36E77620R0006-0002002.pdf

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ASBESTOS INSPECTION REPORT

Modernize A Bank Elevators Project

Iowa City Veterans Administration Medical Center

601 Highway 6 West Iowa City, IA

Project Report Dated: December 8, 2017 a Ci ty V

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I. CONTENTS

A. ASBESTOS INSPECTION REPORT

1. LOCATION

2. CONTACT PERSONS

3. DATE OF INSPECTION

4. FIRM PERFORMING THE INSPECTION

5. LICENSING OF ACCREDITED INSPECTOR(S)

6. BULK SAMPLE LABORATORY

B. SCOPE OF WORK / INSPECTION NOTES

C. SUMMARY OF ASBESTOS MATERIALS

D. BULK SAMPLE ANALYSIS / CHAIN OF CUSTODY

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A. ASBESTOS INSPECTION REPORT DATA

1. LOCATION(s)

Iowa City, IA

2. CLIENT CONTACT

Joel Simonyak Four Front Design Inc.

517 7th Street Rapids City, SD 57701

3. DATE(s) OF INSPECTION

November / December, 2017

4. FIRM PERFORMING INSPECTION

Hawkeye Environmental 814 Wood Lily Road Solon, IA 52333

5. INSPECTOR LICENSING

State of Iowa License # (s):

17-7513 Steve Henneberry

6. LABORATORY USED FOR BULK SAMPLE ANALYSIS

Environmental Testing Laboratories 38900 Huron River Drive, Suite 200 Romulus, MI 48174 a Ci ty V

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B. SCOPE OF WORK

Methods and Procedures:

The project area located at the Iowa City VA Medical Center, 601 Highway 6 West, Iowa City, Iowa was inspected prior to scheduled renovation activities which may disturb asbestos containing building materials in accordance with NESHAPS (National Emission Standards for Hazardous Air Pollutants) regulations.

Field sampling methods were based on (NESHAPS) National Emission Standards for Hazardous Air Pollutants) protocols. Representative samples of suspect building materials were taken from Homogeneous Areas (HA-defined as similar in age, appearance and function). The purpose of this inspection was to identify quantities and locations of asbestos containing building materials prior to the proposed renovation project. Bulk samples of suspect asbestos containing materials (ACM) were analyzed by Polarized Light Microscopy (PLM) with dispersion staining, as described in 40 CFR Part 763 and NESHAPs. Each sample was analyzed for the six different types of fibrous asbestos forms, of which a percentage, by volume, is estimated and summarized. If further analysis and quantification is warranted, this analysis is performed by EPA 600/R-93/116 with 400 Point Count Procedure. Further analysis of samples may also be performed at the client’s request using Transmission Electron Microscopy (TEM).

Sample analysis was performed by Environmental Testing Laboratories, of Romulus, MI. ETL is accredited by the National Institute for Standards and Technology for Polarized Light Microscopy analysis under their NVLAP (National Voluntary Lab Accreditation Program).

Asbestos Containing Building Materials (ACBM)s and their control during renovation or demolition activities is regulated in Iowa by the Iowa Department of Natural Resources.

Specific questions about testing or abatement activities may be directed to Mr. Tom Wuehr, Iowa DNR - Air Quality Division. Tom.Wuehr@DNR.Iowa.gov 515-494-8212 Additional forms, guidance and technical information regarding asbestos can be found on the DNR website at:

http://www.iowadnr.gov/air/prof/asbestos/asbestos.html

INSPECTION NOTES

mailto:Tom.Wuehr@DNR.Iowa.gov a Ci ty V

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In accordance with your request and authorization Hawkeye Environmental has performed an asbestos survey for the project referenced above. It is our understanding that the Modernize A Bank Elevators Project has the potential to disturb suspect building materials. It is the intent of this survey to determine if any of the materials with potential for disturbance are asbestos containing.

A representative number of samples were collected from suspect asbestos building materials in the proposed renovation areas.

The structure is a Veterans Administration Hospital. The building was in good condition for its age and state of use.

No asbestos materials were found within the proposed scope of work for this project.

No suspect lead paint materials were found in the Elevator Cab or passenger spaces.

If structural changes will occur in the elevator shaft, sampling of any affected painted surfaces will be required. Access to this space is restricted and will require the elevators to be locked out of service during any required testing.

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C. SUMMARY OF ASBESTOS BUILDING MATERIALS

IC VA – Modernize A Bank Elevators

Surfacing Materials

Material Description Location Quantity

None

Thermal Systems Insulation

Miscellaneous Materials

Quantities where supplied are estimates. Contractors must field verify all material quantities, locations and conditions prior to bid.

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BULK SAMPLE ANALYSIS RESULTS

Iowa City, IA

Environmental Testing Laboratories, Inc.

