S02_CD_Spec Vol 3_Reno Dialysis.pdf

Anderson Engineering of Minnesota, LLC

13605 1st Avenue North Plymouth, MN 55441

Phone: 763-412-4000 Fax: 763-412-4090

Prepared in association with the following:

IMEG Corp

2882 106th Street Des Moines, IA 50322 Phone: 515-334-9906

Renovate Dialysis

VA PROJECT NUMBER: 636A8-24-001

601 HWY 6 West Iowa City, IA 52246

TECHNICAL SPECIFICATIONS

Volume 3: APPENDICES

ANDERSON ENGINEERING OF MN, LLC

Project Number: 17909

Issue for Construction Documents

April 24, 2025

Prepared for:

ANDERSON ENGINEERING

13605 - 1ST AVENUE NORTH

PLYMOUTH, MN

December 23, 2024

Pre-Renovation Asbestos Survey Iowa City VA Health Care System – Renovate Dialysis Building 1 – 5th Floor Iowa City, Iowa

Landmark Environmental, LLC 9555 James Avenue South, Suite 262 | Bloomington, MN 55431 | Phone: 952-295-9400 | www.landmarkenv.com

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

Asbestos Inspection Report

Iowa City VA Health Care System – Renovate Dialysis

Building 1 – 5th Floor

Iowa City, Iowa

1.0 Executive Summary

2.0 Introduction

3.0 Sampling Methods and Analysis

4.0 Asbestos-Containing Material Assessment

5.0 Findings

6.0 Signatures of Environmental Professional(s)

Appendices

Appendix A Asbestos Certificates

Appendix B Building Diagrams with Sample Locations

Appendix C Asbestos-Containing Materials Physical Assessment

Appendix D Building Diagram with Locations of Asbestos-Containing Materials

Appendix E Asbestos Laboratory Report and Chain of Custody

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

1.0 Executive Summary

Landmark Environmental, LLC (Landmark) was retained by Anderson Engineering (Client) to conduct an asbestos survey (Survey) prior to a renovation project at the Veterans

Affairs (VA) Iowa City Health Care System located in Iowa City, Iowa (Property). The

Client intends to conduct a renovation project titled “Renovate Dialysis” (Project) on the

5th Floor of Building 1.

Landmark conducted a full asbestos survey of 5th floor south (5S), along with a limited survey of 5th floor west (5W) that will temporarily house the dialysis department during the construction Project. Stairwells and elevators were not included in the Survey.

An asbestos survey was previously conducted of Building 1 by Shive-Hattery, Inc. (Shive-

Hattery) in June 2016. No asbestos was found in the Project area during the Shive-

Hattery survey. Sample data from the Shive-Hattery survey was not used during the

Landmark Survey.

A summary of the Survey results are as follows:

Landmark collected 84 bulk asbestos samples as part of the Survey. The contracted laboratory, EMSL Analytical, Inc. (EMSL) separated these 84 samples into 95 individual sample layers and all 95 sample layers were analyzed.

Based on the laboratory report, suspect building materials found to contain asbestos include – gray adhesive on plaster, and 12” x 12” floor tile.

Building materials assumed to contain asbestos include – fire doors, and electric panels.

No attempt was made to locate materials inside walls, doors, ducts, and other areas that would require destructive entry. The possibility exists that materials may be present at these locations. Any untested building materials observed, or suspected in these areas, are assumed to be asbestos-containing. The possibility exists that as these locations are opened during renovation, suspect asbestos-containing material(s) (ACM) may be found.

Fire doors were not sampled since doing so would damage the integrity of the door and void the warranty of the product.

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

Electrical wiring and panels were not sampled for asbestos. Landmark does not perform bulk sampling of electrical equipment unless it has been shut down and tagged by a licensed electrician.

This Survey identifies ACM as they existed on the day of the Survey at the Property.

Conditions may change over time.

The ACM quantities provided are estimates and must be verified by the bidding contractors.

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

2.0 Introduction

Landmark completed an asbestos survey and associated report (Report) at the Property.

The procedures used for this Survey and assessment comply with the Environmental

Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), Iowa

Division of Labor (IDL), and Iowa Department of Natural Resources (IDNR) asbestos standards.

2.1 Purpose

Landmark was retained by the Client to complete the Survey and provide a Report to identify ACM and to quantify ACM in the 5th floor work areas of the Property prior to commencing with a scheduled Project.

2.2 Survey Approach

The Survey, consisting of identifying, sampling, assessing, and quantifying suspect ACM within the Project area, was conducted on November 19, 2024. In 5S, a full survey was conducted on all materials in this portion of the Project area. In 5W, a limited survey was conducted. Only surfaces (flooring, walls, ceiling tiles, etc.) that may be impacted during the Project were included in the Survey. The 5W portion of the Project only involves moving furniture, and possibly tying into existing plumbing in the exam room restrooms as part of the dialysis equipment installation.

2.3 Assumptions, Limitations and Exceptions

The findings and recommendations in this Report are subject to the following assumptions, limitations, and/or exceptions:

• A limited asbestos survey was conducted in 5 West based on the proposed plans for the Project at the time of the Survey. Only flooring, walls, and ceiling materials that may be impacted during the Project were included in the Survey.

• No attempt was made to locate materials inside walls, doors, ducts, and other areas that would require destructive entry. The possibility exists that materials may be present at these locations. Materials observed, or suspected in these areas, are assumed to be ACM. The possibility exists that as these locations are opened during renovation, suspect asbestos-containing material(s) may be found.

• Electrical wiring and panels were not sampled for asbestos. Landmark does not perform bulk sampling of electrical equipment unless it has been shut down and tagged by a licensed electrician.

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

• Fire doors were not sampled since doing so would damage the integrity of the door and void the warranty of the door. Fire doors must be treated as asbestos-containing during abatement, or sampled to determine if they contain asbestos prior to disturbance.

• This Survey identifies materials as they existed on the day of the Survey. Conditions may change over time.

2.4 Qualifications

The Survey was conducted by Mark Meier, an accredited asbestos building inspector with Landmark. A photocopy of the inspector’s IDL certification is included in Appendix A.

Asbestos sample analysis for this project was conducted by EMSL located in New Hope, Minnesota. EMSL is accredited by the National Voluntary Accreditation Program for bulk asbestos analysis (NVLAP lab code 200019-0).

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

3.0 Sampling Methods and Analysis

3.1 Bulk Asbestos Sampling

Building diagrams were utilized to divide the Property building into functional spaces for the purpose of describing sampling locations. The building diagram with sample locations has been included in Appendix B.

