Attachment 36 - Envr. Report - Appendix B.pdf
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- Attached to
- Y1DA--EHRM Infrastructure Upgrades Construction Jefferson Barracks Federal contract opportunity
- Solicitation number
- 36C77623R0009
About this file
This is a solicitation for a construction contract to provide infrastructure upgrades at multiple buildings on the St. Louis Jefferson Barracks VA Medical Center campus. The selected contractor will furnish all labor, materials, and equipment to perform electrical upgrades including new and upgraded panels, power systems, UPS, and BMS interfaces; HVAC reconfigurations and expansions; data center renovations including piping and walls; communication upgrades including new data outlets and fiber backbone; physical security upgrades; and hazardous material abatement. Project locations include Buildings 1, 2, 3, 3T, 18, 23, 24, 25, 51, 51T, 52, 53, 53T, 55, 56, 57, 58, 59, 60, 60T, 61, and 75. The Department of Veterans Affairs Technology Acquisition Center Austin issued the solicitation.
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MANAGEMENT PLAN REMOVAL PRIORITY ASSESSMENT CHARTS
Qualitative (Descriptive) Rankings for Current Condition of ACM Qualitative Ranking Example Descriptions of Current Condition
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying mastic exposed; extensive amounts of dust and debris.
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Qualitative Rankings for Potential for Disturbance of ACM Level of Potential Disturbance Frequency of Potential
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
7 Good Low O&M Required for all friable ACBM, but measures need not be as extensive as
Category 6.
VA JEFFERSON BARRACKS CAMPUS
BUILDING 1
SIX MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/29/21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Winter 2019/2020
Current Condition Summer 2020
Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 1 – Basement
HMA-A1 1 B 12"x12" floor tile – gray w/ black mastic No G Intact G Intact L Floor
Maintenance 7 Gc17c-01 all tile, mastic, and pipes abated
HMA-B1 1 B 9"x9" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7 Gc14-01 all tile, mastic, and pipes abated
HMA-C1 1 B 12”x12” floor tile - green w/ black mastic No D Damaged D Damaged M Floor
Maintenance 3 Gc15-01 all tile, mastic, and pipes abated
HMA-D1 1 B 12"x12" floor tile - white w/ black mastic No G Intact G Intact L Floor
Maintenance 7 Gc15a all tile, mastic and pipes abated
HMA-J1 1 B 9"x9" floor tile - gray w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-K1 1 B 9"x9" floor tile - dark brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-L1 1 B 9"x9" floor tile - tan w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-M1 1 B 9”x9” floor tile - dark grey w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-N1 1 B 12"x12" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-Q 1 B 12”x12” floor tile – light white No G Intact G Intact L Floor Maintenance 7
HMA-1 1 B Black mastic No G Intact G Intact L Maintenance 7
HMA-19 1 B ACM pipe insulation and mudded fittings Yes SD Significantly
Damaged SD Significantly Damaged M Access/
Maintenance 1 See maps for SD locations.
HMA-24 1 B Fire Door No G Intact G Intact L Maintenance 7
HMA-25 1 B Interior window caulk-gray No G Intact G Intact L Maintenance 7
HMA-29 1 B Penetration caulk-white No G Intact G Intact L Maintenance 7
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Winter 2019/2020
Current Condition Summer 2020
Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
HMA-31 1 B Wall mounted heater (PACM) No G Intact G Intact L Maintenance 7
HMA-41 1 B Flange gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-43 1 B Ceiling mounted heater No G Intact G Intact L Maintenance 7
HMA-46 1 B Thick gray caulk on AHU No G Intact G Intact M Maintenance 6
HMA-71 1 B Transite panels No G Intact G Intact L Access/ Maintenance 7
HMA-72 1 B 12”x12” floor tile- green w/ pattern w/black mastic No D Damaged D Damaged M Floor
Maintenance 3
HMA-73 1 B
Black mastic under 12”x12” floor tile-green/gray w/ splotches
No G Intact G Intact L Floor Maintenance 7
HMA-74 1 B Hard gray material on duct Yes G Intact G Intact M Maintenance 6
HMA-75 1 B Felt roofing tar No G Intact G Intact L Maintenance 7
Building 1 – 1st Floor
HMA-A1 1 1 12"x12" floor tile – gray w/ black mastic No G Intact G Intact L Floor
Maintenance 7 1E-23-01-JB All Tile Abated
HMA-B1 1 1 9"x9" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7 1e01,1e02,1e04,1eo7,1e08,1e09, 1e12,1e14,1e15,1e16,1e17
HMA-D1 1 1 12” floor tile- white w/ black mastic No G Intact G Intact L Floor
Maintenance 7 1e17a,1e18 tsi pipes tile mastic
HMA-J1 1 1 9"x9" floor tile - gray w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-N1 1 1 12"x12" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-Q1 1 1 12"x12" floor tile - light whit w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-R1 1 1 9”x9” floor tile – green w/ black mastic No G Intact G Intact L Floor
Maintenance 7
Friable Yes/No
Previous Condition Winter 2019/2020
Current Condition Summer 2020
Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
HMA-T1 1 1 12”x12” floor tile – light brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-19 1 1 ACM pipe insulation and mudded fittings Yes SD Damaged SD Significantly
Damaged M Access/ Maintenance 1 See maps for SD locations.
