Asbestos - Lead-based Paint - Regulated Materials - 3-29-2019 report by Skelly and Loy - 92 pages.pdf

Office Locations: Harrisburg, PA Morgantown, WV State College, PA Hagerstown, MD Hunt Valley, MD

March 29, 2019

Mr. Shane Goodman A│E Works Ltd.

209 Sandusky Street Pittsburgh, Pennsylvania 15212

RE: Asbestos, Lead-based Paint, and Environmentally Regulated Materials Inspection Donald J. Mitchell VA Outpatient Clinic 125 Brookley Road Rome, New York

Mr. Goodman:

On February 11 through 15, 2019, Skelly and Loy, Inc. conducted an asbestos, lead based paint, and environmentally regulated materials inspection of the Donald J. Mitchell VA Outpatient Clinic located in Rome, New York. This inspection was completed in accordance with appropriate Federal and New York state regulations. The objective of this inspection was to document the presence and condition of asbestos-containing material (ACM), lead-based paint (LBP), and environmental regulated materials that will be encountered during renovation activities.

ASBESTOS INSPECTION

Appropriate safety and hygiene protocols were observed during all site activities. A visual inspection was conducted in all accessible areas within the renovation area. Due to the building being occupied during the inspection activities, destructive measures were not used to gain access to inaccessible areas and discreet sampling methods were used. Suspect asbestos building materials were classified into homogeneous areas (HAs), and bulk samples of each HA were collected based on the United States Environmental Protection Agency (US EPA) random sampling protocol.

Appropriate precautions were taken when sampling friable materials. The bulk sampling areas were first wetted with amended water and a small portion was then removed using a razor knife or other means. All bulk samples were sealed in plastic vials and logged with an appropriate chain of custody (COC).

Site asbestos inspection activities were conducted by Mr. Dominick Dercole (NY inspector license #16-02379) and assisted by Mr. Nathaniel Ruhl. Mr. Dercole is EPA trained and licensed in compliance with 12 NYCRR 56, Subpart 56-5. A copy of the inspector’s licenses is enclosed.

A visual inspection was conducted for all accessible areas within the renovation area, including above the drop ceiling tile, for suspect ACM. Suspect ACM typically includes, but is not limited

Mr. Shane Goodman to, resilient flooring, mastics, ceiling tile, wallboard, building insulation, plaster, thermal system insulation (TSI), roofing material, cementitious sheet boards and siding, and cement flue patching.

Upon identification of a suspect material, a bulk sampling scheme was developed which included the collection of the appropriate number of bulk samples per homogeneous material. A homogeneous material is defined as a material that is consistent in appearance, texture, and age of installation. All bulk samples of suspect ACM found in the renovation area were documented on COC forms with results being presented on the analytical reports.

During the inspection, the quantity and condition of suspect ACM were also assessed.

Each suspect material was assessed as either friable or non-friable. By definition, friable material can be crumbled, pulverized, or reduced to powder by hand pressure. In addition, if non-friable material is disturbed or damaged, the material has the potential to become friable. Homogeneous materials were also categorized by condition as being good, damaged, or significantly damaged.

Asbestos bulk samples were analyzed using Polarized Light Microscopy (PLM) per 40 CFR 763 and the Stratified Point-Counting Method approved by the New York State Department of Health. Per 12NYCRR56, Subparts 56-4 and 56-5, non-friable, organically bound (NOB) materials such as floor tile, cove base, mastics and adhesives were analyzed by Item 198.6 (PLM- NOB with disclaimers) and Item 198.4 (quantitative Transmission Electron Microscopy [TEM] with no disclaimers). The bulk samples were shipped to Batta Environmental Associates (BATTA), located in Newark, Delaware, for analysis using PLM with dispersion staining, as specified by the US EPA. Any sample determined to be less than 10 percent asbestos was subsequently re-analyzed using the EPA-Modified PC method. BATTA is accredited through the National Voluntary Laboratory Accreditation Program (NVLAP) and is an approved laboratory by the New York State Department of Health for analysis of asbestos in bulk samples through the Environmental Laboratory Approval Program (ELAP).

Table 1.1, Summary of Asbestos Analytical Results, lists and characterizes all samples collected and analyzed from the Donald J. Mitchell Outpatient Clinic. Bulk sample results are reported by percent and type of asbestos identified by laboratory analysis. Copies of the analytical reports and COC documentation are attached. Materials identified to contain greater than one percent asbestos are considered by definition to be ACM. Likewise, materials identified to contain asbestos equal to, or less than, one percent asbestos are considered by definition to be non- ACM. The location(s) of all ACM identified within the renovation area can be ascertained by cross-referencing the room numbers/descriptions listed in the “Location” column of the tables to the room number/descriptions designations on the enclosed figures. By law, the laboratory analyst is required to analyze all layers of a submitted sample if multiple layers exist, unless otherwise directed in the COC. Based on the information gathered, the following summary of asbestos and non-asbestos findings and conclusions is presented.

