Survey Request_02.09.09_403.doc

ASBESTOS/LEAD SURVEY REQUEST FORM

W.O./J.O. #:

SURVEY #: 96/97

REQUESTER’S NAME AND PHONE #: Sean McNiel LOCATION : Fort MacArthur, Community Center Kitchen Area, Building 403

DATE SUBMITTED: 3/3/2009

DATE REQUIRED (At least 10 days from submission): ASAP DESCRIPTION OF PROPOSED WORK: Renovate Kitchen area including restrooms and storage areas LIST SPECIFIC AREAS THAT MAY BE DISTURBED: Flooring, walls, ceilings, restroom fixtures, ARE SITE MAPS, SKETCHES, and SOW AVAILABLE? FORMCHECKBOX

NO

FORMCHECKBOX

YES, Please attach all building sketches and drawings

& place in CEZV mailbox)

CUSTOMER CONTACT INFORMATION (Name and Phone #):

DO NOT WRITE BELOW THIS LINE

FOR CELS/CEAE USE

PREVIOUS SAMPLES COLLECTED IN HOMOGENEOUS (Similar) AREAS? FORMCHECKBOX

YES, SEE BELOW FORMCHECKBOX

NO

INSPECTION DATE: 02/09/2009

INSPECTION ATTENDEES: Beth Jones INSPECTION INFORMATION: Conducted inspection and sampling of kitchen area

SAMPLE DATA: ASBESTOS

A020909.403.01 A020909.403.02

A020909.403.03 Room 5 Room 1

Room 2

A020909.403.04 A020909.403.05

A020909.403.06 Room 6 Room 6

Room 6

A020909.403.07 A020909.403.08

A020909.403.09 Room 9 Room 9

“Snack Kitchen”

A020909.403.10

A020909.403.11

A020909.403.12 “Snack Kitchen”

“Snack Kitchen”

“Snack Kitchen”

A020909.403.13

A020909.403.14

A020909.403.15 Room 6

Room 6

Room 5

A020909.403.16 A020909.403.17

A020909.403.18 Room 10 Room 10

Room 10

ND denoted Non-Detect for asbestos fiber. Please see CSC Survey # 1014468 for additional lead and asbsetos sampling results.

SAMPLE DATA: LEAD

Any material containing greater than 600 parts per million (ppm) is considered lead-based in the State of California.

RISK ASSESSMENT REQUIRED: FORMCHECKBOX

YES FORMCHECKBOX

NO

FINDINGS AND RECOMMENDATIONS:

ASBESTOS

· Asbestos was not detected in flooring materials. (see survey results above). There were several areas throughout the kitchen and associated rooms, where multiple layers of identical floor tiles were identified. Samples were taken of both the top and bottom layers, both of which were found non-detect for asbestos. If flooring not matching any of the above descriptions is identified, stop work immediately and notify 61 CELS/CEAN.

· These results are for estimation purposes only. If any suspect materials not identified above are identified during the project, work must stop until sampling can be conducted, the contractor will be responsible for conducting all required abatement activities as required per Federal, State and Local regulations.

· If asbestos-containing building materials are disturbed at any time during the project, or if removal is required to complete the project, a certified/registered asbestos abatement contractor shall be utilized to properly remove or impact asbestos-containing materials and dispose of asbestos waste properly.

· All work must comply with Environmental Engineering Asbestos Abatement and Disposal Requirements Specifications 02085.

LEAD-BASED PAINT

· Lead-based coatings were not identified in the blue glaze on the ceramic tiles; however all glossed tiles (present in Room 7, and Room 10) shall be considered lead-glazed unless proven otherwise (see survey results above).

· If lead-based coatings are to be disturbed at any time during the project, or if removal is required to complete the project, a certified/registered lead abatement contractor shall be utilized to properly remove or impact lead containing materials and dispose of lead waste properly.

· All work must comply with Environmental Engineering Lead-based Paint Abatement and Disposal Requirements Specifications 02086 Should you have any questions, please contact Beth Jones at (310) 653-5496 INSPECTOR: Beth Jones

DATE: 3/3/2009

This Form May Not Be Altered

Revised April 2002