples were then collected in a statistically random manner and included all homogenous areas. Since surfacing materials often have uneven mixtures, all surfacing materials were collected according to the “3, 5, 7 rule” whereas, a minimum of three samples were collected from each homogenous area. A minimum of one bulk sample was collected from each TSI or miscellaneous material homogenous area.

For each sample collected the following was noted: sample number, sample location, material description, and condition. Sampling was performed while wearing disposable gloves. Several hand tools were used to sample such as a hammer, screwdriver, chisel, knives, etc. All hand tools were decontaminated with disposable wet wipes after each sample was collected, and gloves were changed between each sample. All suspect materials were also assessed by touch to determine if they are friable materials. Friable is defined as being able to be crushed by hand pressure. Sample locations were marked on hand drawn sketches of each building. Immediately after collection, each sample was placed in an individual Ziploc bag and labeled with a unique sample identification code number and a description of each sample was noted. Standard chain-of-custody (COC) protocol was used to document and ensure a continuous record of sample possession from the time of sample collection until sample receipt by the laboratory.

The suspect ACM bulk samples were analyzed by Polarized Light Microscopy (PLM) using EPA method 600/M4-82-020 (December 1982) by Reservoirs Environmental, Inc. of Denver, Colorado.

The laboratory is currently accredited by the National Voluntary Laboratory Accreditation Program and is specifically accredited to perform asbestos analysis by PLM. When applicable, PLM sample results of trace (TR, less than 1%) were point counted to determine a more accurate result. ACM is defined as containing greater than 1 percent (%) asbestos as determined by PLM analysis.

3 LBP Regulations and Sampling Survey

Procedures The inspector visually assessed painted surfaces of each pumphouse and collected samples.

Survey and sampling procedures were performed in accordance with applicable sections of the following regulatory requirements:

40 CFR Part 745;

40 CFR Part 35;

September 2016 | 3

Lead-Based Paint Hazard Reduction Act of 1992 (Housing and Community Development

Act) (“Title X”, [Public Law {P.L.} 102-550]);

Toxic Substances Control Act (15 United States Code Chapter 53, Subchapter IV);

Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing, United

States Department of Housing and Urban Development, June 1995 (Chapter 7 Revision, 1997); and

EPA Guidance on Identification of Lead-Based Paint Hazards; Notice: 60 CFR 47247: 11

September 1995.

The LBP surveyor performed a visual assessment of the areas that may be disturbed by renovation activities to identify different colors of paint on different substrates. Only readily accessible areas were sampled. Samples were collected with knives or scrapers. Field decontamination procedures for non-disposable sampling equipment (e.g., knives, scrapers) consisted of wiping the equipment off twice using a clean wet disposable wipe between samples.

The samples were placed in individual Ziploc bags and labeled with a unique sample identification code number immediately upon collection and descriptions of the samples were noted. Standard

COC protocol was used to document and ensure a continuous record of sample possession from the time of sample collection until sample receipt by the laboratory.

The suspect LBP paint chip samples were analyzed by Atomic Absorption Spectroscopy/Atomic

Emission Spectroscopy – Inductively Coupled Plasma by EPA SW-846 Method 3050B by Reservoirs

Environmental, Inc. of Denver, Colorado. The laboratory is currently American Industrial Hygiene

Association accredited for metals analyses through the Environmental Lead Proficiency Analytical

Testing - Environmental Lead Laboratory Accreditation Program for environmental samples. LBP is defined in Title X of the 1992 Housing and Community Development Act as equal to, or greater than

1.0 milligram per centimeter squared (mg/cm ) or 0.5% by weight.

4 Sample Results Table 1 below depicts the suspect ACM materials that were sampled and sample results, and

Table 2 below depicts the suspect LBP that was sampled and sample results. See Attachment 2 for sample locations, Attachment 3 for Representative Photos of Sampled Materials, and Attachment

4 for Laboratory Reports.

Table 1. Asbestos Sampling Results

Sample # Location Material Condition Asbestos (%) and type

North Pumphouse

NPH-ACM-01 Interior south wall Suspect ACM wallboard – located behind fiberglass insulation good 12% Chrysotile

NPH-ACM-02 Interior north wall Wall and ceiling insulation (fiberglass) good ND

NPH-ACM-03 Interior north wall Suspect ACM wallboard good 15% Chrysotile

4 | September 2016

Sample # Location Material Condition Asbestos (%) and type

NPH-ACM-04

Pipe along interior east wall

Paper pipe wrap over fiberglass pipe insulation damaged ND

NPH-ACM-05 Exterior south wall Cementitious stucco-like material good ND

NPH-ACM-R Roof White styrofoam-like material, brown fibrous material, grey fibrous material good

White foam layer = ND Brown fibrous material =

ND

Grey fibrous material =

<0.25% Chrysotile

South Pumphouse

SPH-ACM-01 Interior west wall Texture on concrete walls damaged ND

SPH-ACM-02 Interior south wall Texture on concrete walls good ND

SPH-ACM-03 Interior north wall Texture on concrete walls damaged ND

SPH-ACM-04 Interior north wall Wall and ceiling insulation (fiberglass) good ND

SPH-ACM-R Roof Black tar, tan fibrous material, brown fibrous material good

Black micaceous tar = 8% Chrysotile

Black tar = TR Chrysotile Tan fibrous resinous material = TR Chrysotile

Brown fibrous material =

ND

ND = None Detected, TR = trace (<1%)

Table 2. LBP Sampling Results

Sample # Location Material Condition LBP (%)