Table 1.1 Summary of Asbestos Analytical Results

Sampled Material Percent

Asbestos Quantity Location

HVAC Duct Insulation Stick Pin

Mastic

3.12% Chrysotile

500 SF

Above drop ceilings under HVAC duct insulation

12”x12” Cream Floor Tile

Previously Identified

14,000 SF

Basement Hall, Sub-Basement Stairs Rooms G100, G110, G113, G114, G117, G119 Stairs, G127, G128, G131, G136B, G139, G141, G145, 1005, 1006, 1007, 1008, 1009, 1018, 1033, 1051, 1068, 1069, 1069 Hall, 1070, 1074, 1076, 1081, 1110, 1113, 1157, 1165, 1166, 1193, 1195, 1196, 1198, 1200, 1202, 1203, 1204, 1205, 1206, 1207, 1209, 1210, 1213, 1214, 1222, 1224, 1225, 2016, 2017, 2029, 2031, 2032, 2034, 2046, 2047, 2049, 2062, 2064, 2065

12”x12” Cream Floor Tile Mastic

2.69% Chrysotile

14,000 SF

Basement Hall, Sub-Basement Stairs Rooms G100, G110, G113, G114, G117, G119 Stairs, G127, G128, G131, G136B, G139, G141, G145, 1005, 1006, 1007, 1008, 1009, 1018, 1033, 1051, 1068, 1069, 1069 Hall, 1070, 1074, 1076, 1081, 1110, 1113, 1157, 1165, 1166, 1193, 1195, 1196, 1198, 1200, 1202, 1203, 1204, 1205, 1206, 1207, 1209, 1210, 1213, 1214, 1222, 1224, 1225, 2016, 2017, 2029, 2031, 2032, 2034, 2046, 2047, 2049, 2062, 2064, 2065

Black Desktop 30.8%

Chrysotile 1 Unit Room 1014

12”x12” White and Black Floor Tile

3.26% Chrysotile

200 SF Room 1014

12”x12” White and Black Floor Tile

Mastic

Previously Identified

200 SF Room 1014

White Sink Undercoating

3.29% Chrysotile

16 Units Rooms 1022, 1077, 1078, 1085

Generator Exhaust Insulation

40% Chrysotile 300 SF Room G134

Roof Penetration Tar

6.23% Chrysotile

2 SF Corridor 2107

Fire Doors Assumed 75 Units Installed and Stockpiled Doors

• Of 83 suspect homogeneous materials encountered, 133 bulk samples were collected and submitted to the laboratory to be analyzed.

• Confirmatory samples were taken of previously analyzed materials to ensure that the material on-site was the same material previously sampled.

• Of these, HVAC Duct Insulation Stick Pin Mastic (HA 07), 12”x12” Cream Floor Tile Mastic (HA 09A), Black Desktop (HA 22), 12”x12” White and Black Floor Tile Mastic (HA 23A), White Sink Undercoating (HA 27), Generator Exhaust Insulation (HA 32), and Roof Penetration Tar (HA

42) were identified to contain asbestos at a concentration greater than one percent, making them ACM by definition.

• Previously identified materials; 12”x12” Cream Floor Tile (HA 09) and 12”x12” White and Black Floor Tile Mastic (HA 23A) remain on site.

• Due to limited accessibility for sampling, Fire Door Insulation (HA 37) was assumed to be an asbestos containing material.

• All ACM was observed to be in good condition.

LEAD-BASED PAINT INSPECTION

The lead-based paint (LBP) inspection was conducted concurrently with the asbestos inspection. The LBP inspection was completed in accordance with applicable Federal and New York state laws, rules, and regulations with the objective of documenting the presence of LBP that would likely be disturbed during renovation efforts.

The inspection included an assessment of accessible painted surfaces suspected of being LBP. Lead was commonly added to paint as a pigment, drying agent, and to add durability and corrosion resistance. Lead shielding was also identified during the course of the inspection.

All bulk paint samples were collected and sealed in plastic vials and logged with an appropriate COC. Paint samples were analyzed using Atomic Absorption Spectrophotometry (AAS) - EPA Method SW846-(3050B:7420M). The paint samples were shipped to Batta Environmental Associates located in Newark, Delaware, for analysis using AAS, as specified by the EPA with results being presented in the analytical report. The analytical report and corresponding COC documentation are enclosed.

Table 2.1, Summary of Lead Analytical Results, lists and characterizes all samples collected and analyzed from the structure. Sample results are reported in percent lead by weight identified via laboratory analysis. Samples identified to be greater than 0.5 percent lead by weight are considered to be LBP in accordance with EPA/HUD guidelines. Likewise, samples identified to be less than 0.5 percent lead by weight are not considered LBP.

Table 2.1 Summary of Lead Analytical Results

Sample Numbers Results

(% Lead by Weight)

Regulatory Limit (% Lead by

Weight) Location

L01 DD 021319 <0.0063 0.5% Room 1002

L02 DD 021319 0.090 0.5% Room 1127

L03 DD 021319 0.17 0.5% Mechanical Room

L04 DD 021319 0.17 0.5% Room 2028

L05 DD 021319 0.21 0.5% Room 2097

L06 DD 021319 8.1 0.5% Penthouse

L07 DD 021319 <0.0088 0.5% Penthouse

L08 DD 021319 2.0 0.5% Stairs near Penthouse

L09 DD 021319 0.026 0.5% Room 1082

L10 DD 021319 <0.0063 0.5% Corridor 1103

L11 DD 021319 <0.0063 0.5% Room 136B

L12 DD 021319 <0.0063 0.5% Corridor near Room 1082

• Of 12 suspect paints encountered, 12 paint samples were collected and submitted to the laboratory to be analyzed.

• Of these, the Red Structural Steel (HA 06) and Brown Handrail (HA 08) were identified to contain lead at concentrations greater than 0.5% by weight.