HMA-24 1 1 Fire Door No G Intact G Intact L Maintenance 7 South rooms on east abated pipe tile mastic
HMA-31 1 1 Wall mounted heater (PACM) No G Intact G Intact L Maintenance 7
HMA-41 1 1 Flange gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-43 1 1 Ceiling mounted heater (PACM) No G Intact G Intact L Maintenance 7
Building 1 – 2nd Floor
HMA-D1 1 2 12"x12" floor tile - white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-N1 1 2 12"x12" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-P1 1 2 Linoleum floor w/ black mastic Yes G Intact G Intact L Floor Maintenance 7
HMA-Q1 1 2 12"x12" floor tile - light white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-T1 1 2 12”x12” floor tile – light brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-W1 1 2 12”x12” floor tile – dark white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-19 1 2 ACM pipe insulation and mudded fittings Yes SD Significantly
Damaged SD Significantly Damaged M Maintenance 1 See maps for SD locations.
HMA-24 1 2 Fire Door No G Intact G Intact L Access/ Maintenance 7
HMA-31 1 2 Wall mounted heater (PACM) No G Intact G Intact L Maintenance 7
HMA-41 1 2 Flange gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-43 1 2 Ceiling mounted heater (PACM) No G Intact G Intact L Maintenance 7
Friable Yes/No
Previous Condition Winter 2019/2020
Current Condition Summer 2020
Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
HMA-62 1 2 Black lab countertop No G Intact G Intact L Maintenance 7
HMA-65 1 2 Transite vent hood No G Intact G Intact L Maintenance 7
Building 1 – 3rd Floor
HMA-B1 1 3 9"x9" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-D1 1 3 12”x12” floor tile - white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-P1 1 3 Linoleum floor w/ black mastic Yes G Intact G Intact L Floor Maintenance 7
HMA-Q1 1 3 12"x12" floor tile - light white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-T1 1 3 12”x12” floor tile – light brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-W 1 2 12”x12” floor tile – dark white No G Intact G Intact L Floor Maintenance 7
HMA-19 1 3 ACM pipe insulation and mudded fittings Yes G Intact G Intact M Access/
Maintenance 6 3c14-01 tsi pipes abated
HMA-24 1 3 Fire Door No G Intact G Intact L Maintenance 7
HMA-25 1 3 Interior window caulk - gray No G Intact G Intact L Maintenance 7
HMA-31 1 3 Wall mounted heater (PACM) No G Intact G Intact L Maintenance 7
HMA-41 1 3 Flange gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-43 1 3 Ceiling mounted heater (PACM) No G Intact G Intact L Maintenance 7
HMA-62 1 3 Black lab countertop No G Intact G Intact L Maintenance 7
HMA-64 1 3 Black tar – covered duct insulation Yes G Intact G Intact L Maintenance 7
HMA-65 1 3 Transite vent hood No G Intact G Intact L Maintenance 7
Friable Yes/No
Previous Condition Winter 2019/2020
Current Condition Summer 2020
Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
HMA-71 1 3 Transite panels No G Intact G Intact L Access/ Maintenance 7
Building 1 – Penthouse
HMA-D1 1 P 12"x12" floor tile – white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-R1 1 P 9”x9” floor tile – green w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-19 1 P ACM pipe insulation and mudded fittings Yes G Intact G Intact M Access/
Maintenance 6
HMA-24 1 P Fire door No G Intact G Intact L Maintenance 7
HMA-41 1 P Flange gasket (PACM) No G Intact G Intact L Maintenance 7
Building 1 – Exterior
HMA-69 1 Ext Roofing mastic No G Intact G Intact M Maintenance 6
HMA-70 1 Ext Stucco surfacing material-tan Yes D Damaged D Damaged M Maintenance 6 Damaged material is friable.
