36C25220B0007-007.pdf

Asbestos Chain of Custody EMSL Order NumbOit 043 use onot

614161. ANALYTICA11 INC.

6340 CASTLEPUICE PR. -

INDIANAPOLIS, IN 46250

PHONE: (80O 220-3675

FM: 317)803$047

suit. Anat.inem., mipirmeoluimeivosee

Camper* Namet Ceulee.Region Envlmnmenbtl,!LIA ': EML:Oiletemerlar .1/.141...bLLY 5 2----

8traet: 123: N. 4.th Street, Sulta2OL ,. L City:. La Cress, ,.State/P.rovfne.w. WI ZIp/Postal.Coder 64401 ..CountiVi•DSA - • Telephone/1r 6087928872 . .:,Fikth•

' Report To. (Rame : .Rick Stickler . Plisse Provldwitssulta:.. 0 Fax 1St Email •• , . .

Email Address:. re tiekleraotalitcrosacccm .. . • PUrchasiOrden 4'5 Licr57Z-4 ../' Project Naliti/Nurnhef: Vi4:7PIC.Tormi1l • . • ?:a• ;--‘ EilfISCProlect ID filleinit We On

.L1.3;.8tate tlairiPlaa.Takalll L.0 '15deZ • ./. •!OTtamples: a Commercial/Taxable, riRealtfential/Tat Ai •EMS1.418 . 4.: ulEame Cr Different- Wen to a Different note

• :71;Ii.c.IPec4'1111/etieq1atie written authorisation front lasing-tons ia.Commenbe third prirty ..

Chock . Turnaround_TVOSTATI.:01tIOns° -Please 0-. 3 Hour Itj 0, Voile. I 024 Hour • I' U -43 Hour • 71. F.teue " a #3Hout ELI: oak 1 0 2W,_ •

For TEM Alr a .r througne IK.pleapit oil sotto acte4i,neilhore le q pnentein . rinnileil tieurtralMWorifPA.

. authererelinitteintotthtteenike:: 'Aliel.Ola completed in. ecerveterta wilklEM.S9i7litmirerirt

LOW # 7 6it .VOU140 be.684$00.44lot en' Cendifiene leriatediritheAnaliiikettkift Gut*

. RCM Air 0 -.ChogIcif.: samples are ' TEM -Alt I 4-4.5hr TAT (AHERA eniy) ', TEM- Duet "01)10

IR

i.lp.

NY '

MOSH 7400

w/ OSHA 8hr. TWA

I

Micron° - ASTM D 5755 Wipe -ASTM 06480 Comet 8onkation.6413&6004431107)

AHERA 40 CFR; Part 763

NIOSH 7402

EPA Level II •

ISO 10312

41LIVI'''. Sulk', tri000100 (lmitl.

Poi a

, 0 •:0

0.PLM•

Point

PLM EPA 600/R-93/116 (<1%)

EPA NOR (4%)

ount 403 (40:25%), 0100(10.0.1%)

Count w/Gravimeldc 400 (<0.25%) 0 1000 (<0.1%) NYS 1981. (friable In NY) ' ., NYS 198;6 NOB (nen-friable-NY)

NYS198.8•80F4

.1410SH.9002.(,41*.

.,Solintooltatarrnidullte.

w

, 0 : s

KM EPA; 600/R 0011 13 with MOW: prep (41%)-pimiEPA.600/R,9311.16 With Oiling . prep (70.25%): • Tgliit.EPA800/R-03/110 w.fth milling prep (0,154);

Tam Oullitethre4Itt:FEtratlenrOp'.

TEM.ClualitailVivia Drop Mount Prep.

, TEM - Bulk • In w

... 0TEM

'TEM EPA NOB •

NYS NOB 1084 (non-friable-NY) ChatlieldiSOP

Mist. Aririlvei*,EPA 600 sem 2.5 : TEM-:. der EPA 100.2 ' • Cincinnati' Metlicit EPA.600/R-04/004- KNIITEM

Fibers >10pm

All Fiber Sizes

III

Waste •

Waste ••

Drinking

Drfnking

Ethet

12 Cheek For PaisithriStOP Clearly Identify Homogenous ilter Pore Size (Air•Sarttples): 0 0All. I : I PASiiiii .. • , Samplers Name: ..pu..k...snaeet.e.„ Samplers Slgnature: . .4 4•(-4.—v. .

. Sample # . . . Sampler Description i, Volume/Area* • ••

. HAft Mini DateiTIMe.

Sampled

WAZ.34.4511 - 1 .2. .R7

Oorzc ,11191/20,-.

<LAE' 5e1.4.1/3444t. ."

• - %0„,,64,r..,e--.-/Few .i.....5;,.....r 14,*

'V42,07.4.:t5;(q.!::-3.:

i'2.t1r.:Tc i5:14.Y.1 ,.4e6....yi, .*

."'EmiL , ..„.:, -1•?P'P.1'.!