• In addition, lead shielding located in Rooms 1022, 1077, 1078, and 1085 was also identified during the inspection. Location and quantities of the lead shielding is located in Table 2.2.

Table 2.2 Summary of Lead Containing Materials

Identified Materials Quantity Location

Lead Shielding 1,700 SF 1022, 1077, 1078, 1085

HAZARDOUS MATERIALS SURVEY

The hazardous materials inventory was conducted concurrently with the asbestos inspection. The hazardous/environmentally regulated materials portion of this investigation involved the identification of any items, components, and containers potentially containing hazardous/environmentally regulated materials. These materials include, but are not limited to, polychlorinated biphenyls (PCBs), mercury thermostats and lighting, fluorescent lighting, PCB light ballasts, lead acid batteries, ozone-depleting components, refrigerants (CFCs), petroleum or hazardous materials drums, pesticides, chemicals, paints, etc. Additionally, electronic wastes, household chemicals, etc. were cataloged. Actual sampling of these items and/or contents of these items potentially containing hazardous/environmentally regulated materials did not occur and the assumption of the presence of hazardous/environmentally regulated materials is based on inspector experience and knowledge.

The survey of the Donald J. Mitchell Outpatient Clinic identified potentially hazardous/environmentally regulated materials as being present. These materials are listed in Table 3.1 and in the enclosed “Summary of Hazardous/Environmentally Regulated Materials”.

Table 3.1 Summary of Hazardous/Environmentally Regulated Materials

Material Estimated Quantities Location

Fluorescent bulbs 1,200 Units Throughout Building

Ballasts 1,200 Units Throughout Building

Fire Extinguishers 30 Units Throughout Building

Exit Signs 52 Units Throughout Building

Bed Lighting Units 43 Units 2nd Floor Storage (previously inpatient) Wing

Surgery Lighting Units 3 Units 2nd Floor Surgery Wing

Room Call Lights 40 Units 2nd Floor Storage (previously inpatient) Wing

Backup Lighting Lead Acid Battery

14 Units Throughout Building

This report is accurate to the best knowledge of the inspectors. It must be reiterated that the asbestos inspection was limited to visible and accessible portions of the Donald J. Mitchell Outpatient Clinic and that ACM not identified through this inspection may be present in inaccessible areas of the structure. Should suspect ACM beyond that identified through this inspection be encountered at any time in the future, Skelly and Loy recommends that it be treated as ACM until clarification by valid analytical methods is obtained. Skelly and Loy further recommends that all laws, regulations, and guidelines, governing waste disposal and the protection of human health and the environment be strictly adhered to when working with or near any confirmed or suspect ACM. The inspectors and Skelly and Loy assume no liability for financial or health consequences resulting from actions or lack of actions taken by clients as a result of this inspection.

If you have any questions or comments concerning the contents or interpretation of this letter report, please call Mr. Daniel Davis at (412) 828-1412.

Sincerely, SKELLY and LOY, Inc.

Nathaniel Ruhl Environmental Technician

NJR/rcm Enclosures cc:

File:

R19-0045.000 Rome VA ACM-Hazardous Materials Report

MASTER SUMMARY TABLE

Master Summary Table

Skelly and Loy

Donald J. Mitchell Outpatient Clinic

125 Brookley Road

Rome, New York

Structural Description Material Description/Location Quantity % Asbestos

125 Brookley Road

HVAC Duct Insulation Stick Pin Mastic 500 SF 3.12% Chrysotile

12”x12” Cream Floor Tile Mastic 14,000 SF 2.69% Chrysotile

Black Desktop 1 Unit 30.8% Chrysotile

12”x12” White and Black Floor Tile 200 SF 3.26% Chrysotile

White Sink Undercoating 16 Units 3.29% Chrysotile

Generator Exhaust Insulation 300 SF 40% Chrysotile

Roof Penetration Tar 2 SF 6.23% Chrysotile

Fire Doors 75 Units Assumed

Photographs

Skelly and Loy

Building Exterior

HVAC Duct Insulation Stick Pin Mastic

12”x12” Cream Floor Tile Mastic

Skelly and Loy

Black Desktop

12”x12” White and Black Floor Tile

Skelly and Loy

White Sink Undercoating

Generator Exhaust

Skelly and Loy

Roof Penetration Tar

Fire Doors (Stockpiled)

LIST OF ASBESTOS HOMOGENOUS AREAS

AND MAPS

Skelly and Loy, Inc. List of Homogeneous Areas

Skelly and Loy, Inc.

Project Name: Rome NY VA Project Number: R19-0045.000.01

Building Name: Donald J. Mitchell Outpatient Clinic Location: 125 Brookley Road

HA# Material Contain Asbestos?

