Atch_56_Asbestos_ _LBP_Reports _RKMF_16-0062_Rpr_Courtroom _Bldg_16 _Mar_2016.pdf

Nellis Air Force Base Asbestos and Lead Based Paint Inspection Report

Work Order Scope of Work:

Renovate the building

Building Number: 16

Inspection Date: 3/4/2016

Nellis Work Order: 27298

Macrotec Job Number: 16539

The information contained in this report pertains only to the specific area defined in the above scope of work. This summarized report is for reference purposes, only. A detailed generic report is on file with Nellis Air Force Base Civil Engineering. Only proper personnel should interpret this report to determine whether the information herein can be utilized for current and future renovation activities within the building

Macrotec Consulting, LLC. performed an inspection for Asbestos Containing Building Materials and Lead Based Paint. The intent of this inspection was to identify materials containing asbestos and lead, within the subject site, that may be impacted during planned renovation activities.

Introduction:

Report Limitations:

Dustin R. McAllister

Nevada-OSHA Certified Asbestos Abatement Consultant

License # IPM0961

US EPA Lead Risk Assessor

Certificate # NV-R-16781-2

9724 Mild Weather Ct., Las Vegas, NV 89148 Phone: (702) 338-8213 Fax: (702) 629-5677

Macrotec Consulting, LLC.

Appendix A - Asbestos Assessment

Macrotec Job #16539 - Bldg. 16

The following table lists each of the materials suspected to contain asbestos at the subject site. For each material the sample number, location and laboratory result are listed. If the material was found to contain asbestos, the friablity and NESHAP classification is identified.

1 Wall Substrate (Drywall & Mud) - Wallpapered This material is located on various walls throughout the building.

No Asbestos Detected

None DetectedInterior - Open Area - Adj. SW Exterior DoorAB1

None DetectedInterior - Open Area - Adj. Door to Room 1AB2

2 Wall Substrate (Drywall & Mud) - Textured This material is located on various walls throughout the building.

No Asbestos Detected

None DetectedInterior - Room 5 - Adj. doorAB3

None DetectedInterior - Room 2 - Adj. doorAB4

None DetectedInterior - Open Area - Adj. Door to Room 9AB5

3 Spray-on Wall Texture - This material is located atop various walls throughout the building.

No Asbestos Detected

None DetectedInterior - Room 7 - Adj. Door to Open AreaAB6

None DetectedInterior - Room 4 - S wallAB7

None DetectedInterior - Open Area - E wallAB8

None DetectedInterior - Room 9 - SW cornerAB9

None DetectedInterior - Room 3 - Adj. doorAB10

4 Carpet & Base Cove Mastic - Yellow This material is located on the floor below the carpet throughout the building. (except in bathrooms and break room).

No Asbestos Detected

None DetectedInterior - Open Area - Adj. SW Exterior DoorAB11

5 Floor Fill - White This material is located on the floor below the carpet throughout the building. (except in bathrooms and break room).

No Asbestos Detected

None DetectedInterior - Open Area - Adj. Door to Break RoomAB12

6 2X2 Ceiling Tile - This material is located on the ceiling throughout the building.

No Asbestos Detected

None DetectedInterior - Open Area - S sideAB13

Asbestos Survey

WO #27298 - Bldg. 16

Macrotec Job #16539

Appendix A

Macrotec Job #16539 - Bldg. 16

7 Wallpaper & Mastic - Gray This material is located atop various walls throughout the building.

No Asbestos Detected

None DetectedInterior - Open Area - NW cornerAB14

8 Concrete - Gray This material is located on the exterior sidewalks.

No Asbestos Detected

None DetectedExterior - - N sideAB15

9 Brick - This material is located on the exterior walls.

No Asbestos Detected

None DetectedExterior - - N sideAB16

10 Mortar - On Brick This material is located atop the exterior walls.

No Asbestos Detected

None DetectedExterior - - N sideAB17

11 Pipe Wrap - Black Tar/Foam to AC Unit This material is located on the on the pipe to the AC unit adjacent the mechanical room.