HMA-75 1 Ext Roofing tar No G Intact G Intact M Maintenance 6
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
VA JOHN COCHRAN CAMPUS
BUILDING 1
SIX MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/27-21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
Building 1 – Basement
HMA-A1 1 B 12"x12" floor tile – gray w/ black mastic No G Intact G Intact L Floor
Maintenace 7
HMA-B1 1 B 9"x9" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-C1 1 B 12”x12” floor tile - green w/ black mastic No D Damaged D Damaged M Floor
Maintenance 3
HMA-D1 1 B 12"x12" floor tile - white w/ black mastic No G Intact
G Intact L Floor
HMA-J1 1 B 9"x9" floor tile - gray w/ black mastic No G Intact
G Intact L Floor
HMA-K1 1 B 9"x9" floor tile - dark brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-L1 1 B 9"x9" floor tile - tan w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-M1 1 B 9”x9” floor tile - dark grey w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-N1 1 B 12"x12" floor tile - brown w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-Q 1 B 12”x12” floor tile – light white No G Intact G Intact L Floor Maintenance 7
HMA-1 1 B Black mastic No G Intact G Intact L Floor Maintenance 7
HMA-19 1 B ACM pipe insulation and mudded fittings Yes SD Intact SD Significantly
Damaged M Maintenance 1
Building 1 – Basement
HMA- D1 1 0 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 6
HMA- E1 1 0 9”x9” Floor Tile- White w/ Black Mastic No G Intact G Intact M Floor
Maintenance 6
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-F1 1 0
12”x12” Floor Tile- White w/ Brown Streaks w/ Black
Mastic No G Intact G Intact M Floor
Maintenance 6 B003 Tile removed/ but mastic remains
HMA-01 1 0 Pipe Insulation & Fittings Yes D Damage to TSI D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 0 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 0 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-19 1 0 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 0
Wall Mounted Heaters/Steam Convector
Units (Heat Shields Presumed)
No G Intact G Intact L Access 8
HMA-34 1 0
Black Mastic Under
12”x12” White w/ Charcoal Streaks
No G Intact G Intact L Maintenance 7
HMA-102 1 0
12”x12” Floor Tile- Off White/Cream w/
Gray/White Specs w/ Black Mastic
No G Intact G Intact M Floor
HMA-128 1 0 TSI Insulation Saddles on CWS Pipe Hangars Yes G Intact G Intact M Access 6 CB03 all fittgs abated
HMA-140 1 0
Black Mastic Under
Unknown Layer Under
HMA 41
HMA-151 1 0
Unknown Layer Under
HMA 91
HMA-163 1 0 HVAC Duct Insulation, Soft Gray Yes G Intact G Intact M Access 6 No Visibility
HMA-173 1 0 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 1st Floor
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-C1 1 1 12”x12” Floor Tile w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-G1 1 1 9”x9” Floor Tile- Brown w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-H1 1 1
12”x12” Floor Tile- White w/ Green Streaks w/ Black
Mastic
HMA-01 1 1 Pipe Insulation & Fittings Yes D Damage to TSI D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 1 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 1 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-19 1 1 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 1
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-77 1 1
12”x12” Floor Tile- White w/ Large Beige Specs
HMA-128 1 1 TSI Insulation Saddles on CWS Pipe Hangars Yes G Intact G Intact M Access 6
HMA-133 1 1 Black Wrap TSI No G Intact G Intact M Access 6
HMA-140 1 1
Black Mastic Under
Unknown Layer Under
HMA 41
HMA-143 1 1 Unknown Floor Tile Layer Under HMA32 No G Intact G Intact L Floor
Maintenance 7
HMA-151 1 1
Black Mastic Under
Unknown Layer Under
HMA 91
HMA-163 1 1 HVAC Duct Insulation, Soft
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-173 1 1 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 2nd Floor
HMA- D1 1 2 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 6
HMA-F1 1 2
12”x12” Floor Tile- White w/ Brown Streaks w/ Black
Mastic
HMA-I1 1 2
12”x12” Floor Tile- White w/ Brown/Gray Spots w/
Black Mastic
HMA-J1 1 2 12”x12” Floor Tile- Green w/ Black Mastic No G Intact G Intact M Floor
