586-25-101 SOW SITE PREP IR UPGRADE.pdf

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STATEMENT OF WORK

G.V. (Sonny) Montgomery VA Medical Center

Jackson, MS

Project No. 586-25-101 Site Preparation for

Interventional Radiology Upgrade

Demolish, Reconfigure and Reconstruct IR and CT Spaces, Restrooms, and Patient Holding Area to Support New IR and CT

Machines and Optimize Workflow

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Date: 5/27/2025 Revised 1/14/2025

Table of Contents

Scope of Work

Attachments

A. General Vicinity Map

B. 1,590 SF IR Suite, existing space layout

C. 1,205 SF existing space layout

D. 1,590 IR Suite Conceptual layout

E. Latest Asbestos Survey

F. Philips IR Machine (AZURION 7 C20) Data

G. Philips CT machine (Incisive) Data

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Scope of Work This Statement of Work describes specific work activities, deliverables, and timelines the Contractor Team must execute in performance of the specified work – but this statement of work should in no way be considered all-inclusive, which is an impossibility short of a complete design effort. The client for this Statement of Work is: Facility Management Service at the G.V. (Sonny) Montgomery VA Medical Center located at 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116.

CONTRACTOR shall be responsible to perform all requirements expressed in this Statement of Work. CONTRACTOR’s failure to address any requirement and/or submit pricing in proposal does not relieve the CONTRACTOR of the obligation to complete all requirements and provide a complete and fully functional Site Preparation for Interventional Radiology.

TERMS

The term "OWNER” or “VA”, as used throughout this document, refers to the Department of Veterans Affairs. The term "CONTRACTOR" as used throughout this document will mean the winning bidder to this Request for Proposal (RFP).

1. INTENT

The G.V. (Sonny) Montgomery VA Medical Center is looking to identify an exceptional CONTRACTOR to provide a turnkey (Design – Build) solution to renovate approximately 1,590 square feet of existing Radiology Department space to support a new Philips IR machine and a new Philips CT machine, control room and adjacent support spaces. The 1,590 SF are rooms F20, F21, F22, B14D, B14C, F25A F-25, a small section B14, F24, F23A, F23, and 79 sf room with no room number. It also includes the total renovation of 1,205 square feet of vacated IR space to accommodate displaced Radiology administrative services. This area consists of rooms E5B, GA, E5, E5A, E6, and E7. Lastly it includes the disassembling, packing and shipping if IR and CT equipment which has exceeded its service life. The construction area is comprised of the rooms as listed and identified on the attached floor plans for both areas. The site is located on the north side of the hospital on the basement level of Building 1 at the G.V. (Sonny) Montgomery VAMC in Jackson, Mississippi.

2. SCOPE OF WORK

1) The selected CONTRACTOR shall be responsible to provide all necessary project management, Professionally Licensed design professionals for design services, materials, onsite supervision, and labor to perform the renovation of the spaces as described herein.

2) The selected CONTRACTOR is required to provide meeting minutes and sign-in sheets for all meetings. The VA COR shall participate in any & all meetings

P a g e 4 | 13 between the CONTRACTOR, IR and CT Equipment Manufacturer, and End- User that may impact the outcome of the project.

The selected CONTRACTOR shall be responsible to record and provide meeting minutes to all meeting participants for review and approval/comment/rejection within 1 working day of each meeting. Any deviations or agreements not specifically requested and defined in writing – with approval by the VA Contracting Team (including COR) prior to beginning work – shall be invalid and will constitute a CONTRACTOR-initiated work stoppage until the matter is resolved.

3) The selected CONTRACTOR shall completely prepare site, coordinate with VA COR and end-users prior to beginning each phase of work to including design, demolition, construction, equipment de-installation & installation (including existing IR and CT packaging and return to the manufacturer), etc. The selected CONTRACTOR is required to construct hard barriers between the construction site and adjacent working areas to minimize noise and dirt/dust intrusion in order to eliminate disruptions to ongoing patient care. It is the intent to demo all existing items in the spaces to the bare concrete floors and ceilings, all walls and coverings including mechanical, electrical, and plumbing items.

4) Submittals are required for all items. VA review & approval of all submittals is required prior to installation.

5) Both the new IR and CT machine shall be furnished and installed by Philips Medical Equipment under separate contract (see attachment for design/construction details). Ancillary support systems for IR and CT machines such as electrical power, control system raceways, structural mounting systems, cabinetry, handwashing sinks, etc. necessary to facilitate full functionality of the IR/CT Suite shall be provided and installed by the CONTRACTOR. The CONTRACTOR is required to schedule and facilitate the installation of the new IR and CT machine to minimize downtime. The CONTRACTOR’s effort shall extend through Philips IR and CT installation completion.

6) The selected CONTRACTOR shall be required to provide complete architectural, engineering, and construction services for this project. AIA-and/or NCARB-licensed/registered professional architects and licensed professional mechanical, plumbing, fire protection, and electrical engineers are required to design each respective system. Architects and engineers shall only design systems for which they hold specialized degrees and experience.

Professional resumes indicating education, accreditation, and experience submittals are required for VA review and approval.

