Report - Lead and Asbestos_AC-807578_part 2 of 2.pdf

ZIMMETRY ENVIRONMENTAL MANAGEMENT CORP.

Lead Based Paint Inspection

Guard Rails on PR-849

Niton XLp 300, 9/24/2004, ed. 1

Performance Characteristic Sheet

EFFECTIVE DATE: September 24, 2004 EDITION NO.: 1

MANUFACTURER AND MODEL:

Make: Niton LLC

Tested Model: XLp 300 Source: 109Cd

Note: This PCS is also applicable to the equivalent model variations indicated below, for the Lead-in-Paint K+L variable reading time mode, in the XLi and XLp series:

XLi 300A, XLi 301A, XLi 302A and XLi 303A.

XLp 300A, XLp 301A, XLp 302A and XLp 303A.

XLi 700A, XLi 701A, XLi 702A and XLi 703A.

XLp 700A, XLp 701A, XLp 702A, and XLp 703A.

Note: The XLi and XLp versions refer to the shape of the handle part of the instrument. The differences in the model numbers reflect other modes available, in addition to Lead-in- Paint modes. The manufacturer states that specifications for these instruments are identical for the source, detector, and detector electronics relative to the Lead-in-Paint mode.

FIELD OPERATION GUIDANCE

OPERATING PARAMETERS:

Lead-in-Paint K+L variable reading time mode.

XRF CALIBRATION CHECK LIMITS:

0.8 to 1.2 mg/cm2 (inclusive)

The calibration of the XRF instrument should be checked using the paint film nearest 1.0 mg/cm2 in the NIST Standard Reference Material (SRM) used (e.g., for NIST SRM 2579, use the 1.02 mg/cm2 film).

If readings are outside the acceptable calibration check range, follow the manufacturer's instructions to bring the instruments into control before XRF testing proceeds.

SUBSTRATE CORRECTION:

For XRF results using Lead-in-Paint K+L variable reading time mode, substrate correction is not needed for:

Brick, Concrete, Drywall, Metal, Plaster, and Wood

INCONCLUSIVE RANGE OR THRESHOLD:

K+L MODE

READING DESCRIPTION

SUBSTRATE THRESHOLD

(mg/cm2)

Results not corrected for substrate bias on any substrate

Brick

Concrete Drywall

Metal Plaster

Wood

1.0

1.0 1.0

1.0 1.0

BACKGROUND INFORMATION

EVALUATION DATA SOURCE AND DATE:

This sheet is supplemental information to be used in conjunction with Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing ("HUD Guidelines"). Performance parameters shown on this sheet are calculated from the EPA/HUD evaluation using archived building components. Testing was conducted in August 2004 on 133 testing combinations. The instruments that were used to perform the testing had new sources; one instrument’s was installed in November 2003 with 40 mCi initial strength, and the other’s was installed June 2004 with 40 mCi initial strength.

OPERATING PARAMETERS:

Performance parameters shown in this sheet are applicable only when properly operating the instrument using the manufacturer's instructions and procedures described in Chapter 7 of the HUD Guidelines.

SUBSTRATE CORRECTION VALUE COMPUTATION:

Substrate correction is not needed for brick, concrete, drywall, metal, plaster or wood when using Lead-in- Paint K+L variable reading time mode, the normal operating mode for these instruments. If substrate correction is desired, refer to Chapter 7 of the HUD Guidelines for guidance on correcting XRF results for substrate bias.

EVALUATING THE QUALITY OF XRF TESTING:

Randomly select ten testing combinations for retesting from each house or from two randomly selected units in multifamily housing. Use the K+L variable time mode readings.

Conduct XRF retesting at the ten testing combinations selected for retesting.

Determine if the XRF testing in the units or house passed or failed the test by applying the steps below.

Compute the Retest Tolerance Limit by the following steps:

Determine XRF results for the original and retest XRF readings. Do not correct the original or retest results for substrate bias. In single-family housing a result is defined as the average of three readings. In multifamily housing, a result is a single reading.

Therefore, there will be ten original and ten retest XRF results for each house or for the two selected units.

Calculate the average of the original XRF result and retest XRF result for each testing combination.

Square the average for each testing combination.

Add the ten squared averages together. Call this quantity C.

Multiply the number C by 0.0072. Call this quantity D.

Add the number 0.032 to D. Call this quantity E.

Take the square root of E. Call this quantity F.

Multiply F by 1.645. The result is the Retest Tolerance Limit.

Compute the average of all ten original XRF results.

Compute the average of all ten re-test XRF results.

Find the absolute difference of the two averages.