Similar systems and materials were grouped into “homogeneous areas of building materials” (homogeneous materials). Homogeneous materials often exist in more than one functional space within the Property building. Each homogeneous material was assigned a discrete number; the homogeneous material number is indicated in the first number of the sample name. Multiple samples of each homogeneous material were taken in accordance with the EPA-Asbestos Hazard Emergency Response Act (AHERA) guidelines using a random sampling procedure. These multiple samples were designated “A, B, C,” etc. for each homogenous material, as indicated in the sample name. The sample locations and sample descriptions are shown on the building diagram (Appendix B) and the asbestos laboratory report (Appendix E).

Samples were collected by wetting and carefully removing a small representative sample of the suspect material and sealing it in a plastic bag.

3.2 Bulk Asbestos Analysis

Landmark collected 84 bulk asbestos samples as part of the Survey. EMSL separated these 84 samples into 95 individual layer samples and all 95 individual layer samples were analyzed.

The bulk samples were analyzed by polarized light microscopy (PLM) with dispersion staining, EPA method 600/R-93/116 and EPA method 600/M4-82-020. Quantity determinations are made by visual estimation. For each homogeneous material, once a positive sample was identified, the remaining samples were not analyzed.

EPA National Emission Standards for Hazardous Air Pollutants (NESHAP)-Rule 40 CFR

Part 61 states that samples found to contain less than 10% asbestos by visual estimation may be further quantified by point count analysis.

The EPA Asbestos rule states all multi-layer systems, except for wall systems where joint compound was used only at the joints and nail holes, must be analyzed as separate materials. If any layer contains greater than one percent asbestos, that layer must be treated as asbestos-containing. This requires all layers in a multi-layered system to be

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx treated as asbestos-containing if the layers cannot be separated without disturbing the asbestos-containing layer.

Asbestos samples will be held for 30 days after the date of this report.

3.3 Chain of Custody Procedures

To ensure that samples collected in the field are neither lost nor their identity mis-identified, all samples, from the point of collection to receipt in the laboratory, proceeds as follows. Each sample is first assigned a unique and distinct sampling number. After a sample is placed into a plastic bag, that unique number is assigned to that bag. This same number is documented on the laboratory’s chain of custody. The inspector signs each chain of custody before delivering to the lab. Upon receipt of the samples, the lab analyst verifies that each sample matches the corresponding chain of custody number and signs and dates the chain of custody. After analysis, the analyst generates a report that includes the sample results and the project chain of custody forms.

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

4.0 Asbestos-Containing Material Assessment

In each functional space, each homogeneous material was quantified and assessed for friability (i.e. material can be crumbled, pulverized, or reduced to powder by hand pressure when dry). Suspect ACM was then assessed as to their condition and potential for disturbance. This information was recorded on the asbestos physical assessment shown in Appendix C. The model for this system is described in the EPA Draft

Curriculum for Training Building Inspectors.

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

5.0 Findings

5.1 Summary of Asbestos-Containing Materials

Suspect homogeneous materials found to contain asbestos, and their sample numbers, include:

Thermal Insulation

No ACM Observed

Surfacing Material

No ACM Observed

Miscellaneous Materials

Gray adhesive on plaster (Sample 6A).

12” x 12” floor tile, white with gray (Sample 102).

Assumed Materials Fire doors

Electric panels

5.2 Summary of Non-Asbestos-Containing Materials

Suspect ACM is considered negative for asbestos when all samples of the material are found to contain one percent or less asbestos. Suspect homogeneous materials observed, sampled, and found to be negative during Landmark’s Survey includes:

1. Sheetrock and joint compound (Sample 1).

2. Plaster (Sample 2).

3. Black adhesive on concrete wall (Sample 3).

4. 2’ x 2’ ceiling tile, white texture reveal with small fissures and holes (Sample 4).

5. 2’ x 2’ ceiling tile white reveal (Sample 5).

6. Tan adhesive behind sheetrock (Sample 7).

7. Floor sheeting, cream with blue specks & adhesive (Samples 8 & 22).

8. Tan baseboard & adhesive (Samples 9 & 10).

9. 12” x 12” floor tile, pinkish cream with smears & mastic (Samples 11 & 12).

10. Dark gray baseboard & adhesive (Samples 13 & 14).

11. Vinyl flooring, orangish wood plank (Sample 15).

12. Floor sheeting, light blue with white specks & adhesive (Samples 16 & 17).

13. Window caulk, white (Sample 18).

14. Window glazing, interior window (Sample 19).

15. Brown firestop putty (Sample 20).

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

16. Gray duct sealant (Sample 21).

17. Floor sheeting, blue gray with gray specks & adhesive (Samples 23 & 24).

18. Floor sheeting, tan with cream specks (Sample 25).

19. Black baseboard & adhesive (Samples 26 & 27).

20. Gray splashguard adhesive (Sample 28).

21. Dark brown baseboard & adhesive (Samples 29 & 30).

22. Carpet glue, green and tan (Sample 31).

23. White firestop putty (Sample 32).

24. Gray sink undercoating (Sample 33).

25. Brown gummy firestop putty (Sample 34).

26. 2” tan ceramic floor tile, mortar, & grout (Samples 35, 36, & 37).

27. 2” white ceramic wall tile, mortar, & grout (Samples 38, 39 & 40).

28. Plaster (Sample 100).

29. Sheetrock and joint compound (Sample 101).

30. Floor tile mastic, black (Sample 103).

31. 12” tan ceramic wall tile, mortar & grout (Samples 104, 105, & 106).

32. 2” brown ceramic floor tile, mortar, & grout (Samples 107, 108, & 109).

33. 2’ x 2’ ceiling tile, white revel (Sample 110).

34. 12” x 12” floor tile, cream with tan & mastic (Samples 111, & 112).

35. Floor sheeting, gray plank (Sample 113).

36. Black baseboard & adhesive (Samples 114, & 115).

37. Floor sheeting, red stained with wood grain (Sample 116).

5.3 Summary of ACM & Quantities

This Survey was conducted to locate and quantify ACM in the Project area of the

Property building. Based on the Survey and laboratory results, each identified ACM and the estimated quantity of each are summarized below.

Description Total Estimated

Thermal System Insulation

No ACM observed

Surfacing Material No ACM observed

Miscellaneous Materials

Gray adhesive on plaster 10 sf

12” x 12” floor tile, white with gray 100 sf

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

Assumed Materials

Fire doors 7 doors

Electric panels 5 panels

5.4 Recommendations

This Survey was conducted to locate and quantify ACM in the Project area of the

Property building. Based on the Survey and laboratory results, as well as the construction plans provided, the recommendations for the identified ACM are included below.

Remove the ACM identified in this report in accordance with the specifications accompanying this report.