..40-76tw•74.34. • 16M :117571a q-063611

-0(-----aRe- 4n47,....,, .* I ---.-7. --i'l^-5 4-- ...et-e- 4;4"

Client Simple S•fek • • *- .. . , . . .. i: :. • ff,,,Ms Total S ot OeMplear , .

. RelinquipherT(Olient): Dater - 2-01 "7 Time: 11/74.?

: Received (Lab) . . Date; • ... • 'Thnof.. 4' . .,. ..,t

' 900 111/POttOIPPeat lOtryFuonic cy.:444;e. .6 4( ,..R,_ cA042.4t--:01-: . 9.4.., 4

Page 1 of. pages

Oanofflailel Dawned .Asayelm0300 .A10. =WWII pages

ComnarThrNemel Coulee Region Environmental LLO, EMU. Ouelamer 10; 7/14 I 1> 410. 62.-4°-

Skeet:123g eitrIet ems 202 CIVit: La Omega: StatitilroVIncet' WI ZIP/Postal Code; 64881 j,CoUritrit OSA Term:hone #1:, 8887228871 . Pax • i,, • 4 + ! /mut Tectiganiek•RlitkEttakier... , _ • , , t

PiernetProVitietabital.* Asta..„.. Emaftp r4 &.i. : • . R.

t 7Eita iiiiiiiiiiiiii& ,A6tiiiie4i4.4. iiie:Gt6 -,--

: POrntis eOrdlit Zi Pro adieititlinhat 9.14i,troAriZIWTAIAM U.S. Stets EmpIu Taken: PV"& . , •t Mit Pro Oat ID keeint0 ift On. .

Cream est el Oommerelalnexe)je• RealOeng irrox Exempt

EWA!! to; some Wont • Mixt Pow , , , , /ea lab Diltemat notelialtucals In Cornmenle.

4 metherkette OW , t, ,,,,,, ' . .4 • , Tumaroun. Mt ii2f1 :0 Sans* -P a Hour • our I our L" 1 our •1 72 Our U 96 Our I Week U 2 aa

°N01OVitt3hrthiou a ilf plastron streriOre ssilscp/o Mkoa madam reresiourie 8uThalkallion tonri 01080.468 • 0 ,.1.! i , lot !,-2..1,12_40 u - i., . '8 i ma Of EPA LAW Alf Ya4101410081(edto int I 068011tIone • - , Lv la the 1481Fr(Ce

• Cite' If itainP 99 aro ' TEM-Air III 44.8hr TAT (agRA eels) YENI. bust from NY

: 0 NIOSH 7400

• sid OSHA ant 1WA . El AHERA 40 CFR; Part 783

0 NIOSH 7402

1 13 EPA Level II •

: 0 Mionvao eAsTm 0 6785 13 Wipe - ASTM 08480

, 0 Ca9et Sonkation (EPet 094043116n . Pi. ,'. l' freooilino.)1r41 ty.

, Point

El

Point 13400

.134P9110:25WCIM000:(4011112)•:-

- Ltd, Et3.4 800IR-83/118 (41%)

PLM EPA NOB (4115)

Count (40:26%) 0 1000 (<0.1%)

Count w/r3ravimetrlo

NYS 1981. (fdebta in NY) ' NYS 1986. NOS (nondrlable-NY) WS i1913.8 SOP-V

NCO 9002 4114

„II 13010312: 10111RtrekNerriircOiltet 1' ; TEM . auk. , • • : ra KM EPA 8001R-93/11.11 with milling prep (41%) a

,13 TrTEIS

TEM EPA NOB .

NYS NOB 198.4 (non-friable-NY) Chatfield SOP ;.

1104:XiiiiiiVtKiticTie-Eii

El a met

PLM EPA GOO/R-9M la with Wang prep (<0.260/4 TM EPA 600IR-93/118 with milling prep (40.1%).

rfialifiltidifOafillailialPtp .:1 •,,::...r.i..•

00600040116*700 Proli, TEM i- Witch EPA:100.2 ' :OkicittneltMetnect EPA 8.00/104f0C4-. PLM/TEM ogle).

. Fibers ,10pm • Waste • Drinking , NI Fiber Slag El Waste 0 Drinking

Elharl,,

11. Check For Positive Slop .6i Clearly identity Homogenous Group Mita pont it**AliStiti et 00.6 13 6.40m mpteortfotos: iild-Trife40 ,4 ea:

samon signatufge AO'. "0 0" SamPla • y .

Sample Description urnitiAre 7111 COMM 14AlkOloikr Sampled

VA2144311 '''`‘' Se-OL4174d-R4 ' C.,_ R -

,ro

VA1076 /3g mason. oil t _.- ... ,,,,,„ J ea - 80-• ..., Teta' , of am at: ArZe, Raltruplehett(Clian -4 "7.2)C me: Air 4.e.

