4760-2015.pdf

PDF 577 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: 4760

INSPECTION DATE: 11/24/2015

DATE OF LAST INSPECTION: 11/28/2012

INSPECTOR: Todd Springer

MATERIAL DESCRIPTIONRow1: Misc. Debris - Pipe Ins.

TOTAL MEASURE sq ft linear ft etcRow1: 200 SF

MINIMUM SAMPLE NUMBER if statistical is selectedRow1: 5

NOTES: Delete

MATERIAL DESCRIPTIONRow2: Pipe Insulation

TOTAL MEASURE sq ft linear ft etcRow2: 4500 LF

MINIMUM SAMPLE NUMBER if statistical is selectedRow2: 25

NOTES_2:

MATERIAL DESCRIPTIONRow3: Pipe Ins. - Mud on Elbows

TOTAL MEASURE sq ft linear ft etcRow3: 900 Elbows

MINIMUM SAMPLE NUMBER if statistical is selectedRow3: 15

NOTES_3: Reduce to 450 Elbows

MATERIAL DESCRIPTIONRow4:

TOTAL MEASURE sq ft linear ft etcRow4:

MINIMUM SAMPLE NUMBER if statistical is selectedRow4:

NOTES_4:

MATERIAL DESCRIPTIONRow5:

TOTAL MEASURE sq ft linear ft etcRow5:

MINIMUM SAMPLE NUMBER if statistical is selectedRow5:

NOTES_5:

MATERIAL DESCRIPTIONRow6:

TOTAL MEASURE sq ft linear ft etcRow6:

MINIMUM SAMPLE NUMBER if statistical is selectedRow6:

NOTES_6:

MATERIAL DESCRIPTIONRow7:

TOTAL MEASURE sq ft linear ft etcRow7:

MINIMUM SAMPLE NUMBER if statistical is selectedRow7:

NOTES_7:

MATERIAL DESCRIPTIONRow8:

TOTAL MEASURE sq ft linear ft etcRow8:

MINIMUM SAMPLE NUMBER if statistical is selectedRow8:

NOTES_8:

MATERIAL DESCRIPTIONRow9:

TOTAL MEASURE sq ft linear ft etcRow9:

MINIMUM SAMPLE NUMBER if statistical is selectedRow9:

NOTES_9:

MATERIAL DESCRIPTIONRow10:

TOTAL MEASURE sq ft linear ft etcRow10:

MINIMUM SAMPLE NUMBER if statistical is selectedRow10:

NOTES_10:

MATERIAL DESCRIPTIONRow11:

TOTAL MEASURE sq ft linear ft etcRow11:

MINIMUM SAMPLE NUMBER if statistical is selectedRow11:

NOTES_11:

MATERIAL DESCRIPTIONRow12:

TOTAL MEASURE sq ft linear ft etcRow12:

MINIMUM SAMPLE NUMBER if statistical is selectedRow12:

NOTES_12:

MATERIAL DESCRIPTIONRow13:

TOTAL MEASURE sq ft linear ft etcRow13:

MINIMUM SAMPLE NUMBER if statistical is selectedRow13:

NOTES_13:

MATERIAL DESCRIPTIONRow14:

TOTAL MEASURE sq ft linear ft etcRow14:

MINIMUM SAMPLE NUMBER if statistical is selectedRow14:

NOTES_14:

MATERIAL DESCRIPTIONRow15:

TOTAL MEASURE sq ft linear ft etcRow15:

MINIMUM SAMPLE NUMBER if statistical is selectedRow15:

NOTES_15:

MATERIAL DESCRIPTIONRow16:

TOTAL MEASURE sq ft linear ft etcRow16:

MINIMUM SAMPLE NUMBER if statistical is selectedRow16:

NOTES_16:

MATERIAL DESCRIPTIONRow17:

TOTAL MEASURE sq ft linear ft etcRow17:

MINIMUM SAMPLE NUMBER if statistical is selectedRow17:

NOTES_17:

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

1: Off

0: Off

1: Off

0: Off

1: Off

0: Off

1: Off

0: Off

0: Yes

0: Off

1: Yes

0: Off

1: Off

0: Off

0: Yes

0: Off

1: Yes

SD:

0: Off

1: Off

0: Off

0: Yes

1: Off

0: Off

1: Off

0: Off

0: Yes

1: Off

TSI:

0: Off

1: Off

0: Off

0: Yes

1: Yes

SURF:

0: Off

1: Off

0: Off

1: Off

MISC:

0: Off

1: Off

0: Off

1: Off

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.