North Pumphouse

NPH-LBP-01

Floor, northeast portion

Off-white paint on concrete good BRL

NPH-LBP-02 Pipe, northeast area Blue paint over multi-layers (grey, red) on majority of metal pipes good 3.0

NPH-LBP-03

Lower south wall, interior

Yellow paint on wood good BRL

NPH-LBP-04

Pipe by east wall, northeast area

Green paint over small section of metal pipe good 6.5

NPH-LBP-05 Doorway, west wall Yellow paint over red paint on metal door and frame

Minor peeling 1.2

NPH-LBP-06 Exterior south wall Beige paint over cementitious stucco-like material good BRL

South Pumphouse

SPH-LBP-01

North wall, northeast portion

Yellow paint on concrete good 0.030

SPH-LBP-02 Piping along north wall White paint on pipe Poor, peeling, flaking 0.0039

SPH-LBP-03

Piping in southeastern portion

Blue paint over multi-layers (grey, red) on majority of metal pipes good 0.0061

SPH-LBP-04 Floor, central area Off-white paint on concrete good 0.028

SPH-LBP-05 Doorway, west wall Yellow paint over red paint on metal door frame

Minor peeling BRL

BRL = below reporting limit

September 2016 | 5

5 Conclusions The following conclusions are based on the sampling results.

5.1 Asbestos

ACM is defined as containing greater than 1% asbestos as determined by PLM analysis. Asbestos was found in the North and South Pumphouses.

Definitions of Regulatory Asbestos Containing Material (RACM) and Friable are provided below in reference to the asbestos related conclusions.

RACM is defined as any material containing greater than 1% friable asbestos, or non-friable asbestos that may be made friable by mechanical removal methods.

Friable is defined as any material that contains asbestos and when dry can be crumbled, pulverized, or reduced to powder by hand pressure and that contains more than 1% asbestos by weight, area or volume. The term includes non-friable forms of asbestos after such previously non-friable material becomes damaged to the extent that when dry it can be crumbled, pulverized, or reduced to powder by hand pressure.

North Pumphouse

The wallboard of the North Pumphouse had sample results of 12% and 15% Chrysotile asbestos. Some of the wallboard is covered by fiberglass insulation, and some is not. All of this material should be considered as asbestos containing.

In addition, the grey fibrous material layer of the roof contains less than 0.25% Chrysotile asbestos.

Though this percentage of asbestos does not meet the definition of ACM, workers should be made aware of its presence.

South Pumphouse

The black micaceous layer of the roof of the South Pumphouse had a sample result of

8% Chrysotile. All of this material should be considered as asbestos containing.

In addition, the black tar and tan fibrous resinous material layers of the roof contain trace amounts of

Chrysotile asbestos (less than 1%). Though this percentage of asbestos does not meet the definition of ACM, workers should be made aware of its presence.

According to NESHAP:

If a threshold amount of asbestos will be disturbed during renovation or demolition activity, then the owner or operator must provide written notification to the local Pollution Control

Agency responsible for NESHAP enforcement 10 working days prior to the removal. The threshold asbestos amounts that trigger the reporting requirements are at least 260 linear feet of Regulated Asbestos Containing Material (RACM) on pipes, 160 square feet of RACM on other facility components, or at least 35 cubic feet of facility components (equivalent of a

55-gallon drum). In addition, notification must be given for all demolitions, regardless if the building contains asbestos or not.

6 | September 2016

Prior to demolition or renovation, RACM that are friable or may become friable during the demolition or renovation activities must be removed.

Certain procedures must be followed to control emissions of asbestos during renovation and demolition such as ensuring ACM remains adequately wetted to inhibit asbestos fiber release (refer to 40 CFR 61.145).

No RACM shall be stripped, removed, or otherwise handled or disturbed without at least one on-site representative trained as an asbestos competent person.

Asbestos-containing debris from renovations and demolitions must be treated as asbestos-containing waste. The debris must be adequately wetted, bagged, and properly labeled for disposal. The debris is then transported in covered vehicles and it must not emit visible emissions to the outside air. The waste must be deposited at an acceptable waste disposal site.

The wallboard material in the North Pumphouse in its intact state is non-friable; however, any drilling, sanding, cutting, etc. of the material may render it friable. The black micaceous layer of the

South Pumphouse roof is considered friable. In accordance with OSHA section 1910.1001, all workers shall use respiratory protection when disturbing the wallboard or the roofing material.

See Attachment 5 for ADEQ notification forms for ACM renovation and demolition activities, and inspection checklists.

5.2 Lead-based Paint

LBP is defined in Title X of the 1992 Housing and Community Development Act as equal to, or greater than 1.0mg/cm or 0.5% by weight.

North Pumphouse

The following areas and materials in the North Pumphouse contain LBP:

Blue paint over multi-layers (grey, red) on majority of metal pipes = 3.0%

Green paint over small section of metal pipe in the northeast area = 6.5%

Yellow paint over red paint on metal door and frame = 1.2%

During renovation or demolition activities of a building that contains LBP, abatement of the LBP may not always be necessary. If any LBP abatement or demolition activities are to take place, they must conform with OSHA Lead in Construction regulations found in 29 CFR Part 1926.62 which require the employer provide worker protection. In addition, the waste stream may need to be analyzed for hazardous characteristics (lead) by Toxicity Characteristic Leaching Procedure prior to disposal to determine if it is a hazardous waste.