All design and construction for this project shall adhere to associated VA Design Guides, VA Design Manuals, VA Master Specifications, VA National AutoCAD Standard Application Guide, manufacturer requirements (see attached Philips Azurion 7 C20FlexArm – 6000mm-AD7 IR machine details) and(Philips CT Model name Incisive) and other guidance and directives provided by the facility end-users via the COR for this project. VA Central Office standards referenced above may be accessed online at:

P a g e 5 | 13 http://www.cfm.va.gov/TIL/.

The designers shall meet with the VA’s COR, Radiology Staff, VA Biomedical Engineers and Philips Medical Equipment staff as needed to ascertain full requirements.

All designs shall be stamped by each system’s architect- or engineer-of-record holding current license. VA COR shall be notified of the schedule for all meetings to ensure awareness of all aspects of the design and construction process.

7) Design shall include reconfiguration and renovation of the1590 SF area. This area will be referred to as the “IR Suite” throughout this document and a possible layout is included as an attachment to this SOW. All demolished areas/equipment shall be restored to functionally and aesthetically complement adjacent spaces within IR Suite.

8) The selected CONTRACTOR shall be responsible to demolish all existing utilities and finishes within the established construction limits including, but not limited to all architectural, structural, mechanical, electrical and plumbing systems. Utilities supporting adjacent spaces must remain intact although it may be necessary to relocate them to provide a compliant installation. Any and all abandoned systems will be removed from the site and disposed of properly in accordance with applicable Federal, State, and local laws. The selected CONTRACTOR shall provide approximate weights of each material type taken for recycling (steel, aluminum, copper, etc.)

9) The design and construction shall include shielding per VA Radiation Safety Officer (RSO) direction. Some spaces will require homogenously leaded gypsum wallboard, leaded seam seals from the floor to the roof pan above, and specialized doors.

10) The design and construction shall provide new 700 pound (minimum) rated Guldmann GH3+ full range, ceiling mounted, patient lift to facilitate patient access to the new CT equipment. Provide one lift for the CT room. No substitutions permitted – this lift is the facility standard. Coordinate installation with the ceiling-mounted environmental scene lighting. Provide all necessary structural supports for new lift and ensure the lift is located to facilitate patient ingress and egress on and off of the machine.

11) The selected CONTRACTOR shall provide all built-in millwork recommended by the Owner and IR/CT Manufacturer to facilitate IR/CT scanner workstation, IR/CT equipment storage, and general storage. All countertops shall be Corian® or VA approved-equal solid surfacing. As a minimum, provide all of the built-in countertops specified in the Philips Medical CT and IR design guide (including sink & cabinetry the full length of the control room and CT Rooms to support staff & equipment work/storage requirements.) Under-sink plumbing shall be enclosed within cabinetry.

12) Design shall include separate spaces to support each of the two new Philips machines, a single/combined control room and associated utilities & built-in http://www.cfm.va.gov/TIL/

P a g e 6 | 13 millwork to support both IR/CT machines, cabinetry, countertops, work and storage spaces in each of the new rooms, new ceiling and flooring throughout the identified spaces. A new restroom, Mechanical/Computer room, a small Pharmacy space, storage space, and an office. A diagram is included with this scope of work with a conceptual layout of the desired rooms. This concept layout shall be verified and determined to function properly with the equipment.

13) Demolish and replace all existing electrical devices and faceplates with components meeting or exceeding current VA Design Guide requirements within the limits of construction. Provide hospital-grade wiring devices with stainless steel faceplates.

Replace all light fixtures with new specification-grade, 2x2-foot, 5000K, LED-type, with dimming controls designed in conjunction with the staff/end-users.

Dimming controls are required.

Work shall include all new ceiling systems, floor systems, finishes, countertops, shelving, millwork, electrical, lighting and utility services, etc. Solid surface countertops are required for all millwork.

14) All existing-to-remain and new utilities are required to be enclosed within walls or ceilings and include any required access panels. Relocation of utilities-to-remain may be required. The selected CONTRACTOR shall demolish and replace HVAC existing ductwork, registers, grills, dampers, HVAC controls, VAV boxes, etc. with new to support the renovated spaces within the established construction limits and rebalance the system including areas served by the AHU and not in the remodeled space.

Re-route existing ductwork supporting adjacent spaces as necessary in order to facilitate the installation of ductwork and utilities within the new IR Suite.

Individual room temperature control is required in each Room, Control Room, and Waiting Room. VAV boxes shall be single-duct type with hot water re-heat (same as existing). New chilled water S&R connections shall be hot-tapped, include ball-type isolation valves at the tap location. All control system components shall be supplied, programmed, integrated by, and connected to the existing building JCI MetaSys Extended Architecture Building Management System by Johnson Controls, Inc.

15) Contractor shall design and install New Liebert® HVAC systems in both the IR and CT Room. Liebert® is the facility standard. No substitutions are allowed.

Liebert® units shall supplement VAV heating/cooling in IR/CT rooms to meet anticipated heating and cooling loads. Verify HVAC loads and appropriately size the new Liebert® unit or units (Prefer 1 unit to serve both rooms if possible). The new Liebert unit(s) shall be water-cooled. Chilled water supply and return connections for the new Liebert system(s) are located within the pipe basement in the general vicinity of the IR suite. New chilled water S&R connections shall be hot-tapped, include ball-type isolation valves on the S&R circuits at the hot tap location as well as at each new Liebert unit. Provide circuit setters on the new Liebert chilled water circuits. Piping connections of each Liebert unit shall be a flush-mount wall box. Contractor shall connect new Liebert unit(s) to the existing Johnson Controls, Incorporated (JCI) MetaSys Extended Architecture building management system. Liebert units are required

P a g e 7 | 13 to provide the following control/status points to the JCI system: supply air temperature, status (run, ON/OFF, normal or alarm).