Maintenance 6
HMA-01 1 2 Pipe Insulation & Fittings Yes D Damage to TSI D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 2 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 2 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-19 1 2 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 2
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-70 1 2
12”x12” Floor Tile- Dark Blue w/ White Specs
HMA-128 1 2 TSI Insulation Saddles on
HMA-143 1 2 Unknown Layer Under HMA32 No G Intact G Intact L Floor
Maintenance 7
HMA-147 1 2 Unknown Layer Under HMA 32 No G Intact G Intact L Floor
Maintenance 7
HMA-163 1 2 HVAC Duct Insulation, Soft
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-173 1 2 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 3rd Floor
HMA- D1 1 3 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 6
HMA- E1 1 3 9”x9” Floor Tile- White w/ Black Mastic No G Intact G Intact M Floor
Maintenance 6
HMA-I1 1 3
12”x12” Floor Tile- White w/ Brown/Gray Spots w/
Black Mastic
HMA-01 1 3 Pipe Insulation & Fittings Yes D Damaged to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 3 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 3 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-19 1 3 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 3
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-128 1 3 TSI Insulation Saddles on
HMA-163 1 3 HVAC Duct Insulation, Soft Gray Yes G Intact G Intact M Access 6 Limited Visibility
HMA-173 1 3 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 4th Floor
HMA-D1 1 4 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7 412-all piping abated- new floor tle
HMA-E1 1 4 9”x9” Floor Tile- White w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-K1 1 4 12”x12” Floor Tile- Light Tan w/ Brown Spots w/ No G Intact G Intact M Floor
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
Black Mastic
HMA-K2 1 4
12”x12” Floor Tile- Light Tan w/ Brown Spots w/
Yellow Mastic
HMA-N1 1 4
12”x12” Floor Tile- Green w/ Brown Spots w/ Black
Mastic
HMA-N2 1 4
w/ Brown Spots w/ Yellow
Mastic
HMA-O1 1 4 9”x9” Floor Tile- Gray w/
Maintenance 7
HMA-P1 1 4
12”x12” Floor Tile- White w/ Black Stripes w/ Black
Mastic No G Intact G Intact M Floor
Maintenance 7
Tsi abated-a400.h403h,402,435,426,427,428,4 25,424,429,430,423,422,431,421,4
HMA-01 1 4 Pipe Insulation & Fittings Yes D Damage to TSI D Intact L Access 8
A401,476,407,408,443,442,442a,4 40a tsi abated
HMA-01 1 4 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 4 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 1 4 Sink Soundproofing- White No G Intact G Intact H Access 8
HMA-19 1 4 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 4
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-128 1 4 TSI Insulation Saddles on
HMA-142 1 4 Unknown Floor Tile Layer Under HMA 51 No G Intact G Intact L Floor
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-143 1 4 Unknown Floor Tile Layer Under HMA32 No G Intact G Intact L Floor
Maintenance 7
HMA-151 1 4
Black Mastic Under
Unknown Layer Under
HMA 91
No G Intact G Intact L Floor Maintenance 8
HMA-163 1 4 HVAC Duct Insulation, Soft
HMA-173 1 4 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 5th Floor
HMA-D1 1 5 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7 506-aal piping abated-new floor tile
HMA-E1 1 5 9”x9” Floor Tile- White w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-I1 1 5
12”x12” Floor Tile- White w/ Brown/Gray Spots w/
Black Mastic
HMA-J2 1 5 12”x12” Floor Tile- Green w/ Yellow Mastic No G Intact G Intact M Floor
Maintenance 6
HMA-N1 1 5
12”x12” Floor Tile- Green w/ Brown Spots w/ Black
Mastic
HMA-N2 1 5
w/ Brown Spots w/ Yellow
Mastic
HMA-P2 1 5 12”x12” Floor Tile- White w/ Black Stripes No G Intact G Intact M Floor
Maintenance 7
HMA-Q1 1 5
12”x12” Floor Tile- Light Brown w/ Dark Brown and Tan Spots w/ Black Mastic
HMA-X1 1 5 9”x9” Floor Tile- Tan w/
Maintenance 8 575 tsi abated
HMA-01 1 5 Pipe Insulation & Fittings Yes D Damage to TSI D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 5 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD Intact L Access 1