If the difference is less than the Retest Tolerance Limit, the inspection has passed the retest. If the difference of the overall averages equals or exceeds the Retest Tolerance Limit, this procedure should be repeated with ten new testing combinations. If the difference of the overall averages is equal to or greater than the Retest Tolerance Limit a second time, then the inspection should be considered deficient.

Use of this procedure is estimated to produce a spurious result approximately 1% of the time. That is, results of this procedure will call for further examination when no examination is warranted in approximately 1 out of 100 dwelling units tested.

TESTING TIMES:

For the Lead-in-Paint K+L variable reading time mode, the instrument continues to read until it is moved away from the testing surface, terminated by the user, or the instrument software indicates the reading is complete. The following table provides testing time information for this testing mode. The times have been adjusted for source decay, normalized to the initial source strengths as noted above. Source strength and type of substrate will affect actual testing times. At the time of testing, the instruments had source strengths of 26.6 and 36.6 mCi.

Testing Times Using K+L Reading Mode (Seconds)

All Data Median for laboratory-measured lead levels (mg/cm2)

Substrate 25th

Percentile Median 75th

Percentile Pb < 0.25 0.25 < Pb<1.0 1.0 < Pb

Wood Drywall

4 11 19 11 15 11

Metal 4 12 18 9 12 14

Brick Concrete Plaster

8 16 22 15 18 16

CLASSIFICATION RESULTS:

XRF results are classified as positive if they are greater than or equal to the threshold, and negative if they are less than the threshold.

DOCUMENTATION:

A document titled Methodology for XRF Performance Characteristic Sheets provides an explanation of the statistical methodology used to construct the data in the sheets, and provides empirical results from using the recommended inconclusive ranges or thresholds for specific XRF instruments. For a copy of this document call the National Lead Information Center Clearinghouse at 1-800-424-LEAD.

This XRF Performance Characteristic Sheet was developed by the Midwest Research Institute (MRI) and QuanTech, Inc., under a contract between MRI and the XRF manufacturer. HUD has determined that the information provided here is acceptable when used as guidance in conjunction with Chapter 7, Lead-Based Paint Inspection, of HUD’s Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing.

Z

IM

M E

T R

Y E

N V

IR

O

N M

E N

T A

L M

A N

A G

E M

E N

T C

O R

P

L e ad B as ed

P a in t

In sp e ct io n

G u ar d R a ils o n

P R

-8

Guard Rails on PR-852

Guard Rail on PR-852

Performance Characteristic Sheet

EFFECTIVE DATE: September 24, 2004 EDITION NO.: 1

MANUFACTURER AND MODEL:

Make: Niton LLC

Tested Model: XLp 300 Source: 109Cd

Note: This PCS is also applicable to the equivalent model variations indicated below, for the Lead-in-Paint K+L variable reading time mode, in the XLi and XLp series:

XLi 300A, XLi 301A, XLi 302A and XLi 303A.

XLp 300A, XLp 301A, XLp 302A and XLp 303A.

XLi 700A, XLi 701A, XLi 702A and XLi 703A.

XLp 700A, XLp 701A, XLp 702A, and XLp 703A.

Note: The XLi and XLp versions refer to the shape of the handle part of the instrument. The differences in the model numbers reflect other modes available, in addition to Lead-in- Paint modes. The manufacturer states that specifications for these instruments are identical for the source, detector, and detector electronics relative to the Lead-in-Paint mode.

FIELD OPERATION GUIDANCE

OPERATING PARAMETERS:

Lead-in-Paint K+L variable reading time mode.

XRF CALIBRATION CHECK LIMITS:

0.8 to 1.2 mg/cm2 (inclusive)

The calibration of the XRF instrument should be checked using the paint film nearest 1.0 mg/cm2 in the NIST Standard Reference Material (SRM) used (e.g., for NIST SRM 2579, use the 1.02 mg/cm2 film).

If readings are outside the acceptable calibration check range, follow the manufacturer's instructions to bring the instruments into control before XRF testing proceeds.

SUBSTRATE CORRECTION:

For XRF results using Lead-in-Paint K+L variable reading time mode, substrate correction is not needed for:

Brick, Concrete, Drywall, Metal, Plaster, and Wood

INCONCLUSIVE RANGE OR THRESHOLD:

K+L MODE

READING DESCRIPTION

SUBSTRATE THRESHOLD

(mg/cm2)

Results not corrected for substrate bias on any substrate

Brick

Concrete Drywall

Metal Plaster

Wood

1.0

1.0 1.0

1.0

BACKGROUND INFORMATION

EVALUATION DATA SOURCE AND DATE:

This sheet is supplemental information to be used in conjunction with Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing ("HUD Guidelines"). Performance parameters shown on this sheet are calculated from the EPA/HUD evaluation using archived building components. Testing was conducted in August 2004 on 133 testing combinations. The instruments that were used to perform the testing had new sources; one instrument’s was installed in November 2003 with 40 mCi initial strength, and the other’s was installed June 2004 with 40 mCi initial strength.