16) The selected CONTRACTOR shall demolish and replace all plumbing and medical gas piping, devices and equipment within the limits of construction.

Provide new wall mounted OAV medical gas outlets on clear/unobstructed wall space in a serviceable area immediately adjacent to the patient location of the CT and IR machine.

NOTE: Medical gas outlets (OAV) shall be Amico Ohmeda. No substitutions allowed. Amico Ohmeda is the facility standard.

17) Professional (AEE-, NEBB-, or AABC-certified), third-party design and construction commissioning of all mechanical systems shall be provided by the CONTRACTOR. Commissioning plans and results shall be submitted to the VA for review and approval. The Cx consultant will report directly to VA COR.

18) The 1205 Square Foot area requires full demolition to bare ceiling and floors and complete reconstruction/remodel for the administrative offices supporting the Radiology department. This area and some square footage of adjacent area are currently served by air handling unit 1 E located in the mezzanine above the boiler plant. This AHU shall be replaced with a properly sized AHU serving the remodeled space and all existing areas served by the existing AHU 1E. The replacement AHU will be connected into new ductwork in the renovated area and cut over to the existing duct work at an acceptable location for the adjacent areas. The western end of the 1205 SF space identified as rooms E-5B and G- A shall be reconstructed to serve as an equipment room and shall be remodeled with new access panels for the openings in the floor and walls that are sealed airtight. The wall between the equipment room and new adjacent administrative offices shall be minimum 6” thick with acoustic insulation and a door that is also sealed airtight to minimize noise and potential odor entering the office space from the mechanical/equipment room area. The layout of this office space shall be coordinated with the end users. The new AHU should be located in mezzanine space where it is currently located. The existing AHU-1E shall be removed from the site once new system is operational.

19) Architectural finishes shall be the following or approved-equal:

Ceilings: 2’x2’ Armstrong 896 Acoustical Tile Ceiling

Level 5 GWB finishes as defined by the Gypsum Association, Wall Paint: Sherwin Williams Harmony

Base: Johnsonite Millwork rubber wall base, Roppe 4”

Floor Finishes:

Computer Room/Control Room – Mannington Natures Path, Luxury Vinyl Tile All Other Spaces – Mannington Bio Spec, Seamless

New Equipment Room: Epoxy flooring required.

NOTE: The full spectrum of color/sheen selections for all finishes shall be submitted to the VA for selection/approval.

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20) The selected CONTRACTOR is responsible to modify existing sprinkler and fire alarm systems as needed to meet current physical space and current VA Design Guide and NFPA 13 and NFPA 72 requirements. Design and installation certification shall be stamped by the FPE of Record at completion of the design and completion of construction. A site visit by the FPE of record to certify installation compliance at the completion of the project is required.

21) The selected CONTRACTOR shall remove, protect, relocate as necessary & re-install all supportive systems such as telecommunication, individual medical and patient WiFi access points, Real-Time Locating System (RTLS), Siemens FireFinder fire alarm system, and any other active, existing, special system existing within the project limits. Provide new devices and ancillary components as required to meet new IR/CT functional and Code requirements.

Minimum acceptable protection is storage within a sealed bag with roof deck attachment during demolition/construction. Protection, removal, and re-installation are the responsibility of the CONTRACTOR. Professional design services are required to facilitate and ensure proper system re-connection and complete designs.

22) The selected CONTRACTOR shall be required to fully coordinate and implement construction requirements with the IR and CT vendor to ensure the system is fully operational, maintainable, and able to support patient workload in accordance with VA and Joint Commission (hospital accreditation) standards.

23) The selected CONTRACTOR shall be required to coordinate construction operations and phasing to minimize downtime and impact to adjacent patient care services.

24) The selected CONTRACTOR shall be responsible to coordinate all related manufacturing and installation activities of the project with Philips Medical Systems to ensure schedule compliance and minimize impact to patient care.

This includes but is not limited to:

A) IR and CT equipment release for manufacturing, B) de-installation of existing equipment, C) delivery scheduling for new equipment, D) installation scheduling, E) Conducting construction coordination meetings with the owner and end-users, F) IR and CT and Building System Commissioning, G) IR and CT equipment training for staff/end-users, and H) closeout documentation.

Philips Medical equipment documents are attached for reference.

Schedule of deliverables

FIRST SUBMISSION: (35%) Due 60 Calendar Days following NTP

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Drawings: Provide three (3) sets of schematic design drawings – (2) half-size printed and a digital set in PDF format on a CD-ROM.

Reports: Provide a brief narrative report summarizing the design option.

VA Review: To be completed within 10 working days after receipt of 35% Submittal (Drawings).

SECOND SUBMISSION: (65%) Due 60 Calendar days following VA Review of the 35% submission.