If untested material(s) are discovered during renovation or demolition activities, work shall stop immediately. Assume the material(s) contains asbestos or have the material(s) tested to determine asbestos content.

Provide this report to contractor(s) who are working in or around the location(s) where the renovation or demolition activities are occurring, so they are aware of the materials containing asbestos and their locations. In addition, the contractor(s) should be aware of what materials have not been sampled for asbestos and what they should do upon encountering untested materials or suspect ACM.

If this report is reproduced, this report must be copied in its entirety.

F:\PROJECTS\AND-Anderson Engineering\Iowa City - Dialysis Project\Asbestos Survey\Iowa City VAMC Building 1 Level 5-

Renovate Dialysis Asbestos Draft Report 12232024.docx

6.0 Signatures of Environmental Professional(s)

We declare that, to the best of our professional knowledge and belief, the Survey referenced by this report, and the report itself, were conducted in accordance with intent of the EPA, IDNR, IDL, and AHERA regulations to the best of my ability and knowledge.

Mark Meier

Asbestos Building Inspector (24-12078)

Eric Gabrielson, Vice President

Appendices

Appendix A

Appendix B

10 11

0 4' 8' 16'

168 SF

5S25

STAFF

LOUNGE

152 SF

5ST05

Room 33 SF

5S22

STAFF TLT

33 SF

5S520

HSKPG

152 SF

5CS02A

CORRIDOR

36 SF

5S26

CHANGE

ROOM

20 SF

5S23

LINEN

121 SF

5S14

DIALYSATE

STORAGE

146 SF

5S14A

MIT

WORKROOM

106 SF

5S18

REPROCESS

STORAGE

43 SF

5S19

PATIENT

TLT

219 SF

5S21

DIALYSIS

81 SF

5S11

CHIEF

OFFICE

56 SF

5S09

MED PREP

155 SF

5S05

ISOLATION

ROOM

41 SF

5S05A

ISO TLT

70 SF

5S03

SOILED

UTILITY

129 SF

5S01

OFFICE

134 SF

5S04

RECEPTION

5W101

5C01

5W100

5W03

5W05

5W07

5W09A

29 SF

5S04A

STAFF TLT

5E025E04A5E04

172 SF

5S24

RO WATER

TREATMENT

5S28

DIALYSIS

CUBICLES

5S29

DIALYSIS

CUBICLES

5CS02

CORRIDOR

5S27

NURSE

STATION

KEYPLAN - ZONE 1

Project Number

Building Number

Drawing Number

Project Title

Location

Issue Date Checked Drawn

Drawing Title

Approved:

VA FORM 08 - 6231

A

CHARETTE REPORT

FULLY SPRINKLERED

Office of Construction and Facilities Management

U.S. Department of Veterans Affairs

B

C

D

E

F

A

B

C

D

E

F

21 4 5 6 7 8 9 10

Phase

DESIGNER OF RECORD STAMPCONSULTANT

321 4 5 6 7 8 9 10

NOT FOR CONSTRUCTION

IMEG CORP

2882 106th St Des Moines, IA 50322

Contact: Dellan Llewellyn

(515) 334-7921

C U s e rs \M

C a m e ro n \D o c u m e n ts \1

-I C

V A

F L

R -A

-R m c a m e ro n M

T

.r v t

/2

/2

:0

:4

P

M

AD111

FIFTH LEVEL DEMOLITION PLAN -

ZONE 1

RENOVATE DIALYSIS

Iowa City, IA

636A8-24-001 xx/xx/xxxx X X 17909

3/16" = 1'-0"

FIFTH LEVEL DEMOLITION PLAN - ZONE 1

Revisions: Date:

Asbestos Sample Diagram

Non-asbestos containing sample location

Asbestos containing sample location00

35A 38A 36A 39A 37A 40A

6A 1A 5A 2A 7A 3A 8A 4A 22A 9A

10A 11A 12A 2B

13A 14A 15A1B

16A 17A 18A

2C

5W01

100A

8B 19A 22B

20A 21A

23A 24A 25A 26A 27A 28A

4B 5B 29A 30A 31A

32A

11B 12B

21B

23B 24B

1C

2D 2E 3B 20B

2F 2G 18B 34A 33A

5W100

5W07

5W09A

5W09

5W06

5W06A

5W08

5W10

123 SF

5W12

CLEAN

UTILITY

87 SF

5W14

SOILED

UTILITY

25 SF

5W16

TOILET

148 SF

5W18

SOILED

PROCESSING

5W17

5W17A

5C W03A

CORRIDOR

169 SF

5W19

CLEAN / MIT

WORKROOM

135 SF

5W20

ISO BED

DIALYSIS

STATION

59 SF

5W20A

TOILET

62 SF

5W18A

TOILET

5W30A

5ST04

5W24

161 SF

5W30

DIALYSIS

STATION

164 SF

5W32

DIALYSIS

STATIONS

5W32A 5W34A

175 SF

5W34

DIALYSIS

STATIONS

5ST13

5W35

201 SF

5W33

STORAGE

5W33A5W31A

193 SF

5W31

DIALYSIS

STATIONS

235 SF

5W29

DIALYSIS

STATIONS

5C W05

85 SF

5W21

MED PREP

50 SF

5W22

NUTRITION

37 SF

5W25

HSKPG

46 SF

5W15B

TOILET

74 SF

5W29A

TOILET

48 SF

5W27

TOILET

381 SF

5W15

PROVIDER

WORKSTATIONS

5C W03B

193 SF

5W13

BREAKROOM

5W11

REF

ICE

T

R

N

5W11A

5W08A

261 SF

5S24

CHARTING &

RECEPTION

5C W02

CORRIDOR

5C W01

CORRIDOR

70 SF

5W19A

TOILET

16 17 19.1 20.1 21.1

22 23 24

J

K

L

M

5W12

5W11A

5W11 5W13

5W15B5W15

5W25 5W27 5W29

5W29A

5C W05

5W17

5W17A

5W19C 5W19A

5W19

5W18A

5W18

5W16

5W14

5C W03A

5W21

5W22

5C W02

5W20

5W31

5W34

5W33

5W325W30

5W30A 5W32A 5W34A

5W33A 5W31A

5W20A

2119 20

FL2

FL2

FL2

FL2

FL2

20'-6" 21'-5" 8'-8" 16'-1" 25'-10" 20'-6" 21'-0"

134'-0"

66'-8" 67'-4"

13'-9" 8'-8" 13'-9"

KEYPLAN - ZONE 2

TRUE

NORTH

Project Number

Building Number

Drawing Number

Project Title

Location

Issue Date Checked Drawn

Drawing Title

Approved:

VA FORM 08 - 6231

A

SCHEMATIC DESIGN

FULLY SPRINKLERED

Office of Construction and Facilities Management

U.S. Department of Veterans Affairs

B

C

D

E

F

A

B

C

D

E

F

21 4 5 6 7 8 9 10

Phase

DESIGNER OF RECORD STAMPCONSULTANT

321 4 5 6 7 8 9 10

35% SD SUBMISSION

NOT FOR CONSTRUCTION

IMEG CORP

2882 106th St Des Moines, IA 50322

Contact: Dellan Llewellyn

(515) 334-7921

C U s e rs \M

C a m e ro n \D o c u m e n ts \1

-I C

V A

F L

R -A

-R m c a m e ro n M

T

.r v t

/1 /2

:4

:3

A

M

1-A5

5TH FLOOR - FLOOR PLAN - ZONE

RENOVATE DIALYSIS

IOWA CITY, IA

636A8-24-001

11/12/2024 EM MWC

17909

3/16" = 1'-0"1 FIFTH FLOOR WEST PLAN - TEMP SPACE

Revisions: Date:

0 5'4" 10'8"2'8"

Asbestos Sample Diagram

Non-asbestos containing sample location

Asbestos containing sample location00

101A 110A 113B

116B

104 107 105 108 106 109

113A

101B 110B

114A 115A

101C

114B 115B116A

Appendix C

12/18/2024 BUILDING 1 RENOVATE DIALYSIS - IOWA CITY VAHCS

IOWA CITY, IOWA

ASBESTOS-CONTAINING MATERIAL ASSESSMENT DATABASE

Floor Location Type Description Quantity

Height

(Feet) Condition

Disturbance

Potential

Homog.

Material

5 5S24 (RO Mechanical Room) MISC Electric Panel 3 panels 5 G L Assumed

5 5S24 (RO Mechanical Room) MISC Fire Door (1.5 hour) 1 door 0-7 G L Assumed

5 5S24 (RO Mechanical Room) MISC Gray adhesive on plaster (above drop ceiling) 10 sf 9 G L 6

5 5S22 (Staff Restroom) No ACM Observed

5 5S20 (Janitors Closet) No ACM Observed

5 5S26 (Locker Room) No ACM Observed

5 5525 (Break Room) No ACM Observed

5 5S23 (Linen Room) No ACM Observed

5 5S21 No ACM Observed

5 5S19 (Patient Restroom) No ACM Observed

5 5S11 No ACM Observed

5 5S05 No ACM Observed

5 5S03 MISC Fire Door (1 hour) 1 door 0-7 G L Assumed

5 5S01 No ACM Observed

5 5S04 No ACM Observed

5 5S14 MISC Fire Door (1 hour) 1 door 0-7 G L Assumed

Type: TSI=Thermal System Insulation SURF=Surfacing Materials MISC=Misc.

Quantity: CF=Cubic Ft LF=Linear Ft SF=Square Ft Condition: G=Good F=Fair P=Poor Dist. Pot.: L=Low M=Medium H=High

ASBESTOS-CONTAINING MATERIAL ASSESSMENT DATABASE

Floor Location Type Description Quantity

Height

(Feet) Condition

Disturbance

Potential

Homog.

Material

5 5S14A No ACM Observed

5 5S18 MISC Fire Door (1 hour) 1 door 0-7 G L Assumed

5 5S09 No ACM Observed

5 Corridor/Common Area MISC Fire Doors (20 min) 2 door 0-7 G L Assumed

5 5W11 & 5W11A No ACM Observed

5 5W13 & 5W13A No ACM Observed

5 5W13B No ACM Observed

5 5W15 & 5W15B No ACM Observed

5 5W21 No ACM Observed

5 5W22 No ACM Observed

5 5W25 No ACM Observed

5 5W27 No ACM Observed

5 5W29 & 5W29A No ACM Observed

5 5W31 & 5W31A No ACM Observed

5 5W33 & 5W33A No ACM Observed

Quantity: CF=Cubic Ft LF=Linear Ft SF=Square Ft Condition: G=Good F=Fair P=Poor Dist. Pot.: L=Low M=Medium H=High

ASBESTOS-CONTAINING MATERIAL ASSESSMENT DATABASE

Floor Location Type Description Quantity

Height

(Feet) Condition

Disturbance

Potential

Homog.

Material

5 5W35 MISC Fire Door 1 door 0-7 G L Assumed

5 5W34 & 5W34A No ACM Observed

5 5W32 & 5W32A No ACM Observed

5 5W30 & 5W30A No ACM Observed

5 5W24 No ACM Observed

5 5W17 & 5W17A No ACM Observed

5 5W19 & 5W19A No ACM Observed

5 5W20 & 5W20A No ACM Observed

5 5W18 & 5W18A No ACM Observed

5 5W16 No ACM Observed

5 5W14 No ACM Observed

5 5W12B No ACM Observed

5 5W08 & 5W08A No ACM Observed

5 5W01 MISC 12" x 12" floor tile, white with dark gray streaks 100 sf 1 G L 102

5 5W01 MISC Electric panels 2 panels 5 G L Assumed

Quantity: CF=Cubic Ft LF=Linear Ft SF=Square Ft Condition: G=Good F=Fair P=Poor Dist. Pot.: L=Low M=Medium H=High

ASBESTOS-CONTAINING MATERIAL ASSESSMENT DATABASE

Floor Location Type Description Quantity

Height

(Feet) Condition

Disturbance

Potential

Homog.

Material

5 5W25 No ACM Observed

5 5W10 No ACM Observed

5 West Corridor No ACM Observed

Quantity: CF=Cubic Ft LF=Linear Ft SF=Square Ft Condition: G=Good F=Fair P=Poor Dist. Pot.: L=Low M=Medium H=High

Appendix D

Appendix E

EMSL Analytical, Inc.