OPERATING PARAMETERS:

Performance parameters shown in this sheet are applicable only when properly operating the instrument using the manufacturer's instructions and procedures described in Chapter 7 of the HUD Guidelines.

SUBSTRATE CORRECTION VALUE COMPUTATION:

Substrate correction is not needed for brick, concrete, drywall, metal, plaster or wood when using Lead-in- Paint K+L variable reading time mode, the normal operating mode for these instruments. If substrate correction is desired, refer to Chapter 7 of the HUD Guidelines for guidance on correcting XRF results for substrate bias.

EVALUATING THE QUALITY OF XRF TESTING:

Randomly select ten testing combinations for retesting from each house or from two randomly selected units in multifamily housing. Use the K+L variable time mode readings.

Conduct XRF retesting at the ten testing combinations selected for retesting.

Determine if the XRF testing in the units or house passed or failed the test by applying the steps below.

Compute the Retest Tolerance Limit by the following steps:

Determine XRF results for the original and retest XRF readings. Do not correct the original or retest results for substrate bias. In single-family housing a result is defined as the average of three readings. In multifamily housing, a result is a single reading.

Therefore, there will be ten original and ten retest XRF results for each house or for the two selected units.

Calculate the average of the original XRF result and retest XRF result for each testing combination.

Square the average for each testing combination.

Add the ten squared averages together. Call this quantity C.

Multiply the number C by 0.0072. Call this quantity D.

Add the number 0.032 to D. Call this quantity E.

Take the square root of E. Call this quantity F.

Multiply F by 1.645. The result is the Retest Tolerance Limit.

Compute the average of all ten original XRF results.

If the difference is less than the Retest Tolerance Limit, the inspection has passed the retest. If the difference of the overall averages equals or exceeds the Retest Tolerance Limit, this procedure should be repeated with ten new testing combinations. If the difference of the overall averages is equal to or greater than the Retest Tolerance Limit a second time, then the inspection should be considered deficient.

Use of this procedure is estimated to produce a spurious result approximately 1% of the time. That is, results of this procedure will call for further examination when no examination is warranted in approximately 1 out of 100 dwelling units tested.

TESTING TIMES:

For the Lead-in-Paint K+L variable reading time mode, the instrument continues to read until it is moved away from the testing surface, terminated by the user, or the instrument software indicates the reading is complete. The following table provides testing time information for this testing mode. The times have been adjusted for source decay, normalized to the initial source strengths as noted above. Source strength and type of substrate will affect actual testing times. At the time of testing, the instruments had source strengths of 26.6 and 36.6 mCi.

Testing Times Using K+L Reading Mode (Seconds)

All Data Median for laboratory-measured lead levels (mg/cm2)

Substrate 25th

Percentile Median 75th

Percentile Pb < 0.25 0.25 < Pb<1.0 1.0 < Pb

Wood Drywall

4 11 19 11 15 11

Metal 4 12 18 9 12 14

Brick Concrete Plaster

8 16 22 15 18 16

CLASSIFICATION RESULTS:

XRF results are classified as positive if they are greater than or equal to the threshold, and negative if they are less than the threshold.

DOCUMENTATION:

A document titled Methodology for XRF Performance Characteristic Sheets provides an explanation of the statistical methodology used to construct the data in the sheets, and provides empirical results from using the recommended inconclusive ranges or thresholds for specific XRF instruments. For a copy of this document call the National Lead Information Center Clearinghouse at 1-800-424-LEAD.

This XRF Performance Characteristic Sheet was developed by the Midwest Research Institute (MRI) and QuanTech, Inc., under a contract between MRI and the XRF manufacturer. HUD has determined that the information provided here is acceptable when used as guidance in conjunction with Chapter 7, M E

T R

Y E

N V

IR

O

N M

E N

T A

L M

A N

A G

E M

E N

T C

O R

P

L e ad B as ed

P a in t

In sp e ct ar d R a ils o n

P R

Guardrail on PR-861, Bayamón, PR

Performance Characteristic Sheet

EFFECTIVE DATE: September 24, 2004 EDITION NO.: 1

MANUFACTURER AND MODEL:

Make: Niton LLC

Tested Model: XLp 300 Source: 109Cd

Note: This PCS is also applicable to the equivalent model variations indicated below, for the Lead-in-Paint K+L variable reading time mode, in the XLi and XLp series:

XLi 300A, XLi 301A, XLi 302A and XLi 303A.