Drawings: Provide three (3) sets of construction drawings – (2) half-size and

(1) full-size showing the scope and plan for each discipline involved. Utility sizing shall be included on this submittal. This drawing set is expected to include markups from completed site investigation.

Specifications: The specifications shall be in draft format.

Deliverables: Provide one copy of any calculations, computations and engineering data including, but not limited to, structural, electrical, mechanical, and fire safety. 2 sets of progress Drawings.VA Review: To be completed within 10 working days after receiving 65% Submittal.

THIRD SUBMISSION: (100%) Submittal Due 60 Calendar days following VA Review of the 65% submission.

Drawings: Provide three (3) sets of construction drawings – (2) half-size and

(1) full-size showing the scope and plan for each discipline involved. This drawing set is expected to include markups from completed review comments and be ready to issue for construction.

Specifications: The specifications shall be in final draft, completely edited and checked. Deliverables: Provide two (2) copies of any calculations, computations and engineering data including, but not limited to, structural, electrical, mechanical, and fire safety. 2 sets of progress Drawings, 2 Specifications, and Color Rendering. VA Review: To be completed within 10 working days after receiving 100% Submittal.

FINAL SUBMISSION: FOR CONSTRUCTION

The A/E shall make any necessary or identified corrections to drawings, specifications, calculations, or other deliverables to incorporate review comments of the 100% design review. Following revision, all documents and quantities listed in Section 6 above shall be resubmitted as a Final Submittal, “For Construction” set. A/E Final Submission to be delivered 7 days after VA review of 100% is complete. Documents shall be submitted to the Contracting Officer Representative in the following format:

• 1 Full-sized Set on bond

• 1 Full-sized Set regular paper

• 2 Half-sized sets

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• 2 Electronic (CD) copies to include: AutoCAD (DWG) files, PDF Drawings and PDF Specifications.

3. DESIGNATED CONTACTS

VA Project Manager/COR:

Name: Jeffery Knight, PE / COR Email: Jeffery.Knight1@va.gov Phone: 601-364-1330

NAC Equipment Contracting Officer:

Name: Kevin Murphy Email: Kevin.Murphy@va.gov Phone: 708-786-5244

Philips Healthcare Point of Contact:

Name: Matt Callum Email: matt.callum@philips.com Phone: 601-954-7979

601-331-6702

4. CONTACT WITH OWNER DURING PROPOSAL PROCESS

Communication between a CONTRACTOR and a non-designated OWNER contact for anything associated with this contract is non-binding and strictly prohibited. Questions pertaining to any/all requirements associated with this project shall be addressed to the designated Contracting Officer. Failure of a CONTRACTOR, or any of its representatives, to comply with this paragraph may result in removal from the project.

5. TENTATIVE DATES AND SCHEDULE

35% Drawings 60 calendar days after NTP 65% Drawings 60 calendar days after VA 35% Review mailto:Kevin.Murphy@va.gov mailto:matt.callum@philips.com

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100% Drawings 60 calendar days after VA 35% Review For Construction Drawings 10 Days after VA 100% Review Construction Completion Date* 450 calendar days after NTP

* – At completion & VA acceptance of the 35% design, the CONTRACTOR shall submit a proposed construction schedule for VA approval. The CONTRACTOR shall be prepared to meet & discuss with the VA any cause for extending the schedule. The CONTRACTOR shall ensure that reasonable timelines for all work sequences are afforded for construction at this time.

6. GENERAL REQUIREMENTS:

A. SITE INVESTIGATION: CONTRACTOR shall verify, so as to accurately locate, all existing architectural, mechanical, plumbing, electrical, and other utilities affected to incorporate them into the design package, i.e. existing utilities to remain shall be identified, sized, and shown on the new design. Available as-built drawings (if any exist) and other related project drawings are available to the CONTRACTOR, but their validity is not guaranteed in any way.

Comprehensive field measurement and verification of the existing area shall be required of the CONTRACTOR as part of the investigative services. At each submission, the CONTRACTOR shall furnish a set of corrected “as-built drawings” reflecting any discrepancies found during site investigation.

B. DEMOLITION: Project demolition work shall include the removal of *all* architectural (including ceiling, wall, and flooring systems), mechanical, plumbing including fire protection system, and electrical within the renovated spaces identified on the provided contract floor plan. Structural items supporting relocated walls and removed equipment shall be removed as well. All abandoned and demolished items shall immediately removed from the site and disposed of properly.

C. GEOTECHNICAL: NOT APPLICABLE.

D. STRUCTURAL: All modifications required to facilitate the installation of new building systems shall be analyzed and/or designed by a NSPE-licensed structural engineer. The CONTRACTOR’s design team shall perform and provide all calculations used for the basis of design of all new or modified structures.

E. ARCHITECTURAL: Field verification of elevations, building locations and architectural dimensions are required, as the existing drawings are inaccurate.

Architectural design shall include finish selections for all new work and modifications to existing building components for owner review and approval.

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F. INTERIOR DESIGN: Paint, flooring, ceiling, millwork selections for owner review and approval.

G. PLUMBING: Evaluation of the existing plumbing system, to include supply, drainage systems, med gas, etc. are required. Design modifications, additions and relocation of existing plumbing systems, i.e. water, sewer, drain, med gas, chilled water, etc.