South Pumphouse

The following areas and materials in the South Pumphouse contain levels of lead less then the definition of LBP of 0.5%:

Yellow paint on interior concrete wall = 0.030%

September 2016 | 7

White paint on piping along north wall = 0.0039%

Blue paint over multi-layers (grey, red) on majority of metal pipes = 0.0061%

Off-white paint on concrete floor = 0.028%

Therefore, the paint would not be considered LBP; however, workers disturbing these painted materials must comply with OSHA worker safety regulations, and building occupants must be protected if the painted materials are disturbed.

Note: HDR makes no warranty or guarantee to the 100% presence or absence of ACM or LBP on the surveyed structures. Some areas may have been inaccessible at the time of the survey. ACM and LBP may remain hidden or may not have been located or readily apparent at the time of inspection; and were thus not sampled by the inspector. ACM is present in literally hundreds of products; and amounts and specific locations of ACM and LBP may vary due to uneven mixing and application. Thus, it may not be possible to detect every single location of ACM and LBP within a surveyed area during the course of one survey.

8 | September 2016

Attachment 1

Asbestos Inspector and

Lead-Based Paint Inspector

Certifications

Attachment 2

Sample Locations

Attachment 3

Representative Photos of

Sample Materials

Asbestos and Lead-based Paint Sampling Report | Photo Log

Photographs 1 -11 are from the North Pumphouse designated as NPH-XXX-XX

Photo 1. NPH-ACM-01, suspect asbestos wallboard – located behind fiberglass insulation, interior south wall

Photo 2. NPH-ACM-02, wall and ceiling insulation (fiberglass), interior north wall

Photo 3. NPH-ACM-03, suspect asbestos wallboard, interior north wall

Photo 4. NPH-ACM-04, paper pipe wrap over fiberglass pipe insulation, pipe along interior east wall

Photo 5. NPH-ACM-05, cementitious stucco-like material, exterior south wall

Photo 6. NPH-LBP-01, off-white paint on concrete, floor, northeast portion

Photo 7. NPH-LBP-02, blue paint over multi-layers (grey, red) on majority of metal pipes, pipe, northeast area

Photo 8. NPH-LBP-03, yellow paint on wood, lower south wall, interior

Photo 9. NPH-LBP-04, green paint over small section of metal pipe, pipe by east wall, northeast area

Photo 10. NPH-LBP-05, yellow paint over red paint on metal door frame, doorway, west wall

Photo 11. NPH-LBP-06, beige paint over cementitious stucco-like material, exterior south wall

Photographs 12 -20 are from the South Pumphouse designated as SPH-XXX-XX

Photo 12. SPH-ACM-01, texture on concrete walls, interior west wall

Photo 13. SPH-ACM-02, texture on concrete walls, interior south wall

Photo 14. SPH-ACM-03, texture on concrete walls, interior north wall

Photo 15. SPH-ACM-04, wall and ceiling insulation (fiberglass), interior north wall

Photo 16. SPH-LBP-01, yellow paint on concrete, north wall, northeast portion

Photo 17. SPH-LBP-02, white paint on pipe, piping along north wall

Photo 18. SPH-LBP-03, blue paint over multi-layers (grey, red) on majority of metal pipes, piping in southeastern portion

Photo 19. SPH-LBP-04, off-white paint on concrete floor, central area

Photo 20. SPH-LBP-05, yellow paint over red paint on metal door frame, doorway, west wall

Photo 21. NPH-ACM-R, North Pumphouse roofing material

Photo 22. SPH-ACM-R, South Pumphouse roofing material

Attachment 4

Laboratory Reports

Reservoirs Environmental, Inc.

Reservoirs Environmental QA Manual

Effective January 1, 2015

T:\QAQC\Lab\Reservoirs Environmental QA Manual.doc

Subcontract Number: NA

Laboratory Report: RES 359362-1

Project # / P.O. # 10041212

Project Description: NPS Grand Canyon

RES 359362-1

Sincerely, September 6, 2016

Dear Customer, Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and

Environmental matrices by the National Voluntary Laboratory Accreditation Program (NVLAP), Lab Code 101896-0 for Transmission Electron Microscopy (TEM) and Polarized Light Microscopy (PLM) analysis and the American

Industrial Hygiene Association (AIHA), Lab ID 101533 - Accreditation Certificate #480 for Phase Contrast

Microscopy (PCM) analysis. This laboratory is currently proficient in both Proficiency Testing and PAT programs respectively.

Reservoirs Environmental, Inc. has analyzed the following samples for asbestos content as per your request. The analysis has been completed in general accordance with the appropriate methodology as stated in the attached analysis table. The results have been submitted to your office.

HDR (CO)

9781 S. Meridian Blvd. Suite 350-400

Englewood CO 80112 is the job number assigned to this study. This report is considered highly confidential and the sole property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with personnel other than those of the client. The results described in this report only apply to the samples analyzed.

This report must not be used to claim endorsement of products or analytical results by NVLAP or any agency of the

U.S. Government. This report shall not be reproduced except in full, without written approval from Reservoirs

Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you have any questions about this report, please feel free to call 303-964-1986.

Jeanne Spencer

President

P: 303-964-1986

F: 303-477-4275

5801 Logan Street, Suite 100 Denver, CO 80216

1-866-RESI-ENV

www.reilab.com

RES Job Number:

Client:

Client Project Number / P.O.:

Client Project Description:

Date Samples Received:

Turnaround:

Date Samples Analyzed:

RES 359362-1

HDR (CO)

10041212

NPS Grand Canyon

August 26, 2016

3-5 Day

September 06, 2016

TABLE: PLM BULK ANALYSIS, PERCENTAGE COMPOSITION BY VOLUME

Reservoirs Environmental, Inc.