XLp 300A, XLp 301A, XLp 302A and XLp 303A.

XLi 700A, XLi 701A, XLi 702A and XLi 703A.

XLp 700A, XLp 701A, XLp 702A, and XLp 703A.

Note: The XLi and XLp versions refer to the shape of the handle part of the instrument. The differences in the model numbers reflect other modes available, in addition to Lead-in- Paint modes. The manufacturer states that specifications for these instruments are identical for the source, detector, and detector electronics relative to the Lead-in-Paint mode.

FIELD OPERATION GUIDANCE

OPERATING PARAMETERS:

Lead-in-Paint K+L variable reading time mode.

XRF CALIBRATION CHECK LIMITS:

0.8 to 1.2 mg/cm2 (inclusive)

The calibration of the XRF instrument should be checked using the paint film nearest 1.0 mg/cm2 in the NIST Standard Reference Material (SRM) used (e.g., for NIST SRM 2579, use the 1.02 mg/cm2 film).

If readings are outside the acceptable calibration check range, follow the manufacturer's instructions to bring the instruments into control before XRF testing proceeds.

SUBSTRATE CORRECTION:

For XRF results using Lead-in-Paint K+L variable reading time mode, substrate correction is not needed for:

Brick, Concrete, Drywall, Metal, Plaster, and Wood

INCONCLUSIVE RANGE OR THRESHOLD:

K+L MODE

READING DESCRIPTION

SUBSTRATE THRESHOLD

(mg/cm2)

Results not corrected for substrate bias on any substrate

Brick

Concrete Drywall

Metal Plaster

Wood

1.0

1.0 1.0

1.0

BACKGROUND INFORMATION

EVALUATION DATA SOURCE AND DATE:

This sheet is supplemental information to be used in conjunction with Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing ("HUD Guidelines"). Performance parameters shown on this sheet are calculated from the EPA/HUD evaluation using archived building components. Testing was conducted in August 2004 on 133 testing combinations. The instruments that were used to perform the testing had new sources; one instrument’s was installed in November 2003 with 40 mCi initial strength, and the other’s was installed June 2004 with 40 mCi initial strength.

OPERATING PARAMETERS:

Performance parameters shown in this sheet are applicable only when properly operating the instrument using the manufacturer's instructions and procedures described in Chapter 7 of the HUD Guidelines.

SUBSTRATE CORRECTION VALUE COMPUTATION:

Substrate correction is not needed for brick, concrete, drywall, metal, plaster or wood when using Lead-in- Paint K+L variable reading time mode, the normal operating mode for these instruments. If substrate correction is desired, refer to Chapter 7 of the HUD Guidelines for guidance on correcting XRF results for substrate bias.

EVALUATING THE QUALITY OF XRF TESTING:

Randomly select ten testing combinations for retesting from each house or from two randomly selected units in multifamily housing. Use the K+L variable time mode readings.

Conduct XRF retesting at the ten testing combinations selected for retesting.

Determine if the XRF testing in the units or house passed or failed the test by applying the steps below.

Compute the Retest Tolerance Limit by the following steps:

Determine XRF results for the original and retest XRF readings. Do not correct the original or retest results for substrate bias. In single-family housing a result is defined as the average of three readings. In multifamily housing, a result is a single reading.

Therefore, there will be ten original and ten retest XRF results for each house or for the two selected units.

Calculate the average of the original XRF result and retest XRF result for each testing combination.

Square the average for each testing combination.

Add the ten squared averages together. Call this quantity C.

Multiply the number C by 0.0072. Call this quantity D.

Add the number 0.032 to D. Call this quantity E.

Take the square root of E. Call this quantity F.

Multiply F by 1.645. The result is the Retest Tolerance Limit.

Compute the average of all ten original XRF results.

If the difference is less than the Retest Tolerance Limit, the inspection has passed the retest. If the difference of the overall averages equals or exceeds the Retest Tolerance Limit, this procedure should be repeated with ten new testing combinations. If the difference of the overall averages is equal to or greater than the Retest Tolerance Limit a second time, then the inspection should be considered deficient.

Use of this procedure is estimated to produce a spurious result approximately 1% of the time. That is, results of this procedure will call for further examination when no examination is warranted in approximately 1 out of 100 dwelling units tested.