H. ELECTRICAL: Evaluate electrical system components within the project area.

Design modifications, additions, possible relocation and reutilization of any existing electrical equipment or systems as may be required. The CONTRACTOR’s design team shall perform and provide all computations and sizing calculations for new electrical loads anticipated and altered existing loads. All designs shall comply with the most recent version of the National Electric Code (NEC) at bid submission.

• CERTIFIED INDEPENDENT THIRD-PARTY (CITP) SAFETY

REVIEW: NOT APPLICABLE.

I. ENERGY & RESOURCE CONSERVATION: Any alterations or new equipment (light fixtures, Roofing Assemblies) shall be energy and resource efficient.

Energy Star, LEED Silver, and VA Commissioning criteria shall be utilized

J. FIRE SAFETY – The VA uses NFPA 101, Life Safety Code, as the primary reference for all Fire Safety concerns. A/E shall provide a design that is compliant with NFPA 101. An onsite CONTRACTOR fire protection engineers review/certification witnessed by the VA COR at project closeout is required.

K. DESIGN DOCUMENTATION – The selected CONTRACTOR shall provide all documentation (i.e., calculations, reports, recommendations, etc.) as appropriate to support the design effort and to keep the Government fully informed of all issues or potential problems. Provide computations and sizing calculations for new members/components based on loads anticipated, altered loads and existing loads for electrical, plumbing, sanitary, and structural designs.

For computerized calculations, submit complete and clear documentation of computer programs, interpretation of input/output, and description of program procedures. Provide an investigation and explanation of code requirements incorporated into the design.

L. DESIGN CRITERIA – The selected CONTRACTOR’s design team shall review all pertinent VA construction criteria, standard details, and space criteria and is responsible for incorporating all such references in the design of this project. The CONTRACTOR may obtain copies of the complete VA Design Guides, Design Manuals, and other resources from the VA Facilities Management Technical InformationLibraryatwebsite/page:http://www.va.gov/facmgt/standard/ standard.htm. The VA is mandated to follow http://www.va.gov/facmgt/standard/standard.htm

P a g e 13 | 13 the most stringent rules, Codes & etc.; therefore, the CONTRACTOR’s design team shall also review all applicable VA, Federal, State, County, City, Industry Standard design guides, codes, standards, regulations and policies. All utilities shall be enclosed within walls. CT circuits shall be installed under the concrete floor unless specifically requested and approved in writing by the design team.

M. DRAWINGS: The CONTRACTOR shall provide electronic copies of drawings at each review step generated in the latest version of AutoCAD or its companion products. The standard drawing size shall be ARCH E1 [30” x 42”]. The format to be used in creating the CAD drawings is the latest edition of the National CAD Standard {www.nationalcadstandard.org}.

The A/E shall follow these level/layer formats, file-naming conventions, and symbol library. Drawings to be drawn from the VA’s “As Built” drawings updated by site verification, not scanned reproductions.

N. SPECIFICATIONS: The CONTRACTOR may obtain a copy of the complete VA Construction Specifications from the VA Facilities Management Technical Information Library at web site/page:

www.va.gov/facmgt/standard/standard.htm. The AE shall use the VA Specifications in developing material/product selections.

O. CONTRACT TIMELINE - Approximate timeline is projected to be as follows (Reference Task Order when made available):

Notice to Proceed (NTP) estimated date – TBD

Project completion is anticipated within 450 calendar days from NTP.

7. Attachments

A. General vicinity map B. 1,590 SF IR Suite existing space layout.

C. 1,205 SF existing space layout D. 1,590 SF Conceptual Layout E. Latest Asbestos Survey F. Philips CT Data G. Philips IR Data http://www.nationalcadstandard.org/ http://www.va.gov/facmgt/standard/standard.htm.

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Attachment A

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OFFICE - OFFlCE � OFFICE

F-20 F-21 \ F-22 R � Ra<iology l r l ' l = d

Radiology

134SF 113SF

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! - - - - - -U. . - ==1 , T I

9 0 i F A r e a

B-11A Radology

217SF

N

B-14 Bio Med

1661 SF

CORRIDOR

Convnon

� D

I

SHOWER

B-140

Bio Med

78SF

rx

7MALE TOILET

B-14C _ , , . Bio Med l c n c

SHOWER IA

F-25A � , Bio Med

74SF

FEMALE TOILET

F-25

Bio Med

98SF �

CT

F-24

Radiology

726SF

18SF

� � E

OENSOMETER

F-23A Radiology

110SF

READING RM

F-23 Radiology

173SF

Radiology

79SF

'===,.;8SF

CORRIDOR

Common

816SF

Attachment B

E-68 Radiology

SF

G-A Radiology

126-SF

E-5 Radiology

304SF

E-9 Radioloov

1,205 SF Area

E-6 Radiology

E-SA

Raoology

507SF

E-7 Radiology

134SF

N

F-801 Radiology

112SF

Attachment C

Rough Dimensions Control Room/Obs

; Storage Office - - - - - - - - - - - ' , ! · · - - - - - - - - - - - + - - - - - . t

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- l ' - - - - - + - - - - 1 T - l l ' ' ' - - - - - - - - - , t Make all doors 48" if possible

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Mechanical & C,a-rµrter ;,. Restroom Patient Holding/Intake

- - - - - - - - - - - - - - - : j ; : : = : s = = = t 1 - = - = - = - = - 1 - ; : : ; r . 1 · ; : : : : ' . • _ _ - , r

Attachment D

HGS Engineering, Inc.