Quantity Yes No Assumed

01 Plaster X

01A Skim Coat X

02 Black Sink Undercoating X

03 2’x4’ White Dot and Pit Ceiling Tile X

04 2’x4’ White Wormhole Ceiling Tile X

05 4” Black Cove Base X

05A 4” Black Cove Base Mastic X

06 4” Brown Cove Base X

06A 4” Brown Cove Base Mastic X

07 HVAC Duct Insulation Stick Pin Mastic X 500 SF

08 Vibration Dampener X

09 12”x12” Cream Floor Tile X 14,000 SF

09A 12”x12” Cream Floor Tile Mastic X 14,000 SF

10 Yellow Sheet Flooring X

11 12”x12” Tan Floor Tile X

11A 12”x12” Tan Floor Tile Mastic X

12 12”x12” Blue Floor Tile X

12A 12”x12” Blue Floor Tile Mastic X

13 12”x12” Purple Floor Tile X

13A 12”x12” Purple Floor Tile Mastic X

14 4” Tan Cove Base X

14A 4” Tan Cove Base Mastic X

15 Cementitious Wallboard X

16 Joint Compound X

17 12”x12” White Floor Tile X

17A 12”x12” White Floor Tile Mastic X

18 12”x12” Green Floor Tile X

Quantity Yes No Assumed

18A 12”x12” Green Floor Tile Mastic X

19 Black Epoxy Flooring X

20 Green Sheet Flooring X

21 12”x12” Purple Floor Tile X

21A 12”x12” Purple Floor Tile Mastic X

22 Black Desktop X 1 Unit

23 12”x12” White and Black Floor Tile X 200 SF

23A 12”x12” White and Black Floor Tile Mastic X 200 SF

24 4” Wall Tile Mastic X

25 4” Wall Tile Grout X

26 2’x4’ White Faux 2’x2’ Ceiling Tile X

27 White Sink Undercoating X 16 Units

28 2’x4’ White Smooth Ceiling Tile X

29 Tan and Purple Wallpaper X

30 Roof Drain Mudded Fitting over Fiberglass X

31 Tan Woven Wallpaper X

32 Generator Exhaust Insulation X 300 SF

33 Black Duct Caulk X

34 White Wrap on Fiberglass Breeching X

35 Plumber’s Paste X

36 Spray-on Fireproofing X

37 Fire Door Insulation X 75 Units

38 White Wrap on Pipe Insulation X

39 6” Black Cove Base X

39A 6” Black Cove Base Mastic X

40 1’x1’ White Wall Tile X

Quantity Yes No Assumed

41 1’x1’ White Wall Tile Mastic X

42 Roof Penetration Tar X 2 SF

43 4” Gray Cove Base X

44 Red Circle Stair Tread X

45 1” Ceramic Floor Tile Grout X

46 Beige Sheet Flooring (Under Red Circle Stair Tread) X

47 Black Underlayment (Under Red Circle Stair Tread) X

48 6” Brown Cove Base X

48A 6” Brown Cove Base Mastic X

49 Cream Sheet Flooring X

50 2nd Floor Renovation Area 12”x12” Tan Floor Tile X

50A 2nd Floor Renovation Area 12”x12” Tan Floor Tile

Mastic

X

51 2nd Floor Renovation Area 12”x12” Tan Floor Tile X

51A 2nd Floor Renovation Area 12”x12” Tan Floor Tile

52 2nd Floor Renovation Area 12”x12” Green Floor Tile X

52A 2nd Floor Renovation Area 12”x12” Green Floor Tile

53 1st Floor Corridor 12”x12” Light Tan Floor Tile X

53A 2nd Floor Renovation Area 12”x12” Green Floor Tile

54 1st Floor Corridor 12”x12” Dark Tan Floor Tile X

54A 1st Floor Corridor 12”x12” Dark Tan Floor Tile Mastic X

55 1st Floor Corridor 12”x12” Red Floor Tile X

55A 1st Floor Corridor 12”x12” Red Floor Tile Mastic X

56 Grey Speckled Sheet Flooring X

56A Grey Speckled Sheet Flooring Mastic X

57 12”x12” Pink Floor Tile X

Quantity Yes No Assumed

57A 12”x12” Pink Floor Tile Mastic X

58 4” Pink Cove Base X

58A 4” Pink Cove Base Mastic X

59 Carpet Mastic X

60 Stack Coating X

LEGEND

AE WORKS LTD.

ROME, NEW YORK 13441

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-1A

FIRST FLOOR

HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

HA-27 - WHITE SINK UNDERCOATING

HA-23 - 12"x12" WHITE AND BLACK FLOOR TILE

HA-22 - BLACK DESKTOP

HA-09A - 12"x12" CREAM FLOOR TILE MASTIC

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-1B

FIRST FLOOR

HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

LEGEND

HA-37 - FIRE DOORS

HA-07 - HVAC STICK PIN MASTIC

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-2A

SECOND FLOOR

HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

LEGEND

HA-42 - ROOF PENETRATION TAR

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-2B

SECOND FLOOR

HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

HA-32 - GENERATOR EXHAUST

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-3A

BASEMENT

HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-3B

BASEMENT

HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

LEGEND

SUSPECT ASBESTOS BULK SAMPLING

AND MAPS

Skelly and Loy, Inc. Suspect Asbestos Bulk Sampling Form

*If first or any sample in a supplied group is positive, then all are assumed positive ND – No Asbestos Detected