TESTING TIMES:

For the Lead-in-Paint K+L variable reading time mode, the instrument continues to read until it is moved away from the testing surface, terminated by the user, or the instrument software indicates the reading is complete. The following table provides testing time information for this testing mode. The times have been adjusted for source decay, normalized to the initial source strengths as noted above. Source strength and type of substrate will affect actual testing times. At the time of testing, the instruments had source strengths of 26.6 and 36.6 mCi.

Testing Times Using K+L Reading Mode (Seconds)

All Data Median for laboratory-measured lead levels (mg/cm2)

Substrate 25th

Percentile Median 75th

Percentile Pb < 0.25 0.25 < Pb<1.0 1.0 < Pb

Wood Drywall

4 11 19 11 15 11

Metal 4 12 18 9 12 14

Brick Concrete Plaster

8 16 22 15 18 16

CLASSIFICATION RESULTS:

XRF results are classified as positive if they are greater than or equal to the threshold, and negative if they are less than the threshold.

DOCUMENTATION:

A document titled Methodology for XRF Performance Characteristic Sheets provides an explanation of the statistical methodology used to construct the data in the sheets, and provides empirical results from using the recommended inconclusive ranges or thresholds for specific XRF instruments. For a copy of this document call the National Lead Information Center Clearinghouse at 1-800-424-LEAD.

This XRF Performance Characteristic Sheet was developed by the Midwest Research Institute (MRI) and QuanTech, Inc., under a contract between MRI and the XRF manufacturer. HUD has determined that the information provided here is acceptable when used as guidance in conjunction with Chapter 7, M E

T R

Y E

N V

IR

O

N M

E N

T A

L M

A N

A G

E M

E N

T C

O R

P

L e ad B as ed

P a in t

In sp e ct ar d ra il o n P

R -8

, B ay a m ó n

P R

Guard Rail on PR-876

Performance Characteristic Sheet

EFFECTIVE DATE: September 24, 2004 EDITION NO.: 1

MANUFACTURER AND MODEL:

Make: Niton LLC

Tested Model: XLp 300 Source: 109Cd

Note: This PCS is also applicable to the equivalent model variations indicated below, for the Lead-in-Paint K+L variable reading time mode, in the XLi and XLp series:

XLi 300A, XLi 301A, XLi 302A and XLi 303A.

XLp 300A, XLp 301A, XLp 302A and XLp 303A.

XLi 700A, XLi 701A, XLi 702A and XLi 703A.

XLp 700A, XLp 701A, XLp 702A, and XLp 703A.

Note: The XLi and XLp versions refer to the shape of the handle part of the instrument. The differences in the model numbers reflect other modes available, in addition to Lead-in- Paint modes. The manufacturer states that specifications for these instruments are identical for the source, detector, and detector electronics relative to the Lead-in-Paint mode.

FIELD OPERATION GUIDANCE

OPERATING PARAMETERS:

Lead-in-Paint K+L variable reading time mode.

XRF CALIBRATION CHECK LIMITS:

0.8 to 1.2 mg/cm2 (inclusive)

The calibration of the XRF instrument should be checked using the paint film nearest 1.0 mg/cm2 in the NIST Standard Reference Material (SRM) used (e.g., for NIST SRM 2579, use the 1.02 mg/cm2 film).

If readings are outside the acceptable calibration check range, follow the manufacturer's instructions to bring the instruments into control before XRF testing proceeds.

SUBSTRATE CORRECTION:

For XRF results using Lead-in-Paint K+L variable reading time mode, substrate correction is not needed for:

Brick, Concrete, Drywall, Metal, Plaster, and Wood

INCONCLUSIVE RANGE OR THRESHOLD:

K+L MODE

READING DESCRIPTION

SUBSTRATE THRESHOLD

(mg/cm2)

Results not corrected for substrate bias on any substrate

Brick

Concrete Drywall

Metal Plaster

Wood

1.0

1.0 1.0

1.0

BACKGROUND INFORMATION

EVALUATION DATA SOURCE AND DATE:

This sheet is supplemental information to be used in conjunction with Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing ("HUD Guidelines"). Performance parameters shown on this sheet are calculated from the EPA/HUD evaluation using archived building components. Testing was conducted in August 2004 on 133 testing combinations. The instruments that were used to perform the testing had new sources; one instrument’s was installed in November 2003 with 40 mCi initial strength, and the other’s was installed June 2004 with 40 mCi initial strength.

OPERATING PARAMETERS:

Performance parameters shown in this sheet are applicable only when properly operating the instrument using the manufacturer's instructions and procedures described in Chapter 7 of the HUD Guidelines.