No Asbestos Detected

None DetectedExterior - - Adj. Mech. RoomAB18

12 HVAC Duct Wrap - This material is located on the HVAC duct in the mechanical room and assumed to be in the interior of the building.

No Asbestos Detected

None DetectedInterior - Mech Room - W sideAB19

13 HVAC Duct Mud - Gray - On Duct Seams This material is located on the HVAC duct seams in the mechanical room and assumed to be in the interior of the building.

No Asbestos Detected

None DetectedInterior - Mech Room - W sideAB20

Asbestos Survey

WO #27298 - Bldg. 16

Macrotec Consulting, LLC.

Appendix B - Lead Assessment

Macrotec Job #16539 - Bldg. 16

Macrotec conducted analysis of the painted surfaces and/or bulk materials that may be impacted during the defined scope of work, using an XRF analyzer. No lead was detected during the inspection of the suspect materials. Appendix D lists the painted surfaces that were analyzed during this inspection along with its location and analysis result. Note: If suspect materials are found during renovation activities outside what was identified in this report, stop work immediately until further testing can be completed.

Lead Paint Survey

WO #27298 - Bldg. 16

Asbestos and Lead Based Paint Inspection

Nellis AFB—Building 16

Macrotec Project # 16539

Appendix C

Sample Location Diagram

AB1

The walls in the interior and exterior above were tested for lead based paint with a XRF Analyzer. See results page for materials & locations.

AB2

AB3

AB4

AB5

AB6

5 6 7

Break Room

Men’s Room

Woman’s Room

Open Room

Mech. Room

AB7

AB8

AB9

AB10

AB11

AB12

AB13

AB14

AB15AB16

AB17

AB18

AB19

AB20

Macrotec Consulting

TRIANGLE ENVIRONMENTAL SERVICE CENTER, INC.

13509 East Boundary Road, Suite B, Midlothian, VA 23112

2*.(1-3(+1/+ _ MJ\4 2*.(1-3(+1/-

BULK ASBESTOS SAMPLE ANALYSIS SUMMARY

9724 Mild Weather Ct.

Las Vegas, NV 89148

16539

WO #26843- Bldg. 16

160307I

3/7/2016 3/7/2016 3/9/2016

B.TrimmerJOB SITE:

TESC LOGIN #:

DATE OF RECEIPT:

DATE OF ANALYSIS:

DATE OF REPORT:

ANALYST:

TESC

SAMPLE #

CLIENT SAMPLE ID

& GROSS DESCRIPTION

ESTIMATED

% ASBESTOS

NON ASBESTOS

% FIBERS

NON FIBROUS

% MATERIALS

CLIENT:

CLIENT JOB:

10% Cellulose 90%AB1- Drywall / White Powder, Brown Fibers NAD1A

100%AB1- Mud / White Powder NAD1B

10% Cellulose 90%AB2- Drywall / White Powder, Brown Fibers NAD2A

100%AB2-Mud / White Powder NAD2B

10% Cellulose 90%AB3-Drywall / White Powder, Brown Fibers NAD3A

100%AB3- Mud / White Powder NAD3B

10% Cellulose 90%AB4- Drywall / White Powder, Brown Fibers NAD4A

100%AB4- Mud / White Powder NAD4B

5% Cellulose 95%AB5- Drywall / White Powder, Brown Fibers NAD5A

100%AB5- Mud / White Powder NAD5B

Wednesday, March 09, 2016 Page 1 of 3

JQ\_[Ub QaU Q]Q[hiUT Y] QSS^aTQ]SU fYcX jB]cUaY\ EUcX^T V^a cXU =UcUa\Y]QcY^] ^V 9bRUbc^b Y] ;d[Z B]bd[QcY^] JQ\_[Ubk( >H9 2,,+E0)4.),.,( =US* -54.

and "Method for the Determination of Asbestos in Bulk Building Materials", EPA 600/R-93/116, July 1993. None Detected: not detected at/or below the detected limit of method (Reporting limit: 1% Asbestos). Glass fiber is analyzed for quality control blank. TESC recommends by point count or Transmission Electron Microscopy (TEM), for materials regulated by the EPA NESHAP (National Emission Standards for Hazardous Air Pollutants) and found to contain less than ten percent (<10%) asbestos by Polarized Light Microscopy (PLM). Both services are available for an additional fee. This report shall not be reproduced, except in full written approval of Triangle Environmental Service Center, Inc. This report must not be used by the customer to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government. This test report relates only to the item(s) tested.