Building Name: Donald J. Mitchell Outpatient Clinic Address: 125 Brookley Road

Sampled By: DD Date: 02-15-19

Sample Number

Material HA # Location % Asbestos

01 DD

021319

Plaster – Base Coat 01 Room 2016 ND

02 DD

021319

Plaster – Base Coat 01 Room 2017 ND

03 DD

021319

Plaster – Base Coat 01 Basement Corridor ND

04 DD

021319

Plaster – Base Coat 01 Basement Corridor ND

05 DD

021319

Plaster – Base Coat 01 Basement Corridor ND

06 DD

021319

Plaster – Base Coat 01 1st Floor Corridor ND

07 DD

021319

Plaster – Base Coat 01 1st Floor Corridor ND

01A DD

021319

Plaster – Top Coat 01A Room 2016 ND

02A DD

021319

Plaster – Top Coat 01A Room 2017 ND

03A DD

021319

Plaster – Top Coat 01A Basement Corridor ND

04A DD

021319

Plaster – Top Coat 01A Basement Corridor ND

05A DD

021319

Plaster – Top Coat 01A Basement Corridor ND

06A DD

021319

Plaster – Top Coat 01A 1st Floor Corridor ND

07A DD

021319

Plaster – Top Coat 01A 1st Floor Corridor ND

08 DD

021319

Black Sink Undercoating 02 Room 2047 <0.05% Chrysotile

09 DD

021319

Black Sink Undercoating 02 Room 2070A <0.05% Chrysotile

10 DD

021319

2’x4’ White Dot and Pit Ceiling Tile 03 Room 2060 ND

11 DD

021319

2’x4’ White Wormhole Ceiling Tile 04 2nd Floor Reception Area 2012 ND

12 DD

021319

4” Black Cove Base 05 Room 2046 ND

Material HA # Location % Asbestos

12A DD

021319

4” Brown Cove Base Mastic 05A Room 2046 ND

13 DD

021319

4” Brown Cove Base 06 2nd Floor Reception Area 2012 ND

13A DD

021319

4” Brown Cove base Mastic 06A 2nd Floor Reception Area 2012 ND

14 DD

021319

HVAC Stick Pin Mastic 07 2nd Floor Corridor near Room

3.12% Chrysotile

15 DD

021319

HVAC Stick Pin Mastic 07 2nd Floor Corridor near Room

16 DD

021319

Vibration Dampener 08 G134 ND

17 DD

021319

Vibration Dampener 08 Penthouse ND

18 DD

021319

12”x12” Cream Floor Tile 09 Basement Corridor at G146 Previously Identified

18A DD

021319

12”x12” Cream Floor Tile Mastic 09A Basement Corridor at G146 2.69% Chrysotile

19 DD

021319

Yellow Sheet Flooring 10 Room 2040 ND

20 DD

021319

12”x12” Tan Floor Tile 11 Corridor 2107 ND

20A DD

021319

12”x12” Tan Floor Tile Mastic 11A Corridor 2107 Insufficient Material for Analysis

21 DD

021319

12”x12” Blue Floor Tile 12 Corridor 2107 ND

21A DD

021319

12”x12” Blue Floor Tile Mastic 12A Corridor 2107 0.09% Chrysotile

22 DD

021319

12”x12” Purple Floor Tile 13 Corridor 2107 ND

22A DD

021319

12”x12” Purple Floor Tile Mastic 13A Corridor 2107 0.08% Chrysotile

23 DD

021319

4” Tan Cove Base 14 Corridor 2107 ND

23A DD

021319

4” Tan Cove Base Mastic 14A Corridor 2107 ND

24 DD

Cementitious Wallboard 15 Room 2070A ND

Material HA # Location % Asbestos

25 DD

021319

Cementitious Wallboard 15 Room 1005 ND

26 DD

021319

Joint Compound 16 Room 2070A ND

27 DD

021319

Joint Compound 16 Room 1005 ND

28 DD

021319

12”x12” White Floor Tile 17 Corridor 2091 ND

28A DD

021319

12”x12” White Floor Tile Mastic 17A Corridor 2091 Insufficient Material for Analysis

29 DD

021319

12”x12” Green Floor Tile and Mastic 18 Corridor 2091 ND

29A DD

021319

12”x12” Green Floor Tile Mastic 18A Corridor 2091 Insufficient Material for Analysis