' Recalved OA* .... M ...4rio.. 0 ‘- +ate t '') ' 0 44+1 II row. . ' . ammonia/Spa &itlitistrasttonat W .

GerdWelaiquinft.MbightleCIO.110041114121111

• 'Asbestos Chain.of Custody OWL Order Number ash uscOn44:

OrderID: 161911)59 fzi..7 2ttt i rtas....t ..

50;

CIMCL

•EMU AivurricAL, INC.

amp CACIUIPLACE

IN0IAN4P01491 1448250

Moe: (COO) 2204676

FAX (317)8034CW

!, f

OrderID: 161911759

Coulee Region Environmental LLC .t

, 183 North 0101 farce! -Suite 202 La CroSari Wisconsirl • Phone (608) 784.8688 to• • ,* ••••••• ft • • •• .1 I •••• " '-44- 1 4 ta,-

Facility 6): Project No: . • Analysis Requestedt, Collected By: Rick Stickier

Bulk Sam)* Log Form)

State Certirication. A11-00425 ,.Date. lee ' Date Stibridtted: ("-IfY"- v-fdif7 .6144

Main %emote A eta

Submitted To EMU, Analytical. nc:.

Submitted By: Rick Sticklei, Signature:.

Date Received: •Racelved Et

36tsidt— aogm

i. p.ftviiifitzu; .4 rottrA7L'ilifiVW11.?Moidiiiii1-1-1:21,0,156,smr.wo..,../viplikgAru_.--.15 trx-i rdar $0.2 ?,.7. 17-7.1 P"1-' Wffifin r."*MN -4-4 -441111,7 etriPtel iMc i'

"3 19. 1K77,Per

4.46*. - ••-..ei irtaPplarigt irOMMIt:11" 41. 111111 4 0701r .111Mjah bit i

4 - W'r' 44 4711r, .,./j)fir

Card ed Ex

Paw! 2 Of 3 rrustaittrAs Area

OrderiD.: 161911759 ,'44iik.iaki•P4.iery,:..

• v. i.

Coulee Region Environmental, UC .22.3North4th Street . Su1162020 La OVaWisaakald Phan Ma 'IPA461111

• Bulk Sample Log Form

Analysis Requested: PLM, EPA,600 toilette Zra Rick Stickler '

State Certcationt_A11.00.425 Date C cte 'late Submitted' 60--ev--49 ' Submitted To: Eiv!4LAttalytical. Jnc

Submitted Br Rick Sticklei Date Received:

Bulk Sample um bet

LocatiOn & Description or Bulk Sample

Q•11-'7.0

.64311-.-zidleOw''Sex 2,06156?-e241xa‘

1/41;6451,123A41

Vitt , Iri a 13(1-Z1 319-281.

ti .4. .

or

''illi:(0 /4/:°1

V i ' 41364 ‘ 41kVit ; '14:, : ,,`-,,, '. , .

0 ., ' ,.. , , J..*

.., It 'It' . I .

m -LialanizArmsqumatlempr, 4..", +a r,......... .. ell, ANIV.01 .....:.a .r.iniarAlirk". 01/11:...' .."'"'11111 ..L5 Ct.,'Cretai9191 PI', cataci

Titsraiuionfrirrol, I.

/1111..1.4

Page 3 Of

EMSL Analytical, inc.

0340 CesitePlace Dr. Indianapolis, IN 48280

Tel/Fax: (317) 803-2997 / (317)803-3047 hltplIwww.EMSLcom I Indlanapollslaggemslcom

None Detected

2% Chrysotile

None Detected

Test Report: Asbestos Analysis of Bulk Materials via EPA 6001R-93/116 Method using Polarized Light Microscopy

DescrIPOOtt Appearance, % Fibrous

12x12" vinyl floor tile White/Beige beige pattern/black Non-Fibrous mastiegyellow mastic Homogeneous

17.'0(12" vinyl floor tile Yellow beige pattern/black Non-Fibrous mastic/yellow mastic Homogoneoue

12"x12" vinyl floor tile beige pattern/black mastic/yellow mastic

12"x12" vinyl floor tile beige pattern/black mastic/yellow mastic

12502" vinyl floor tile beige pattern/black mastic/yellow mastic

12x12" vinyl floor tile beige pattern/black mastic/yellow mastic, 4" ceramic wall Ille/It gray grout/grey adhesive shower rm

Black Non-Fibrous Homogeneous

Pink/Beige Non-Fibrous Homogeneous

Yellow Non-Fibrous Homogeneous

Black Non-Fibrous Homogeneous

White Non-Fibrous Homogeneous

Gray Non-Fibrous Homogeneous

None Detected 4" ceramic wall tile/It gray grout/grey adhesive shower rm

VA2381319-10-Grout

181911769.00104

16% Quartz 85% Non-Ilbrous (Other)

Gray Non-Fibrous Homogeneous

None Detected 4" ceramic wall tile/it gray grout/grey adhesive shower rm

10% Quartz 90% Non-fibrous (Other)