3410 Winnetka Avenue North New Hope, MN 55427

Tel/Fax: (763) 449-4922 / (763) 449-4924 http://www.EMSL.com / minneapolislab@emsl.com

352411034EMSL Order:

Customer ID: LMEN42

Customer PO:

Project ID:

Attention: Phone:Mark Meier (952) 666-2422

Fax:Landmark Environmental, LLC (952) 887-9605

Received Date:9555 James Avenue South – Suite 262 11/20/2024 3:55 PM

Analysis Date:Bloomington, MN 55431 11/26/2024 - 11/27/2024

Collected Date:

Project: VAMC Iowa City/23107.02

Test Report: Asbestos Analysis of Bulk Materials via AHERA Method 40CFR 763 Subpart E

Appendix E supplemented with EPA 600/R-93/116 using Polarized Light Microscopy

Sample Description Appearance % Fibrous % Non-Fibrous

Non-Asbestos Asbestos

% Type

1A

352411034-0001

None DetectedNon-fibrous (Other)96%Glass4%White

Non-Fibrous

Heterogeneous

Sheetrock + Joint

Compound

This is a composite result of wallboard, jt. compound, and tape

1B

352411034-0002

None DetectedNon-fibrous (Other)97%Glass3%White

Non-Fibrous

Heterogeneous

Sheetrock + Joint

Compound

This is a composite result of wallboard, jt. compound, and tape

1C

352411034-0003

None DetectedNon-fibrous (Other)94%Cellulose

Glass

3%

3%

White

Non-Fibrous

Heterogeneous

Sheetrock + Joint

Compound

This is a composite result of wallboard, jt. compound, and tape

2A-Plaster

352411034-0004

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

2A-Skim Coat

352411034-0004A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

2B-Plaster

352411034-0005

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

2B-Skim Coat

352411034-0005A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

2B-Adhesive

352411034-0005B

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Plaster

2C-Plaster

352411034-0006

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

2C-Skim Coat

352411034-0006A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

2D-Plaster

352411034-0007

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

2D-Skim Coat

352411034-0007A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

2E-Plaster

352411034-0008

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

2E-Skim Coat

352411034-0008A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

2F-Plaster

352411034-0009

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

Initial report from: 11/27/2024 14:34:35

Page 1 of 6ASB_PLM_0008_0002 - 2.31 Printed: 11/27/2024 2:34 PM

Tel/Fax: (763) 449-4922 / (763) 449-4924 http://www.EMSL.com / minneapolislab@emsl.com

352411034EMSL Order:

Customer ID: LMEN42

Customer PO:

Project ID:

Test Report: Asbestos Analysis of Bulk Materials via AHERA Method 40CFR 763 Subpart E

Appendix E supplemented with EPA 600/R-93/116 using Polarized Light Microscopy

Sample Description Appearance % Fibrous % Non-Fibrous

Non-Asbestos Asbestos

% Type

2F-Skim Coat

352411034-0009A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

2G-Plaster

352411034-0010

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

2G-Skim Coat

352411034-0010A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

3A

352411034-0011

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Black Adhesive

3B

352411034-0012

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Black Adhesive

4A

352411034-0013

None DetectedPerlite

Non-fibrous (Other)

30%

5%

Cellulose

Glass

50%

15%

Beige

Fibrous

Homogeneous

2x2 CT White text

Reveal w/small F+H

4B

352411034-0014

None DetectedPerlite

Non-fibrous (Other)

30%

5%

Cellulose

Glass

50%

15%

Beige

Fibrous

Homogeneous

2x2 CT White text

Reveal w/small F+H

5A

352411034-0015

None DetectedPerlite

Non-fibrous (Other)

15%

10%

Cellulose

Glass

30%

45%

Beige

Fibrous

Homogeneous

2x2 CT white Reveal

5B

352411034-0016

None DetectedPerlite

Non-fibrous (Other)

15%

10%

Cellulose

Glass

15%

60%

Beige

Fibrous

Homogeneous

2x2 CT white Reveal

6A

352411034-0017

7% ChrysotileNon-fibrous (Other)93%Gray

Non-Fibrous

Homogeneous

Gray Adh on Plaster

7A

352411034-0018

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

Tan Adh Behind

Sheetrock

8A

352411034-0019

None DetectedNon-fibrous (Other)35%Cellulose

Synthetic

40%

25%

Tan/Blue

Non-Fibrous

Homogeneous

Cream Floor Sheeting w/ blue Specs

8B

352411034-0020

None DetectedNon-fibrous (Other)35%Cellulose

Synthetic

40%

25%

Tan/Blue

Non-Fibrous

Homogeneous

Cream Floor Sheeting w/ blue Specs

9A

352411034-0021

None DetectedNon-fibrous (Other)100%Tan

Non-Fibrous

Homogeneous

Tan BB

10A

352411034-0022

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

BB Adh

11A

352411034-0023

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

12"x12" FT pinkish cream w/ smears

12A

352411034-0024

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

FT Mastic

11B

352411034-0025

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

FT Mastic

12B

352411034-0026

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

FT Mastic

Page 2 of 6ASB_PLM_0008_0002 - 2.31 Printed: 11/27/2024 2:34 PM

Tel/Fax: (763) 449-4922 / (763) 449-4924 http://www.EMSL.com / minneapolislab@emsl.com

352411034EMSL Order:

Customer ID: LMEN42

Customer PO:

Project ID:

Test Report: Asbestos Analysis of Bulk Materials via AHERA Method 40CFR 763 Subpart E

Appendix E supplemented with EPA 600/R-93/116 using Polarized Light Microscopy

Sample Description Appearance % Fibrous % Non-Fibrous

Non-Asbestos Asbestos

% Type

13A

352411034-0027

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Dark gray BB

14A

352411034-0028

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

BB Adh

15A

352411034-0029

None DetectedNon-fibrous (Other)95%Glass5%White

Non-Fibrous

Homogeneous orangey wood plank flooring

16A

352411034-0030

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous

Floor sheet, Light

Blue w/ white specks

17A-Adhesive

352411034-0031

None DetectedNon-fibrous (Other)100%Green

Non-Fibrous

Homogeneous

Adhesive

17A-Leveler

352411034-0031A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Adhesive

18A

352411034-0032

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Window Caulk white

18B

352411034-0033

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Window Caulk white

19A

352411034-0034

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Window glazing on interior window

20A

352411034-0035

None DetectedNon-fibrous (Other)92%Synthetic8%Red

Non-Fibrous

Homogeneous

Brown firestop putty

20B

352411034-0036

None DetectedNon-fibrous (Other)100%Red

Non-Fibrous

Homogeneous

Brown firestop putty

21A

352411034-0037

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous gray duct sealant

21B

352411034-0038

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous gray duct sealant

22A

352411034-0039

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

Adhesive under #8

22B

352411034-0040

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

Adhesive under #8

23A

352411034-0041

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous

Blue/Gray floor sheeting w/ gray specs

23B

352411034-0042

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous

Blue/Gray floor sheeting w/ gray specs

24A

352411034-0043

None DetectedNon-fibrous (Other)90%Cellulose10%Gray/Green

Non-Fibrous

Homogeneous

Adhesive under 23

24B

352411034-0044

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

Adhesive under 23

Page 3 of 6ASB_PLM_0008_0002 - 2.31 Printed: 11/27/2024 2:34 PM

Tel/Fax: (763) 449-4922 / (763) 449-4924 http://www.EMSL.com / minneapolislab@emsl.com

