Attachment_-_5_ACM_Reports_30_Nov_16.pdf

REPAIR HVAC, 18 CONS, B95

KADENA AIR BASE, OKINAWA, JAPAN

FA5270-17-B-0003

LXEZ 17-1395

Attachment – 5 ACM Reports Page 1 of 1

ATTACHMENT – 5

ACM REPORTS

BUILDING INSPECTION SUMMARY FORM

Installation ID Building Number Building Name l-X£~ crs 1-\Q bQ..ol)P

Year Constructed Revised Building Name/Use (if needed) tql7 t-.\A I Building Contact & Rank I Phone Number

I Building Description, Location and Secured I Inaccessible Areas

L '5TOCL'f o~~\c..e:_ e:,cY,L..Dl~U: ........ No A<-C..ef;51 \31t-n't' \S5lJ~

Building Status Area (sq. ft.) #of Floors

<4 Sampled I 0 I No SACM/PACM I 0 I Demolished I 0 I PACM only 1~ I IlL( 't.

Building Photo

Photo Date: Camera: Roll/Disk: Photo: MediaiD:

'-4- OCA- 0 Co fll(-:. I lA'-

HVACType: C. t..IJI n.. A c...

Exterior Type: L£~Nt ~LOCtc:..

Structure Type: L_ STO(l-Y

Plumbing Type: hC-\At-

Interior Type: C£H6~(/ BLOGt. I /)(L r(£-VAL<._

Roof Type: No ACL-e5~

Electrical (Select Two)

~ Interior electrical wiring appeared to be non ACM 0 Incoming electrical .wiring appeared to be non ACM 0 Interior electrical wiring appeared to be ACM 0 Incoming electrical wiring appeared to be ACM 0 No interior electrical wiring was observed during the building in~ection 0 No incoming electrical wiring was observed during the building inspection

Inspector Name(s) Today's Date

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IL6.Q..Q.Y ~lfUM

ASBESTOS BUILDING INSPECTION SAMPLING DATA SHEET

Page _j_ of .b._ Building Number: liS Inspectors: NJ,v ~ {~ Signature: )j ..LlAh S<J J }/'--(

L.. 71 .

Sample ID Sample Presumed Photo ID

(Base-building-material code-samp #) Location Time

ACM (Base-building-photo#) Comments

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ASBESTOS BUILDING INSPECTION SAMPLING DATA SHEET

Page L- of ~

Building Number: O;c:;- Date: l o\ 0--(~ Inspectors: ~tit!) Signature: \1 ~-~ AAA ..

" I "' 11 v

Sample ID Sample Presumed Photo ID v

(Base-building-material code-samp #) Location Time

ACM (Base-building-photo #) Comments

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COMPUTER

MACHINE R.M

RECEPTION ST.

I) /)

(8 f(p 17

OFFICE

lD

!O

OFFICE OFFICE OFFICE OFFICE

1ST FLO 0 R PLAN B LOG. 9 5

SCALE 1 /1OOm m

OFFICE OFFICE

OFFICE

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OFFICE

2ND FLOOR PLAN BLDG 95

SCALE 1/1 OOmm

MATERIAL CODE AND DESCRIPTION

Page _ /_of_/_

Building Number: 95 Inspectors: lvfC14 [C6 Signature: /??r...u / ~ _,/ tu~

( I

Material Material Type Total Building Code Description

(TSI, SM, Mise) Quantity Comments

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ASBESTOS SURVEY FORM

Building Number: _......:..._.9._S:J--_ Building Name: ..... f{£...J...!,J.a.!::....._....!..6.J.Je~~~f> ___________ _

Page _J_ of E_

Date: Z4 -a:::.-7 -o~

Inspectors: Mw ·- tB Signature: ~-- L ..... / I j P"':?:. Building Population: /() - ltJO

Homogenous Functional Material Quantity Activity Potential for Damaged Quantity

Water Air Movement

Potential for Friable?

Area Space/Room Code (fetuner tt) Damage Vibration Contact Damage (Y or N)

1 0} or 5'10 ~'L t/1 0<0 q too ~.f..'--

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Building Number: Of 5 Building Name: --L..!H~~~....!b:<.!!:::e.Dt.>:::::::..:..P ___________ _

Page~of ___iL

Date: 2 q ~oc7- d t;.

Inspectors: Mw ~ k..(2 Signature: m.h /, ~ ~ . (.AJ4AJC_ Building Population: /{)- [(YJ I ( }

Homogenous Functional Material Quantity Damaged Quantity

Water '- Activity Air Movement Potential for Potential for Friable?

Area Space/Room Code (fe/uner ft} Damage Vibration Contact Damage (Y or N)

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Building Number: _ q;__{ __ _ Building Name: -+M...L....>o<:>~ ..... 6 '-"12..D=-"....:...P ___________ _

Page ___2_ of~ Date: 2 <t -oc..T -o 4>

Inspectors: kW . t.B Signature: 7/l~ w~ Building Population: /o -roo I (]'-_

Homogenous Functional Material Quantity Damaged Quantity

Water ...__...Activity Air Movement

Potential for Potential for Friable?

Area Space/Room Code (fe/Liner ft) Damage Vibration Contact Damage (Y or N)

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Area Space/Room Code (te/Liner ft) Damage Vibration

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Page !:L_ of jf)_

Date: 2't·t?C.:r-o~

Building Population: l o- roo

Air Movement Potential for Potential for Friable'?

Contact Damage (Y o r N)

Building Number: - -'-· 1..1-o'S"--/ - - Building Name: ---P~:..:::O.~~Gt.ll.<Le>~v~el.--________ _

Page .) of JQ_

Date: ~q ·OCT ...of, Inspectors: ~,W \L& Signature: miLA j u..i W.J..!!;:;: Building Population: {o-(c:c

Homogenous Functional Material Quantity Damaged Quantity Water~ Activity

Air Movement Potential for Potential for Friable?

Area Space/Room Code (ff/Liner ft) Damage Vibration Contact Damage (Y or N)

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Building Number: _ _;_q__:__:<:____ Building Name: __ q..J.f..!::!:()__~~~::J...· !:::::e..o= v ..!._P _________ _

Page~otjg_

Date: 2 '1- tX.--r- -0 '- ·

Inspectors: /V[l)_) lLB Signature: 1n~· WA.A&.

Building Population: to- roo

Homogenous Functional Material Quantity Damaged Quantity Water Activity Air Movement

Potential for Potential for Friable!

Area Space/Room Code (fetuner ft) Damage Vibration Contact Damage (Y or N)

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Building Number: _..;_fll....<S~- Building Name: \-\-G.. (b Q.ov e Inspectors: Xt7k> i

IL6 Signature: ?7'7 A . A~ lA J A" A ( J

Homogenous Functional Material Quantity Damaged Quantity Water A ctivity

Area Space/Room Code (fetuner ft) Damage Vibration

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Page __:J_ of &.__

Date: 2q -OGT -o C:.

Building Population: /V [00

Air Movement Potential for Potential for Friable'?

Contact Damage (Y or N)

[OI-Y WI'\ {.-l..- "57_71 ~ :x'5_)

a. -;;u Building Number: --'-'· 1_~:::~ __

Inspectors: ~(l) k..B Building Name: H-6... b Q.ooP

Signature: r???~ ..~ /.,u.~ j J

Homogenous Functional Material Quantity Damaged Quantity Water

Area Space/Room Code (fetuner ft) Damage

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Activity

Vibration

Page _g_ of _/1__

Date: "2 Y - ocr · OrLJ ·

Building Population: /0-(CJO

Air Movement Potential for Potential for Friable!