VA2381319-10-Adheelv

101011789.0010B

None Detected VA2361319-11-Ceramio Tile

141011752.0011

100% Non-fibrous (Other) 4" ceramic well tile/ft White gray grout/grey Non-Fibrous adhesive shower rm Homogeneous

Gray Non-Fibrous Homogeneous

None Detected 4" ceramic wall tile/It gray grout/grey adhesive shower rm

VA2381319-11-Grout

16191f 76.0.0011A

15% Quartz 86% Non-fibrous (Other)

None Detected 10% Quartz 90% Non-fibrous (Other)

VA2361319-11-Adheelv

181011790-0011B

4" ceramic wall Set Gray gray grout/grey Non-Fibrous adhesive shower rm Homooeneaus

While Non-Fibrous Homogeneous

None Detected 4" ceramic wall tile/It gray grout/grey adhesive shower rm

VA2381319-12-Ceramic Tile

161911769.0012

100% Non-fibrous (Other)

Gray Non-Fibrous Homogeneous

None Detected 4" ceramic wall tile/it gray grout/grey adhesive shower rm

VA2361319-12-Grout

181911759.00124

100% Non-fibrous (Other)

IMINMemeammiumi111111111.1111101111r (initial report from: 06/19/2019 15:21:50

ASB_PLIN 000k.000r -1.78 Printed: 8/19/2019 3:21 PM

VA2361319-12-Adhestv 4" ceramic wall tile/it Gray grey grout/grey Non-Fibroue whet*, VA2381319-12-Grout

161911769-0012C

20% Quartz 80% Non-fibrous (Other)

100% Non-flbroue (Other)

None Detected

(1% Chrysolite 4" ceramic wall tile/it gray grout/grey 0011031Ve shower rm

White Non-Fibrous Homogeneous

Aeliestat

% Pe None Detected

None Detected

2% Chrysottle

None Detected

% Non-Fibrous

100% Non-fibrous (Other)

100% Non-fibrous (Oilier)

98% Non-fibrous (Other)

100% Non-flbrous (Other)

100% Non-fibrous (Other)

98% Non-flbrous (Other)

100% Non-fibrous (Other)

IWO*

VA2381319-8-Floor Tile

1819117504008

VA2361319-8-Mastio

L61911759.00084

VA2381319-8-Mastic 2

161911769.0008E1

VA2381319-9-Floor Tile

101911759.0009

VA2361319-9-MeStic

161911759.0009A

VA2381319-9-Mastic 2

161911759.0009B

VA2381319-10-Ceramic Tile laimmoato

EMSL Orden 161911759

Customer ID: MIDW52

Customer PO: A5195241

Project ID:

EMSL Analytical, Inc.

040 CastlePiece Dr. Indianapolis, IN 45250

Tel/Fax: (317) 803-2997 /(317) 803-3047 hltp://www,EM81..com I indlanapollslab©emsl.com

( Initial report from: 08/19/2019 16:21:50

.43B_PLA1 0008_0001 1.78 Printed: 6/19/2019 3:21 PM

181011759-M2A

VATM61319-33-Floortn

181911759.0032

Sample Description VATM81319-32-Masfic 125(12" stone pattern vinyl floor tile grey & white mastic

Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy limokima 'A Fibrous % Non-Fibrous

100% Non-fibrous (Other)

12N12" stone pattern vinyl floor tile grey & white mastic

Appearance While Non-Fibrous Homogeneous

Gray/Red Non-Fibrous Homogeneous

100% Non-fibrous (Other) None Detected

Asbestos % Type

None Detected

100% Non-fibrous (Other) <1% Chrysolite

Tile ceiling tile & brown Fibrous Fintrinnerromor

VA407131319-35-Mastic 12"x12" acoustical calling tile & brown unemamonA •eghimiVe

66% Mln. Wool

Joshua?, Mar (45) Paul RIhm (23)

Ftlohard HeftlIngi laitOretorylvtettager or Other Approved Signatory

VATM61319-33-Mastio

181011759.00334

VA40781319-34-Celling Tile

12x12" atone pattern vinyl floor tile gray & white mastic

12"x12" acoustical ceiling tile & brown

White/Slack Non-Fibrous Homogeneous

Tan Fibrous

60% Cellulose 20% Min. Wool

6% Penile 16% Non-fibrous (Other)

100% Non-fibrous (Other) None Detected

Nona Detected

12x12" acoustical Brown 100% Non-fibrous (Other) ceiling tile & brown Non-Fibrous mastic Hoomteheaus ceiling Me & brown Fibrous 20% Min. Wool 16% Nonlbrouspthef adhesive

VA40761319-34-Mastio

181011780.0034A

<1% Claysottle

None Detected

VA40781319-38-M esti 12x12" acoustical ceiling tile & brown

151011759.0030A adhesive

Brown 100% 'Non-fibrous (Other) <1% Chrysolite Non-Fibrous HemOgeneouti

41888illemeemmmomeeimossmsmoappor

Anelyet(s)