352411034EMSL Order:

Customer ID: LMEN42

Customer PO:

Project ID:

Test Report: Asbestos Analysis of Bulk Materials via AHERA Method 40CFR 763 Subpart E

Appendix E supplemented with EPA 600/R-93/116 using Polarized Light Microscopy

Sample Description Appearance % Fibrous % Non-Fibrous

Non-Asbestos Asbestos

% Type

25A

352411034-0045

None DetectedNon-fibrous (Other)100%Beige

Non-Fibrous

Homogeneous

Tan w/ cream specs floor sheeting

26A

352411034-0046

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Black BB

27A

352411034-0047

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

BB adh

28A

352411034-0048

None DetectedNon-fibrous (Other)100%Clear

Non-Fibrous

Homogeneous

Gray Splashguard

Adh

29A

352411034-0049

None DetectedNon-fibrous (Other)100%Gray/Black

Non-Fibrous

Homogeneous

Dark brown BB

30A

352411034-0050

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

BB Adh

31A

352411034-0051

None DetectedNon-fibrous (Other)100%Yellow/Green

Non-Fibrous

Homogeneous green + Tan Carpet

Glue

32A

352411034-0052

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

White FS putty

33A

352411034-0053

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous gray Sink SD

34A

352411034-0054

None DetectedNon-fibrous (Other)90%Synthetic10%Red

Non-Fibrous

Homogeneous

Brown gummy Fire

Stop putty

35A

352411034-0055

None DetectedNon-fibrous (Other)100%Tan

Non-Fibrous

Homogeneous

2" Tan ceramic FT

36A

352411034-0056

None DetectedNon-fibrous (Other)100%Tan

Non-Fibrous

Homogeneous

2" Tan ceramic Mortar

37A

352411034-0057

None DetectedNon-fibrous (Other)96%Cellulose4%Gray

Non-Fibrous

Homogeneous

2" Tan ceramic Grout

38A

352411034-0058

None DetectedNon-fibrous (Other)100%Tan

Non-Fibrous

Homogeneous

2" White Ceramic WT

39A-Mortar

352411034-0059

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

2" White Ceramic WT

Mortar

39A-Adhesive

352411034-0059A

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

2" White Ceramic WT

Mortar

40A

352411034-0060

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

2" White Ceramic WT

Grout

100A-Plaster

352411034-0061

None DetectedNon-fibrous (Other)100%White/Various

Non-Fibrous

Homogeneous

Plaster

100A-Skim Coat

352411034-0061A

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Plaster

Page 4 of 6ASB_PLM_0008_0002 - 2.31 Printed: 11/27/2024 2:34 PM

Tel/Fax: (763) 449-4922 / (763) 449-4924 http://www.EMSL.com / minneapolislab@emsl.com

352411034EMSL Order:

Customer ID: LMEN42

Customer PO:

Project ID:

Test Report: Asbestos Analysis of Bulk Materials via AHERA Method 40CFR 763 Subpart E

Appendix E supplemented with EPA 600/R-93/116 using Polarized Light Microscopy

Sample Description Appearance % Fibrous % Non-Fibrous

Non-Asbestos Asbestos

% Type

101A

352411034-0062

None DetectedNon-fibrous (Other)95%Cellulose

Glass

2%

3%

White

Non-Fibrous

Heterogeneous

Sheet Rock + Joint

Compound

This is a composite result of wallboard, jt. compound, and tape

101B

352411034-0063

None DetectedNon-fibrous (Other)95%Cellulose

Glass

2%

3%

White

Non-Fibrous

Heterogeneous

Sheet Rock + Joint

Compound

This is a composite result of wallboard, jt. compound, and tape

101C

352411034-0064

None DetectedNon-fibrous (Other)94%Cellulose

Glass

3%

3%

White

Non-Fibrous

Heterogeneous

Sheet Rock + Joint

Compound

This is a composite result of wallboard, jt. compound, and tape

352411034-0065

7% ChrysotileNon-fibrous (Other)93%Tan

Non-Fibrous

Homogeneous

12x12 FT White w/

Gray

352411034-0066

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

FT Mastic

352411034-0067

None DetectedNon-fibrous (Other)100%Brown

Non-Fibrous

Homogeneous

Ceramic Wall Tile 12"

Tan

352411034-0068

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous

Ceramic Wall Tile

Mortar

352411034-0069

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

Ceramic Wall Tile

Grout

352411034-0070

None DetectedNon-fibrous (Other)100%Brown

Non-Fibrous

Homogeneous

2" Brown Ceramic

Floor tile

352411034-0071

None DetectedNon-fibrous (Other)100%Gray

Non-Fibrous

Homogeneous

2" Brown Ceramic

Floor Mortar

352411034-0072

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

2" Brown Ceramic

Floor Grout

110A

352411034-0073

None DetectedPerlite

Non-fibrous (Other)

20%

10%

Cellulose

Glass

25%

45%

Beige

Fibrous

Homogeneous

2x2 CT white Reveal

110B

352411034-0074

None DetectedPerlite

Non-fibrous (Other)

20%

10%

Cellulose

Glass

25%

45%

Beige

Fibrous

Homogeneous

2x2 CT white Reveal

352411034-0075

None DetectedNon-fibrous (Other)100%White

Non-Fibrous

Homogeneous

12x12 FT Cream w/

Tan

352411034-0076

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

FT Mastic

113A

352411034-0077

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Gray Vinyl Plank flooring

113B

352411034-0078

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Gray Vinyl Plank flooring

114A

352411034-0079

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Black BB

Page 5 of 6ASB_PLM_0008_0002 - 2.31 Printed: 11/27/2024 2:34 PM

Tel/Fax: (763) 449-4922 / (763) 449-4924 http://www.EMSL.com / minneapolislab@emsl.com

352411034EMSL Order:

Customer ID: LMEN42

Customer PO:

Project ID:

Test Report: Asbestos Analysis of Bulk Materials via AHERA Method 40CFR 763 Subpart E

Appendix E supplemented with EPA 600/R-93/116 using Polarized Light Microscopy

Sample Description Appearance % Fibrous % Non-Fibrous

Non-Asbestos Asbestos

% Type

114B

352411034-0080

None DetectedNon-fibrous (Other)100%Black

Non-Fibrous

Homogeneous

Black BB

115A

352411034-0081

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

BB Adh

115B

352411034-0082

None DetectedNon-fibrous (Other)100%Yellow

Non-Fibrous

Homogeneous

BB Adh

116A

352411034-0083

None DetectedNon-fibrous (Other)100%Beige

Non-Fibrous

Homogeneous red stained Flooring, wood grain

116B

352411034-0084

None DetectedNon-fibrous (Other)100%Beige

Non-Fibrous

Homogeneous red stained Flooring, wood grain

Analyst(s)

Andrew Capaul (95) Rachel Travis, Laboratory Manager or Other Approved Signatory

EMSL maintains liability limited to cost of analysis . Interpretation and use of test results are the responsibility of the client. This report relates only to the samples reported above, and may not be reproduced, except in full, without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations . The report reflects the samples as received.