Contact Damage (Y or N)

Remarks: '2.7)"~'21 ( B pc.. t:-- wAt-t- f)(l. 'I~ Au.-) 'l. "1 ) 3'-/.)c 1. I (... 3 "--' .At4. ()a. '{ w ALL.-~ 1.10) 1'1..-'r lt- c ~ IAJ ~(..c... DR. '1' (.VAt..(..) l Z. ~Au... ir-'.Dt-'- fA IZ:yZ_)

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Page _J_ of !.f2_

Building Number· 91._ Building Name· /£_9. c..:, d_L; , p Date· zcr -a o'i -o~ . . I .

Inspectors: Mw tf?> Signature: J7J_.ut / .. }'/, Ju"T Building Population: /0-/tJd

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Homogenous Functional Material Quant ity Damaged Quantity

Water \._ L_.l Act ivity Air Movement

Potential for Potential for Friable?

Area Space/Room Code {fe /uner ft) Damage Vibration Contact Damage {Y or N)

) ~0 Ol L/0 9-c..l\..

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Building Number: 1.) Building Name: HQ 6£Lo ,JP

Inspectors: Mc.u jL.B Signature: @2pr L / i-t JA.~ .r-t-

Homogenous Functional Material Quantity Damaged Quantity

Water"'""" Activity Area Space/Room Code (te/Liner ft) Damage Vibration

?>t..t o\ 4'Lo ~.£ '1.

34 I~ "L { .s;--6

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Remarks: ?><..t} 20 )j. "21 l 2.. {)SL-'i r.v P, L..l ... uJAl.-c..S)

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BULK ASBESTOS ANALYSIS REPORT 6

J apanese lniStry 0 ea ' a M .. t f H lth L b or an e are e 0 d W If M th d p age: 11 f 19 0

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 1 0/PLM Date Reported: 27 -Apr-2007 2000 - 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena- Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLEID ASBESTOS FIELD XRD PLM** 3) Date/Time Collected

% TYPE LAB Quant* Qual 4) Date Analyzed

Misc. I) 50-60% Cellulose

LXEZ-95-02-02 <0.1 None Detected NEG ND 2) 40-50% Paint, Bndr, Other m.p.

Lab ID# 1138-00165-051 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. I) 50-60% Cellulose

LXEZ-95-02-28 <0.1 None Detected NEG ND 2) 40-50% Paint, Bndr, Other m.p.

Lab ID# 1138-00165-052 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. I) 71-85% Fiberglass,Cellulose

LXEZ-95-03-03 0.8 Chrysotile 0.8% ND ND 2) 15-29% Bndr, Calc, Other m.p.

Lab ID# 1138-00165-053 Ceiling Tile-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1) 70-80% Cellulose

LXEZ-95-04-05 <0.1 None Detected NEG ND 2) 20-30% Calc, Bndr, Other mp.

Lab ID# 1138-00165-054 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. I) None Detected

LXEZ-95-06-08 <0.1 None Detected NEG ND 2) 20-30% Calc, Bndr, Other mp.

Lab ID# 1138-00165-055 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

*- XRD quantitative result corrected for matenallost by acid washmg and ashmg (ashmg occurs only when orgaruc matenal1s mdtcated) treannents.

**- PLM point count result corrected for material lost by ashing treatinent only when organic material is indicated.

Data reported in square parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treannents.

Lab QC Reviewer ----=(/"'--- - - ------------

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

7-,M--L ~ Analyst----------------

630 Bancroft Way, Berkeley, CA 94710 (510) 704-8930 With offices in Reno, NV (775) 359-3377

BULK ASBESTOS ANALYSIS REPORT ..._.. Japanese Ministry of Health, Labor and Welfare Method Page: 12 of 19

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 10/PLM Date Reported: 27 -Apr-2007 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena - Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLEID ASBESTOS FIELD XRD PLM** 3) Date!Time Collected o;o TYPE LAB Quant* Qual 4) Date Analyzed

Misc. 1) 70-80% Cellulose

LXEZ-95-06-27 <0.1 None Detected NEG ND 2) 20-30% Calc, Bndr, Other mp.

Lab ID# 1138-00165-056 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1) 0

LXEZ-95-07-09 0.14 Chrysotile 0.14% Chrys? 1-5% 2) 20-35% Calc, Bndr, Other mp.

Lab ID# 1138-00165-057 Ceiling Tile-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1) 65-80% Fiberglass,Cellulose

LXEZ-95-07-29 0.14 Chrysotile 0.14% Chrys'! 1-5% 2) 20-35% Calc, Bndr, Other mp.

Lab ID# 1138-00165-058 Ceiling Tile-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. I) I -5% Fiberglass

LXEZ-95-08-1 0 <0.1 None Detected NEG ND 2) 95-99% Gyp, Other m.p.

Lab I D# 1138-00 165-059 Drywall-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. l) 1-5% Fiberglass

LXEZ-95-08-21 <0.1 None Detected NEG ND 2) 95-99% Gyp, Other m.p.

Lab 10# 1138-00165-060 Drywall-Off-White 3) Oct-24-06 4) Apr-24-07

* - XRD quantitative result corrected for matenallost by ac1d washmg and ashmg (ashing occurs only when orgaruc matenal1s mdicated) treatments.

**- PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer _--.!ec;7'-------- ----------

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

7/H-<-. ~ Analyst ______________ _

BULK ASBESTOS ANALYSIS REPORT

J apanese lniS!ry 0 ea a M . . t f H lth L b or an e are e 0 d W If M th d p age: 13 f 19 0

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 1 0/PLM Date Reported: 27-Apr-2007 2000 - 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena - Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLEID ASBESTOS FIELD XRD PLM** 3) Oate!Time Collected o;o TYPE LAB Quant* Qual 4) Date Analyzed

Misc. I) 90-95% Synthetics

LXEZ-95-09-11 <0.1 None Detected NEG ND 2) 5- 10% Calc, Glue, Bndr, Other m.p.

Lab ID# 1138-00165-061 Carpet/Backing/Glue-Brown 3) Oct-24-06 4) Apr-24-07

Misc. 1) 90-95% Synthetics

LXEZ-95-09-24 <0.1 None Detected NEG ND 2) 5-10% Calc, Glue, Bndr, Other m.p.

Lab ID# 1138-00165-062 Carpet/Backing/Glue-Brown 3) 0-Jan-1900 4) Apr-24-07

Misc. 1) 70-80% Fiberglass

LXEZ-95-10-12 <0.1 None Detected NEG ND 2) 20-30% Metal Foil, Other m.p .

Lab ID# 1138-00165-063 Insulation-Brown/Silver 3) Oct-24-06 4) Apr-24-07

Misc. I) 70-80% Fiberglass

LXEZ-95-1 0-13 <0.1 None Detected NEG ND 2) 20-30% Metal Foil, Other m.p .

Lab I D# 1138-00165-064 Insulation-Brown/Silver 3) Oct-24-06 4) Apr-24-07

Misc. I) 70-80% Fiberglass

LXEZ-95-10-20 <0.1 None Detected NEG ND 2) 20-30% Metal Foil, Other m.p .

Lab ID# 1138-00165-065 Insulation-Brown/Silver 3) Oct-24-06 4) Apr-24-07

*- XRD quant:Jtatlve result corrected for matenallost by acid washing and ashing (ashing occurs only when orgamc matenal1s md1cated) treatments.

** - PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer _ ___,(/ _ _ _ _ _ _ _ _ _______ _

ASBESTOS TEM LABORATORIES, INC.

www.asbestostemlabs.com

7/U-<._ ~ Analyst---------------

BULK ASBESTOS ANALYSIS REPORT ...._.. J apanese M". fH lniStry 0 ealth, Labor an dW f el are Method Paee: 14 of 19

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 10/PLM Date Reported: 27 -Apr-2007 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena - Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLE ID ASBESTOS FIELD XRD PLM** 3) Date/Time Collected

% TYPE LAB Quant* Qual 4) Date Analyzed

Misc. I) 95-99% Fiberglass

LXEZ-95-1 0-50 <0.1 None Detected NEG ND 2) 1-5% Bndr, Calc, Other m.p.