SUBSTRATE CORRECTION VALUE COMPUTATION:

Substrate correction is not needed for brick, concrete, drywall, metal, plaster or wood when using Lead-in- Paint K+L variable reading time mode, the normal operating mode for these instruments. If substrate correction is desired, refer to Chapter 7 of the HUD Guidelines for guidance on correcting XRF results for substrate bias.

EVALUATING THE QUALITY OF XRF TESTING:

Randomly select ten testing combinations for retesting from each house or from two randomly selected units in multifamily housing. Use the K+L variable time mode readings.

Conduct XRF retesting at the ten testing combinations selected for retesting.

Determine if the XRF testing in the units or house passed or failed the test by applying the steps below.

Compute the Retest Tolerance Limit by the following steps:

Determine XRF results for the original and retest XRF readings. Do not correct the original or retest results for substrate bias. In single-family housing a result is defined as the average of three readings. In multifamily housing, a result is a single reading.

Therefore, there will be ten original and ten retest XRF results for each house or for the two selected units.

Calculate the average of the original XRF result and retest XRF result for each testing combination.

Square the average for each testing combination.

Add the ten squared averages together. Call this quantity C.

Multiply the number C by 0.0072. Call this quantity D.

Add the number 0.032 to D. Call this quantity E.

Take the square root of E. Call this quantity F.

Multiply F by 1.645. The result is the Retest Tolerance Limit.

Compute the average of all ten original XRF results.

If the difference is less than the Retest Tolerance Limit, the inspection has passed the retest. If the difference of the overall averages equals or exceeds the Retest Tolerance Limit, this procedure should be repeated with ten new testing combinations. If the difference of the overall averages is equal to or greater than the Retest Tolerance Limit a second time, then the inspection should be considered deficient.

Use of this procedure is estimated to produce a spurious result approximately 1% of the time. That is, results of this procedure will call for further examination when no examination is warranted in approximately 1 out of 100 dwelling units tested.

TESTING TIMES:

For the Lead-in-Paint K+L variable reading time mode, the instrument continues to read until it is moved away from the testing surface, terminated by the user, or the instrument software indicates the reading is complete. The following table provides testing time information for this testing mode. The times have been adjusted for source decay, normalized to the initial source strengths as noted above. Source strength and type of substrate will affect actual testing times. At the time of testing, the instruments had source strengths of 26.6 and 36.6 mCi.

Testing Times Using K+L Reading Mode (Seconds)

All Data Median for laboratory-measured lead levels (mg/cm2)

Substrate 25th

Percentile Median 75th

Percentile Pb < 0.25 0.25 < Pb<1.0 1.0 < Pb

Wood Drywall

4 11 19 11 15 11

Metal 4 12 18 9 12 14

Brick Concrete Plaster

8 16 22 15 18 16

CLASSIFICATION RESULTS:

XRF results are classified as positive if they are greater than or equal to the threshold, and negative if they are less than the threshold.

DOCUMENTATION:

A document titled Methodology for XRF Performance Characteristic Sheets provides an explanation of the statistical methodology used to construct the data in the sheets, and provides empirical results from using the recommended inconclusive ranges or thresholds for specific XRF instruments. For a copy of this document call the National Lead Information Center Clearinghouse at 1-800-424-LEAD.

This XRF Performance Characteristic Sheet was developed by the Midwest Research Institute (MRI) and QuanTech, Inc., under a contract between MRI and the XRF manufacturer. HUD has determined that the information provided here is acceptable when used as guidance in conjunction with Chapter 7, M E

T R

Y E

N V

IR

O

N M

E N

T A

L M

A N

A G

E M

E N

T C

O R

P

L e ad B as ed

P a in t

In sp e ct ar d R a il o n

P R

Forma PGC-009

GOBIERNO DE PUERTO RICO

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago de sus cuotas de colegiación e Inspectores de Asbesto deberán someter evidencia de la tarjeta de registro provista por la JCA.

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488 Tel. (787) 767-8181 • Fax (787) 767-1962

Corozal

Joanne Negrón Soltera

Bayamón

787 995 2160 787 995 0005

787 376 9010

2 enero 2020

PO Box 3545

Bayamón 00958

Overheads located at PR-5, Km 6.20, Km 6.25, Km 6.70, Km 7.60 in Bayamón, Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

Certification

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488 Tel. (787) 767-8181 • Fax (787) 767-1962

Forma PGC-010

GOBIERNO DE PUERTO RICO

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE PINTURA CON BASE DE PLOMO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_______________________ (Inspector o Evaluador de Riesgos) (Estado Civil) (Municipio)

Dirección Postal_________________________________________________________________________________ (Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. Estoy certificado por la Junta de Calidad Ambiental como ( Inspector / Evaluador de Riesgos) con Número de

Certificación ___________________________, la cual se encuentra vigente.

2. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de pintura con base de plomo.

3. La información antes indicada es cierta y correcta.

4. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

5. Para que así conste, firmo la presente certificación en _______________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma del Inspector o Evaluador de Riesgos (en original)

Nota : Deberá someter evidencia de la tarjeta o certificado provista por la JCA.

00958

6387-0319-RA-006

Overheads located at PR-5, Km 6.20, Km 6.25, Km 6.70, Km 7.60 in Bayamón, Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

X

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago de sus cuotas de colegiación e Inspectores de Asbesto deberán someter evidencia de la tarjeta de registro provista por la JCA.

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488

Guardrails located at PR-6, from Km 0.19 Both Sides, Km 0.22 Both Sides, Km 0.25, Km 0.30 Both Sides, Km 0.33, Km 0.36, Km 0.41, Km 0.45, Km 0.51, Km 0.52,Km 0.55, Km 0.61, Km 0.70, Km 0.73, Km 0.74, Km 0.80, Km 0.84, Km 0.90, Km 0.93 Both Sides, Km 0.96, Km 1.15, Km 1.21, Km 1.24, Km 1.53, Km 1.58, Km 1.59, Km

1.60 Both Sides, Km 1.61, Km 1.62, Km 1.63, Km 1.64, Km 1.66, Km 1.67, Km 1.68 & Km 1.69 Both Sides in Bayamón Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926

Tel. (787) 767-8181 • Fax (787) 767-1962

Forma PGC-010

GOBIERNO DE PUERTO RICO

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE PINTURA CON BASE DE PLOMO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_______________________ (Inspector o Evaluador de Riesgos) (Estado Civil) (Municipio)

Dirección Postal_________________________________________________________________________________ (Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. Estoy certificado por la Junta de Calidad Ambiental como ( Inspector / Evaluador de Riesgos) con Número de

Certificación ___________________________, la cual se encuentra vigente.

2. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de pintura con base de plomo.

3. La información antes indicada es cierta y correcta.

4. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

5. Para que así conste, firmo la presente certificación en _______________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma del Inspector o Evaluador de Riesgos (en original)

Nota : Deberá someter evidencia de la tarjeta o certificado provista por la JCA.

Guardrails located at PR-6, from Km 0.19 Both Sides, Km 0.22 Both Sides, Km 0.25, Km 0.30 Both Sides, Km 0.33, Km 0.36, Km 0.41, Km 0.70, Km 0.73, Km 0.74, Km 0.80, Km 0.84, Km 0.90, Km 0.93 Both Sides, Km 0.96, Km 1.15, Km 1.21, Km 1.24, Km 1.53, Km 1.58, Km 1.59, Km 1.60 Both Sides, Km 1.61, Km 1.62, Km 1.63, Km 1.64, Km 1.66, Km 1.67, Km 1.68 & Km 1.69 North Side in Bayamón Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago de sus cuotas de colegiación e Inspectores de Asbesto deberán someter evidencia de la tarjeta de registro provista por la JCA.

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488

Guardrail located at at PR-20 exit to PR-177, north roadside in Guaynabo Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago de sus cuotas de colegiación e Inspectores de Asbesto deberán someter evidencia de la tarjeta de registro provista por la JCA.

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488

Metal post located at PR-27, Km 3.80 in San Juan Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926

Tel. (787) 767-8181 • Fax (787) 767-1962

Forma PGC-010

GOBIERNO DE PUERTO RICO

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE PINTURA CON BASE DE PLOMO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_______________________ (Inspector o Evaluador de Riesgos) (Estado Civil) (Municipio)

Dirección Postal_________________________________________________________________________________ (Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. Estoy certificado por la Junta de Calidad Ambiental como ( Inspector / Evaluador de Riesgos) con Número de

Certificación ___________________________, la cual se encuentra vigente.

2. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de pintura con base de plomo.

3. La información antes indicada es cierta y correcta.

4. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

5. Para que así conste, firmo la presente certificación en _______________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma del Inspector o Evaluador de Riesgos (en original)

Nota : Deberá someter evidencia de la tarjeta o certificado provista por la JCA.

Metal post located at PR-27, Km 3.80 in San Juan Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago de sus cuotas de colegiación e Inspectores de Asbesto deberán someter evidencia de la tarjeta de registro provista por la JCA.