Results are generated from the field sampling data (sampling volumes and areas, locations, etc.) provided by the client on the Chain of Custody. Samples are within quality control criteria and met method specifications unless otherwise noted. The above analyses were performed in general compliance with Appendix E to Subpart E of 40 CFR (previously EPA 600/M4-82-020 “Interim Method”) but augmented with procedures outlined in the 1993 (”final”) version of the method. This report must not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST or any agency of the federal government. Non- friable organically bound materials present a problem matrix and therefore EMSL recommends gravimetric reduction prior to analysis . Unless requested by the client, building materials manufactured with multiple layers (i.e. linoleum, wallboard, etc.) are reported as a single sample. Estimation of uncertainty is available on request.

Samples analyzed by EMSL Analytical, Inc. New Hope, MN NVLAP Lab Code 200019-0; Colorado AL-24478

Page 6 of 6ASB_PLM_0008_0002 - 2.31 Printed: 11/27/2024 2:34 PM

OrderID: 352411034

3345 Stop 8 Rd, Dayton OH 45414 • (800) 535-5585 • (937) 461-1988 fax • www.ameriwater.com

December 19, 2024

Iowa City VA Medical Center 601 US 6 West Iowa City, IA 52246

ATTN: Ed Markfort EMarkfort@ae-mn.com

Quote Number: 52016A – Dialysis Central System – Quote SAC Contract: #36C10G22D0010

Dear Mr. Markfort:

Hope you are well.

Enclosed you will find the AmeriWater proposal for the supply of a Central Dialysis Water Treatment System for the Iowa City VAMC.

CLIN’s quoted: #2001AA (QTY 1) and #2001AG (QTY 12)

AmeriWater is one of the few water treatment companies that offers a FDA 510K certification on all components. All components have been carefully selected and sized to meet your specific requirements.

If you have any questions please do not hesitate to contact me.

We truly appreciate this opportunity to be of service.

Sincerely, Travis Tashjian Vice President of Strategic Accounts AmeriWater mailto:EMarkfort@ae-mn.com

2022 Heat Central System Quote Template – Rev 7/14/22 Page 2 of 8

IOWA CITY VAMC

12 STATION WATER TREATMENT SYSTEM

#52016A 12.19.2024

This proposal encompasses the AmeriWater equipment of a direct feed system that meets both AAMI and FDA design standards for dialysis. The 510K authorization number issued for this AmeriWater, Inc. Class II Medical Device is K99159.

SCOPE:

This quotation covers the sale of equipment for a pure water system sized to provide 10 stations and 2 maintenance stations.

SIZING REQUIREMENTS:

- 3 Patient Shifts with a Total of 12 Hours of Operation

- 10 GPG Water Hardness with Softener Regeneration Every 2 Day(s)

- New Loop – 1” PEX at an Estimated Loop Length of 300 Feet

- RO goes up to 90% recovery - dependant upon water quality and usage

- High recovery mode to keep water under 90 gallons per treatment – dependant upon water quality and usage

- Minimum RO Recovery Rate of 75%

- Requires 0 Acid Tanks and 0 Bicarb Tanks

- Voltage Requirements of 208V, 3 PH

EQUIPMENT:

CLIN #2001AA $227,532.34

Central Dialysis Water Purification and Distribution System for Dialysis Center: 1-12 Stations

Quantity Product Description Blend Valve Assembly:

1 0054-0037 1¼" x 1¼", Flow Range 5 - 37 GPM, Left to Right The all brass thermostatically controlled blend valve mixes hot and cold water to adjust the RO feed water to approximately 77°F (25°C) ±5°F. The blend valve is sized to the feed flow rate, which is twice the product flow. It has an adjustment knob for temperature adjustment and internal check valves on both the hot and cold sides to prevent back flow from one side to the other. The blend valve assembly includes inlet and outlet valves with a cold water bypass for service. Included are a pressure gauge and thermometer on the outlet. FRP unistrut is utilized to mount the assembly to the wall.

Booster Pump: CME Variable Pressure

1 0080190 1½ HP, 208-230V, 1PH

The variable pressure booster pump provides flow rates up to 25 GPM @ 50 PSI. Single pump design includes: stainless steel pump, installation plumbing including 3 valve bypass, check valve, outlet pressure gauge, and pressure switch. The control panel requires a 230V, single-phase power source. The controller will transform the 230V single-phase power to the required three-phase power to operate the pump motor.

Pretreatment Headers:

1 009602 1” Multiple 4 Carbon Tank with Bypass 2 009591 1" Assembly with Bypass

Header assembly includes isolation and bypass valves, outlet PSI gauge, and sample port.

2022 Heat Central System Quote Template – Rev 7/14/22 Page 3 of 8

System Pre-Filter 1 0021015 1", IN/OUT for 20" x 4½" Cartridges

The system pre-filter protects the pretreatment equipment from particulate matter that may be present in the source water. The pre-filter is sized for the highest required flow rate in the system. The pre-filter housing is all polypropylene construction with inlet and outlet isolation valves and pressure gauges. The design utilizes dual open-end (DOE) cartridges of 1-5 micron nominal filtration (greater than 80% efficiency). A sump drain and wrench are provided.

System Pre-Filter Cartridges:

2 20-1056 20" x 4½", 5 Micron, Polybond

Carbon Fleck 2850 SXT Backwashable Filters: Requires 29.71 Cubic Feet to Meet 10 Minute EBCT 4 0095031 24" x 65", 9 cu ft

All non-corrosive design with acid-washed, granular activated carbon with Fleck Series 2850 control head, electronic 7-day timer with programmable backwash time at any time of day.

A full flow 1½” valve. Filter has 12 x 40 mesh with an iodine number greater than 1,000.

Filters interface to lockout the RO when in backwash. Pretreatment headers are sold separately.

Automatic Fleck 2850 SXT Water Softener: Based on 10 Grains Hardness (Subject to change based on actual water hardness)

1 0095016 24" x 65", 270,000 Grains A single tank water softener sized to the maximum possible water usage by the RO based on the water hardness and a 30% safety factor is designed to regenerate every night that the center operates. A full flow 1½” valve. The water softener is constructed of all non-corrosive components with a programmable electronic 7-day timer Fleck 2850 control, with the time of regeneration and all cycles fully adjustable. Pretreatment headers are sold separately.