Lab ID# 1138-00165-066 Insulation-Yellow/Brown 3) Oct-24-06 4) Apr-24-07

Misc. 1) <I% Cellulose

LXEZ-95-11-14 <0.1 None Detected NEG ND 2) I 00-1 000/o Bndr, Calc, Other m.p.

Lab ID# 1138-00165-067 Flooring-Red 3) Oct-24-06 4) Apr-24-07

Misc. I) < !%Cellulose

LXEZ-95-11-15 <0.1 None Detected NEG ND 2) I 00-1 000/o Bndr, Calc, Other m.p.

Lab ID# 1138-00165-068 Flooring-Red 3) Oct-24-06 4) Apr-24-07

Misc. I) < I% Cellulose

LXEZ-95-11-25 <0.1 None Detected NEG ND 2) 100-1000/o Bndr, Calc, Other m.p.

Lab ID# 1138-00165-069 Flooring-Red 3) Oct-24-06 4) Apr-24-07

Misc. I) 1-5% Cellulose

LXEZ-95-12-45 <0.1 None Detected NEG ND 2) 95-99% Calc, Paint, Bndr, Other mp.

Lab I D# 1138-00165-070 Paint/Texture-Off-White 3) Oct-24-06 4) Apr-24-07

*- XRD quanntattve result corrected for matenallost by actd washmg and ashmg (ashmg occurs only when orgarnc matenalts mdicated) treatments.

**- PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer-~(?'~---------------

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

7/U--L ~ Analyst----------- -----

J apanese lniS!ry 0 ea a M .. t f H lth L b or an dW If e are e 0 M th d p age: 15 f 19 0

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 10/PLM Date Reported: 27-Apr-2007 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: 0

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLEID ASBESTOS FIELD XRD PLM** 3) Date/Time Collected o;o TYPE LAB Quant* Qual 4) Date Analyzed

Misc. 1) l-5% Cel lulose

LXEZ-95-12-46 <0.1 None Detected NEG ND 2) 95-99% Calc, Paint, Bndr, Other mp.

Lab I D# 1138-00165-071 Paint/Texture-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1) 1-5% Cellulose

LXEZ-95-12-47 <0.1 None Detected NEG ND 2) 95-99% Calc, Paint, Bndr, Other mp.

Lab ID# 1138-00165-072 Paint/Texture-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1) None Detected

LXEZ-95-13-16 <0.1 None Detected NEG ND 2) 99-100% Calc, Bndr, Other m.p.

Lab ID# 1138-00165-073A Floor Tile-Beige 3) Oct-24-06 4) Apr-24-07

Misc. 1) None Detected

LXEZ-95-13-35 <0.1 None Detected NEG ND 2) 99- I 00% Calc, Bndr, Other m.p.

Lab 10# 1138-00165-074A Floor Tile-Beige 3) Oct-24-06 4) Apr-24-07

Misc. 1) 50-60% Cellulose

LXEZ-95-14-17 <0.1 None Detected NEG ND 2) 40-50% Calc, Bndr, Paint, Other mp.

Lab 10# 1138-00165-075 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

*- XRD quantJ.tattve result corrected for matenallost by actd washing and ashmg (ashing occurs only when orgaruc matenalts mdtcated) treatments.

** - PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer _ _,c?' _ ___ _ _ _ _ _ _ _ _ _ _ _ _

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

7/U-<_ ~ Analyst ____________________________ __

BULK ASBESTOS ANALYSIS REPORT ...._,.. J apanese lniS(_ry 0 ea ' a M .. t f H lth L b or an e are e 0 d W If M th d Page: 16 of 19

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 10/PLM Date Reported: 27 -Apr-2007 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena - Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLEID ASBESTOS FIELD XRD PLM** 3) Date/Time Collected 0/o TYPE LAB Quant* Qual 4) Date Analyzed

Misc. 1) 50-60% Cellulose

LXEZ-95-14-30 <0.1 None Detected NEG ND 2) 40-50% Calc, Bndr, Paint, Other mp.

Lab 10# 1138-00165-076 Wal lpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. I) 50-60% Cellulose

LXEZ-95-15-18 <0.1 None Detected NEG ND 2) 40-50% Calc, Bndr, Paint, Other mp.

Lab 10# 1138-00165-077 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1) 50-60% Cellulose

LXEZ-95-15-19 <0.1 None Detected NEG ND 2) 40-50% Calc, Bndr, Paint, Other mp.

Lab 10# 1138-00165-078 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. I) 50-60% Cellulose

LXEZ-95-15-26 <0.1 None Detected NEG ND 2) 40-50% Calc, Bndr, Paint, Other mp.

Lab 10# 1138-00165-079 Wallpaper-Off-White 3) Oct-24-06 4) Apr-24-07

Misc. 1} None Detected

LXEZ-95-16-32 <0.1 None Detected NEG ND 2) 99-100% Calc, Bndr, Other m.p.

Lab 10# 1138-00165-080A Cove Base-Brown 3) Oct-24-06 4} Apr-24-07

*- XRD quantitative result corrected for matenallost by actd washing and ashmg (ashmg occurs only when orgamc matenalts mdicated) treatments.

**- PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses [) are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer _ __!!t!':__ _____ _ ________ _

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

7/U-c. ~ Analyst ______ ________ _

J apanese lniStry 0 ea a M . . t f H lth L b or an dW If e are e 0 M th d p age: 0 1 17 f 9

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co., Ltd. Split Layers Analyzed: 1 0/PLM Date Reported: 27-Apr-2007 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena- Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLEID ASBESTOS FIELD XRD PLM** 3) DatefTime Collected 0/o TYPE LAB Quant* Qual 4) Date Analyzed

Misc. 1) None Detected

LXEZ-95-16-32 <0.1 Chrysotile Not enough mastic for quantitative test <0.1 POS 1-5% 2) 95-99% Calc, Glue, Other m.p.

(Est. 0.04% For A & B) of mastic only-XRD includes cove base.

Lab ID# 1138-00165-0808 Glue-Yellow/Brown 3) Oct-24-06 4) Apr-24-07

Misc. l) None Detected

LXEZ-95-17-38 <0.1 None Detected NEG ND 2) 99-100% Bndr, Opq, Other m .p.

Lab I D# 1138-00165-081 Foam Insulation-Black 3) Oct-24-06 4) Apr-24-07

Misc. 1) None Detected

LXEZ-95-17-39 <0.1 None Detected NEG ND 2) 99-100% Bndr, Opq, Other m .p.

Lab ID# 1138-00165-082 Foam Insulation-Black 3) Oct-24-06 4) Apr-24-07

Misc. I) None Detected

LXEZ-95-17-40 <0.1 None Detected NEG ND 2) 99-100% Bndr, Opq, Other m .p.

Lab ID# 1138-00165-083 Foam Insulation-Black 3) Oct-24-06 4) Apr-24-07

Misc. 1) None Detected

LXEZ-95-18-48 <0.1 None Detected NEG ND 2) 99-100% PlastFoam, Bndr, Other m.p.

Lab I D# 1138-00165-084 Foam w/ coating-Grey/white 3) Oct-24-06 4) Apr-24-07

*- XRD quantitative result corrected for matenallost by acid washmg and ashmg (ashing occurs only when orgamc matenal1s md1cated) treatments.

**- PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses []are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer -~tf':...._ ____ __________ _

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

7/U-<_. ~ Analyst ______________ _

~ J apanese lniStry 0 eat , a M .. t f H I h L b or an dW f M el are ethod Page: 18 of 19

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Report No. 61869 Reg. Samples Analyzed: 90 Date Submitted: 16-Apr-2007

Address: Acty Co. , Ltd. Split Layers Analyzed: 1 0/PLM Date Reported: 27 -Apr-2007 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: Kadena- Base Wide Asbestos Survey Phase 3

OTHER DATA

1) Non-Asbestos Fibers

DESCRIPTION ANALYSES 2) Matrix Materials

SAMPLE ID ASBESTOS FIELD XRD PLM** 3) Date/Time Collected o;o TYPE LAB Quant* Qual 4) Date Analyzed

Misc. 1) None Detected

LXEZ-95-19-42 <0.1 None Detected NEG ND 2) 99-100% PlastFoam, Bndr, Other m.p.

Lab ID# 1138-00165-085 Foam w/ coating-Grey/white 3) Oct-24-06 4) Apr-24-07

Misc. l) None Detected

LXEZ-95-19-43 <0.1 None Detected NEG ND 2) 99-1 00% PlastFoam, Bndr, Other m.p.

Lab ID# 1138-00165-086 Foam w/ coating-Grey/white 3) Oct-24-06 4) Apr-24-07

Misc. I) None Detected

LXEZ-95-19-44 <0.1 None Detected NEG ND 2) 99-100% PlastFoam, Bndr, Other m.p.

Lab ID# 1138-00165-087 Foam w/ coating-Grey/white 3) Oct-24-06 4) Apr-24-07

Misc. 1) 70-80% Fiberglass

LXEZ-95-3-34 0.24 ChrysotiJe 0.24% POS 1-5% 2) 15-29% Bndr, Calc, Other mp.

Lab ID# 1138-00165-088 Ceiling Tile-Grey 3) Oct-24-06 4) Apr-24-07

Misc. 1) None Detected

LXEZ-95-5-31 <0.1 None Detected NEG ND 2) 99-100% Bndr, Calc, Other m.p.

Lab ID# 1138-00165-089A Cove Base-Brown 3) Oct-24-06 4) Apr-24-07

* - XRD quantltative result corrected for matenallost by acid washmg and ashing (ashmg occurs only when orgamc matenal1s md1cated) treatments.

** - PLM point count result corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in square parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treatments.

Lab QC Reviewer ---"~'-------------------

ASBESTOS TEM LABORATORIES, INC.

www .asbestostemlabs.com

;1:(/U.-<--~ Analyst ---------------

~ Japanese Ministry of Health, Labor and Welfar(}~Method

Contact: Ms. Kayoko Noritake Samples Indicated: 90 Reg. Samples Analyzed: 90

Address: Acty Co., Ltd. Split Layers Analyzed: 1 0/P 2000- 14 Miyoshi Okayama-Shi, Japan 703-8261 Project Name/No.: adena - Base Wide Asbestos Survey I

DESC~ ANALYSES

SAMPLEID ASBESTOS FIE XRD PLM**

% TYPE ]/AB Quant* Qual

LXEZ-95-5-31 <0.1 Chrysotile ~~:,L <0.1 NEG 1-5%

(Est. <0.01)

Lab 10# 1138-00165-0898 Glue-}ir"ey

LXEZ-425-1-04-12 <0.1 NoneDetec/

NEG ND

Lab 10# 1138-00165-090A Floor Tile-Brown

Lab 10# I Lab 10# I v Lab 10# I

* - XRD quantitative res t corrected for material lost by acid washing and ashing (ashing occurs only when organic material is indicated) treat

** - PLM point count suit corrected for material lost by ashing treatment only when organic material is indicated.

Data reported in squ e parentheses [ ] are measured values uncorrected for material lost by acid washing and/or ashing treatments.

~ 7---LabQ eviewer Analyst

ASBESTOS TEM LABORATORIES, INC. 630 Bancroft Way, Berkeley, CA 94710 . www .asbestostemlabs.com With offices in Reno, NV (775) 35!

OL P..D, US,l..FCEr:I../5~.

ANALYTIC.;t CrlEHS~Y BRA~!C:i

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LABO~TORY REPORT

TO: (!! Ct>i:S/Pc7-j('

Jff'o .Yp qc.;; .;C) /( /'tz-?r.:."":JV I"' ~

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BULK MATERIAL SAMPLING DATA

( U .v e ll1 is sp~ce lo r meChtJnt«:.al imprint)

A-A CCIDENT/ INCIDENT F -F OLLOWU P ! CLE A N U P

R-R OUTINE B.l.CKGROUND/PERIODIC SURVEY 0-0THER

Bui lding Material E X IST lNG CONTROLS ( Peraonal p rotoc tl v,. equ lpment, Englneerlng, A dministrative )

NA

OEHL SAMPLE NUMBER

BASE SAMPLE NUMBER

A CHECK FOR

ANALYSES

REQUESTED

Description of Material

Location of sample

AF FORM

JAN 8, 2751

7,.,;-1"2, ; I C-

ROOM/ AREA

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·sULK MATERIAL SAMPLING DATA

(U:te this space /or mech~tn/c•l imprint)

A-ACCIDENT/INCIDENT C-COMPLAINT F-FOLLOWUP/CLEANUP

R-ROUTINE BACKGROUNO/PERIOOIC SURVEY 0-0THER

Building Material EXIST ING CONTROLS ( Peraonal protective equ/pment,En/llneering, Adm/nlatretlve)

NA

OEHL SAMPLE NUMBER

BASE SAMPLE NUMBER

A CHECK Fon

ANALYSES

REQUESTED

E

Description of Material

Location of sample

AF

I

FORM

JAN 61 2751

SAMP-LE COLLECTION DATA

BULK MATERIAL SAMPLit-IG DATA

( Use t11i., spttce lor m~chanrca/ im p rint)

A-ACCIDENT /INCIDENT

R-ROUTINE BACKGROUND/F'ERIODIC SURVEY 0-0THER

SOURCE BEINt;; 5AMF'LEO

Buildin g Material E XISTING CONTROLS ( Peraon"l p rotuctlv,. equ /pment,Englnoerlnll, Admin/"rr"t/ve)

NA

OEHL SAMF'LE NUMBER

BASE SAMPLE NUMBER

A CHECK FOR

ANALYSES

REOU EST EO

E

Description of Material

Location of sample

AF FORM

JAM 61

J

96239

I ' r .

ROOM/ AREA

' ""- ,:_ (_ .. - k y: f\.r-

:. r _ , l

-OAT':: COL.L.EC o E.J ( YYJfMDD)

/ r' l 1 I 1 , 1

- "iAI L - • --REPORTS-~ ORIGINAL

TO I

( Circle II o COPY 1 chang<J ) I

COPY 2

0 6 /.;, I I

WOR KPLri CS OR SITE

BLDG NO/ L OCATION

18 CESS/DEEJE APO S.F. 96239

313th Xedical Grou~SGP3 APO S.F. 9623 9 (Coov Onb)

SAMPLE COLLECTED BY ( Namoo c,adt!,A.FSC ) .SIPNATURE \ I ,. AUTOVON

\. __ ~ :.·L'-1 f\-"- \\;~'-..\\ -:.\--.~ c._--~ r ~ )_. ~·~o~-J\..Ju-~ SO~~ LG ~~\- c "'I..>. 7 REASOt< FOR ~

SUBMISSION ~

SOURCE i3E !N0 SAMPLED

A. AC:: I O . .::.E.:...N_T_/ _1 N_C:.._I_D~E:...:N=-T..:::::..._zC=.--C-0-MLP_L.::A:;I N;:,T....;,..o.=:eF -F~O..:..L~L.._O_W_,U,' p""""o C=L"'-E-A,_N_U_P----~;:;::C· .·>.··:·. : ·. Cli>~>- PI D.· :· . ·.