30 DD

021319

Black Epoxy Flooring 19 Corridor 2091 ND

31 DD

021319

Green Sheet Flooring 20 Corridor 2091 ND

32 DD

021319

12”x12” Purple Floor Tile 21 Corridor 2091 ND

32A DD

021319

12”x12” Purple Floor Tile Mastic 21A Corridor 2091 ND

33 DD

021319

Black Desktop 22 Room 1014 30.8% Chrysotile

34 DD

021319

Black Desktop 22 Room 1014 *

35 DD

021319

12”x12” White and Black Floor Tile 23 Room 1014 3.26% Chrysotile

35A DD

021319

12”x12” White and Black Floor Tile Mastic

23A Room 1014 Previously Identified

36 DD

021319

4” Wall Tile Mastic 24 Room 1014 ND

37 DD

021319

4” Wall Tile Grout 25 Room 1014 ND

38 DD

021319

2’x4’ White Faux 2’x2’ Ceiling Tile 26 1st Floor Corridor ND

39 DD

2’x4’ White Faux 2’x2’ Ceiling Tile 26 1st Floor Corridor ND

Material HA # Location % Asbestos

40 DD

021319

White Sink Undercoating 27 Room 1006 3.29% Chrysotile

41 DD

021319

White Sink Undercoating 27 Room 1009 *

42 DD

021319

2’x4’ White Smooth Ceiling Tile 28 Basement Corridor ND

43 DD

021319

2’x4’ White Smooth Ceiling Tile 28 Basement Corridor ND

44 DD

021319

Tan and Purple Wallpaper 29 Corridor 2107 ND

45 DD

021319

Tan and Purple Wallpaper 29 Corridor 2107 ND

46 DD

021319

Roof Drain Mudded Fitting over Fiberglass

30 Room 2027 ND

47 DD

021319

Tan Woven Wallpaper 31 Room 2034 ND

48 DD

021319

Tan Woven Wallpaper 31 Room 2029 ND

49 DD

021319

Generator Exhaust Insulation 32 Room G134 40% Chrysotile

50 DD

021319

Black Duct Caulk 33 Room G134 ND

51 DD

021319

Black Duct Caulk 33 Room G134 ND

52 DD

021319

White Wrap on Fiberglass Breeching 34 Room G134 ND

53 DD

021319

White Wrap on Fiberglass Breeching 34 Room G134 ND

54 DD

021319

White Wrap on Fiberglass Breeching 34 Room G134 ND

55 DD

021319

Plumber’s Paste 35 Room G134 ND

56 DD

021319

Plumber’s Paste 35 Room G134 ND

57 DD

021319

Spray-on Fireproofing 36 2nd Floor Corridor ND

58 DD

Fire Door Insulation 37 Room 2090 Assumed

Material HA # Location % Asbestos

59 DD

021319

Fire Door Insulation 37 Room 2033 – Stockpiled Doors Assumed

60 DD

021319

White Wrap on Pipe Insulation 38 Room G134 ND

61 DD

021319

White Wrap on Pipe Insulation 38 Room G134 ND

62 DD

021319

White Wrap on Pipe Insulation 38 Room G134 ND

63 DD

021319

6” Black Cove Base 39 Room GS2 ND

64 DD

021319

6” Black Cove Base 39 Room GS2

ND

63A DD

021319

6” Black Cove Base Mastic 39A Room GS2

ND

64A DD

021319

6” Black Cove Base Mastic 39A Room GS2

ND

65 DD

021319

1’x1’ White Wall Tile 40 Room 2022 ND

66 DD

021319

1’x1’ White Wall Tile 40 Room 2022 ND

67 DD

021319

1’x1’ White Wall Tile Mastic 41 Room 2022 ND

68 DD

021319

1’x1’ White Wall Tile Mastic 41 Room 2022 ND

69 DD

021319

Roof Penetration Tar 42 Corridor 2107 6.23% Chrysotile

70 DD

021319

Roof Penetration Tar 42 Corridor 2107 *

71 DD

021319

4” Gray Cove Base 43 Room 2011A ND

72 DD

021319

Red Circle Stair Tread 44 Stair S2 Landing ND

73 DD

021319

Red Circle Stair Tread 44 Stair S1 Landing ND

74 DD

021319

1” Ceramic Floor Tile Grout 45 Room 2020 ND

75 DD

1” Ceramic Floor Tile Grout 45 Room 1002 ND

Material HA # Location % Asbestos

76 DD

021319

Beige Sheet Flooring (Under Red Circle Stair Tread)

46 Stair S2 Landing ND

77 DD

021319

Beige Sheet Flooring (Under Red Circle Stair Tread)

46 Stair S2 Landing ND

78 DD

021319

Black Underlayment (Under Red Circle Stair Tread)

