4200-2015.pdf

PDF 593 KB Posted Jun 22, 2017

Attached to: Central Steam Distribution Replacement Phase 1
Solicitation number: NNM17615413E
Issued by: National Aeronautics and Space Administration Marshall Space Flight Center

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Asbestos Report

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MSFC ASBESTOS CONTAINING MATERIAL PERIODIC INSPECTION FORM

BUILDING:

COMPLETE STATISTICAL

INSPECTION TYPE: (CHECK ONE)

If "statistical" is selected, minimum sample size is based on chart at right. (from ANSI/ASQZ1.9-2009)

TOTAL MEASURE MINIMUM SAMPLES

<90 3

91-150 4

INSPECTION DATE: 151-280 5

281-400 7 401-500 10

DATE OF LAST INSPECTION: ABBREVIATIONS:

TSI – Thermal System Insulation SURF – Surfacing Material MISC – Miscellaneous Debris

G – Good D – Damaged SD – Significantly Damaged

501-1,200 15 1,201-3,200 20 3,201-10,000 25

INSPECTOR: 10,001-150,000 30

>150,001 75

MATERIAL DESCRIPTION TOTAL MEASURE

(sq. ft, linear ft, etc.)

MINIMUM SAMPLE

NUMBER

(if statistical is selected)

ASBESTOS-

CONTAINING

MATERIAL TYPE

CONDITION

SAME

NEW

CONDITION NOTES

TSI SURF MISC G D SD YES NO G D SD

MSFC Form 4542 (January 2010)

MSFC ASBESTOS CONTAINING MATERIAL PERIODIC INSPECTION FORM (continued)

MATERIAL DESCRIPTION TOTAL MEASURE

(sq. ft, linear ft, etc.)

MINIMUM SAMPLE

NUMBER

(if statistical is selected)

ASBESTOS-

CONTAINING

MATERIAL TYPE

CONDITION

SAME

NEW

CONDITION NOTES

TSI SURF MISC G D SD YES NO G D SD

Page 2 – MSFC Form 4542 (January 2010)

BUILDING: 4200

INSPECTION DATE: 5/20/2015

DATE OF LAST INSPECTION: 5/17/2012

INSPECTOR: Todd Springer & Greg Smith

MATERIAL DESCRIPTIONRow1: Mastic 2'x2' Blk & Blue Carpet Sqr

TOTAL MEASURE sq ft linear ft etcRow1: 100000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow1: 30

NOTES: Delete Black & Blue Carpet Removed

MATERIAL DESCRIPTIONRow2: 12x12 FT Olive w/White Speck

TOTAL MEASURE sq ft linear ft etcRow2: 2250 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow2: 20

NOTES_2:

MATERIAL DESCRIPTIONRow3: Plaster - Acoustical Texture

TOTAL MEASURE sq ft linear ft etcRow3: 15000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow3: 30

NOTES_3: Reduce Amount to 14000 SF

MATERIAL DESCRIPTIONRow4: 9x9 FT Blk & White Streak

TOTAL MEASURE sq ft linear ft etcRow4: 24000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow4: 30

NOTES_4:

MATERIAL DESCRIPTIONRow5: 9x9 FT Blk & White Speckles

TOTAL MEASURE sq ft linear ft etcRow5: 24000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow5: 30

NOTES_5:

MATERIAL DESCRIPTIONRow6: 9x9 FT Dark Brown w/ Maroon Str

TOTAL MEASURE sq ft linear ft etcRow6: 24000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow6: 30

NOTES_6:

MATERIAL DESCRIPTIONRow7: 9x9 FT Beige w/Brown & Maroon

TOTAL MEASURE sq ft linear ft etcRow7: 24000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow7: 30

NOTES_7:

MATERIAL DESCRIPTIONRow8: 9x9 FT Med. Brown w/ Orange Str

TOTAL MEASURE sq ft linear ft etcRow8: 24000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow8: 30

NOTES_8:

MATERIAL DESCRIPTIONRow9: Mastic - Black Mastic

TOTAL MEASURE sq ft linear ft etcRow9: 13000 LF

MINIMUM SAMPLE NUMBER if statistical is selectedRow9: 30

NOTES_9:

MATERIAL DESCRIPTIONRow10: HVAC Duct Ins. Hard Sq. Duct

TOTAL MEASURE sq ft linear ft etcRow10: 4000 LF

MINIMUM SAMPLE NUMBER if statistical is selectedRow10: 25

NOTES_10:

MATERIAL DESCRIPTIONRow11: Fireproofing Ins. - Tan

TOTAL MEASURE sq ft linear ft etcRow11: 170000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow11: 75

NOTES_11:

MATERIAL DESCRIPTIONRow12: Misc. Debris - Above Ceiling

TOTAL MEASURE sq ft linear ft etcRow12: 170000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow12: 75

NOTES_12:

MATERIAL DESCRIPTIONRow13: Pipe Ins. - White Cloth Wrap

TOTAL MEASURE sq ft linear ft etcRow13: 30500 LF

MINIMUM SAMPLE NUMBER if statistical is selectedRow13: 30

NOTES_13: Reduce Amount to 5000 LF

MATERIAL DESCRIPTIONRow14: Pipe Ins. - Hard Mudded Elbows

TOTAL MEASURE sq ft linear ft etcRow14: 3000 Elbows

MINIMUM SAMPLE NUMBER if statistical is selectedRow14: 20

NOTES_14: Reduce Amount to 1000 Elbows

MATERIAL DESCRIPTIONRow15: HVAC Duct Ins. - Wrap on Foil

TOTAL MEASURE sq ft linear ft etcRow15: 4000 LF

MINIMUM SAMPLE NUMBER if statistical is selectedRow15: 25

NOTES_15:

MATERIAL DESCRIPTIONRow16: Mastic 2'x2' Blue & Grn Carpet Sq

TOTAL MEASURE sq ft linear ft etcRow16: 100000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow16: 30

NOTES_16:

MATERIAL DESCRIPTIONRow17: Exterior Transite Panels

TOTAL MEASURE sq ft linear ft etcRow17: 100000 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow17: 30

NOTES_17: Add to Database

MATERIAL DESCRIPTIONRow18:

TOTAL MEASURE sq ft linear ft etcRow18:

MINIMUM SAMPLE NUMBER if statistical is selectedRow18:

NOTES_18:

MATERIAL DESCRIPTIONRow19:

TOTAL MEASURE sq ft linear ft etcRow19:

MINIMUM SAMPLE NUMBER if statistical is selectedRow19:

NOTES_19:

MATERIAL DESCRIPTIONRow20:

TOTAL MEASURE sq ft linear ft etcRow20:

MINIMUM SAMPLE NUMBER if statistical is selectedRow20:

NOTES_20:

MATERIAL DESCRIPTIONRow21:

TOTAL MEASURE sq ft linear ft etcRow21:

MINIMUM SAMPLE NUMBER if statistical is selectedRow21:

NOTES_21:

MATERIAL DESCRIPTIONRow1_2:

TOTAL MEASURE sq ft linear ft etcRow1_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow1_2:

NOTES_22:

MATERIAL DESCRIPTIONRow2_2:

TOTAL MEASURE sq ft linear ft etcRow2_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow2_2:

NOTES_23:

MATERIAL DESCRIPTIONRow3_2:

TOTAL MEASURE sq ft linear ft etcRow3_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow3_2:

NOTES_24:

MATERIAL DESCRIPTIONRow4_2:

TOTAL MEASURE sq ft linear ft etcRow4_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow4_2:

NOTES_25:

MATERIAL DESCRIPTIONRow5_2:

TOTAL MEASURE sq ft linear ft etcRow5_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow5_2:

NOTES_26:

MATERIAL DESCRIPTIONRow6_2:

TOTAL MEASURE sq ft linear ft etcRow6_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow6_2:

NOTES_27:

MATERIAL DESCRIPTIONRow7_2:

TOTAL MEASURE sq ft linear ft etcRow7_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow7_2:

NOTES_28:

MATERIAL DESCRIPTIONRow8_2:

TOTAL MEASURE sq ft linear ft etcRow8_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow8_2:

NOTES_29:

MATERIAL DESCRIPTIONRow9_2:

TOTAL MEASURE sq ft linear ft etcRow9_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow9_2:

NOTES_30:

MATERIAL DESCRIPTIONRow10_2:

TOTAL MEASURE sq ft linear ft etcRow10_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow10_2:

NOTES_31:

MATERIAL DESCRIPTIONRow11_2:

TOTAL MEASURE sq ft linear ft etcRow11_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow11_2:

NOTES_32:

MATERIAL DESCRIPTIONRow12_2:

TOTAL MEASURE sq ft linear ft etcRow12_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow12_2:

NOTES_33:

MATERIAL DESCRIPTIONRow13_2:

TOTAL MEASURE sq ft linear ft etcRow13_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow13_2:

NOTES_34:

MATERIAL DESCRIPTIONRow14_2:

TOTAL MEASURE sq ft linear ft etcRow14_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow14_2:

NOTES_35:

MATERIAL DESCRIPTIONRow15_2:

TOTAL MEASURE sq ft linear ft etcRow15_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow15_2:

NOTES_36:

MATERIAL DESCRIPTIONRow16_2:

TOTAL MEASURE sq ft linear ft etcRow16_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow16_2:

NOTES_37:

MATERIAL DESCRIPTIONRow17_2:

TOTAL MEASURE sq ft linear ft etcRow17_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow17_2:

NOTES_38:

MATERIAL DESCRIPTIONRow18_2:

TOTAL MEASURE sq ft linear ft etcRow18_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow18_2:

NOTES_39:

MATERIAL DESCRIPTIONRow19_2:

TOTAL MEASURE sq ft linear ft etcRow19_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow19_2:

NOTES_40:

MATERIAL DESCRIPTIONRow20_2:

TOTAL MEASURE sq ft linear ft etcRow20_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow20_2:

NOTES_41:

MATERIAL DESCRIPTIONRow21_2:

TOTAL MEASURE sq ft linear ft etcRow21_2:

MINIMUM SAMPLE NUMBER if statistical is selectedRow21_2:

NOTES_42:

MATERIAL DESCRIPTIONRow22:

TOTAL MEASURE sq ft linear ft etcRow22:

MINIMUM SAMPLE NUMBER if statistical is selectedRow22:

NOTES_43:

MATERIAL DESCRIPTIONRow23:

TOTAL MEASURE sq ft linear ft etcRow23:

MINIMUM SAMPLE NUMBER if statistical is selectedRow23:

NOTES_44:

MATERIAL DESCRIPTIONRow24:

TOTAL MEASURE sq ft linear ft etcRow24:

MINIMUM SAMPLE NUMBER if statistical is selectedRow24:

NOTES_45:

MATERIAL DESCRIPTIONRow25:

TOTAL MEASURE sq ft linear ft etcRow25:

MINIMUM SAMPLE NUMBER if statistical is selectedRow25:

NOTES_46:

MATERIAL DESCRIPTIONRow26:

TOTAL MEASURE sq ft linear ft etcRow26:

MINIMUM SAMPLE NUMBER if statistical is selectedRow26:

NOTES_47:

MATERIAL DESCRIPTIONRow27:

TOTAL MEASURE sq ft linear ft etcRow27:

MINIMUM SAMPLE NUMBER if statistical is selectedRow27:

NOTES_48:

0: Off

1: Off

0: Off

0: Yes

0: Off

0: Yes

1: Yes

0: Off

1: Off

0: Off

0: Yes

0: Off

0: Yes

0: Off

1: Yes

0: Off

1: Off

0: Off

1: Off

0: Off

1: Off

0: Off

1: Off

SD:

0: Off

1: Off

0: Off

0: Yes

0: Off

1: Off

0: Off

1: Off

0: Off

0: Yes

0: Off

1: Off

TSI:

0: Off

1: Off

0: Off

0: Yes

0: Off

0: Yes

0: Off

1: Off

SURF:

0: Off

1: Off

0: Off

0: Yes

0: Off

0: Yes

0: Off

1: Off

MISC:

0: Off

1: Off

0: Off

0: Yes

0: Off

0: Yes

0: Off

0: Yes

0: Off

0: Yes

1: Yes

NO:

0: Off

1: Off

0: Off

0: Yes

1: Off

YES:

0: Off

1: Off

0: Off

0: Yes

0: Off

1: Yes

InspectionType: Statistical

File details come from the government source that posted it. Updated Nov 14, 2017.