1121 Noble Street Anniston, AL 36201 Phone: 256-236-1848 ● Fax: 256-236-2979 www.hgsengineeringinc.com

ENGINEERING AND PROFESSIONAL SERVICES

AHERA 6-Month Asbestos Surveillance

G.V. (Sonny) Montgomery VA Medical Center

October 2022

Attachment G http://www.hgsengineeringinc.com/

G.V. (Sonny) Montgomery VA Medical Center

AHERA 6-MONTH ASBESTOS SURVEILLANCE – Background

HGS Engineering, Inc was contracted by the Jackson, Mississippi Department of Veterans Affairs Medical Center Safety Department office to conduct the visual surveillance of asbestos at the Jackson, Mississippi VAMC. This contract required HGS to visually inspect the condition of all friable asbestos-containing materials with the potential for damage and previously identified damaged non-friable asbestos that may have become friable as required by AHERA.

AHERA 6-MONTH ASBESTOS SURVEILLANCE – Inspectors and Dates

Tim Thompson, certified asbestos inspector, and management planner inspected the Jackson VAMC. The inspection started on 29 September, 2022 at the Seattle VAMC and was escorted by Jennifer Newman.

AHERA 6-MONTH ASBESTOS SURVEILLANCE – Inspections

At the Jackson VAMC HGS inspected 2 buildings. The CLC was not inspected as it has been recently renovated; I inspected both floors during the renovation process. Both floors were totally gutted, exterior wall to exterior wall and floor to ceiling.

HGS used the asbestos assessment sheet to locate the asbestos-containing materials and visually inspect the condition of the material. A surveillance sheet has been attached with the inspection date and material conditions.

Tim Thompson State of Mississippi DEQ Asbestos Inspector ABI-00007993 Asbestos Supervisor ABS-00007992

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material Description Location Quantity Unit of Measure Picture # Drawing # Friable ACM Status Material

Condition

AHERA

Category Contact Air Vibration Potential for Damage Response Action VA Comments Current Condition Date Inspected

E-3 TSI MS VMAC JVA-M-B-W2 TSI WRAP Main Basement TSI Pipe Wrap Mecanical Room MS VMAC Basement N 2% Chrysotile Good 1 Moderate High High 3 Leave In Place until Renovation Good 10/10/2022

E-3 TSI MS VMAC JVA-M-B-T1 TSI WRAP Main Basement TSI Equipment Wrap Mecanical Room MS VMAC Basement Y 35% Chrysotile- 2% Chrysotile Good 1 Moderate High High 3 Leave In Place until Renovation Good 10/10/2022

F-40 TSI

Jackson

Mississippi

VMAC

NESHAP

April 2022

F40/1,F401-2,3 TSI WRAP Main 1st TSI TSI Mastic/Wrap Jackson MS VMAC

Main 1st Floor N 3% - 5% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

B-17 Floor Jackson

Mississippi

VMAC

NESHAP

February 2022

B17 Flooring Main 1st Miscellaneous Black floor Glue Jackson MS VMAC

Main 1st Floor N 2% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-32 Floor Jackson

Mississippi

VMAC

NESHAP

April 2022 C32-1,2

Flooring Main 1st Miscellaneous Black mastic Jackson MS VMAC Main 1st Floor N 3% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

F-23 Floor Jackson

Mississippi

VMAC

NESHAP

May 2019 F-23-F1-2

Flooring Main 1st Miscellaneous Black mastic Jackson MS VMAC Main 1st Floor N 2% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material Description Location Quantity Unit of Measure Picture # Drawing # Friable ACM Status Material

Condition

AHERA

Category Contact Air Vibration Potential for Damage Response Action VA Comments Current Condition Date Inspected

A-104 IT Floor Jackson

Mississippi

VMAC

JVA-M-A104-1/2 Plaster Main 1st Miscellaneous Green and Brown Striped Tile Flooring Jackson MS VMAC Main 1st Floor N 2,3,7,5% Chrystile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

F-102 Floor Jackson

Mississippi

VMAC

Kitchen 1-4 Flooring Main 1st Miscellaneous 9X9 Tile Jackson MS VMAC Main 1st Floor N 3,5,7% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

F-115 Floor Jackson

Mississippi

VMAC

Kitchen 5-6 Flooring Main 1st Miscellaneous 9X9 Tile Jackson MS VMAC Main 1st Floor N Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

B-113A Floor Jackson

Mississippi

VMAC

JVA-M-4-3,4 Flooring Main 1st Miscellaneous White Grey Striped Jackson MS VMAC Main 1st Floor N 3% -5% Crysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-152 Floor Jackson

Mississippi

VMAC

NESHAP

June 2018

C-152,C-141 Flooring Main 1st Miscellaneous Tan floor tile / black mastic Jackson MS VMAC

Main 1st Floor N 2% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-154 Floor Jackson

Mississippi

VMAC

NESHAP

June 2018

C-152,C-141 Flooring Main 1st Miscellaneous Foor tile / black mastic Jackson MS VMAC

Main 1st Floor N 4% -7% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-141 TSI