Reservoirs Environmental QA Manual

Effective January 1, 2015

Q:\QAQC\LAB\Reservoirs Environmental QA Manual.doc

RESERVOIRS ENVIRONMENTAL INC.

NVLAP Lab Code 101896-0

Client

Sample

Number

Lab

ID Number

L A Y E R

Mineral

Method: EPA 600/R-93/116 - Short Report, Bulk

Physical Description

Sub Part

Visual

Estimate

ND=None Detected TR=Trace, <1% Visual Estimate Trem/Act=Tremolite/Actinolite

Non Asbestos Fibrous

Components

Non- Fibrous

Components

Asbestos Content

880NPH-ACM-01 EM 1697745 Gray fibrous cementitious materialA 100 12 Chrysotile

1090NPH-ACM-02 EM 1697746 Yellow fibrous materialA 100 ND

832NPH-ACM-03 EM 1697747 Gray fibrous cementitious material w/ tan paintA 100 15 Chrysotile

4060NPH-ACM-04 EM 1697748 White/silver wrapA 100 ND

1000SPH-ACM-01 EM 1697749 Black materialA 3 ND

1000Gray granular cementitious material w/ tan paintB 97 ND

1000SPH-ACM-02 EM 1697750 Black materialA TR ND

1000Gray granular cementitious material w/ tan paintB 100 ND

1000SPH-ACM-03 EM 1697751 White/gray granular cementitious material w/ tan paintA 100 ND

595SPH-ACM-04 EM 1697752 Yellow fibrous materialA 100 ND

1000NPH-ACM-05 EM 1697753 Tan granular cementitious material w/ tan paintA 100 ND

TEM Analysis recommended for organically bound material (i.e. floor tile) if PLM results are <1%.

Analyst / Data QAAnalystAnalystAnalystAnalyst

P: 303-964-1986

F: 303-477-4275

1-866-RESI-ENV

www.reilab.com

5801 Logan Street, Suite 100, Denver, CO 80216

Effective January 1, 2015

T:\QAQC\Lab\Reservoirs Environmental QA Manual.doc

Laboratory Code: RES

Subcontract Number: NA

Laboratory Report: RES 359363-1

Project # / PO #: 10041212

Project Description:

RES 359363-1

Sincerely, August 31, 2016

Dear Customer, Reservoirs has analyzed the following sample(s) using Atomic Absorption Spectroscopy (AAS) / Atomic Emission

Spectroscopy - Mass Spectrometry (ICP-MS) per your request. Reported sample results were not blank corrected. The analysis has been completed in general accordance with the appropriate methodology as stated in the analysis table.

Results have been sent to your office.

property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with personnel other than those authorized by the client. The results described in this report only apply to the samples analyzed. This report shall not be reproduced except in full, without written approval from Reservoirs Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you should have any questions about this report, please feel free to call me at 303-964-1986.

Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and

Environmental matrices by the American Industrial Hygiene Association, Lab ID 101533 - Accreditation Certificate #480.

The laboratory is currently proficient in both IHPAT & ELPAT programs respectively.

is the job number assigned to this study. This report is considered highly confidential and the sole

NPS Grand Canyon

Englewood CO 80112

9781 S. Meridian Blvd. Suite 350-400

HDR (CO)

Jeanne Spencer

President

P: 303-964-1986

F: 303-477-4275

5801 Logan Street, Suite 100 Denver, CO 80216

Effective January 1, 2015

T:\QAQC\Lab\Reservoirs Environmental QA Manual.doc

Client Project Number / P.O.:

Client Project Description:

Date Samples Received:

Analysis Type:

Turnaround:

Date Samples Analyzed:

Client Lab Reporting LEAD

ID Number ID Number Limit CONCENTRATION

NPH-LBP-01 EM 1697734 0.0039 BRL

NPH-LBP-02 EM 1697735 0.0027 3.0

NPH-LBP-03 EM 1697736 0.0041 BRL

NPH-LBP-04 EM 1697737 0.011 6.5

NPH-LBP-05 EM 1697738 0.010 1.2

NPH-LBP-06 EM 1697739 0.0061 BRL

SPH-LBP-01 EM 1697740 0.0044 0.030

SPH-LBP-02 EM 1697741 0.0033 0.0039

SPH-LBP-03 EM 1697742 0.0027 0.0061

SPH-LBP-04 EM 1697743 0.0030 0.028

SPH-LBP-05 EM 1697744 0.0057 BRL

Analyst / Data QA:________________________

3-5 Day

RESERVOIRS ENVIRONMENTAL, INC.

5801 Logan St., Suite 100

Denver CO 80216

TABLE ANALYSIS: LEAD IN PAINT

RES 359363-1

August 30, 2016

* Unless otherwise noted all quality control samples performed within specifications established by the laboratory.

HDR (CO)

10041212 NPS Grand Canyon August 26, 2016

USEPA SW846 3050B / AA (7420)

BRL = Below Reporting Limit

P: 303-964-1986

F: 303-477-4275

5801 Logan Street, Suite 100 Denver, CO 80216

Effective January 1, 2015

T:\QAQC\Lab\Reservoirs Environmental QA Manual.doc

Subcontract Number: NA

Laboratory Report: RES 360551-1

Project # / P.O. # 1Q041212

Project Description: NPS Gland Canyon

RES 360551-1

Sincerely, is the job number assigned to this study. This report is considered highly confidential and the sole property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with personnel other than those of the client. The results described in this report only apply to the samples analyzed.