R - ROUTINE BACI<GROUN D/P E RIODIC SURVEY 0 -0THER ,:,:.:·r:-· r:::. r 1 r ... · ..

Building Materi al EXIST ING CONTROLS ( Peraont!l pro toctlv" <Jqutpment,Engln<J <Jt!nfl, AdminJOtrat/ v e )

NA

A CHECK F O R 0 MAJOR COMPONE~ITS D MA JOR C OMPONENTS

ASBESTOS ASilESTOS f----~_,c,_,_,r=-r--6,.-.,--4,.......,......7 1 s 1 o 1 o 1 o !£;~if ~u__U~-r-;-4-,-j --:;7,...,...1-s~,.....,..l """'o'"'j"""'o~! -oo"'t...,.., SJZ·~·

Desc:-:.pc:.on of Material

Locat:.on of sample

FCRM

JAH 8 1 2751

_L I I 1--w&" ~:·:-,.,:: ... ·-::::·.~:-

I I I I I I I g%!k

0 HAZAROOUS/ 70XIC WAST E

~ ~ \- >. (~ K-:::.-CJ'\

t"-'0

\) · t- ~\---cc i-

J J

D HAZARDOUS/TOXIC "NAS7E

S\ ,\, ~~__ "--~ ~~-~ \,-'- ~:_ S \ \=- 0.__: D c - ~ '-.,' '\ \.._ \J \ 'v -=

I .,

- .~~~~==~~~~~,=~r·,---~,=rr=~=r-4r~ ASBESTOS ASSESSMENT I ~u& (YniW!>In WJRKPL!CE I I I I 1'1 I I I II I I I

.~J ~I'~I-~1-~I~I~lDEK_TIF~ml~~~,l~~~~~

PART 1: DWGE ASSESSWEll'l'

1. PHYSICAL: _ m ~~'lE

- (2) LOW

- (1) IUIIIIW.

,\ (0) KO¥£

2. POTMIAL FOlt COi'llC'l:

1. <lOFT (8) HIGH

-- (5) WEDIUK

- (21 LOW

B. >lOFt -- (5) HIGH

- l3l MEDIUM = (0) l.OW

3. WATER DJJU.GE:

(3) YES = (0) )10

t. PiOIUfi'lY 'lO ITEMS FOlt ltEP 111. IF BOTH 1 AliD B APPLY, SCORE THE OIIE WITH THE HIGHEST WIIG. Ulll 3 HSl

1. SPUYED Olt TROWELED-Oil: • (31 <l F'l 01 CElLliG PlllEL COllUM.

·.• - (2) 1<?<5 F'l

- (1) )5 FT

- (0) >5 Ft, 10 iOUTIIE ll&lllt. .

B. PIPE, B~tn. Oi DUCT IllSOLATIOI, DWGE BY lOUT.

K!Ii'l. ? (3) CEILiliG PmL COIT!M.

- (11 YES = (0) )10

5. TYPE OF WATERIAL:

(tl CEILIIGS Ol ~

- (31 anc ...__ (1) BOILEI OD/01 PIPE -* (0-tl OTIIEl FltUBU: WATDUL

6. ASBEStOS COliTEliT:

lijZW)UTU!G

(5) )501

- (3) 30-501

- .- (1) 1-301

C?' ... <11 liO BWBD

TOTAL FROil PliT 1: DWGE (D):

TOTAL FRO¥ PliT B: EIPOSUltE (El= _

UTlllG lil= 12.032t - 0.1683 t D - 0.16Q3 t E

II=-

BASE SmLE a

SOPPOiTiliG SAMPLE VUKBEiS

LOClTIOI iESULT

OMAM:t%4'1'J:OM

P!ii' B: EIPOSUltE ASSESSWEVf

1. FiilBLE: (6) HIGH

- (3) ~DERATE

=(I) LO~

2. !iE! OF VISIBLE IU.TEiiAL:

(3) >1000 SQ Fl

- (21 100-1000 SQ F'l

- (I) 10-100 SQ F'l = (0) <10 SQ FT

3. WALLS: W ROUGH

- (3) PITTED

X (2) ~DERATE

_ lll SWXlTll

t. YmiLlTIOII (IU.I 7 PfS) l5l llltEliOi SUPPLY

- (2) IIITEliOi BETUU

- (I) All SUPPLI-FIBEl fO'lEiltl!L = (0) liOIIE

5! 1Il MlYDIEMT !FFEC'lUIG IU.TEiiAL _2.(_ (5) ROUT. TOiBDLm 01 lBiUP'l ill ¥M

(2) EXPOSED TO PElCEPT Ali :::: (0) llO P~EPTAlk

Cl. !CTIYITY: .J (5) HIGH-cQIIST!IT YIW'llOI

- (2) WEDIUll-OCCASSIOilAL YIBUTIOI = (0) LOw-1DJUI, CLASSiOOII, tiAITliG 1ltE!

1. FLOOi: W CWET

- (2) SWED Ol lOOGB SlliFlCE

- (1) Sli>OTB COII'liiOOUS SUB.F!CE ::::: (0-t) UMIQOE SITUATIOIS

8. BWIEBS. IF BOTH 1 AliD B, APPLY HIGHEST UTliG.

1. SPUYED Oi UOWELED-QM: (IU.l t PTS)

~ W IOIIE

(3) UlLUIG Oi WillE

- (2) EIICAPSULlTIOi

- (l) SUSPEIID CEILIIG

B. PIPE, BOIWl DUCT, Oi OTHER KATDUL {) '15-1001

- (3) 50-751

- (2) 25-501 = (l) <251

a. POPUL!flOM: (5) >1000 Oi KED Oi YOUTH --.. (t} 501-1000

- (3) 201-500 --:;- (2) 10-200

- (l) Hl

COWWEIItS UllCLUDE PROPOSED 1C'll01ll

~o~r~(e_ ·

Aiel 1-

PART 1: DWGE !SSESSWEll'l'

1. PHYSICAL: -m~~

- (2) LOW

- (1) WUIUW.

-,..... '0) »on:

2. POTMIAL FOB COI'f!CT:

1. <lOFt (8) HIGH

- (5) WEDIU)(

- (2) LOW

B. >lOFt - (51 HIGH

- (31 WEDIUK = (0) LOW

3. W!TEi D!)UGE:

(3) YES

--:- (0) 10

t. PBODIIITI TO ITEKS FOi iEP1Il. IF !OTB 111D I APPLY, SCOiE THE OKE WITH THE HIGHEST WIIG. UIAI 3 PfS)

1. SPi!YED Oi Tiflla'ELED-GI: • (31 <1 Ft Oi CEILIIG PmL COliTAll.

._, - (2) 1<1<5 Ft

- (l) )5 Ft

- (0) >5 Ft, 10 iOUTII! IIAUIT.

B. PIPE, Bn!W, Oi DUCT JISUL!TIOI, DWGE BY lOUT.

WVT. ? (31 CIILIIG PmL COIT!ll.

- Ul YES --;- (0) »o

5. fYfi OF KATEiiAL:

___.._ W CilLJIGS Oi UU.S

(3) iY!C .__ (1) BOILD OD/Oi PIPE = (0-U OTHEi Fil!BU: IIAfWAL

6. ASBESTOS COITM:

(5) >SOX = (3) 30-501

. (1) 1-301 --v" ( 11 10 llWiD llWRD i!TUlG

TOTAL FBOil P!it 1: DWGE (D)=

TOTAL FRO¥ P!it B: DPOSUii (£): _

BATI»G (BJ: 12.0324 - 0.1683 I D - O.l6Q3 I !