NVLAP Lab Code: 200794-0 LEGEND NAD=No Asbestos Detected, Lino.=Linoleum, JC=Joint Compound][

Reviewed By Authorized Signatory:

Feng Jiang, MS Senior Geologist, Laboratory Director Yuedong Fang, Senior Geologist

13509 East Boundary Road, Suite B, Midlothian, VA 23112

2*.(1-3(+1/+ _ MJ\4 2*.(1-3(+1/-

BULK ASBESTOS SAMPLE ANALYSIS SUMMARY

9724 Mild Weather Ct.

Las Vegas, NV 89148

16539

WO #26843- Bldg. 16

160307I

3/7/2016 3/7/2016 3/9/2016

B.TrimmerJOB SITE:

TESC LOGIN #:

DATE OF RECEIPT:

DATE OF ANALYSIS:

DATE OF REPORT:

ANALYST:

TESC

SAMPLE #

CLIENT SAMPLE ID

& GROSS DESCRIPTION

ESTIMATED

% ASBESTOS

NON ASBESTOS

% FIBERS

NON FIBROUS

% MATERIALS

CLIENT:

CLIENT JOB:

2% Cellulose 98%AB6 / White Powder NAD6

2% Cellulose 98%AB7 / White Powder NAD7

100%AB8 / White Powder NAD8

100%AB9 / White Powder NAD9

100%AB10 / White Powder NAD10

5% Fiberglass

5% Cellulose 90%AB11 / Yellow Adhesive NAD11

2% Cellulose 98%AB12 / White Powder NAD12

20% Fiberglass

70% Cellulose 10%AB13 / Gray Fibers NAD13

95% Synthetic 5%AB14 / White and Gray Fibers NAD14

2% Cellulose 98%AB15 / Gray Cement NAD15

Wednesday, March 09, 2016 Page 2 of 3

JQ\_[Ub QaU Q]Q[hiUT Y] QSS^aTQ]SU fYcX jB]cUaY\ EUcX^T V^a cXU =UcUa\Y]QcY^] ^V 9bRUbc^b Y] ;d[Z B]bd[QcY^] JQ\_[Ubk( >H9 2,,+E0)4.),.,( =US* -54.

and "Method for the Determination of Asbestos in Bulk Building Materials", EPA 600/R-93/116, July 1993. None Detected: not detected at/or below the detected limit of method (Reporting limit: 1% Asbestos). Glass fiber is analyzed for quality control blank. TESC recommends by point count or Transmission Electron Microscopy (TEM), for materials regulated by the EPA NESHAP (National Emission Standards for Hazardous Air Pollutants) and found to contain less than ten percent (<10%) asbestos by Polarized Light Microscopy (PLM). Both services are available for an additional fee. This report shall not be reproduced, except in full written approval of Triangle Environmental Service Center, Inc. This report must not be used by the customer to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government. This test report relates only to the item(s) tested.