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488

Guardrails located at PR-29, Km 0.00, Km 0.20, Km 0.26 North Side, Km 0.26 to Km 30 South Side, Km 1.00 Km 1.15 to Km 1.16, Km 1.17, Km 1.20, Km 1.25, Km 1.46, Km 2.09 to Km 2.15, Km 2.18 to 2.23 North Side, Km 2.18 to 2.23 Center, Km 2.18 to 2.23 South Side in Bayamón Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926

Tel. (787) 767-8181 • Fax (787) 767-1962

Forma PGC-010

GOBIERNO DE PUERTO RICO

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE PINTURA CON BASE DE PLOMO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_______________________ (Inspector o Evaluador de Riesgos) (Estado Civil) (Municipio)

Dirección Postal_________________________________________________________________________________ (Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. Estoy certificado por la Junta de Calidad Ambiental como ( Inspector / Evaluador de Riesgos) con Número de

Certificación ___________________________, la cual se encuentra vigente.

2. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de pintura con base de plomo.

3. La información antes indicada es cierta y correcta.

4. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

5. Para que así conste, firmo la presente certificación en _______________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma del Inspector o Evaluador de Riesgos (en original)

Nota : Deberá someter evidencia de la tarjeta o certificado provista por la JCA.

Guardrails located at PR-29, Km 0.00, Km 0.20, Km 0.26 North Side, Km 0.26 to Km 30 South Side, Km 1.00 Km 1.15 to Km 1.16, Km 1.17, Km 1.20, Km 1.25, Km 1.46, Km 2.09 to Km 2.15, Km 2.18 to 2.23 North Side, Km 2.18 to 2.23 Center, Km 2.18 to 2.23 South Side in Bayamón Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago de sus cuotas de colegiación e Inspectores de Asbesto deberán someter evidencia de la tarjeta de registro provista por la JCA.

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926 Dirección Postal: Apartado 11488, Santurce, PR 00910-1488

Overheads located at PR-41, from Km 1.11, Km 1.36, Km 1.56 & Km 1.85 in San Juan, Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

Dirección Física: Ave. Ponce de León 1308, Carr. Estatal 8838, Sector el Cinco, Río Piedras, PR 00926

Tel. (787) 767-8181 • Fax (787) 767-1962

Forma PGC-010

GOBIERNO DE PUERTO RICO

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE PINTURA CON BASE DE PLOMO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_______________________ (Inspector o Evaluador de Riesgos) (Estado Civil) (Municipio)

Dirección Postal_________________________________________________________________________________ (Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. Estoy certificado por la Junta de Calidad Ambiental como ( Inspector / Evaluador de Riesgos) con Número de

Certificación ___________________________, la cual se encuentra vigente.

2. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de pintura con base de plomo.

3. La información antes indicada es cierta y correcta.

4. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

5. Para que así conste, firmo la presente certificación en _______________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma del Inspector o Evaluador de Riesgos (en original)

Nota : Deberá someter evidencia de la tarjeta o certificado provista por la JCA.

Overheads located at PR-41, from Km 1.11, Km 1.36, Km 1.56 & Km 1.85 in San Juan, Puerto Rico part of Hurricane María Efforts for Signing & Guardrails for Bayamón, Cataño, Guaynabo, San Juan & Trujillo Alto - AC-812541 project

OFICINA DEL GOBERNADOR

JUNTA DE CALIDAD AMBIENTAL

Área de Calidad de Agua

CERTIFICACION DE NO PRESENCIA DE ASBESTO

EN ESTRUCTURAS A DEMOLERSE

(Deberá completarse en letra de molde o impresa)

PGC-_____________________

PARA USO OFICIAL

Yo, ______________________________, mayor de edad,______________, y vecino de_________________________ (Nombre) (Estado Civil) (Municipio)

Dirección Postal___________________________________________________________________________________

(Pueblo) (Zip Code)

Teléfonos: Residencial (______) ______- ________ Oficina (______) ______- ________ Ext._________

Fax (______) ______- ________

Certifico que:

1. La estructura localizada en__________________________________________________, la cual será objeto de una demolición se encuentra libre de asbesto.

2. La información antes indicada es cierta y correcta.

3. Afirmo y reconozco las consecuencias de incluir y someter información falsa en este documento.

4. Para que así conste, firmo la presente certificación en _____________________________________ de Puerto Rico, (Municipio) hoy día ____ de ____________________ de _________

Firma y Sello del Profesional o

Firma del Inspector de Asbesto registrado por la JCA (Original)

Nota: Ingenieros o Arquitectos deberán someter evidencia de que se encuentra al día en el pago…