Il=-

BASE SWLE I

SUPPOHUIG Smt.E XUliBDS

LOC.UIOII

liOJo~ aT cau.-,-&0U.CI l ~ ..I I -w---- .,. - - ,_.4 iESULT

~ - I

PABT B: EIPOSUiE !SSESSWEIT

1. FRI!BLE: (6) HIGH

- (3) ~DEBATE = (l) LO~

2. !W OF YISIBLE IU.TEiUL:

(31 > 1000 SQ Ft

- (2) lOG-1000 so Ft :::;:: m 1o-1oo soFt

_ (01 <10 SQ FT

3. WALLS: ({) BOUGH

- (3) PITTED

::;:: (2) ~DEBATE

_ (l) SW>Otli

t. YEHIWIOII (IIAI 7 PTSI

-+ m ~~~~~ ~t~

- (1) 111 SUPPI.Y-FIBEi POTEITIAI. = (0) IOIE

5. Ali W!YDIEI'f AFFICTUIG IIATWAL ~ (5) iOUf. TURBULm Oi ABRUPT 1U M'M

(2) EIPOSED TO PEiCEPT Ali = (01 )10 PEiCEPT 11!1.

G. lCTIYITT: (51 HIGH-co»ST11T YIWTIOII

- 121 WEDIUil-OCCASSIOII11. YIBi!TIOI ---;- (0) LOW-ADIUII , CI.!SSI!OOII, W11TliG !RE.1

1. FLOOR: W CAIPET

- (2) SWIED Oi iOUGB SURFACE

- (1) SlllO'fH COIITIIUOUS SUB.F.lCE ::::: 10-t) UIIQUE SITU!TIOliS

8. BWIEiS. IF BOTII111D 8, APPLY HIGHEST BATIIG.

1. SPi!YED Oi TiOWELE»-011: UIAX 4 PTSI

~ W IIOiE

- (JI WLIIIG OB. WliE

- 12) EIClPSULATIOI

- Ul SUSPIIID CEILUIG

B. PIPE, BO!lnl DUCT, Oi OTHEi KATDIAL {) 75-1001

- (31 5G-751

- (2) 25-501 - ::::: (l} <251

Q. POPUL!TlOM: (51 >1000 OR MED OR YOUTB - w 501-1000

- (31 201-500 ----- (2) 10-200 =Ill 1-Q

COIQIEITS (UCI.UDI PBOPOSID !CTIOM)

/J/c1 4-

---r--------r---~;;;-=;==r=rr=-;r=--=-r--==y-=- . -r="TT"'"-=;==r"""-'1"-r-·--=r·- ~=·-·=-

ASBESTOS ASSESSMENT I ~•u 'TniWD~, WRKPIJ.CE I I I I J1 I I I II I ' I .~P~I~I~~.j~J~II,I_DE~_IF_m~tl~~~~~~~~

PART A: DAWAGE ASSESSKM

1. PHYSICAL: _ m ~~'l£

- (2) LOW

- (1) WUIIIW.

-X. (0) ~OKE

2. PotMIAL FOR COM'UCT:

A. <lOFT (8) SIGH

-- (5) WEDIUK

--:i: (21 LOW

B. >lOFT - (5) HIGH --;;- t3l W>lQW = (0) l.OW

3. ~fER Dw.G£:

(3) YES

"\ (0) JIO

4. PBOIIWITT TO ItEMS FOR BEPlii. IF BOTil &liD B APPLY, SCORE THE OIIE WITH THE HIGHEST i!fliG. Ulll 3 PfSl

A. SPRAYED OR TBOWELED-01: •

(3) (1 Ff 01 CEILIIG PmL COMT!M.

·.• - (2) 1<?<5 FT

- (1) >5 FT

- (0) >5 FT, 10 iOUTll! ILlUIT.

B. PIPE, BIITW, Oi DUCT UISUL!TlOI, D!KAGE BY iOUT.

ILli~. ? (3) CEILIIG PAJIEL COlt d.

- (1) YES

'V tOl JIO

5. TYfE OF ILlTERIAL:

(4) CEILIJIGS 01 WALLS

~(3) BVAC

(1) BOIW &JID/Oi PIPE = (0-tl OTBEI FaUBLE ILlfDIAL

6. ASBESTOS COITEJIT:

BAZ!B.D RATI»G

(5) )501

) 30-501

-.- 1) 1-301 <11 )10 BWiD totAL FBOW PART A: DW.GE lDl=

TotAL FBO¥ PART B: EIPOSIJBE (El = _

BATIIG (Rl= 12.0324 - 0.1683 I D - 0.1693 IE

11=-

SOPPOiflliG SIDLE VllWBEIS

BASE SIDLE a LOCATIOJI IESULT

011Al.XI:U.1'IOX

PAlfT B: EIPOSIJBE ASSESSUM

1. FRIABLE: (6) BIGII

- (3) YlDWfE

-7- (1) LOW

2. ABU OF VISIBLE ILlTEiiAL:

(31 >1000 SQ FT

- (21 100-1000 SQ FT

__,;21.. (1) 10-100 SO FT

_ (0) <10 SQ FT

3. WALLS: W iOUGH

- (3) PITTED

- (2) YlDWfi = (1) S~TH

4. YMILATIOII (IIAI 7 PfSl

(5) UTERIOl SUPPLY

- (2) liTEiiOi IETORII

- (l) 111 SUlPLY-FIBEi POfMUL _f.._ (0) JOVE

5. Ali W>YDIEIT lFFECTIIG WAmiAL _PL t5l iOOT. mBULIIT 01 !BIOPf 111 WM

(2) EIPOSEI TO P£iCEPf liB = (Ol 110 PEBCEPT llJl

6. lCTIYITY: (5) ilGH-coJSTm YIWTIOII ~ (2) WEDIUK-OCCA.SSIOJW. YlBilTIOI _ -_ (0) LOw-lDMU, CLASSBOOII, W!ITIIG .&R£A

1. FLOOR: ~ (4) CWET

(2) SEAWED 01 iOUGH SURFACE

- Ul Sli>OTII COITIIOOUS SUBFAC£ ::::: (0-t) UMIQIE SITUATIOMS

8. BWIEiS. IF BOTH 1 &liD R. APPLY lllGBESt BAfliG.

1. SPilYED Oi TiOm.ED-Ol: UUI 4 PfS)

-:...al W KOllE

(3) WLIMG 01 WliE

- (2) UCAPSILATIOI

- Ul SOSPW CEILUG

B. PIPE, BOitlil DUCT, 01 OfHEi WATEiiAL tl 15-1001

- (3) 50-751

- (2) 25-50% ::::: (1) <251 g, POPOLATIOM: (5) >1000 Ol liED 01 YOUTH - w 501-1000

- (3) 201-500 ~ (2) 10-200

- (l) 1-g

COIIMEJITS UMCLUDE PiOPOSED lCTIO~l )

- ( -h 011/ DL<ei ,wsc.., ~

/1/ci 4-

ASBESTOS ASSESSMENT t ».U& (Tn!WDOJ IIIURXPLACE I I I I II I I I II l ' I -~n~~~~-~~~~~~IDE_HI_FIU~tj~~~~~~~~~~~

PART !:_ DWGE !SSESSWT

1. PHYSICAL: (5) HIGH

- W ~DEBATE

- (2) LOW

- (l) MIIIUlAL -;A- (0) )lOWE

2. POTEHIAL FOR COliUCf:

! . <lOFT (8) HIGH

- (5) WEDIUK

:::;: (2) LOW

B. >lOFT (5) HIGH

- (3) WEDIOK = (0) LOW

3. W!TEi DWGE:

(3) YES = (0) liO

4. PiOIIKITY TO ITEMS FOi BEP1Il. IF BOTH 1 UD B APPLY, SCORE THE OWE WITH THE HIGHEST iAtliG. (W 3 PTS)

A. SPBAYED OR TiOWELED-011: • (3l <l FT Oi CEILlliG PmL COIITAK.

· , - (2) 1<?<5 FT

- Ul >5 FT

- (0) >5 FT, 10 iOIJTII! llllJIT. .