Jackson

Mississippi

VMAC

NESHAP

June 2018

C-152,C-141 TSI Main 1st TSI Grey pipe elbows Jackson MS VMAC

Main 1st Floor N 5% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-105A Floor Jackson

Mississippi

VMAC

Persumed Main 1st Miscellaneous Jackson MS VMAC Main 1st Floor N Persumed Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-106 Floor Jackson

Mississippi

VMAC

Persumed Main 1st Miscellaneous Jackson MS VMAC Main 1st Floor N Persumed Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-127E Floor Jackson

Mississippi

VMAC

Persumed Main 1st Miscellaneous Jackson MS VMAC Main 1st Floor N Persumed Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-106C Floor Jackson

Mississippi

VMAC

Persumed Main 1st Miscellaneous Jackson MS VMAC Main 1st Floor N Persumed Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-106D Floor Jackson

Mississippi

VMAC

Persumed Main 1st Miscellaneous Jackson MS VMAC Main 1st Floor N Persumed Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

C-106D Corridor Floor Jackson

Mississippi

VMAC

Persumed Main 1st Miscellaneous Jackson MS VMAC Main 1st Floor N Persumed Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

G-101 TSI

Jackson

Mississippi

VMAC

JVA-Boiler-8 TSI Boiler 1st TSI Pipe elbow Unit #6C (must use Ladder) Jackson MS VMAC Main 1st Floor N 10,15% Chrysotile Good 1 Low Moderate Low 2 Leave In Place until Renovation Good 10/10/2022

G-101 TSI

Jackson

Mississippi

VMAC

Boiler 10 TSI Wrap Boiler 1st TSI Black Mastic Jackson MS VMAC Main 1st Floor N 5% Chrysotile Good 1 Low Moderate Low 2 Leave In Place until Renovation Good 10/10/2022

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material Description Location Quantity Unit of Measure Picture # Drawing # Friable ACM Status Material

Condition

AHERA

Category Contact Air Vibration Potential for Damage Response Action VA Comments Current Condition Date Inspected

B218 Floor MS VMAC

JVA-M-4-3,4

B218 June 2018

Flooring Main Main 2nd Tan floor tile / black mastic MS VMAC Main 2nd N 2% -3% Crysotile Good 1 Low Moderate Moderate 2 Leave In Place until Renovation Good 10/10/2022

B238 Floor MS VMAC B238 February 2022 Flooring Main Main 2nd Tan floor tile MS VMAC Main 2nd N 3% -5% Chrysotile Good 1 Low Moderate Moderate 2 Leave In Place until Renovation Good 10/10/2022

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material Description Location Quantity Unit of Measure Picture # Drawing # Friable ACM Status Material

Condition

AHERA

Category Contact Air Vibration Potential for Damage Response Action VA Comments Current Condition Date Inspected

B322 Floor MS VMAC JVA-M-4-3,4 Flooring Main Main 2nd MS VMAC Main 2nd N Good 1 Low Moderate Moderate 2 Leave In Place until Renovation Good 10/10/2022

A345 Floor MS VMAC JVA-M-3-3/4 Brown Floor Tile Main Main 3rd Miscellaneous Brown Tile MS VMAC Main 3nd N 5% Chrysotile - 3% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

CORRIDOR A307-A311 Floor MS VMAC JVA-M-3-2 White and Grey Striped Flooring Main Main 3rd Miscellaneous White and Grey Striped Flooring MS VMAC Main 3nd N 2% Chrystoile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

CORRIDOR A336A-A344 Floor MS VMAC JVA-M-3-2 White and Grey Striped Flooring Main Main 3rd Miscellaneous White and Grey Striped Flooring MS VMAC Main 3nd N 2% Chrystoile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

Main Hospital: Basement

Main Hospital: 1st Floor

Main Hospital: 3nd Floor

Main Hospital: 2nd Floor

CORRIDOR A345-A349 Floor MS VMAC JVA-M-3-2 White and Grey Striped Flooring Main Main 3rd Miscellaneous White and Grey Striped Flooring MS VMAC Main 3nd N 2% Chrystoile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

CORRIDOR A356-A359 Floor MS VMAC JVA-M-3-2 White and Grey Striped Flooring Main Main 3rd Miscellaneous White and Grey Striped Flooring MS VMAC Main 3nd N 2% Chrystoile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material Description Location Quantity Unit of Measure Picture # Drawing # Friable ACM Status Material

Condition

AHERA

Category Contact Air Vibration Potential for Damage Response Action VA Comments Current Condition Date Inspected

4222 Floor MS VMAC JVA M-4-3/4 White and Gray Striped Floor Tile Main Main 4th Miscellaneous 9X9 Tile MS VMAC 4th Floor N 2% Chrysotile Good 1 High High High 3 Leave In Place until Renovation Good 10/10/2022