-,Ervist.motouriss tiehtlitylintitelleanst of mieiya. Tliàbiwe•sostyses•weis pertbmani in.*Ontiodnastenoo vrfirrApperatte Etc Subpart gof 40 OFR.(Previottely EPA 50.11/M442,020 Interim • Mollimi"); but euemontetwith••prookluree dulltoed. In the 1683',efineil vitAlan of themathod. This repent tsiato only to Iha amptae releined.aern)a, anti may not beteproil,itestkenspl.infelli Veleta W.,1080-aPP117yel by vat boorM no responsIbitylbr Simple coieuteonsoliviuss'or ansiVilosi met* listimilorte...1ntreoreteilexterid iterroflitit•Moulisem ihelesperelbilltyer lb. Olen!. Alt

.,14171444•tebolvert In etomptublosoortfilen unreel' ethenvise Wed. iniamparliblartnot be used Wilisi•coont In Osttn otareibtonnittimpori. ApPrOvat.or on4oreement by NW:AP, MST, &shy agency pt .the 0.00!ptiriernmot, ••ebiet. meMnemods tyaslmeldejedballOn.ler all non-IMMItzelpfaleallt bound Malailala prior to analysis, 'EsanistIOn'ortmoortsunyls sveteofe.an nuttiest.

Samples analyzed by EMSL Inc. Indianapolis, IN NVLAP Lab Coda 200100.0, A20939, 0A2676, COAL-I8132, TX 300202, LA 04136

EMSL Order; 161911759 Customer ID; MIDW52

Customer PO: AS195241

EMSL Order: 161911759

Customer ID: MIDW52 Customer PO: AS195241

Phone: (608) 784-5688

Fax: (608) 784-7350 Received: 06/17/2019 9:40 AM

Analysis Date: 06/25/2019 Collected: 06/13/2019

EMSL Analytical, Inc.

6340 CastlePlace Dr. Indianapolis, IN 46250

Phone/Fax: (317) 803-2997 /(317) 803-3047 http://www.EMSL.com / indlanapolislab@emsl.com

Attention: Rick Stickler Coulee Region Environmental, LLC 123 North 4th Street La Crosse, WI 54601

Project: VAMC TOMAH BLDG #23

Disclaimer:Some samples may contain asbestos fibers present in dimensions below PLM resolution limits, The limit of detection as stated In the method is 0.26%. EMSL Analytical Inc suggests that samples reported as 00,25% or none detected undergo additional analysis via TEM. The above test report relates only to the items tested, This report may not be reproduced, except in full, without written approval of EMSL Analytical Inc. This test report must not be used by the client to claim product endorsement by NVLAP or any agency of the United States Government EMSL

Analytical Inc., bears no responsibility for sample collection activities, analytical method limitations, or the accuracy of results when requested to separate layered samples, 5MSL Analytical

Inc., liability is limited to the cost of sample enelysis.The test results contained within this report meet the requirements of NELAC unless otheiwise noted. Samples received in good condition unless otherwise noted, Unless requested by the client, building materials manufactured with multiple layers (Le, linoleum, wallboard, etc.) are reported as a single sample.

Samples analyzed by EMSL Analytical, Inc. Indianapolis, IN

Initial report front: 06/25/2019 14:55:31

Test Report: Asbestos Analysis of Bulk Materials via EPA 6001R-93/116 Method using Polarized Light Microscopy. Quantitation using 400 Point Count Procedure

Non-Asbestol Aakiatis

Sample Description Appearance °A Fibrous % Non-Fibrous °A, Type

VA2361319-12-Gro 4" ceramic wall tile/It White 100,0% Non-fibrous (Other) 40.25%Chrysotile ut gray grout/grey Non-Fibrous

161911759-0012C adhesive shower rm Homogeneous

Analyst(s)

Trevor Maggert (1) Richard Harding, Laboratory Manager or other approved signatory

' Printed 6/25/2019 2:55:35PM Page 1 of 1

Attn: Rick Stickler Coulee Region Environmental, LLC 123 North 4th Street Suite 202 La Crosse, WI 54601

Project: VAMC TOMAH BLDG #23

Phone:

Fax:

Received:

Analysis Date:

Collected:

(608) 784-5688

(608) 784-7350

06/17/19 9:40 AM

6/25/2019

6/13/2019

VA40761319-

35-Mastic 161911759-0036A

12x12" Brown acoustical Non-Fibrous ceiling tile & brown adhesive Homogeneous

56.0 Non-fibrous (other) 0.3 Chrysotile 43.7 0.0

EMSL Order: 161911759

Customerl 0: MIDW52

CustomerPO: AS195241

ProjectID:

EMSL Analytical, Inc.