B. PIPE, BO!W, Oi DOCf UISUL!fiOII, DWGE BY lOUT.

lUI liT. ? (3) CEILIIIG PlliEL COWT!M.

m ~~

5. TYPE OF WATEiiAL:

(4) CEILIIIGS 01 WALLS

- (3) HVAC

:Z Ul BOlW IID/01 PIPE _ (0-4} OTI!Ei FlUBLI KATEil!L

6. ASBESTOS COliTEliT:

lUZ!RD i!TIIIG

(5) )50%

- (3} 30-50% _:._,(1) 1-30% _v · <lX liO H.WiD

TOTAL FBOW PART !: DWGE (D):

TOTAL FRO¥ PART B: EXPOSURE (£): _

B!TlliG (R): 12.0324 - 0.1683 • D - O.l6Q3 I!

i=_

BASE S!WPL£ I

SUPPOiTUIG S!WPLE liUYBDS

LOC!TIOII

Ol'l.

&Vk~ 8T <IUWII.~I,Ioi'ICI

'K..u , I • -· · ..j

RESULT

au a

I

OIIUl.uii:U.TlOII

PARt B: EXPOSlliE !SSESSYEliT

1. FRIABLE: (6) HIGH

- (3) ~DEBATE

4 (1) LOW

2. !W OF YISIBLE KATEiiAL:

(3) >1000 SQ FT

----- t2l 1oo-1ooo so rr

----- (1) 10-100 SQ FT

.< tol <10 sQ rr

3. WALLS: W BOUGH

- (3) PITTED

- (2) WJDWTE = (1) S~Tll

4. YEIITIL!TIOII (llAI 7 PTSl

(5) lliTEilOR SUPPLY

__L (2) lliTWOi iETOill

(1) Ali SUPPLY·FIB£1 POTEITI!L = (0) IIOIIE

5. 111 M:lVEWT !FFECfUIG KATEil!L 'X (5) BOUT. TURBULEIIT Oi ABRUPT lli Km

----- (2) EXPOSED TO PEICEPT llR = (0) MO PERCEPT !li

6. lCTIYITY: (5) HIGH·COIISTlliT YIBi!tlOM

- (2) WEDlml-OCC!SSIOI!L YIBB!TIOI l( (0) LOw-ADKIW, CL!SSROOK, W!ITIMG !W

7. FLOOi: (4) C.WE'f ----- (2) SE!WED Oi lOUGH SURFACE ~ (1) S~H COVTIKUOUS SURFACE = (0·4) UIIIQUE SITU!tlOIIS

8. B!BiiEiS. IF BotH 1 DD B, APPLY IDGRESt B!TiiG.

A. SPRAYED Oi fiOWELED-Oll: (W 4 PTSl

.. 'v (4) WOllE

~ (3) B!ILIIIG OR WIRE

----- (2) EliC!PSUL!TIOII ----- (1} SUSPEliD CEILIIIG

B. PIPE, BOIIlil DUCT, Oi OTHEi ll!TEil!L

4) '15-1001

- (3} 50-'151

- (2) 25-501 = (l} (251

G. POPULATIOII: (5} >1000 OR M£D 01 YOUTH

----- (t) 501-1000 ----- (3) 201-500 ----- (2} 10-200 ~ (1} 1-0

COMWTS (UICLUDE PROPOSED 1Cfl0ll) . W\.)

w odc \ hs"'\ \c.~

UVl&W&O If ClloUII,OaAPI,Ioi'IOI

11/ci 4

PART A: DWGE ASSESSWEII'f

1. PHYSICAL: (5) HIGH

- W ~DWT£

- (2) LOW

- (l) IU»>IU.L = lOl IIOliE

2. POTEIITIAL FOil COH!CT:

! . <lOFT (8) HIGH

- (5) IIEDIOll

- (2 ) LOW

B. >lOFt -- (5) HIGH

- (3) IIEDIUW = (0) toW

3. laTER DWGE:

(3) YES = (0) 110

t . PROIUfiTY TO ITEWS FOR 11£P1li. IF BOtH 1 &Ill) B APPLY, SCORE THE Oil£ WITH THE HIGHEST WIIG. (KAI 3 PTS)

A. SPUYED Oil TiOWELED-011: •

(3) (1 Ff OR CEILIIIG P!»EL COIITAM.

·.• - (2l 1<1<5 FT

- (ll >5 FT

- (0) )5 FT I )10 iOU!IW MAIIIT.

B. PIPE, B!ITW, OR DUCT IIISUL!TIOII, DWGE BY ROUT.

KUH. ? (J) CEILIIIG PAIEL COllUM.

- (l) YES __:-__ ( 0 l liO

5. TYPE OF IU.TERIAL:

(t) CEILIIIGS Oi WALLS

- {3) BY!C

~ (ll BOILER 1111)/0R PIPE = (0-U OTHER FiiABL£ MATERIAL

G. ASBESTOS COliTEIIT:

H,WRD R!TlliG

{5) )50t

- (Jl 30-501

- -- (l) 1-301

~ <11 }10 II!ZW)

TOTAL FROK PART ! : DWGE (D)=

TOTAL FRO¥ PART B: EXPOSURE (£): _

R!TIIIG (R): 12.0324 - 0.1683 I D- 0.1693 IE

i=_

BASE SAMPLE I

SUPPOII.fUIG SAMPLE liUWBERS

LOCA1'1011 IESULT

au&

II\OOWAA&A

r \

Oacl.UCI%41.1'101111

PART B: EXPOSURE ASSESSltm

1. FRIABLE: (6l HIGH

- (3) ~DWTE

.7 Ol LO~

2. AW OF VISIBLE IU.TERIAL:

3. WALLS:

(Jl >1000 SQ FT

- (2) 100-1000 SQ FT

- (1) 10-100 SQ FT = (0) <10 SQ FT

W ROUGH

- (3) PITTED

- (2) ~DWTE = (1) S~TH

t. VEHIL!TIOII (IU.I 7 PTSl

(5) liiTERIOR SUPPLY

- (2l IHERIOi BETUU

- (1) All SUPPLY-FIBER POTEIITUL :;:-,; (Ol liOliE

5. 11R W>VEWt 1FFECTUIG MATERIAL

(5) ROUT. TIJB.BULEIIt OR ABiUPf ill tma

- (2) EXPOSED TO PERCEPT Ali ~ (Ol 110 PERCEPT Alll

G. J.CTIYI!Y: (51 HIGH-COliSTlllt YIWTIOII

- (2) WEDIOll-OCCASSIOiAL YIBUTIOI = (0) LO\Il-ADW.lll, CLASSiOOll, WJJTliG AREA

7. FLOOi: WCARPET

- (2) SEmD 011. lOUGH SURFACE

- ,.. (1) Sli>OTH COIITUIOOUS SURFACE = (0-tl UIIIQUE SITU!TIOIIS

8. BWIERS. IF BOTH 1 !liD B, APPLY HIGHEST R!TiiG.

! . SPiA'iED Oil TII.OWELED-Qll: (KAI 4 PTSl

.. W MOllE

- l3l R!ILIIIG Oil WIRE

- (2) EIIC!PSULATIOll

- (l) SOSPEIID CEILiliG

B. PIP£, BOIWl DUCT, oa orm MATERIAL () 75-1001

- (3) 50-751

- (2) 25-501 -.::::; (1} (251

9. POPUL!TIOII: (5) >1000 OR KED Oi YOUTH

- {() 501-1000

- (3) 201-500

- (2} 10-200 ~ (l) 1-0

COWWTS UIICLUDE PROPOSED ACTIOII)

f (.k w ~ Vt--f

11/ci 1-

ASBESTOS ASSESSMEN~ Is I ~i.DWI>) I "\ r5fttrxhl I I I II I I I II I I I

PABT A: DWGE ASSESSWIT

1. PHYSICAL: -m~~,E

- (2) LOW

-.-7 (1) linl IIW.