NVLAP Lab Code: 200794-0 LEGEND NAD=No Asbestos Detected, Lino.=Linoleum, JC=Joint Compound][

Reviewed By Authorized Signatory:

13509 East Boundary Road, Suite B, Midlothian, VA 23112

2*.(1-3(+1/+ _ MJ\4 2*.(1-3(+1/-

BULK ASBESTOS SAMPLE ANALYSIS SUMMARY

9724 Mild Weather Ct.

Las Vegas, NV 89148

16539

WO #26843- Bldg. 16

160307I

3/7/2016 3/7/2016 3/9/2016

B.TrimmerJOB SITE:

TESC LOGIN #:

DATE OF RECEIPT:

DATE OF ANALYSIS:

DATE OF REPORT:

ANALYST:

TESC

SAMPLE #

CLIENT SAMPLE ID

& GROSS DESCRIPTION

ESTIMATED

% ASBESTOS

NON ASBESTOS

% FIBERS

NON FIBROUS

% MATERIALS

CLIENT:

CLIENT JOB:

2% Cellulose 98%AB16 / Brown Granular NAD16

2% Cellulose 98%AB17 / Red Granular NAD17

100%AB18 / Black Foam-like NAD18

15% Fiberglass

70% Cellulose 15%AB19 / Tan Fibers, Foil NAD19

5% Cellulose 95%AB20 / Gray Adhesive NAD20

Total Samples/Layers Analyzed: 25

Wednesday, March 09, 2016 Page 3 of 3

JQ\_[Ub QaU Q]Q[hiUT Y] QSS^aTQ]SU fYcX jB]cUaY\ EUcX^T V^a cXU =UcUa\Y]QcY^] ^V 9bRUbc^b Y] ;d[Z B]bd[QcY^] JQ\_[Ubk( >H9 2,,+E0)4.),.,( =US* -54.

and "Method for the Determination of Asbestos in Bulk Building Materials", EPA 600/R-93/116, July 1993. None Detected: not detected at/or below the detected limit of method (Reporting limit: 1% Asbestos). Glass fiber is analyzed for quality control blank. TESC recommends by point count or Transmission Electron Microscopy (TEM), for materials regulated by the EPA NESHAP (National Emission Standards for Hazardous Air Pollutants) and found to contain less than ten percent (<10%) asbestos by Polarized Light Microscopy (PLM). Both services are available for an additional fee. This report shall not be reproduced, except in full written approval of Triangle Environmental Service Center, Inc. This report must not be used by the customer to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government. This test report relates only to the item(s) tested.

NVLAP Lab Code: 200794-0 LEGEND NAD=No Asbestos Detected, Lino.=Linoleum, JC=Joint Compound][

Reviewed By Authorized Signatory:

XRF Data Table

Time Duration Component Substrate Side Color Condition Building Room Results Depth PbC PbC Error PbL PbL Error PbK PbK Error

3/4/16 10:40 1.06 Cal Orange Positive 1.08 1.5 0.4 1.5 0.4 < LOD 3.75

3/4/16 10:41 0.83 Cal Orange Positive 1.29 1.9 0.9 1.9 0.9 < LOD 5.25

3/4/16 10:41 1.06 Cal White Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.77

3/4/16 10:42 2.59 Wall Drywall A White Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.95

3/4/16 10:42 1.6 Wall Drywall B White Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.38

3/4/16 10:43 1.9 Wall Drywall C Gray Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.05

3/4/16 10:44 1.07 Wall Drywall D Gray Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.85

3/4/16 10:45 5 Wall Drywall A White Intact 16 2 Negative 5.19 < LOD 0.05 < LOD 0.05 < LOD 0.9

3/4/16 10:45 1.82 Wall Drywall B White Intact 16 2 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.1

3/4/16 10:46 1.68 Wall Drywall C White Intact 16 2 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.29

3/4/16 10:46 1.14 Wall Drywall D Gray Intact 16 2 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.81

3/4/16 10:46 1.06 Door Wood B Brown Intact 16 2 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.55

3/4/16 10:47 1.06 Doorframe Metal B Gray Intact 16 2 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.35

3/4/16 10:48 2.74 Wall Drywall A White Intact 16 3 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.8

3/4/16 10:48 2.58 Wall Drywall B White Intact 16 3 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.95

3/4/16 10:48 1.75 Wall Drywall C White Intact 16 3 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.14

3/4/16 10:49 1.75 Wall Drywall D Gray Intact 16 3 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.04

3/4/16 10:50 1.06 Door Wood B Brown Intact 16 3 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.62