6340 CastlePlaca Dr., Indianapolis, IN 46250

Phone/Fax: (317)803-2997 /(317) 803-3047 Itth liwww.EIALcont indlanapotheahtematem

Test Report: Polarized Light Microscopy (PLM) - Point Count Performed by EPA 600/R-

93/116 Method with Gravinnetric Reduction and 400 Point Count

(%) Matrix NON- ASBESTOS SAMPLE ID DESCRIPTION APPEARANCE Organic Acid % Fibrous

VA40761319- 12x12" 34-Mastic acoustical 161911759-0034A ceiling tile & brown mastic Insufficient Material

NON- ASBESTOS

% NON-FIBROUS

ASBESTOS

% TYPES

Insufficient Material

Brown 47.2 0.0 52.8 Non-fibrous (other) <0.25 ChrysatIle Non-Fibrous

VA40761319-

36-Mastic 181911759-003M

12x12" acoustical ceiling tile & brown adhesive Homogeneous

Analyst(s)

Richard Harding, Laboratory Manager or other approved signatory

• Disclaimers: Some samples may contain asbestos fibers present In dimensions below PLM resolution IMO& The limit Oldeteeiton as stated in the method is 0.25%: EMSL Analytical Inc. suggests that samples reported as 00.25% or none detected undergo additional analysis via TEM. The above test report relates only to the Hams tested.,.. This report may not be reproduced, except In MI, without written approval by EMSL Analytical inc,. This report must not be used to claim product endorsement by NVLAP or any agency of the United States Government. EMSL Analytical Inc. bears no rim4chelbility for sampleccileMlarrsullvllles analytical method limite0ons, or theetotutcyet reetilewhan'reqUested:00Wate layer samples. EMSLAnMytICal Inc.ttebility Is lima/lit to the cost of sample

..,ittely0W:The test resulte.gokielhei**thinitilszeptOit meet the requirements of NELASrLinlpeeothatwleenoteti. samdeassaaNad In good condition unlitate.otherwise noted. Unless requested by the client, building materials manufactured with multiple layers (Le. linoleum, wallboard, etc.) are repotted ass single sample.

Samples analyzed by EMSL Analytical, Inc, Indianapolis, IN

Initial report from 06/25/2019 15:01:19

Test Report PLMPCGrav-7.26.0 Printed: 6/25/2019 3:01:19 PM THIS IS THE LAST PAGE OF THE REPORT.

Trevor Maggart (2)

/5ra •

V- I

.104,0-01644r-frIl to‘"44-Alt•Cre—A.

Bulk Sample Number

Locatran & Description ' of Sulk Sample

HomogepeoUs Area

OrderID: 16191236p

Coulee Region Environmental, LLC 1;

123 plonk 4th Street: Sidte,201 • CM"? yViscOnsld • Mina (910 784-54,11 cr

Bulk Sample Log Form)

Facility ID:, Vikl"we.-Iranue.a.., 7 te41,1iftiect NO:, AS14152.141-3

Analysis Requested: PLIVI, SPA 601 Collected By: Rick Stickier.

State Certilleption: ALI-09425 time ed .— ' 1 te Submitted• 6 -7-4 -261

Submitted To. cal

Submitted Ity- Rick Stickle'''.

Date Received:

Signatur

Recet

Pacre 3 Of 3

.:.stouReakivennteoute OPLIkEPA emosavi la with milling prep (<1%) o PLM EPA 6001343/115 with milling prep (<0.25%) O TPA EPA 600111-93/116 with milling prep (<0.1%).

OTEM Qualitative vis.ElitraUan Prep • 0 TEM Qualitative via Drop Mount Prep

Cincinnati Method EPA 600/R-04/004 PLIfittEM 00.011v) ftar

• TEM- Dust

0 Moravec- ASTM D 5755 0 Wipe - ASTM 08480 oarpet Sonloation (EPA 60(J-03/187) al Received ILO Comments/4e

Company Name : Coulee NC** Environmental LI.0 . EMSL Cindomer ID:

Afresh 123 N. 4 Street. Suite 202 . • , Citv: La Crone , . State/Frovirre: WI

Fax 0: '

ZiplPostal Code: 54801 raountrvi USA Telephone 9: 8087928672 ' Repcirt To (Name): Rink Weider .

Pines provide'Reerifte: 0 Fax Email — - .

ratioldertic learomuutOnti ' _EntallAildreed: Purchase' Oder: A5 135-Ver—S . ' , Project Nerlie/NUmbe0 - -1—putit‘trit. 13 M *1...3 EMI :Protect ID Unlemed Usb Only)f

HA State Samples Take -CT Sera ConnercialiTasable Residential lam

, EMSL-1391 tel Same , Different - 71)1M Parivitann rendrotorridan

Millie Is Different nate ImIngtlans In Comments" authoriganon from thlrd mutv

Page 1 of pease

Oareglel borati -Aikidos 0012.411-osminie

Pace 1 Of

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4 k;

Asbestos Chain of Custody gma Order Nismbititob uadi ona.