Tsi abated h505h,504,557,555,558a,556,556a, 554,559,559a,552,561,562,550,549
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-05 1 5 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7 549a,548,571,573,548,568a,568b,5 67a,576b,566,569,570a,565a,565,5
HMA-17 1 5 Sink Soundproofing- White No G Intact G Intact H Access 8
HMA-19 1 5 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 5
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-39 1 5
12”x12” Floor Tile White w/ Large Dark Gray Specs
HMA-48 1 5
12”x12” Floor Tile – Slate Blue w/ Gray and White
Markings
HMA-127 1 5 Black Tar Wrap on Fiberglass HVAC No G Intact D Intact M Access 6
HMA-128 1 5 TSI Insulation Saddles on CWS Pipe Hangars Yes G Intact G Intact M Access 6
HMA-140 1 5
Black Mastic Under
Unknown Layer Under
HMA 41
HMA-142 1 5 Unknown Layer Under HMA 51 No G Intact G Intact L Floor
Maintenance 8
HMA-143 1 5 Unknown Layer Under HMA 32 No G Intact G Intact L Floor
Maintenance 8
HMA-163 1 5 HVAC Duct Insulation, Soft Gray Yes G Intact G Intact M Access 6 Limited Visibility
HMA-173 1 5 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 6th Floor
HMA-D1 1 6 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-K2 1 6 12”x12” Floor Tile- Light Tan w/ Brown Spots w/ No G Intact G Intact M Floor
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
Yellow Mastic
HMA-N1 1 6
12”x12” Floor Tile- Green w/ Brown Spots w/ Black
Mastic
HMA-S1 1 6
12”x12” Floor Tile- Dark Tan w/ Tan and Brown Spots w/ Black Mastic
No G Intact G Intact M Floor Maintenance 7
Tsi abated A614,h601,610,611,611a,61a,612,6 09,613,608,613a,613b,697,605,606
HMA-01 1 6 Pipe Insulation & Fittings Yes D Damage to TSI D Intact L Access 8 Tsi abated
HMA-01 1 6 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 6 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-19 1 6 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 6
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-34 1 6 12”x12” Floor Tile- White w/ Charcoal Streaks No G Intact G Intact M Floor
Maintenance 8
HMA-39 1 6
Black Mastic Under
12”x12” Floor Tile White w/ Large Dark Gray Specs
HMA-128 1 6 TSI Insulation Saddles on
HMA-143 1 6 Unknown Layer Under HMA 32 No G Intact G Intact L Floor
Maintenance 8
HMA-163 1 6 HVAC Duct Insulation, Soft Gray Yes G Intact G Intact M Access 6 No Visibility
HMA-173 1 6 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 7th Floor
HMA-A1 1 7 Black Mastic Under Linoleum No G Intact G Intact L Floor
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-D1 1 7 12”x12” Floor Tile- Light Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-H1 1 7
12”x12” Floor Tile- White w/ Green Streaks w/ Black
Mastic
HMA-M1 1 7
12”x12” Floor Tile- Dark
Tan w/ Brown Spots w/Black Mastic
HMA-01 1 7 Pipe Insulation & Fittings Yes D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 7 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 7 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 1 7 Sink Soundproofing- White No G Intact G Intact H Access 5
HMA-19 1 7 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 7
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
HMA-34 1 7
12”x12” Floor Tile- White w/ Charcoal Streaks
HMA-35 1 7
12”x12” Floor Tile- Light Tan w/ Gray Streaks
HMA-36 1 7
12”x12” Floor Tile- White w/ Navy Streaks and Specs
HMA-106 1 7
12”x12” Floor Tile- Peach w/ White and Faint Peach
Specs
HMA-128 1 7 TSI Insulation Saddles on
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-143 1 7 Unknown Layer Under HMA 32 No G Intact G Intact L Floor
Maintenance 8
HMA-153 1 7
Black Mastic Under
Unknown Layer Under
HMA 36
HMA-163 1 7 HVAC Duct Insulation, Soft
HMA-164 1 7
12”x12” Floor Tile- Beige w/ Gray and Red Specs w/
Black Mastic
HMA-173 1 7 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 8th Floor
HMA-J1 1 8 12”x12” Floor Tile- Green w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-N1 1 8
12”x12” Floor Tile- Green w/ Brown Spots w/ Black
Mastic
HMA-O1 1 8 9”x9” Floor Tile- Gray w/
Maintenance 7
HMA-T1 1 8
12”x12” Floor Tile- White w/ Brown Splotches w/ Black Mastic