_1L.._ lOl MOllE

2. PO!MIAL FOB COHAct:

A. <lOFT (8) HIGH

- (5) liEDIUll

~(2) LOW

B. >lOFT -- (5) HIGH

- l3l liEDIUW

---:- (0) LOW

3. WA!Ei DAIU.G£:

(3} YES

--::::::- ( 0 l )10

t. PROlllil!Y TO ITEMS FOB iEPlli. IF BOTlll AJID B lPPLT, SCORE THE O»E WITH THE HIGHEST WliG. Ul&l 3 HS)

!. SPRAYED OR TiOWEW-Oii: • l3l (1 FT OR CEILIIG Pl»EL COHAW.

·.• - (21 1<1<5 FT

- (1) >5 FT

1.::7"(0) >5 FT, 110 iOtrrll! KAIH. .

B. PIPE, Bnltll, OR DUCT UISOLATIOi, DWGE BY ROUT.

WAIH. ? (3) CEILIIG PAm COYTAll.

-::--_,( ll YES :z-- (0) )10

5. !YfE OF WATEiiAL:

~ W CEILUIGS Oi WW.S

- (3) BYAC

~ t~~lr~~~{~l~tEBIAL

6. ASBESTOS COliTEliT:

aAZ!B.D BAT I JiG

(5) )501

- (3) 30-501

- -- (1) 1-301 --;7 < 11 liO H.WBD

TOTAL FROil PART A: DWGE (D)= _

TOTAL FRO¥ PART B: EIPOSIIBE (E) : _

B!TlliG (Rl= 12.032l - 0.1683 • D - 0.1693 I !

li =-

•.u•

OM.ull:U.TlOK

WClRXrl..t.C&

~(? _;tiC_ fJ' - t f\

PARt B: EIPOSIIBE ASSESS!I(EM'f

1. FRIABLE: (6) HIGH

- (3) ~DEBATE

~ (l) LO~

2. AREA OF VISIBLE II!TEiiAL:

(3) > 1000 SQ FT

- l2l 100-1000 SQ FT

~(1) 10-100 SQ FT = (0) <10 SQ FT

3. WALLS: W ROUGH

- (ll PITTED

~t ~~~TE

l. YEiTILATIOll (liAI 7 PTSl

(5) lrTEilOR SUPPLY \ Z l2l UITEiiOi BETUlUI

(l) All SUPPLY-FIBEi POTEIITIAL = (0) JIOME

5. 1Il W>YDIEJIT 1FFEctUIG II!TEilAL l5l ROUT. TUBBULEIIT Oi ABRUPT 111! liM

- (2) EXPOSED TO PERCEPt Ali ~(0) MO PERCEPt Alk

6. ACTIVITY: (5) HIGH-coliST11T YlBBlTIOY

- (2) W£01UW-OCC1SSIOiiAL VIBBATIOI :::;:: (0) LOw-ADIUI, CLASSiOOII, WAITIIIG AREA l.- (l) CARPET

- (2) SEAWEll OR iOUGH SURFACE

- <u s~u connuous sURFACE ::::: (0-ll UYIQUE SITUATIOKS

7. FLOOR:

8. BWIEBS. IF BOTH 1 AJID B, APPLY HIGHEST iATiiG.

A. SPRAYED Oi fiOWELED-QI: (11!1 l PTSl

.. W MO»E

- (l) B!ILUIG Oi WIRE

- (2) EJICAPSOLATIOM

~(1) SUSPEliD CEILIMG

B. PIPE, BOltn.

DUct, OR OTHEi IIATWAL tl 75-1001

- (3) 50-757.

- (2) 25-507.

'/ (l) <251

Sl . POPULAtiOM: (5) >1000 01 liED Oi YOutH ----- (l) 501-1000 -- (l) 201-500

---- J2) 10-200 -vr-u m 1-0

SUPPORTlliG SIDLE WWBEBS COMWEiTS (IJICLUDE PROPOSED ActiOM)

1-BAS_E_s_m_LE_• ___ LOC_AT_Io_x _____ BES_UL_!_--1 c. c: I c'h_s t r' { e QM. C''\ 10 fo>l (r G·-r:;vl y , 1

IJO ~

UYUW&O If CIU.WI,.aAPa:,U'IO)

/1/ci 4-

..\:._ M- IIIOOWI.utl:4

PABT ! : DWGE !SSESSMM PART B: EXPOSURE ASSESSWEIT

(5) HIGH

- W lilDWU

- (2} LOW

- Ill MUIIMAL

1. PHYSICAL:

~ (0) 110ft:

2. POfEIITIAL FOR COIT!Cf:

A. <lOFT (8) HIGH

- (5} MEDIUM

\:-"' (2) LOW

B. >lOFT (5) HIGH

- (3) MEDIUII

,7 (0) t.OW

3. WATEi DWGE:

(3) YES

---;:::-(0) 10

4. PiOIUliTY '10 ItEMS FOR iEP111. IF !OTB 1 AiD 8 lPPLT, SCORE Tll£ OWE WITH THE HIGHEST WIIG. UIAX 3 PTS)

A. SPRAYED OR UOWELED-01: •

(3) <l FT 01 CEILIJIG PAm CO»TlM.

· .• ----- (2) 1<?<5 FT

----- Ul )5 Ft v-10) >5 Ft, 110 iOU!IIE lllUIT .

B. PIPE, Bn!W, OR DUCT IISOLATIOI, DWGE BY BOUT.

MAII'l. ? (l) CEILiliG PAJIEL COllUM.

----- Ul YES ~tOlliO

S. TYfE OF WATEi~U CEILIIIGS 01 tiLLS

----- (3) BYAC

~ (1) BOILEi ID/01 PIPE = (0-t) OTHEi FlUBLE MATERIAL

6. ASBESTOS COIITEllf:

HAZARD R!TIIIG

(5) >SOX

--~(3) 30-501

. (1) 1-301

=OX 110 BAWD

TOTAL FiOM PART !: DWGE (D)=

TOTAL FROW PART B: EXPOSURE tEl= _

IBATIIIG (:): 12.032( - 0.1683 I D - 0.1693 I E •

1. FRIABLE: (6) HIGH

----- (3) lilDW'fE :JZ'(l) LO~

2. !W OF VISIBLE IU.TEiiAL:

(31 >1000 SQ Ft ~(2} 100-1000 SQ F'l

(1) 10-100 SQ F'l = (0) <10 SQ Ft

3. WALLS: (() lOUGH

- {3) PITTED

~(2) MODERATE = (1) Sli)()TH t . YMILATIOI (IIAI '1 PfS)

(5) IIITEiiOR SUPPLY

- (2) liTEiiOR llETUBi

• ~(11 All SUPPLY-FIBEl POTEITIAL = (0) IOIIE

5. All WIYDIEIIt AFFECfiiG WATERIAL

(5) iOUT. TURBULEIIT 01 ABRUPT iii \lVVr

----- (2) EXPOSED TO PERCEPT liR , / (0) MO PERCEPT Alii

G. lC'llVITT: (5) HIGB-COIS'lAIT YIBB!TIOII

- (2) WEDIUK-OCC!SSIOlllL YIBBATIOI

7'"'(0)…