1(,19 i-1 3 10 9

OrderID: 161912369 iSL ANALYTICALk WO.

6340 CASTLSPIACE

INDIANAPOLIS, itf 46250

PHONE: 060)2204675

FAx (317)8038047

.TheneroundT

TEM - Air 0 4-4.5hr TAT pen only)

El AHERA 40 CFFt; Part 763

O NIOSH 7402

O EPA Level It El leo 10312

'yem Bulk

E1 TEM EPA NOS

o NYS NOS 195.4 (non-triable-NY) O Chatfield SOP

TEMYass Anettele-EPA 800 sec. 2.5 TEM terrAPA 100,2'

Share >113wm 0 Waste 0 Drinking

All Fiber Sizes 0 Waste 0 Drinking

1:1;10.8Um 4r4 0.451jni

:Tam [3:010.klitonottro :

:.fratftNY o NIOSH 7400

O wi OSHA ehr. rmA tnithetlertina multi

I.14 EPA 800/11-93/116 (41%)

o PLM EPA NO (41%) Point Count 0 400 (40.25%) 0 1000 (c0.1%) Point Cqunt w/GravImetrio 0 400 (<0.25%)40 1000 (40.1%)

O NYS tral (friable In NV) • 13 NYS 1118.0 NOS (non-frlabte-NY)

NYsilpas sOF-v NIOSH 9002 to%

AT) 0

8 flour C lEitour 98 Hour famitwelek. Jfa..2 week, TEAl ' 3 orEPA LevortrAT.)WASIO.48110 404(Onan and Condftmat ItaaW NOM AMA*? 'Pike OnAta.

leuiaa -Please Check :,:t113. HO I . 24Hour

Tem Vir wog hr ffeaSe 0101110:1111. *MOO :Manta. funonlomi.lbr Minimal* Mai*. c6rna1aladatooskla***9.EMItli

0 CheticiFor Positive Stop-Clearly Identify Homogenous Group- Filter pore Size (Air Sa

Samplers• Name: Samplers Signature:

Sample lifeeve-

'eT-0

Sample Description ake/Area

HA # iStulki • Date/Time Sampled

0,7-doz4(1,- I e)

Total *O SSA

Date: Vine .

Data

Client lianIple (4:

• ' 1 • • linquiphed(ClIen

6340 CastlePlace Dr., Indianapolis, IN 46250

Phone.: OM 803-2997 Fax; (311) 003-3047 Email: ladlaminp1181abfbamslicc.6

Attn: Rick Stickler Coulee Region Environmental, LLC 123 North 4th Street Suite 202 La Crosse, WI 54601

Customer ID: MIDW52 Customer PO: AS195241-3 Received: 06/25/19 9:15 AM

Confirmation of Samples Received

Cust Samnle W62419-1

EMSL

Order ID

161912369-0001 Test

PLM

Received Date

6/25/2019

9:15:00 AM

TAT

48 Hour

Due Date 6/27/2019

9:15:00 AM

W62419-2 161912369-0002 PLM 6/25/2019

9:15:00 AM

48 Hour 6/27/2019

9:15:00 AM

W62419-3 161912369-0003 PLM 6/25/2019

9:15:00 AM

48 Hour 6/27/2019

9:15:00 AM

W62419-4 161912369-0004 PLM 6/25/2019

9:15:00 AM

48 Hour 6/27/2019

9:15:00 AM

V2362419-8 161912369-0005 PLM 6/25/2019

9:15:00 AM

48 Hour 6/27/2019

9:15:00 AM

V2362419-9 161912369-0006 PLM 6/25/2019

9:15:00 AM

48 Hour 6/27/2019

9:15:00 AM

V2362419-10 161912369-0007 PLM 6/25/2019

9:15:00 AM

48 Hour 6/27/2019

9:15:00 AM

Date Sent 6/25/2019 12:16:18 PM

6340 CastlePlace Dr. Indianapolis, IN 46250

Tel/Fax: (317) 803-2997 / (317) 803-3047 http://ww.EMSLcom I indianapolislab@emsl.com

EMSL Order: 161912369

Customer ID: MIDW52

Customer PO: AS195241-3

Project ID:

Phone:

Fax:

Received Date:

Analysis Date:

Collected Date:

(608) 784-5688

(608) 784-7350

06/25/2019 9:15 AM

06/27/2019 06/24/2019

Attention: Rick Stickler

Coulee Region Environmental, LLC

123 North 4th Street

La Crosse, WI 54601

% Non-Fibrous

100% Non-fibrous (Other)

Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy

Non-Asbestos Asbestm % Type

None Detected

100% Non-fibrous (Other) None Detected

Spray-on Ceiling Insulation- Loading Dock

White 100% Non-fibrous (Other) None Detected

Non-Fibrous fffiii*90600.4S

Maroon Stair Tread & Baick Mastic 1st Fl Stair 2nd Stair

V2362419-9-Flooring

161912369.0006

None Detected 100% Non-fibrous (Other)