RO Pre-Filter:

1 0021015 1", IN/OUT for 20" x 4½" Cartridges

The RO pre-filter protects the RO membranes from plugging with carbon fines. The pre-filter is sized for twice the rate of the RO product water. The pre-filter housing is all polypropylene construction with inlet and outlet isolation valves and pressure gauges. The design utilizes dual open-end (DOE) cartridges of 1-5 micron nominal filtration (greater than 80% efficiency). A sump drain and wrench are provided.

MRO Pre-Filter Cartridges:

2 20-1016 20" x 4½", 1 Micron, Polybond

RO Bypass Headers:

1 0011-0039 1” Loop, 1” Pretreatment

2022 Heat Central System Quote Template – Rev 7/14/22 Page 4 of 8

Reverse Osmosis System:

1 00MDP4-230 Dual Pass, 5 Membrane, up to 14,400 GPD, 208/230V, 3 Ph

The MediQA system uses proven reverse osmosis technology combined with heat disinfection to provide a unique combination of performance, reliability, and functionality.

This fully integrated water purification solution when coupled with pre-treatment and PEX distribution pipework makes a complete system. Dual Pass membrane configuration provides maximum flexibility in water quality. Automated heat disinfection of RO membranes provides system efficiency/labor savings and ensures that any potential for bacterial growth on membrane surfaces is minimized. Full color touch screen display with comprehensive menu navigation, including full schematics. Advanced data logging technology with password protection. Information is available via an integrated touch screen display or downloaded to Excel. Stored data includes active status indicators, alarm conditions and performance logs. 8” TFC membranes in FRP vessels. Compact, powder coated aluminum skid mounted package. Note: Permeate flow rate at 77°F. Variations in feed water temperature can affect output by up to ± 3% per degree Fahrenheit. Based on 1,000 microsiemens water or less.

Heat Disinfection System:

1 00HS20815 460V, 15 kW, 3 Ph

The HeatSan is an integrated heat disinfection system for disinfecting the distribution loop and dialysis machines with the ability to adjust for each day of the week, heating intervals, holding times and disinfection temperatures. Provides up to 100 gallons of 185°F hot water and can disinfect two separate loops. The PLC controller, dual color touch screen displays alarms, system status, tank level, disinfection temperatures and event log with added password protection. Easy step through programming (7 day program) syncs dialysis machines with the HeatSan. Intelligent monitoring routines, leak detection, and over use.

The heat disinfect will abort if leak is detected. There are four levels of password protection.

The event log holds up to 12 months of data and can be downloaded to Excel. Stainless steel skid complete with insulated stainless steel storage tank with sloping base fitted with three phase heating elements, level transmitter and temperature monitor. Stainless steel recirculation pump, stainless steel solenoid valves. The isolation of the RO and bicarb mixing system is accomplished with three way motorized ball valves that are controlled by the HeatSan.

Installation Kit:

1 0088-0008 Heatsan to MediQA, 1”

Post-Treatment Rack:

1 00PTR2-L2R 1” Dual Housing, 20”, Left to Right

An ultra-filter for endotoxin is required on systems utilizing a storage tank or deionizer tanks. Aluminum powder-coated frame has dimensions of 26 9/16” x 14 ¼” x 65 ⅜”and consists of a DI bypass header, alarm panel, and single or dual endotoxin housings.

Endotoxin equipped with pressure gauges, inlet/outlet sample ports, inlet/outlet manual isolatation valves, and drain valves. DI bypass includes 1 Meg-Ohm resistivity monitor, resistivity monitor probe, automatic dump valve, and sample port. Alarm Panel with both conductivity/resistivity monitors and ability to communicate with RO, bicarb, and Heatsan disinfection system.

2022 Heat Central System Quote Template – Rev 7/14/22 Page 5 of 8

Endotoxin Filter Cartridges:

4 20-3046 0.2 Micron, 2.5" x 20", 222, Pall, 10 GPM

CMS Water Treatment Label Kit:

1 99-9075 Label Kit

Includes color coded directional flow arrows and product identification labels to meet CMS requirements.

Central System Valve Tags and Labels:

1 0099-0001 Central System Valve Tags (100) and Labels

Pretreatment Water Sample Port Box:

1 0082-0024 Pretreatment Water Sample Port Box The AmeriWater sample box for pretreatment water is designed to deliver test sample water to a central collection point. This provides easy sampling and draining of the test lines. Single piece ABS construction wall box is recessed to prevent damage to the valves.

Water valves are PVC ball type with a lever handle for ease of operation. Measuring cup makes sure tubing to the sample box is flushed before sample is drawn. Drain connection is 1” PVC pipe.

Installation Kits:

1 0088-0020-3 Kit, Install, 1.0" Loop, PEXa, 0-400, With Insulation 1 001-142-0002 Central System Drain Waste Manifold 2" 1 001-014-0005 Complete Water System Install Kit, 1.0” Pretreatment Manifolds

PACKAGING:

Packaging: Central Systems 1 PKG7-13 7 to 13 Stations

CLIN #2001AG $872.80 each Dialysis Wall Station Box with Connections for Water, Drain, Machine

PEX Wall Boxes*:

12 000-082-0040 Water Only, 1” PEX

White single piece ABS construction with an opening cut out of 14⅝"W x 13⅝"H with a depth of 4¾”.

* Wall boxes do not include dialysis machine fittings!

OFF – CONTRACT ITEMS $16,654.00

Dealkalizer

Series 2850 SXT Fleck Chloride Anion Dealkalizer:

1 0095051 24" x 65", 9.5 cu ft, Flow Rate 27 GPM

A full flow 1½” valve. The dealkalizer is constructed of all non-corrosive components with a programmable electronic 7-day timer Fleck 2850 control, with the time of regeneration and all cycles fully adjustable. Pretreatment headers are sold separately. Grain capacity depends on water analysis. Max flow rate based on 3 GPM per cubic foot.

2022 Heat Central System Quote Template – Rev 7/14/22 Page 6 of 8

INSTALLATION:

Installation of complete water treatment system listed in this proposal with the following exceptions. The buyer is responsible for:

- Supplying hot and cold water supply

- Completion of site preparation requirements – To be determined

- Installation of all required drains

- Piping to drain for wall boxes

- Wall box installation to cabinetry

- Installation of hanging support requirements (for distribution loop)

- All electrical wiring and utilities including disconnects

The following are AmeriWater requirements to consider when providing your installation quote.

1. System requires hot and…