ESBD_401277_1748872566336_AT04E2~1.PDF

ATTACHMENT G.L - Ellington Field JRB Final Asbestos Abatement Report Template

ELLINGTON FIELD JOINT RESERVE BASE

FINAL ASBESTOS ABATEMENT REPORT

FOR WORK PERFORMED AT:

PROJECT NUMBER:

PREPARED FOR:

Ellington Field JRB

14657 Sneider Street Houston, Texas 77034

REPORT DATE:

14657 Sneider Street

Houston, Texas 77034 281-929-2013

Project Number: Date:

FINAL ASBESTOS ABATEMENT REPORT

Date

Address of Company

Ellington Field JRB Project Number:

Prepared by: ____________________________________________

Project Manager

Reviewed by: ____________________________________________

TDSHS Asbestos Consultant, License #

Company Logo

Company Address

Table of Contents

PROJECT INFORMATION _______________________________________________ 1

ASBESTOS ABATEMENT COMPLETION REPORT 1

Project Location

PROJECT SUMMARY 1

APPENDICES _________________________________________________________ 3

Appendix 1: TDSHS Notifications

Appendix 2: Summary of Air Samples

Air Sample Results

Appendix 3: Chain of Custody Forms

Appendix 4: Summary of Monitoring

Air Monitoring Field Forms

Appendix 5: Daily Project Notes & Additional Field Forms

Appendix 6: TDSHS Certifications and Licenses

Prime and Subcontractors

Appendix 7: Pictures- (Before and After)……………………………………………………………3

Appendix 8: Signed Copies of All Waste Manifests…………………………………….3

Project Information

ELLINGTON FIELD PROJECT NUMBER:

ASBESTOS ABATEMENT COMPLETION REPORT

This report represents a summary of the asbestos abatement, project duration, and air monitoring results for the abatement project conducted on Date:

Project Location

All of the work described within this report was conducted at the following location:

Location:

Owner/Generator: Ellington Field Joint Reserve Base Environmental Manager Mr. Mark A. Garcia

Project Type: Asbestos abatement of ???????????.

Ellington Project: #######

PROJECT SUMMARY (EXAMPLE TEXT SUBMISSION)

ACME Environmental submitted the Original Notification for abatement to the Texas Department of State Health Services (TDSHS) on November 14, 20?? (Attached) to precede the 10 day notification for the State. ACME Environmental submitted an amendment on December 1, 20??

If required. The project will comply with Texas Health and Human Services, Texas Laws and Regulations under Operational Codes Chapter 1954-Asbestos Health Protection, Texas Administrative Code, Title 25, Part 1, Chapter 296-Texas Asbestos Health Protection and Federal Code of Regulations, Title 40, Chapter1, Part 61-National Emission Standards for Hazardous Air Pollutants (NESHAP).

ACME Environmental, TDSHS License Number ##-####, conducted the asbestos abatement for the project listed above. ACME Environmental, TDSHS Waste Transporter License Number ##- #### and EPA ID Number ##-#####, provided waste transportation to ##### Landfill located in Houston, Texas.

The abatement project included the removal of approximately 1,350 square feet (sf) of asbestos-containing floor tile and mastic. The materials removed from the site were collected and manifested (Manifest Number #####) per regulations set forth by the Texas Commission on Environmental Quality (TCEQ). The manifest was properly signed by the Ellington Field Base Environmental Manager signifying the military base as the generator.

Mr. Bob Doe, TDSHS Asbestos Air Monitoring Technician License Number ##-####, continually monitored work performance and compliance with federal, state and local regulations, conducted the final visual inspection for cleanliness, and provided daily air monitoring during the abatement project. All licenses can be found in Appendix 6.

ACME SUBCONTRACTOR collected and analyzed Phase Contrast Microscopy (PCM) samples according to National Institute of Occupational Safety and Health (NIOSH) methods. ACME SUBCONTRACTOR is a participant in the NIOSH Proficiency and Analytical Testing Program (PAT) and performs fiber count analysis by the NIOSH Method 7400 Revision 3, Rule A. ACME SUBCONTRACTOR is a licensed asbestos laboratory with the TDSHS, Toxic Substance Control Division for analysis of airborne asbestos fibers.

Area air monitoring was conducted by ACME SUBCONTRACTOR in accordance with the Texas Asbestos Health Protection Rules (TAHPR). Area samples were collected on December 1-6, 20XX. All of the area air samples collected outside the work area were at or below the threshold value of 0.01 fibers / cubic centimeter (f/cc) or below the limit of detection (L.O.D.).

All of the personal samples were below the OSHA Permissible Exposure Limit (PEL) for the Short Term Exposure (STEL) of 1.0 f/cc and the Time Weighted Average (TWA) limit of 0.1 f/cc.

The contract was performed in general compliance with contract documents. All ACME SUBCONTRACTOR post-abatement submittals are attached. ACME Environmental post-abatement submittals will be sent under separate cover from the contractor.

Appendices

TECHNICAL DETAILS AND ATTACHMENTS

Appendix 1: TDSHS Notifications

Appendix 2: Air Sample Results

Appendix 3: Chain of Custody Forms

Appendix 4: Air Monitoring Field Forms

Appendix 5: Daily Project Notes & Additional Field Forms

Appendix 6: TDSHS Certifications and Licenses

Appendix 7: Pictures

Appendix 8: Signed Copies of All Waste Manifests

TDSHS Notifications

Air Sample Results

Chain of Custody Forms

Air Monitoring Field Forms

Daily Project Notes & Additional Field Forms

TDSHS Certifications and Licenses

PICTURES

Copies of All Signed Waste Manifests