47 Stair S1 Landing ND

79 DD

021319

Black Underlayment (Under Red Circle Stair Tread)t

47 Stair S1 Landing ND

80 DD

021319

6” Brown Cove Base 48 Behavioral Health – Room 1211 ND

81 DD

021319

6” Brown Cove Base 48 Behavioral Health – Room 1201 ND

80A DD

021319

6” Brown Cove Base Mastic 48A Behavioral Health ND

81A DD

021319

6” Brown Cove Base Mastic 48A Behavioral Health ND

82 DD

021319

Cream Sheet Flooring 49 Room 1040 ND

83 DD

021319

Cream Sheet Flooring 49 Room 1040 ND

84 DD

021319

2nd Floor Renovation Area 12”x12” Dark Tan Floor Tile

50 Corridor 2114 ND

84A DD

021319

2nd Floor Renovation Area 12”x12” Dark Tan Floor Tile Mastic

50A Corridor 2114 Insufficient Material for Analysis

85 DD

021319

2nd Floor Renovation Area 12”x12” Tan Floor Tile

51 Corridor 2114 ND

85A DD

021319

2nd Floor Renovation Area 12”x12” Tan Floor Tile Mastic

51A Corridor 2114 ND

86 DD

021319

2nd Floor Renovation Area 12”x12” Green Floor Tile

52 Room 2127 ND

86A DD

021319

2nd Floor Renovation Area 12”x12” Green Floor Tile Mastic

52A Room 2127 Insufficient Material for Analysis

87 DD

021319

1st Floor Corridor 12”x12” Light Tan Floor Tile

53 1st Floor Corridor ND

87A DD

021319

2nd Floor Renovation Area 12”x12” Green Floor Tile Mastic

53A 1st Floor Corridor Insufficient Material for Analysis

88 DD

021319

1st Floor Corridor 12”x12” Dark Tan Floor Tile

54 1st Floor Corridor ND

Material HA # Location % Asbestos

88A DD

021319

1st Floor Corridor 12”x12” Dark Tan Floor Tile Mastic

54A 1st Floor Corridor Insufficient Material for Analysis

89 DD

021319

1st Floor Corridor 12”x12” Red Floor Tile

55 1st Floor Corridor ND

89A DD

021319

1st Floor Corridor 12”x12” Red Floor Tile Mastic

55A 1st Floor Corridor ND

90 DD

021319

Grey Speckled Sheet Flooring 56 Room 1102 ND

91 DD

021319

Grey Speck Sheet Flooring 56 Room 1102 ND

90A DD

021319

Grey Speckled Sheet Flooring Mastic 56A Room 1102 ND

91A DD

021319

Grey Speckled Sheet Flooring Mastic 56A Room 1102 ND

92 DD

021319

12”x12” Pink Floor Tile 57 Room 1038 ND

93 DD

021319

12”x12” Pink Floor Tile 57 Room 1100 ND

92A DD

021319

12”x12” Pink Floor Tile Mastic 57A Room 1093 Insufficient Material for Analysis

93A DD

021319

12”x12” Pink Floor Tile Mastic 57A Room 1100 Insufficient Material for Analysis

94 DD

021319

4” Pink Cove Base 58 Room 1093 ND

95 DD

021319

4” Pink Cove Base 58 Room 1100 ND

94A DD

021319

4” Pink Cove Base Mastic 58A Room 1093 ND

95A DD

021319

4” Pink Cove Base Mastic 58A Room 1100 ND

96 DD

021319

Carpet Mastic 59 Room 2084 ND

97 DD

021319

Carpet Mastic 59 Room 1038 0.33% Chrysotile

98 DD

021319

Stack Coating 60 G134 0.28% Chrysotile

99 DD

Stack Coating 60 G134 ND

POSITIVE SAMPLE

NEGATIVE SAMPLE

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - BS-1

FIRST FLOOR

BULK SAMPLE LOCATIONS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

25, 27

36, 37 97 82, 83

6, 6A, 39

87, 87A 7, 7A, 38 88, 88A

89, 89A

80, 80A

81, 81A

35A

BULK SAMPLE NUMBER FORMAT - ## DD 021319

92, 92A, 94, 94A

90, 90A, 91, 91A

93, 93A, 95, 95A

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - BS-2

SECOND FLOOR

BULK SAMPLE LOCATIONS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

LEGEND

POSITIVE SAMPLE

NEGATIVE SAMPLE

32, 32A

31 45 28, 28A

29, 29A, 30

24, 26, 09

11 59

13, 13A

02, 02A

72, 76, 77 65, 66, 67, 68

1001, 01A

0812, 12A

73, 78, 79

84, 84A, 85, 85A, 86, 86A

69, 70

BULK SAMPLE NUMBER FORMAT - ## DD 021319

20, 20A, 23, 23A

21, 21A, 22, 22A 47

NOTE: SAMPLE 17 DD 021319 LOCATED IN PENTHOUSE (NOT SHOWN)

BULK SAMPLE NUMBER FORMAT - ## DD 021319

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - BS-3

BASEMENT

BULK SAMPLE LOCATIONS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

5, 5A, 43 18

4, 4A, 42

54, 62

50, 51, 52, 55, 61

53, 56, 60

98, 99

03, 03A

18A

63, 63A, 64, 64A

ANALYTICAL RESULTS

AND CHAIN OF CUSTODY

ASBESTOS SITE PHOTOGRAPH

INFORMATION

Site Photograph Information

Project Name: Rome NY VA Project Number: R19-0045.000.01

Description: HVAC Duct Insulation Stick Pin Mastic Location:

Above Drop Ceilings Throughout Building

Photograph No: 01 Date: 2-12-19

Photographer: NJR

Description: 12”x12” Cream Floor Tile Mastic Location:

Basement Hall, Sub-Basement Stairs Rooms G100, G110, G113, G114, G117, G119 Stairs, G127, G128, G131, G136B, G139, G141, G145, 1005, 1006, 1007, 1008, 1009, 1018, 1033, 1051, 1068, 1069, 1069 Hall, 1070, 1074, 1076, 1081, 1110, 1113, 1157, 1165, 1166, 1193, 1195, 1196, 1198, 1200, 1202, 1203, 1204, 1205, 1206, 1207, 1209, 1210, 1213, 1214, 1222, 1224, 1225, 2016, 2017, 2029, 2031, 2032, 2034, 2046, 2047, 2049, 2062, 2064, 2065

Photograph No: 02 Date: 2-12-19

Project Name: Rome NY VA Project Number: R19-0045.000.01

Description: Black Desktop Location: Room 1014

Photograph No: 03 Date: 2-12-19

Description: 12”x12” White and Black Floor Tile Location: Room 1014

Photograph No: 04 Date: 2-12-19

Project Name: Rome NY VA Project Number: R19-0045.000.01

Description: White Sink Undercoating Location: Dental Suite

Photograph No: 05 Date: 2-12-19

Description: Generator Exhaust Location: Room G134

Photograph No: 06 Date: 2-12-19

Project Name: Rome NY VA Project Number: R19-0045.000.01

Description: Roof Penetration Tar Location: Room 2071

Photograph No: 07 Date: 2-12-19

Description: Fire Doors Location: Throughout Building

Photograph No: 08 Date: 2-12-19

LEAD BASED PAINT MASTER SUMMARY

Skelly and Loy

Donald J. Mitchell Outpatient Clinic

125 Brookley Road

Rome, New York

Structural Description Material Description/Location Quantity % Lead

125 Brookley Road

Red Structural Steel TBD 8.1

Brown Handrails 1,100 SF 2.0

Lead Wall Lining 1,700 SF Known Mateial

Photographs

Building Exterior

Red Structural Steel

Brown Handrail

Lead Wall Lining

LIST OF LEAD BASED PAINT

HOMOGENOUS AREAS AND MAPS

Contain Lead?