HMA-01 1 8 Pipe Insulation & Fittings Yes D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 8 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 8 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 1 8 Sink Soundproofing- White No G Intact G Intact H Access 5
HMA-19 1 8 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 8
Wall Mounted
Heaters/Steam Convector Units (Heat Shields
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
Presumed)
HMA-128 1 8 TSI Insulation Saddles on CWS Pipe Hangars Yes G Intact D Intact M Access 6 Free saddle sitting above cables, see map
HMA-163 1 8 HVAC Duct Insulation, Soft Gray Yes G Intact G Intact M Access 6 Limited Visibility
HMA-173 1 8 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 9th Floor
HMA-F2 1 9 12”x12” Floor Tile- White w/ Brown Streaks No G Intact G Intact M Floor
Maintenance 7 901-all piping,tile,mastic,and duct insulation abated
HMA-X1 1 9 9”x9” Floor Tile- Tan w/ Black Mastic No G Intact G Intact M Floor
Maintenance 7
HMA-18 1 9
12”x12” Floor Tile- Tan w/
Brown Streaks w/ Black Mastic
HMA-01 1 9 Pipe Insulation & Fittings Yes D Damage to
TSI M Access 3 See maps for specific locations of Damaged TSI
HMA-01 1 9 Pipe Insulation & Fittings Yes SD Significant Damage to
TSI
SD
Significant Damage to
TSI
M Access 1 See maps for specific locations of
Significantly Damaged TSI
HMA-05 1 9 Fire Doors (Assumed) No G Intact G Intact L Maintenance 7
HMA-08 1 9 Transite Counters No G Intact G Intact M Maintenance 6
HMA-17 1 9 Sink Soundproofing- White No G Intact G Intact H Access 5
HMA-18 1 9
12”x12” Floor Tile- Tan w/
Brown Streaks w/ Black Mastic
HMA-19 1 9 Black Tar on Fiberglass Pipe Insulation No G Intact G Intact M Access 6
HMA-20 1 9
Wall Mounted Heaters/Steam Convector
Units (Heat Shields
Friable Yes/No
Previous Condition Current Condition 1 Potential for Disturbance 2 Removal
Priority 3 Comments
Rating Based On Rating Based On
Rating Based On
HMA-127 1 9 Black Tar Wrap on Fiberglass HVAC No G Intact G Intact M Access 6
HMA-128 1 9 TSI Insulation Saddles on CWS Pipe Hangars Yes G Intact G Intact M Access 6
HMA-163 1 9 HVAC Duct Insulation, Soft Gray Yes G Intact G Intact M Access 6 No Visibility
HMA-173 1 9 Cork and Tar Pipe Insulation No G Intact G Intact M Access 6 Loose cork substrate damaged in locations noted on maps; tar intact
Building 1 – 10th Floor
No ACM
Building 1 – 11th Floor
No ACM
Building 1 – Exterior
HMA-124 1 Ext Residual Exterior Door Caulk- White (Old/Brittle) Yes G Intact G Intact M Maintenance 6 Appears to be caulking from old door frame; loading dock area
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
BUILDING 1T
SIX MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/29/21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 1T – 1st Floor
HMA-8 1T 1 Fire door (PACM) No G Intact G Intact L Renovation 7
Building 1T – Exterior
No ACM Detected
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
BUILDING 2
SIX MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/29/21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 2 – Basement
HMA-6 2 B Fire Door (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 2 B Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-39 2 B Seam Sealant – White No G Intact G Intact L Maintenance 7
Building 1 – 1st Floor
HMA-D 2 1 12”x12” Floor Tile- Tan No G Intact G Intact L Floor Maintenance 6
HMA-E1 2 1 9”x9” Floor Tile- Tan w/ Black Mastic No G Intact G Intact L Floor
Maintenance 6
HMA-F1 2 1 9”x9” Floor Tile- Gray w/ Black Mastic No G Intact G Intact L Floor
Maintenance 6
HMA-G1 2 1 9”x9”x Floor Tile- Brown w/ Black Mastic No G Intact G Intact L Floor
Maintenance 6
HMA-5 2 1 Pipe Insulation and Fittings Yes D Damage G Intact L Access 7 Encapsulated
HMA-6 2 1 Fire Door (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 2 1 Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-28 2 1 Steam Convector Unit (PACM) No G Intact G Intact L Maintenance 7
HMA-39 2 1 Seam Sealant -White No G Intact G Intact L Maintenance 7
Building 2 – 2nd Floor
HMA-B1 2 2 Black Mastic Under 12”x12” Floor Tile- White No G Intact G Intact L Floor
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
HMA-D 2 2 12”x12” Floor Tile- Tan No G Intact G Intact L Floor Maintenance 6