This report must not be used to claim endorsement of products or analytical results by NVLAP or any agency of the

U.S. Government. This report shall not be reproduced except in full, without written approval from Reservoirs

Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you have any questions about this report, please feel free to call 303-964-1986.

Jeanne Spencer

President

September 20, 2016

Dear Customer, Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and

Environmental matrices by the National Voluntary Laboratory Accreditation Program (NVLAP), Lab Code 101896-0 for Transmission Electron Microscopy (TEM) and Polarized Light Microscopy (PLM) analysis and the American

Industrial Hygiene Association (AIHA), Lab ID 101533 - Accreditation Certificate #480 for Phase Contrast

Microscopy (PCM) analysis. This laboratory is currently proficient in both Proficiency Testing and PAT programs respectively.

Reservoirs Environmental, Inc. has analyzed the following samples for asbestos content as per your request. The analysis has been completed in general accordance with the appropriate methodology as stated in the attached analysis table. The results have been submitted to your office.

HDR (CO)

P: 303-964-1986

F: 303-477-4275

5801 Logan Street, Suite 100 Denver, CO 80216

Client Project Number / P.O.:

Client Project Description:

Date Samples Received:

Turnaround:

Date Samples Analyzed:

RES 360551-1

HDR (CO)

1Q041212

NPS Gland Canyon

September 12, 2016

3-5 Day

September 20, 2016

TABLE: PLM BULK ANALYSIS, PERCENTAGE COMPOSITION BY VOLUME

Reservoirs Environmental, Inc.

Reservoirs Environmental QA Manual

Effective January 1, 2015

Q:\QAQC\LAB\Reservoirs Environmental QA Manual.doc

RESERVOIRS ENVIRONMENTAL INC.

NVLAP Lab Code 101896-0

Client

Sample

Number

Lab

ID Number

L A Y E R

Mineral

Method: EPA 600/R-93/116 - Short Report, Bulk

Physical Description

Sub Part

Visual

Estimate

ND=None Detected TR=Trace, <1% Visual Estimate Trem/Act=Tremolite/Actinolite

Non Asbestos Fibrous

Components

Non- Fibrous

Components

Asbestos Content

1000NPH-ACM-R EM 1706554 White foamA 4 ND

3070Brown fibrous perlitic materialB 12 ND

8020Gray fibrous resinous materialC 84 TR Chrysotile

920SPH-ACM-R EM 1706555 Black micaceous tarA 3 8 Chrysotile

1000Black tarB 5 TR Chrysotile

8020Tan fibrous resinous materialC 35 TR Chrysotile

2080Brown fibrous materialD 57 ND

TEM Analysis recommended for organically bound material (i.e. floor tile) if PLM results are <1%.

Analyst / Data QAAnalystAnalystAnalystAnalyst

P: 303-964-1986

F: 303-477-4275

1-866-RESI-ENV

www.reilab.com

Effective January 1, 2015

T:\QAQC\Lab\Reservoirs Environmental QA Manual.doc

Subcontract Number: NA

Laboratory Report: RES 360551-2

Project # / P.O. # 1Q041212

Project Description: NPS Gland Canyon

RES 360551-2

Sincerely, is the job number assigned to this study. This report is considered highly confidential and the sole property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with personnel other than those of the client. The results described in this report only apply to the samples analyzed.

This report must not be used to claim endorsement of products or analytical results by NVLAP or any agency of the

U.S. Government. This report shall not be reproduced except in full, without written approval from Reservoirs

Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you have any questions about this report, please feel free to call 303-964-1986.

Jeanne Spencer

President

September 21, 2016

Dear Customer, Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and

Environmental matrices by the National Voluntary Laboratory Accreditation Program (NVLAP), Lab Code 101896-0 for Transmission Electron Microscopy (TEM) and Polarized Light Microscopy (PLM) analysis and the American

Industrial Hygiene Association (AIHA), Lab ID 101533 - Accreditation Certificate #480 for Phase Contrast

Microscopy (PCM) analysis. This laboratory is currently proficient in both Proficiency Testing and PAT programs respectively.

Reservoirs Environmental, Inc. has analyzed the following samples for asbestos content as per your request. The analysis has been completed in general accordance with the appropriate methodology as stated in the attached analysis table. The results have been submitted to your office.

HDR (CO)

P: 303-964-1986

F: 303-477-4275

5801 Logan Street, Suite 100 Denver, CO 80216

Client Project Number / P.O.:

Client Project Description:

Date Samples Received:

Turnaround:

Date Samples Analyzed:

RES 360551-2

HDR (CO)

1Q041212

NPS Gland Canyon

September 12, 2016

3-5 Day

September 21, 2016

TABLE: PLM BULK ANALYSIS, PERCENTAGE COMPOSITION BY VOLUME

Reservoirs Environmental, Inc.

Reservoirs Environmental QA Manual

Effective January 1, 2015

Q:\QAQC\LAB\Reservoirs Environmental QA Manual.doc

RESERVOIRS ENVIRONMENTAL INC.