38900 Huron River Drive, Suite 200 Romulus, Michigan 48174

(734) 955-6600

Fax: (734) 955-6604

To :

Attention :

Hawkeye Environmental

814 Wood Lily Rd

Solon, IA 52333

Project Location :

Steve Henneberry

Iowa City VA Hospital

601 Hwy 6 West, Iowa City, IA

Login # Sample ID Work Requested Completed

200225 ETC Job :

12/8/2017Report Date :

Client Project : N/A

635810 Asbestos Analysis001 12/08/2017

635811 Asbestos Analysis002 12/08/2017

635812 Asbestos Analysis003 12/08/2017

635813 Asbestos Analysis004 12/08/2017

635814 Asbestos Analysis005 12/08/2017

635815 Asbestos Analysis006 12/08/2017

635816 Asbestos Analysis007 12/08/2017

Reviewed by:

Quality Assurance Coordinator

This report is intended for use solely by the individual or entity to which it is addressed. This report may not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government. It may contain information that is privileged, confidential and otherwise exempt by law from disclosure. If the reader of this information is not the intended recipient or an employee of its intended recipient, you are herewith notified that any dissemination, distribution or copying of this information is strictly prohibited. If you have received this information in error, please notify ETL immediately. Thank you.

Certificate of Analysis

Polarized Light Microscopy Asbestos Analysis Report

Location :

To :

Solon,IA 52333

Hawkeye Environmental

814 Wood Lily Rd

Iowa City VA Hospital

601 Hwy 6 West, Iowa City, IA

ETC Job :

Client Project :

200225

N/A

Environmental Testing Laboratories, Inc.

38900 Huron River Drive, Suite 200, Romulus, Michigan 48174,

(734) 955-6600, Fax: (734) 955-6604

Sample Description Appearance % Fibrous % Non-Fibrous % Asbestos

12/06/2017

12/08/2017

12/07/2017

Date Collected :

Date Received :

Date Analyzed :

None Detected635810

97% Other3% CelluloseBrownSheet Flooring

Non-Fibrous

HomogenousElev A-4

Analyst: Dave Cousino

None Detected635811

94% Other6% CelluloseYellowAdhesive

Non-Fibrous

HomogenousElev A-4

Analyst: Dave Cousino

None Detected635812

99% Other1% CelluloseGreyFloor Tile

Non-Fibrous

HomogenousElev A-1

Analyst: Dave Cousino

None Detected635813

95% Other5% CelluloseYellowAdhesive

Non-Fibrous

HomogenousElev A-1

Analyst: Dave Cousino

None Detected635814

99% Other1% CelluloseGreyFloor Tile

Non-Fibrous

HomogenousElev A-2

Analyst: Dave Cousino

None Detected635815

96% Other4% CelluloseYellowAdhesive

Non-Fibrous

HomogenousElev A-2

Analyst: Dave Cousino

None Detected635816

20% Other40% Cellulose

40% Fiberglass

White2x2 Ceiling Tile

Fibrous

HomogenousElev A Lobbies

Analyst: Dave Cousino

ETL, Inc. maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced without written approval by ETL, Inc. Test Method EPA 600/R-93-116 & EPA 600/M4-82/020 or NYSDOH-ELAP item 198.1 and/or 198.6 was used to analyze all samples. Matrix interference and/or resolution limits (i.e. detecting asbestos in non-friable organically bound materials) may yield false results in certain circumstances. Quantitative transmission electron microscopy (TEM) is currently the only method that can pronounce materials as non-asbestos containing. Interpretation and use of test results are the responsibility of the client. ETL, Inc. is not responsible for the accuracy of the results when requested to physically separate and analyze layered samples. Any

PLM results below 10% should be re-analyzed using the EPA recommended Point Count method. Any material that has greater than 1% asbestos content is considered to be an Asbestos Containing Material (ACM). These materials are regulated by both OSHA and the EPA and must be treated accordingly. Results are related to only to samples that were tested.

Certificate of Analysis

Polarized Light Microscopy Asbestos Analysis Report

Location :

To :

Solon,IA 52333

Hawkeye Environmental

814 Wood Lily Rd

Iowa City VA Hospital

601 Hwy 6 West, Iowa City, IA

ETC Job :

Client Project :

200225

N/A

Environmental Testing Laboratories, Inc.

38900 Huron River Drive, Suite 200, Romulus, Michigan 48174,

(734) 955-6600, Fax: (734) 955-6604

Sample Description Appearance % Fibrous % Non-Fibrous % Asbestos

12/06/2017

12/08/2017

12/07/2017

Date Collected :

Date Received :

Date Analyzed :

Lab Supervisor/Other Signatory

Analyst: Dave Cousino

400 Point Count Results by EPA 600/R-93/116 PLM (denoted by "PC")

Item 198.1: PLM Methods for Identifying and Quantitating Asbestos in Bulk Samples

Item 198.6: PLM Methods for Identifying and Quantitating Asbestos in Non-Friable Organically Bound Bulk Samples

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

EPA 600/M4-82-020: Interim Method for Determination of Asbestos in Bulk Insulation Samples

ETL, Inc. maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced without written approval by ETL, Inc. Test Method EPA 600/R-93-116 & EPA 600/M4-82/020 or NYSDOH-ELAP item 198.1 and/or 198.6 was used to analyze all samples. Matrix interference and/or resolution limits (i.e. detecting asbestos in non-friable organically bound materials) may yield false results in certain circumstances. Quantitative transmission electron microscopy (TEM) is currently the only method that can pronounce materials as non-asbestos containing. Interpretation and use of test results are the responsibility of the client. ETL, Inc. is not responsible for the accuracy of the results when requested to physically separate and analyze layered samples. Any

PLM results below 10% should be re-analyzed using the EPA recommended Point Count method. Any material that has greater than 1% asbestos content is considered to be an Asbestos Containing Material (ACM). These materials are regulated by both OSHA and the EPA and must be treated accordingly. Results are related to only to samples that were tested.