HMA-F1 2 2 9”x9” Floor Tile- Gray w/ Black Mastic No G Intact G Intact L Floor
Maintenance 6
HMA-5 2 2 Pipe Insulation and Fittings Yes D Damaged G Intact L Access 7 Encapsulated
HMA-6 2 2 Fire Door (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 2 2 Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-28 2 2 Steam Convector Unit (PACM) No G Intact G Intact L Maintenance 7
HMA-32 2 2 Sink Soundproofing- White, Textured No G Intact G Intact L Maintenance 6
HMA-39 2 2 Seam Sealant -White No G Intact G Intact L Maintenance 7
Building 2 – 3rd Floor
HMA-B1 2 3 Black Mastic Under 12”x12” Floor Tile- White No G Intact G Intact L Floor
Maintenance 7
HMA-D 2 3 12”x12” Floor Tile- Tan No G Intact G Intact L Floor Maintenance 6
HMA-F1 2 3 9”x9” Floor Tile- Gray w/ Black Mastic No G Intact G Intact L Floor
Maintenance 6
HMA-6 2 3 Fire Door (Assumed) No G Intact G Intact L Maintenance 7
HMA-17 2 3 Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-28 2 3 Steam Convector Unit (PACM) No G Intact G Intact L Maintenance 7
HMA-32 2 3 Sink Soundproofing- White, Textured No G Intact G Intact L Maintenance 6
HMA-35 2 3 Penetration Caulk- Brown No G Intact G Intact L Maintenance 7
HMA-39 2 3 Seam Sealant -White No G Intact G Intact L Maintenance 7
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 2 – Attic
HMA-39 2 Attic Seam Sealant -White No G Intact G Intact L Maintenance 7
Building 2 – Exterior
HMA-15 2 Ext Exterior Louver Sill Sealant
– Black No G Intact G Intact L Maintenance 7
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
BUILDING 3
SIX-MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/29/21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 3 – Basement
HMA-5 3 B Fire Door (PACM) No G Intact G Intact L Maintenance 7
HMA-10 3 B Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-18 3 B Interior Textured Wall Material No G Intact G Intact L Maintenance 7
HMA-33 3 B TSI Pipe Insulation Yes SD Significantly Damaged SD Significantly
Damage M Access/ Maintenance 1 Sealed confined space entry to tunnels
HMA-33 3 B TSI Pipe Insulation Yes G Intact G Intact L Maintenance 6
Building 3 – 1st Floor
HMA-B1 3 1 12”x12” Floor Tile – Gray w/ Black Mastic No G Intact G Intact L Flooring
Maintenance 7 Assumed underneath wood sub-floor
HMA-C1 3 1 9”x9” Floor Tile – Green w/ Black Mastic No G Intact G Intact L Flooring
Maintenance 7 Assumed underneath wood sub-floor
HMA-D1 3 1 9”x9” Floor Tile – Brown w/ Black Mastic No G Intact G Intact L Flooring
Maintenance 7 Assumed underneath wood sub-floor
HMA-F 3 1 Felt No G Intact G Intact L Flooring Maintenance 7 Assumed underneath wood sub-floor
HMA-1 3 1 Black Mastic Under Carpet No G Intact G Intact L Flooring Maintenance 7
HMA-5 3 1 Fire Door (PACM) No G Intact G Intact L Maintenance 7
HMA-10 3 1 Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-13 3 1 Wall Mounted Heater (PACM) No G Intact G Intact L Maintenance 7
HMA-18 3 1 Interior Textured Wall Material No G Intact G Intact L Maintenance 7
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
HMA-24 3 1 Interior Window Caulk – Grey No G Intact G Intact L Maintenance 7
HMA-33 3 1 TSI Pipe Insulation Yes G Intact G Intact L Access/ Maintenance 6
Building 3 – 2nd Floor
HMA-B1 3 2 12”x12” Floor Tile – Gray w/ Black Mastic No G Intact G Intact L Flooring
Maintenance 7 Assumed underneath wood sub-floor
HMA-D1 3 2 9”x9” Floor Tile – Brown w/ Black Mastic No G Intact G Intact L Flooring
Maintenance 7 Assumed underneath wood sub-floor
HMA-F 3 2 Felt No G Intact G Intact L Flooring Maintenance 7 Assumed underneath wood sub-floor
HMA-5 3 2 Fire Door (PACM) No G Intact G Intact L Maintenance 7
HMA-10 3 2 Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
HMA-13 3 2 Wall Mounted Heater (PACM) No G Intact G Intact L Maintenance 7
HMA-18 3 2 Interior Textured Wall Material No G Intact G Intact L Maintenance 7
HMA-33 3 2 TSI Pipe Insulation No G Intact G Intact L Access/ Maintenance 6
Building 3 – Attic
HMA-10 3 A Flange Gasket (PACM) No G Intact G Intact L Maintenance 7
Building 3 – Exterior
No ACM Detected No records of ACM stucco abatement. ACM layer may exist under non- ACM layer.