NVLAP Lab Code 101896-0

Client

Sample

Number

Lab

ID Number

L A Y E R

Mineral

Method: EPA 600/R-93/116 - Point Count, Bulk

Physical Description

Sub Part

Visual

Estimate

ND=None Detected TR=Trace, <1% Visual Estimate Trem/Act=Tremolite/Actinolite

Non Asbestos Fibrous

Components

Non- Fibrous

Components

Asbestos Content

1000NPH-ACM-R EM 1706554 White foamA 4 ND

3070Brown fibrous perlitic materialB 12 ND

8020Gray fibrous resinous materialC 84 TR Chrysotile

<0.25 Point Count

920SPH-ACM-R EM 1706555 Black micaceous tarA 3 8 Chrysotile

1000Black tarB 5 TR Chrysotile

8020Tan fibrous resinous materialC 35 TR Chrysotile

2080Brown fibrous materialD 57 ND

TEM Analysis recommended for organically bound material (i.e. floor tile) if PLM results are <1%.

Analyst / Data QAAnalystAnalystAnalystAnalyst

P: 303-964-1986

F: 303-477-4275

1-866-RESI-ENV

www.reilab.com

Attachment 5

ADEQ Notification Forms and

Inspection Checklist

Asbestos NESHAP Program Waste Disposal Site Checklist 07/2013 Page 1 of 3

Asbestos NESHAP Checklist Waste Disposal Site Operations

Records Inspection Comments

Has the source report been filed with ADEQ or other government agency responsible for administering the asbestos NESHAP program?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.153(a)]

Choose an item.

ADEQ Air Quality Permit No.

Click here to enter text.

Are the waste shipment records maintained?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(1)]

Choose an item.

Click here to enter text.

Do the waste shipment records contain:

1) Waste generator’s information

Name

Address

Telephone number [A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(1)(i)]

Choose an item.

Click here to enter text.

Do the waste shipment records contain:

2) Transporter’s information

Name

Address

Telephone number

Signature [A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(1)(ii)]

Choose an item.

Click here to enter text.

Do the waste shipment records contain:

3) Quantity of Asbestos Containing Waste Materials (ACWM) in cubic yards or meters

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(1)(iii)]

Choose an item.

Click here to enter text.

Do the waste shipment records contain:

4) Presence of improperly enclosed or uncovered waste, or any ACWM not sealed in leak-tight containers.

Has the landfill operator reported to ADEQ, in writing, by the following day, the presence of a significant amount of improperly enclosed or uncovered waste?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(1)(iv)]

Choose an item.

Click here to enter text.

Do the waste shipment records contain:

5) The date of receipt

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(1)(v)]

Choose an item.

Click here to enter text.

Are copies of all required records and reports retained for 2 years?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(4)]

Choose an item.

Click here to enter text.

Have signed copies of the waste shipment records been sent to the generator as soon as possible, but no longer than 30 days after receipt of the waste?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(2)]

Choose an item.

Click here to enter text.

Has the landfill operator attempted to reconcile differences between the quantities of waste designated on the waste shipment record and the quantity actually received?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(3)]

Choose

Click here to enter text.

Asbestos NESHAP Program Waste Disposal Site Checklist 07/2013 Page 2 of 3

Records Inspection Comments

If a discrepancy is not resolved within 15 days after receiving the waste, has a report been filed immediately with the government agency responsible for administering the asbestos NESHAP program for the waste generator?

And If different, the government agency responsible for administering the asbestos NESHAP program for the disposal site.

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(e)(3)]

Click here to enter text.

Is a map or diagram of the disposal area being maintained?

Does the map or diagram contain the following ACWM information?

Location

Depth

Area

Quantity (cubic yards or meters) [A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(f)]

Choose an item.

Click here to enter text.

Attach a copy of map if available

Has ADEQ been notified in writing at least 45 days prior to excavating or otherwise disturbing any ACWM already deposited and covered?

Does the notice include:

Scheduled starting and completion dates?

Reason for disturbing the waste?

Emission control procedures?

Location of temporary/final disposal site Has the notice of a new start date been provided to ADEQ at least 10 working days before excavation begins?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(j) & §61.152(d)]

Site Operations Comments Is the disposal site operated in compliance with one of the following site requirements?

1) No visible emissions [61.154(a)] and warning signs and fencing, or natural barrier [61.154(b)]

2) 6-inch cover within 24 hours [61.154(c)(1)]

3) Dust suppressant within 24 hours [61.154(c)(2)] and warning signs and fencing, or natural barrier [61.154(b)]

4) Administrator approved alternative method [61.154(d)]

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154]

Choose an item.

Click here to enter text.

Is there any ACWM visible at the site?

Was it deposited within the past 24 hours?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154 (c)]

Choose an item.

Click here to enter text.

Is there any ACWM visible at the site?

Is it sealed in leak-tight containers or wrapping?

[61.145(c)(4)]

If no, is the ACWM exempt from packaging requirements for one of the following reasons?

1) Ordered demolition

2) Discovered after demolition began

3) Encased in concrete

4) Category I nonfriable (not in poor condition, not friable

5) Category II nonfriable which is not RACM

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154(a)and (c)] an item. Click here to enter text.

Asbestos NESHAP Program Waste Disposal Site Checklist 07/2013 Page 3 of 3

Site Operations Comments Are vehicles seen unloading ACWM?

If yes, are they marked with the following information?

Easy to read legend

20” x 14” upright format sign

Asbestos hazard warning [A.A.C. R18-2-1101(A)(8) / 40 CFR §61.149(d)(1)(i)(ii)(iii) & §61.150(c)]

Click here to enter text.

Does the transporter possess a properly completed waste manifest?

If not, determine as many of the following as possible:

Transporter company name

Address

Telephone No.