3/4/16 10:50 1.06 Doorframe Metal B Gray Intact 16 3 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 3.92

3/4/16 10:51 3.04 Wall Drywall A White Intact 16 4 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.2

3/4/16 10:51 1.37 Wall Drywall C White Intact 16 4 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.43

3/4/16 10:52 1.9 Wall Drywall D Gray Intact 16 4 Negative 1.69 < LOD 0.04 < LOD 0.04 < LOD 2.08

3/4/16 10:52 0.3 Wall Drywall A Gray Intact 16 7 Null 10 < LOD 0.55 < LOD 0.55 < LOD 7.35

3/4/16 10:53 1.6 Wall Drywall A Gray Intact 16 7 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.24

3/4/16 10:53 1.37 Wall Drywall B White Intact 16 7 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.52

3/4/16 10:53 1.67 Wall Drywall C Gray Intact 16 7 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.14

3/4/16 10:54 0.91 Wall Drywall C White Intact 16 9 Null 1 < LOD 0.03 < LOD 0.03 < LOD 4.35

3/4/16 10:55 1.37 Wall Drywall B Gray Intact 16 9 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.22

3/4/16 10:55 1.75 Wall Drywall C White Intact 16 9 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.24

3/4/16 10:56 1.06 Door Wood D Brown Intact 16 9 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.7

3/4/16 10:56 1.06 Doorframe Metal D Gray Intact 16 9 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.35

3/4/16 10:57 1.06 Doorframe Metal A Gray Intact 16 7 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.3

3/4/16 10:57 1.06 Door Wood A Brown Intact 16 7 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.85

3/4/16 10:58 1.06 Door Wood A Brown Intact 16 6 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.7

3/4/16 10:58 1.06 Doorframe Metal A Gray Intact 16 6 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.06

3/4/16 10:58 1.06 Doorframe Metal A Gray Intact 16 4 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.33

3/4/16 10:59 1.06 Door Wood A Brown Intact 16 4 Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.25

3/4/16 10:59 1.07 Door Metal C Brown Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 3.98

3/4/16 10:59 1.07 Doorframe Metal C Brown Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.1

3/4/16 11:00 1.82 Doorframe Metal A Black Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 2.38

Nellis Air Force Base Building 16 Macrotec Job #16539 1

XRF Data Table

Time Duration Component Substrate Side Color Condition Building Room Results Depth PbC PbC Error PbL PbL Error PbK PbK Error

3/4/16 11:01 3.04 Door Metal A Black Intact 16 Open Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.46

3/4/16 11:10 0.23 Wall Brick A Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 18.9

3/4/16 11:10 3.04 Wall Brick A Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.5

3/4/16 11:11 1.06 Handrail Metal A Brown Intact 16 Exterior Negative 2.23 < LOD 0.06 < LOD 0.06 < LOD 4.72

3/4/16 11:11 1.06 Handrail Metal A Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.65

3/4/16 11:11 1.07 Handrail Metal A Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.65

3/4/16 11:12 1.06 Door Metal D Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.05

3/4/16 11:12 1.06 Doorframe Metal D Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.03

3/4/16 11:13 3.27 Wall Brick B Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 1.35

3/4/16 11:14 1.06 Door Metal B Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.14

3/4/16 11:14 1.22 Doorframe Metal B Brown Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 3.66

3/4/16 11:15 1.06 AC Metal B Beige Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 3.85

3/4/16 11:15 1.06 AC Metal B Gray Intact 16 Exterior Negative 1 < LOD 0.03 < LOD 0.03 < LOD 4.37