Main Hospital: 4th Floor

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material

Description Drawing # Friable ACM Status Material Condition

AHERA

Category Contact Air Vibration

Potential for

Damage

Response Action

Current Condition

Date Inspected

SB-04 Floor MS

VMAC JVA-RE-SB-1/2

Creama nd Brown Floor

Tile R&E Sub-basement Miscellaneous Cream and Brown Striped

MS VMAC R&E

SB First Floor N

2% Chysotile Tile and Mastic

Good 1 Low Low High 3 Leave in untilil replacement

Good 10/10/2022

SB-05A Floor MS

VMAC JVA-RE-2-2

White and Beige Tile

Floor R&E Sub-basement Miscellaneous White and Beige Tile

MS VMAC R&E

2nd Floor N

Floor tile ND, mastic 3% Chrooystile

Good 1 Low Low High 3 Leave alone until replacement

Good 10/10/2022

SB-06 Floor MS

VMAC JVA-RE-2-2

White and Beige Tile

Floor R&E Sub-basement Miscellaneous White and Beige Tile

MS VMAC R&E

2nd Floor N

Floor tile ND, mastic 3% Chrooystile

Good 1 Low Low High 3 Leave alone until replacement

Good 10/10/2022

SB-08A Floor MS

VMAC JVA-RE-2-2

White and Beige Tile

Floor R&E Sub-basement Miscellaneous White and Beige Tile

MS VMAC R&E

2nd Floor N

Floor tile ND, mastic 3% Chrooystile

Good 1 Low Low High 3 Leave alone until replacement

Good 10/10/2022

SB-8B Floor MS

VMAC JVA-RE-2-2

White and Beige Tile

Floor R&E Sub-basement Miscellaneous White and Beige Tile

MS VMAC R&E

2nd Floor N

Floor tile ND, mastic 3% Chrooystile

Good 1 Low Low High 3 Leave alone until replacement

Good 10/10/2022

SB-07 Floor MS

VMAC JVA-RE-SB-1/2

Creama nd Brown Floor

Tile R&E Sub-basement Miscellaneous Cream and Brown Striped

MS VMAC R&E

SB First Floor N

2% Chysotile Tile and Mastic

Good 1 Low Low High 3 Leave in untilil replacement

Good 10/10/2022

SB-07 A Floor MS

VMAC JVA-RE-SB-1/2

Creama nd Brown Floor

Tile R&E Sub-basement Miscellaneous Cream and Brown Striped

MS VMAC R&E

SB First Floor N

2% Chysotile Tile and Mastic

Good 1 Low Low High 3 Leave in untilil replacement

Good 10/10/2022

SB-07 B Floor MS

VMAC JVA-RE-SB-1/2

Creama nd Brown Floor

Tile R&E Sub-basement Miscellaneous Cream and Brown Striped

MS VMAC R&E

SB First Floor N

2% Chysotile Tile and Mastic

Good 1 Low Low High 3 Leave in untilil replacement

Good 10/10/2022

SB-07 C Floor MS

VMAC JVA-RE-SB-1/2

Creama nd Brown Floor

Tile R&E Sub-basement Miscellaneous Cream and Brown Striped

MS VMAC R&E

SB First Floor N

2% Chysotile Tile and Mastic

Good 1 Low Low High 3 Leave in untilil replacement

Good 10/10/2022

SB-07 D Floor MS

VMAC JVA-RE-SB-1/2

Creama nd Brown Floor

Tile R&E Sub-basement Miscellaneous Cream and Brown Striped

MS VMAC R&E

SB First Floor N

2% Chysotile Tile and Mastic

Good 1 Low Low High 3 Leave in untilil replacement

Good 10/10/2022

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material

Description Drawing # Friable ACM Status Material Condition

AHERA

Category Contact Air Vibration

Potential for

Damage

Response Action

Current Condition

Date Inspected

(Elevator Lobby) Floor MS

VMAC JVA-RE-2-2

White and Beige Tile

Floor R&E 2nd Floor Miscellaneous White and

Beige Tile

MS VMAC R&E

2nd Floor N Floor tile ND, mastic 3% Chrooystile

Good 1 Low Low High 3 Leave alone until replacement

Good 10/10/2022

(Elevator Lobby) Floor MS

VMAC JVA-RE-2-2

White and Beige Tile

Floor R&E 2nd Floor Miscellaneous White and

Beige Tile

MS VMAC R&E

2nd Floor N Floor tile ND, mastic 3% Chrooystile

Good 1 Low Low High 3 Leave alone until replacement

Good 10/10/2022

Room/Location Title Campus Sample # Homogeneous Designation Building Floor AHERA Class Material

Description Drawing # Friable ACM Status Material Condition

AHERA

Category Contact Air Vibration

Potential for

Damage

Response Action

Current Condition

Date Inspected

(Elevator Lobby) Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

403 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

R&E Building Sub-Basement

R&E Building 2nd Floor

R&E Building 4th Floor

403A Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

405 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

405A Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

407 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

409 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

411 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

411A Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

413 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

415 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

(Elevator Lobby) Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

422 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

R420 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

R422A Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

418 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

416 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

414 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

R414A Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

412A Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

410 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

408 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

406 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

402 Floor MS

VMAC

JVA-RE-403

JVA-RE-420-1

Off white green striped 12x12 tile R&E 4th Floor Miscellaneous White and

Green Striped

MS VMAC R&E

4th Floor N 3% Chrysotile tile and mastic Good 1 Low Low High 3 Leave in until replacement Good 10/10/2022

C1 THIS SHEET IS PART OF THE DOCUMENT SET LISTED ON SHEET C1 AND SHOULD NOT BE SEPARATED.

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Revision History Note for Architects and/or Contractors: If revisions are listed, these drawings must be thoroughly reviewed so that all…