Generator’s Name

Address

Telephone No.

Location where ACWM is being collected [A.A.C. R18-2-1101(A)(8) / 40 CFR §61.150(b)(1)]

Choose

In-Active Waste Disposal Site Operations Comments Upon Closure, has the disposal site operator informed ADEQ as to the location and amount of waste?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154 (g)]

Choose an item.

Click here to enter text.

Upon Closure, has a notification concerning the presence of asbestos containing waste bee placed on the deed to the property?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154 (a)]

Choose an item.

Click here to enter text.

Are records available for inspection?

[A.A.C. R18-2-1101(A)(8) / 40 CFR §61.154 (i)]

Choose

Asbestos NESHAP Program Reno/Demo Checklist 07/2013 Page 1 of 2

Asbestos NESHAP Checklist Renovation/Demolition Operations

Applicability Comments

Does this source meet the definition of a facility and/or facility component and subject to the Asbestos NESHAP Standard.

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.140 & §61.141]

Choose an item.

Click here to enter text.

Was the affected asbestos NESHAP facility thoroughly inspected for the presence, amounts and categories of asbestos containing materials prior to demolition and threshold amounts of renovation activities?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(a)]

Choose

Notification Requirements Comments

Was an asbestos NESHAP notification submitted 10 working days prior to start of renovation activities involving threshold amounts of regulated asbestos containing materials?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.1459(b)(1)]

Choose an item.

Click here to enter text.

Was an asbestos NESHAP notification submitted 10 working days prior to start of demolition activities even when no asbestos is present?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(b)(1) / §61.145(b)(3)(i)]

Choose an item.

Click here to enter text.

Did operations start on date contained in the original asbestos NESHAP notification, and if not was a new start date provided by completing a revised notification?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(b)(3)(iv)]

Choose an item.

Click here to enter text.

If the activity is an emergency renovation was the asbestos NESHAP notification submitted no later than the following working day and meets the requirements of unexpected event, equipment damage, unsafe condition, unreasonable financial burden.

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(b)(1) §61.145(b)(4)(xv)]

Choose an item.

Click here to enter text.

If the activity is an ordered demolition was the asbestos NESHAP notification submitted no later than the following working day with letter of authority of order attached to notification?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(b)(4)(xiv)]

Choose

Work Practice Procedures - Emissions Controls Comments

Was all identified regulated asbestos containing materials (RACM) removed from the regulated facility prior to the start of the renovation and/or demolition activity?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(c)(1)]

Choose an item.

Click here to enter text.

Was at least one on-site trained representative maintained at all times during which regulated asbestos containing materials (RACM) is being stripped, removed or otherwise handled at the effected asbestos NESHAP facility.

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(c)(8)]

Choose an item.

Click here to enter text.

Was identified regulated asbestos containing materials (RACM) adequately wetted while being stripped from facility components which have been taken out as a unit or in sections from a facility?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(c)(4)(i) (c)(6)(1)]

Choose

Asbestos NESHAP Program Reno/Demo Checklist 07/2013 Page 2 of 2

Work Practice Procedures - Emissions Controls Comments

Are regulated asbestos containing materials (RACM), that included materials that have been removed or stripped adequately wetted and have remain wet until collected and contained or treated in preparation for disposal.

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(c)(6)(1)]

Choose an item.

Click here to enter text.

Were facility components that are covered with or coated with regulated asbestos containing materials (RACM) contained in a leak-tight wrapping after they have been taken out of an affected asbestos NESHAP facility.

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145(c)(4)]

Choose an item.

Click here to enter text.

Visible emissions were not observed being discharged to the outside air generated from regulated asbestos containing material (RACM) handling operations?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.145 (c) / 40 CFR §61.150(a)]

Choose

Waste Transportation and Disposal Comments Is the OSHA warning label(s) present on containers or wrapped asbestos containing waste materials?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.150(a)(1)(iv)]

Choose an item.

Click here to enter text.

Are labels present containing the name of waste generator and the location at which the waste was generated on asbestos containing waste materials that are going to be transported off facility site?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.150(a)(1)(v)]

Choose an item.

Click here to enter text.

Did the waste generator dispose of all asbestos containing waste materials as soon as practical at an approved disposal site?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.150(b)(1)]

Choose an item.

Click here to enter text.

Were vehicles marked that are used to transport asbestos containing waste materials during the loading and unloading of waste from asbestos NESHAP regulated facility, so that the signs are visible, and contain required markings.

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.149(d)(1)(i),(ii), and (iii) 40 CFR §61.150(c)]

Choose an item.

Click here to enter text.

Was waste shipment records maintained for all asbestos containing waste materials transported from an asbestos NESHAP facility site using a form that includes all required information?