Quantity Yes No Assumed

01 Light Blue Doorframes X

02 Red Doorframes X

03 Tan Doorframes X

04 Mauve Doorframes X

05 Purple Doorframes X

06 Red Structural Steel X TBD

07 Red Pipes X

08 Brown Handrail X 1,100 SF

09 Off-white Walls X

10 Yellow Walls X

11 Blue Walls X

12 Green Walls X

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-L-01

FIRST FLOOR

LEAD HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

AND ABOVE CEILING THROUGHOUT BUILDING

NOTE: HA-06 - RED STRUCTURAL STEEL BEHIND WALLS

LEAD WALL LINING

HA-08 - BROWN HANDRAIL

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-L-2

SECOND FLOOR

LEAD HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

LEGEND

AND ABOVE CEILING THROUGHOUT BUILDING

NOTE: HA-06 - RED STRUCTURAL STEEL BEHIND WALLS

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - HA-L-3

BASEMENT

LEAD HOMOGENOUS AREAS

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

LEGEND

AND ABOVE CEILING THROUGHOUT BUILDING

NOTE: HA-06 - RED STRUCTURAL STEEL BEHIND WALLS

SUSPECT LEAD BASED PAINT BULK

SAMPLING AND MAPS

Skelly and Loy, Inc. Suspect Lead Based Paint Bulk Sampling Form

Sampled By: DD/NJR Date: 02-15-19

Material HA # Location % Lead by Weight

L01 DD

021319

Light Blue Doorframes 01 Room 1002 <0.0063

L02 DD

021319

Red Doorframes 02 Room 1127 0.090

L03 DD

021319

Tan Doorframes 03 Mechanical Room 0.17

L04 DD

021319

Mauve Doorframes 04 Room 2028 0.17

L05 DD

021319

Purple Doorframes 05 Room 2097 0.21

L06 DD

021319

Red Structural Steel 06 Penthouse 8.1

L07 DD

021319

Red Pipes 07 Penthouse <0.0088

L08 DD

021319

Brown Handrail 08 Stairs near Penthouse 2.0

L09 DD

021319

Off-white Walls 09 Room 1082 0.026

L10 DD

021319

Yellow Walls 10 Corridor 1103 <0.0063

L11 DD

021319

Blue Walls 11 Room 136B <0.0063

L12 DD

Green Walls 12 Corridor near Room 1082 <0.0063

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - BS-L-1

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

FIRST FLOOR

LEAD BULK SAMPLE LOCATIONS

L01

L02

L10

L09/L12

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

NOT TO SCALE

FIGURE - BS-L-2

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

SECOND FLOOR

LEAD BULK SAMPLE LOCATIONS

L05

L04

L08

L07

NOTE: L06 IN PENTHOUSE MECHANICAL ROOM (POSITIVE)

IN PENTHOUSE MECHANICAL ROOM (NEGATIVE)

BUILDING 510

125 BROOKLEY ROAD

ROME VA OUTPATIENT CLINIC

SKELLY LOY,

CONSULTANTS IN

ENVIRONMENT - ENERGY

ENGINEERING - PLANNING

and Inc.

BASEMENT

LEAD BULK SAMPLE LOCATIONS

NOT TO SCALE

FIGURE - BS-L-3

L03

L11

ANALYTICAL RESULTS

AND CHAIN OF CUSTODY

LEAD BASED PAINT SITE PHOTOGRAPH

INFORMATION

Project Name: Rome NY VA Project Number: R19-0045.000.01

Description: Red Structural Steel Location: Throughout Building

Photograph No: 01 Date: 2-12-19

Description: Brown Handrail Location: Stairwells

Photograph No: 02 Date: 2-12-19

Project Name: Rome NY VA Project Number: R19-0045-000-01

Description: Lead Wall Lining Location: Room 1022

Photograph No: 03 Date: 2-12-19

Project Name: Rome NY VA Project Number: R19-0045-000-01

Description: Lead Wall Lining Location: Room 1078, Room 1077

Photograph No: 04 Date: 2-12-19

Project Name: Rome NY VA Project Number: R19-0045-000-01

Description: Lead Wall Lining Location: Room 1022

Photograph No: 05 Date: 2-12-19

ENVIRONMENTALLY REGULATED

MATERIALS SUMMARY TABLE

PRE-RENOVATION ASBESTOS AND HAZARDOUS/

ENVIRONMENTALLY REGULATED MATERIALS INSPECTION

125 BROOKLEY ROAD

ROME, NEW YORK

SUMMARY OF HAZARDOUS/ENVIRONMENTALLY REGULATED MATERIALS

MATERIALS ESTIMATED QUANTITY LOCATION

Fluorescent bulbs 1,200 Units Throughout Building

Ballasts 1,200 Units Throughout Building

Fire Extinguishers 30 Units Throughout Building

Exit Signs 52 Units Throughout Building

Bed Lighting Units 43 Units 2nd Floor Storage (previously inpatient) Wing

Surgery Lighting Units 3 Units 2nd Floor Surgery Wing

Room Call Lights 40 Units 2nd Floor Storage (previously inpatient) Wing

Backup Lighting Lead Acid Battery

14 Units Throughout Building

Hazardous Materials Photographs

Fluorescent Light Bulbs and Ballasts

Fire Extinguishers

Exit Sign

Bed Lighting Units

Room Call Lights

Lead Acid Batteries in Backup Lights

INSPECTORS LICENSES