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
BUILDING 3T
SIX MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/29/21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 3T- Crawlspace
No ACM Detected
Building 3T – 1st Floor
No ACM Detected
Building 3T – Exterior
Good (G) Surfacing material has no visible damage; covering on TSI is intact; miscellaneous materials are intact; no visible debris.
Damaged (D) Surfacing material has moderate but not extensive visible damage; covering on TSI is cut or torn, exposing small but not extensive amounts of insulation; miscellaneous materials have moderate but not extensive damage; moderate but not extensive amounts of visible debris
Significantly Damaged (SD) Extensive damage to surfacing material; covering on TSI is cut or torn extensively and insulation itself is damaged; miscellaneous materials such as floor tile is extensively damaged and underlying
Note: Damage is considered “extensive” when the total area of distributed damage exceeds 10%, or 25% localized damage.
Contact (accessibility) Influence of Vibration Potential for Air Erosion or
Water Damage
HIGH (H)
(potential for significant damage) High Any Value Any Value
Any Value High Any Value Any Value Any Value High
MODERATE (M)
(potential for damage)
Moderate Moderate or Low Moderate or Low Moderate or Low Moderate Moderate or Low Moderate or Low Moderate or Low Moderate
LOW (L) Low Low Low Note: Overall rating determined by assigning disturbance probabilities under all 3 categories then adopting highest individual score for each material.
Qualitative Rankings and Numerical Ratings for Removal Priority of ACM Hazard Rank/
Removal Priority ACBM Condition ACBM Disturbance
Potential Recommended Response Actions
1 Significantly Damaged
Any Evacuate or isolate area immediately. Remove ACBM immediately. O&M Required for all friable ACBM.
2 Damaged High Evacuate or isolate area immediately. Remove, enclose, encapsulate or repair ACBM to correct immediately. Reduce potential for disturbance of remaining materials. O&M Required for all friable ACBM.
3 Damaged Moderate Remove, enclose, encapsulate, or repair to correct damage as soon as feasible.
O&M Required for all friable ACBM.
4 Damaged Low Remove, enclose, encapsulate, or repair to correct damage as needed to facilitate future projects. Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
5 Good High Take steps to reduce potential for disturbance. O&M Required for all friable ACBM.
6 Good Moderate O&M Required for all friable ACBM.
BUILDING 18
SIX MONTH PERIODIC SURVELLIANCE FORM
09/01/21-09/29/21
Homogeneous Area No. Bldg Floor Material Description
Friable Yes/No
Previous Condition Current Condition Potential for Disturbance Removal
Priority Comments
Rating Based On Rating Based On
Rating Based On
Building 18 – Crawlspace
HMA-52 18 C Contaminated crawlspace soil Yes SD Significant damage SD Significant Damage M Maintenance/
Access 1 Crawlspace soil exists under thick rubber flooring
Building 18 – Basement
HMA-A1 18 B 12”x12” floor tile – white w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-B1 18 B 12”x12” floor tile – tan w/ black mastic No G Intact G Intact L Floor
Maintenance 7
HMA-6 18 B ACM pipe insulation and mudded fittings Yes G Intact G Intact L Maintenance/
Access 5
HMA-6 18 B ACM pipe insulation and mudded fittings Yes D Damaged D Damaged M Maintenance/
Acc…
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