[A.A.C. R18-2-1101(A)(8) 40 CFR §61.150(d)(1)]

Choose

ARIZONA DEPARTMENT OF ENVIRONMENTAL QUALITY

ASBESTOS NESHAP NOTIFICATION FOR RENOVATION AND DEMOLITION ACTIVITIES

National Emission Standards for Hazardous Air Pollutants (NESHAP)

1. TYPE OF NOTIFICATION: ☐Original ☐Revision 1 ☐Revision 2 ☐Revision 3 ☐Revision 4 ☐Revision 5 ☐Revision 6 Revision _______ ☐Cancel

2a. FACILITY OWNER INFORMATION

Name of Company or Individual:

Address:

City/Community: State: Zip:

Contact Person: Contact No.: Email:

2b. ASBESTOS REMOVAL CONTRACTOR/OPERATOR:

Address:

City: State: Zip:

Contact Person: Contact No.: Email:

2c. DEMOLITION CONTRACTOR/OPERATOR:

Address:

City: State: Zip:

Contact Person: Contact No.: Email:

3. TYPE OF OPERATION: ☐ Renovation ☐ Emergency Renovation ☐ Demolition ☐ Ordered Demolition ☐ Annual Non-scheduled Operations

4. PROVIDE DATE OF THOROUGH INSPECTION OF FACILITY, OR AFFECTED PART BY AN

AHERA (Asbestos Hazard Emergency Response Act) CERTIFIED BUILDING INSPECTOR DATE:

5. FACILITY DESCRIPTION (Attach site location map for multiple structures at one street address or installation)

Building Name:

Area/Location of Activities: (building # - floor # - units - equipment - identifying features)

Street Address:

City: Zip: County:

6. PROCEDURE, INCLUDING ANALYTICAL METHOD, EMPLOYED TO DETECT THE PRESENCE OF RACM AND CATEGORY I AND CATEGORY II

NONFRIABLE ACM. ☐ Polarized Light Microscopy-PLM ☐ Point Counting ☐ Assumed ☐ Other ___________________

NVLAP Laboratory Name______________________________________________ Number of Samples Date Analyzed _______________________________

7. APPROXIMATE AMOUNT OF ASBESTOS, INCLUDING:

*NOTE: Update notice as necessary including when the amount of asbestos affected changes by a least 20%

Amount of RACM to be Removed or Generated

Amount of Nonfriable ACM to be removed

Amount of Nonfriable ACM not to be removed during demo

CAT I CAT II CAT I CAT II

On Facility Components; Pipes (Linear Feet)

On Facility Components; Surface Area (Square Feet)

Off Facility Components; Volume (Cubic Feet)

8. DATES FOR ASBESTOS REMOVAL

Start Date: Completion Date:

Days of Operations: M T W TH F SA SU

Hours of Operations:

9. DATES FOR DEMOLITION

Start Date: Completion Date:

Days of Operations: M T W TH F SA SU

Hours of Operations:

MAIL / DELIVER TO:

ADEQ - Asbestos NESHAP Program

1110 West Washington Street Phoenix, Arizona 85007

(602) 771-2333 or (602) 771-4553

THIS AREA FOR NESHAP REGULATORY AGENCY USE ONLY

U.S. Postal Service Postmark Date: Commercial / Hand Delivery Date:

10. DESCRIPTION OF PLANNED DEMOLITION/RENOVATION WORK: (Check all that apply)

☐ Thermal System Insulation ☐ Ceiling Texture/Tiles ☐ Duct/Seam Tape ☐ Regulated Drywall System ☐ Asbestos-Containing Roof Removal

☐ Asbestos Cement Pipe ☐ Asbestos Cement Shingles ☐ VAT/Mastic ☐ Asbestos Cement Siding >5580 sq ft w/rotating blade cut

Other, please specify:______________________________________________________________________________________________________________

REMOVAL METHODS: ☐ Hand/Non-Mechanical Tools ☐ Mechanical/Power Tools ☐ Mastic Solvents

Other:___________________________________________________________________________________________________________________________

11. DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO PREVENT ASBESTOS EMISSIONS: (Check all that apply)

☐ Adequately Wet ☐ Full Containment ☐ Critical Barriers ☐ Negative Air Machines

☐ Glove-Bag ☐ Leak-Tight Wrap ☐ 6-mil Bags ☐ Mini-containment

☐ Decontamination Unit with Hot/Cold Water and Soap for OSHA Class I work Other:__________________________________________________

12a. ASBESTOS WASTE TRANSPORTER #1:

Company Name:

Address:

City: State: Zip:

Contact Person: Contact No.: Email:

12b. ASBESTOS WASTE TRANSPORTER #2:

Company Name:

Address:

City: State: Zip:

Contact Person: Contact No.: Email:

13. ASBESTOS WASTE DISPOSAL SITE:

Company Name:

Address:

City: State: Zip:

Contact Person: Contact No.: Email:

14. FOR ORDERED DEMOLITIONS (40 CFR 61, §61.145(A)(3), ATTACH A COPY OF THE AGENCY’S ORDERED DEMOLITION LETTER

Name: Title:

State or Local Government Agency: Authority:

Date of Order (MM/DD/YY): Date Demolition Ordered to Begin (MM/DD/YY):

15. FOR EMERGENCY RENOVATIONS (40 CFR 61, §61.145(a)(4)(iv))

Date and Hour of Emergency (MM/DD/YY - HH:MM):

Description of the Sudden, Unexpected Event:

Explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden:

16. In the event that unexpected RACM is found or discovered or CATEGORY I or CATEGORY II NONFRIABLE ACM becomes crumbled, pulverized, or reduced to powder the following procedures will be followed: Stop Work, Notify Owner, Revise Notification , Follow 40 CFR 61, §61.145(c) Procedures with an AHERA Certified Contractor/Supervisor on-site.

17. I CERTIFY THAT AT LEAST ONE AHERA CERTIFIED CONTRACTOR/SUPERVISOR WILL SUPERVISE THE STRIPPING AND REMOVAL OF RACM

DESCRIBED IN THIS NOTIFICATION AND THAT THE TRAINING CERTIFICATE WILL BE POSTED OR READILY AVAILABLE ON-SITE.

(Print Name: Owner/Operator) (Title)…