3/4/16 11:22 0.23 Cal Yellow Positive 1.41 < LOD 4.8 < LOD 4.8 < LOD 16.65

3/4/16 11:22 0.23 Cal Yellow Positive 1.52 < LOD 5.85 < LOD 5.85 < LOD 15.75

3/4/16 11:22 0.31 Cal Yellow Positive 1.12 2.8 1.7 2.8 1.7 < LOD 11.4

Nellis Air Force Base Building 16 Macrotec Job #16539 2

DISAPPROVED

DOUGLAS C. FITZPATRICK, RA, GS-14

Deputy Base Civil Engineer

28. NAME AND GRADE (Please Type or Print)

99 CES

1. FROM (Organization)

CENMP 20160301

3. DATE OF REQUEST 4. WORK REQUEST NO. (For BCE Use)

Danilo T. Ocampo

DSN 682-8437

5. NAME AND PHONE NO. OF REQUESTER

20160330

6. REQUIRED COMPLETION DATE

Bldg 16

Sampling and testing of materials for asbestos and lead-based paint (LBP) in support of SRM project RKMF 16-0062, Repair Courtroom, Bldg 16, Nellis AFB (Work Order # 26843)

8. DESCRIPTION OF WORK TO BE ACCOMPLISHED (Include Sketch or Plan, when appropriate)

30. DATE

Building 16 is being reconfigured to accommodate a courtroom. Project scope includes demoliton of walls, ceiling, and floor covering, replacement of existing HVAC system. Installation of new partition walls with communications and power drops.

Removal and reinstallation of existing lighting, fire alarm and mass notification systems. An asbestos and LBP aurvey is required to ensure that hazardous materials, if present, are identified and properly abated.

9. BRIEF JUSTIFICATION FOR WORK TO BE ACCOMPLISHED (Not required for maintenance and repair)

Will be paid using Engineering Flight's GPC

10. DONATED RESOURCES

DANILO T. OCAMPO

Project Engineer

11. NAME OF REQUESTER

GS-12

12. GRADE OF REQUESTER

27. REMARKS

SECTION IV - APPROVING AUTHORITY

BASE CIVIL ENGINEER WORK REQUEST

(See Reverse for Instructions) OMB No. 0704-0188

Form Approved

Public reporting burden for this collection of information is estimated to average .3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Department of Defense, Washington

Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project 0704-0188, Washington DC 20503. Please DO NOT RETURN your form to either of these addresses.

Send your completed form to HQ AFESC/DEMG.

SECTION I - TO BE COMPLETED BY REQUESTER

SYMBOL

2. OFFICE

7. BUILDING, FACILITY OR STREET ADDRESS

WHERE WORK IS TO BE ACCOMPLISHED

AF IMT 332, 19910101, V4 PREVIOUS EDITION IS OBSOLETE. MASTER FILE COPY

ASSESSMENT (AFR 19-2)

23.

THERE IS NO NEED FOR AN ENVIRONMENTAL

FUNDS LABOR MATERIAL CONTRACT BY REQUESTER NONE

13. SIGNATURE OF REQUESTER (See Reverse of Form)

SECTION II - FOR BASE CIVIL ENGINEER USE

SECTION III - COMPLETE ONLY IF WORK IS TO BE ACCOMPLISHED BY WORK ORDER

IN-SERVICE SELF-HELP CONTRACT SABER

EMERGENCY URGENT ROUTINE SELF-HELP

BRIEFING REQUIRED ADEQUATE COORDINATION INSPECTION REQUIRED

M/C

15. WORK ORDER (Place an "X" in the appropriate box.)

17. SELF-HELP (Place an "X" in the appropriate box.)

16. DIRECT SCHEDULED WORK (Place an "X" in the appropriate box.)

18. WORK CLASS 19. PRIORITY 20. ESTIMATED HOURS

COST

21. ESTIMATED FUNDED

COST

22. ESTIMATED TOTAL

BEING/HAS BEEN PROCESSED

24.

A WRITTEN ASSESSMENT IS APPROVED

25. 26.

29. SIGNATURE

14. COORDINATION

OCAMPO.DANILO.T.

1028298613

Digitally signed by OCAMPO.DANILO.T.1028298613 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=OCAMPO.DANILO.T.1028298613 Date: 2016.03.01 11:42:16 -08'00'

1028298613C Rectangle

Text1: EDDIE N. CAIN, WS-15 Operations Manager