Black Non-Fibrous Homogeneous

Red Non-Fibrous Homogeneous

V2362419-9-MastIc

161912369-0006A

V2362419-10-Stair Tread

161912369-0007

Maroon Stair Tread & Baick Mastic 1st Fl Stair 2nd Stair

Maroon Stair Tread & Baick Mastic 1st Fl Stair 2nd Stair

100% Non-fibrous (Other) None Detected

100% Non-fibrous (Other) None Detected

Black Non-Fibrous Homogeneous

Maroon Stair Tread & Baick Mastic let Fl Stair 2nd Stair

V2362419-10-Mastic

161912369-0007A

100% Non-fibrous (Other) None Detected

Analyst(s)

Joshuah /Wet (7)

Paul Rlhm (3)

Richard Harding, Laboratory Manager or Other Approved Signatory

Page 1 of 1 ASB_PLA4 0008 0001 -1.78 Printed: 6/27/2019 12:03 PM

Sample

VV62419-1

161912369-0001

VV62419-2

161912369-0002

W62419-3

161912369-0003

Description

Spray-on Ceiling Insulation - Loading Dock

Spray-on Ceiling Insulation - Loading Dock

Appearance

White Non-Fibrous Homogeneous

White Non-Fibrous Homogeneous

% Fibrous

W62419-4 Spray-on Ceiling White insulation - Loading Non-Fibrous

1619723694004 Dock -Hornegerreolie

V2362419-8-Flooring Maroon Stair Tread & Red Balck Mastic let Fl Non-Fibrous

161912369-0006 Stair 3rd Stair Hontogerlaelis

100% Non-fibrous (Other) None Detected

100% Non-fibrous (Other) None Detected

V2362419-8-MastIc Maroon Stair Tread & Baick Mastic 1st Fl

161912369-00000 Stair 3rd Stair

Black Non-Fibrous Homogeneous

Red Non-Fibrous Homogeneous

100% Non-fibrous (Other) None Detected

Initial teport from: 06/27/2019 12:03:44

Project: VA Tomah

EMSL maintains liability limited to cost of analysis. The above analyses were performed In general compliance with Appendix E to Subpart E of 40 CFR (previously EPA 600/M4-82-020 'Interim

Method"), but augmented with procedures outlined in the 1993 ("final") version of the method, This report relates only to the samples reported above, and may not be reproduced, except in full, without

Written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. All samples received In acceptable condition unless otherwise noted. This report must not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST or any agency of the federal government. EMSL recommends gravimetrlo reduction for all non-friable organically bound materials prior to analysis Estimation of uncertainty Is available on request.

Samples analyzed by EMSL Analytical, Inc, Indianapolis, IN NVLAP Lab Code 200188-0, AZ0930, CA 2575, COAL-15132, TX 300262, LA 0035

United States Department of Commerce National Institute of Standards and Technology

04, COM:ea o Of. monec 7025:2005

NVLAP LAB CODE: 200188-0

EMU' Analytical, Inc.

Indianapolis, IN is accredited by the National Voluntary Laboratory Accreditation Program for specific services, fisted on the Scope of Accreditation, for:

Asbestos Fiber Analysis

This laboratory is =wilted in accordance OM the recognized International Standard ISCV1EC 17025:2005.

This accreditation demonstrates technical competence fora defined scope and the operation of a laboratory qualify management system (refer to joint ISO-LAC-IAF Communique dated January 2009).

ciN, 601, 44L, :f

For the National Voterthity.LiAboratoOccteditatten AMMO, 2019-04-01 through 2020-03-31

Effecrwe Dates

Forth() National Voltage bora meditator! Program

BJ

6) National Voluntary Laboratory Accreditation Program

SCOPE OF ACCREDITATION TO ISO/IEC 17025:2005

6340 Castleplace Dr.

Indianapolis, IN 46250 Mr. Richard Harding

Phone: 317-803-2997 Fax: 317-803-3047 Email: rharding®emsl.com http://www.emsi.com

ASBESTOS FIBER ANALYSIS NVLAP LAB CODE 200188-0

Bulk Asbestos Analysis fag, ,Desoription 18/A01 EPA 40 CFR Appendix E to Subpart E of Part 763, Interim Method of the Determination of

Asbestos in Bulk Insulation Samples

18/A03 . EPA 600/R-93/116: Method for the Determination of Asbestos in Bulk Building Materials

Airborne Asbestos Analysis

Code PocrOlion 18/A02 U.S. EPA's "Interim Transmission Electron Microscopy Analytical Methods-Mandatory and

Nonmandatory-and Mandatory Section to Determine Completion of Response Actions" as found in 40 CFR, Part 763, Subpart E, Appendix A.

Effective 2019-04-01 through 2020-03-31 Page 1 of 1