ABS_1026_02_99CS.pdf

RAVENNA, ARMY ADMONITION PLANT

Building Sunmary Sheet

Form A

Building ID:

Building Type (Use):

Number of People/

Percentage of Time:

Area:

Inspection Team (Names):

Drawing Numbers:

Year of Construction:

Total Square

Footage Buildirg:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms:

Samples Taken:

Q.A. Samples Taken:

Survey Date:

Comments:

(L,\ l^/fc/fr C<o\J'fr<ke

Sunmary Data

00/ 002 a

Type of Ccnstruction:

(Check Applicable)

Wood Frame

Masonry lite Siding

Steel Frame

Reinforced Concrete

Portion of Building Not Inspected (square feet): _Q_

Reason: '

R A V E N N A A R M Y A M P t r T I C N P L A N T

B U H D I N G

S C M M A R Y S H E E T

F O F M B

B u i l d i n g

C c a n m e n t s

BS7ESKA

PIANT

Building No:

Drawing No:

Date:

\O2(a

ASSESSMENT SHEET

C

Floor No:

Room No:

Evaluator:

KR ASSESSING POTENTIAL FIBER

Current condition of ACBM

Present ential for Future

Damage or Erosion of

Lew

Proximity of Air Plenum or

Direct Air Stream of buildijyg

Accessibility (to ccupants and maintenance and degree of activity tts, vibration, movement occupants)

K

Occupancy

Occupied

Absent

Evidence of deterioration_of delamination from underlying

High

TTnnrcUPJed

RAVENNA ARM* HMHTTICN PLANT

RISK ASSESSMENT SHEET

FORM C

Building No:

Drawing No:

Date:

£> 00 >. 7> Q

Floor No:

Room No:

Evaluator:

-tf-

EACICR FCR ASSESSING POTENTIAL FIBER RELEASE

Currtait Condition of ACEM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

X

K

X

Potential far Future Disturbance

Damage or Erosion of NZOi

Low

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

Occupancy

High

Occupied Unoccupied

RAVENNA ARMX jflMKTUCN PIANT

POEM C

Building No:

Drawing No:

Date:

) CDO -

Floor No:

Room No:

Evaluator:

EACICR KK ASSESSING POTENriAL FIBER RELEASE

Currait Condition of ACEM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage ntial for Future Disturbance

Damage or Erosion of ACHf

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

Low y

High

X

Occupancy

RAVENNA ARM* AMMOKETION PIANT

FORM C

Building No:

Drawing No:

Date:

* 3-0

Floor No:

Room No:

Evaluator: j / i

EACTCR PCR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

X

X for Future Disturbance

Damage or Erosion of ACBM

Low

Occupancy

Occupied

Current Occupancy

High

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

X

Unoccupied

RAVENNA ARMY AtMtCCTICK PLANT

PCBM C

Building No:

Drawing No:

Date:

Floor No:

Room No: f

Evaluator: i£

EACTCR PCR ASSESSING PCnENTIAL FIBER RELEASE

Current Condition of ACBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage potential far Riture Disturbance

Damage or Erosion of ACBM

Low

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

X

X

Hicfli

Occupancy

RAVENNA AIM* AMPtTTICN PLANT

FCEM C

Building No:

Drawing No:

Date:

/6D.C0 Floor No:

Room No:

Evaluator:

FACTOR FCR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACBK

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potential far Future Disturbance

Damage or Erosion of ACffl

Occupancy

Current Occupancy

Low

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use y

High

RAVENNA ARK AMPHTICN ECANT

FORM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage >C

Potential far Future Disturbance

Damage or Erosion of ACEM

Occupancy

Occupied

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

Low Hicft y

Current Occupancy

RAVENNA ARMY AMMQNTFICN PEART

FORM C

Building No:

Drawing No:

Date:

i oat*

3a

Floor No:

Room No:

Evaluator:

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

X

X

Potential far Future Disturbance

Damage or Erosion of ACBM

Low

Occupancy

Occupied

High

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity

(air movements, vibration, movement of building occupants)

Change in Building Use

X

RAVENNA. ARM* AMOHTTCN PLANT

FCBM C

Building No:

Drawing No:

Date:

/0o>C Floor No:

Room No:

Evaluator:

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACH4

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potaitial far Future Disturbance

Damage ar Erosion of ACBM

Low

Occupancy

High

Proxiitdty of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

X

RAVENNA AE947 AWOEETTON PLANT

POEM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

a

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage V

Potential far Riture Disturbance

Damage or Erosion of ACBM

Low

Occupancy

Occupied

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity

(air movements, vibration, movement of building occupants)

Change in Building Use

Y

X

RAVENNA ARM* AMMCKTTICH PLANT

RISK ASSESSMENT

FCEM C

Building No:

Drawing No:

Date:

Floor No: .

Room No:

Evaluator:

FACTOR K3R ASSESSING POTENTIAL FIBER RELEASE

Current Condition of AGBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage potential far Future Disturbance

Damage or Erosion of ACEM

Lew

Proximity of Air Plenum or

Direct Air Stream i

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of building occupants)

Change in Building Use

X

Occupancy

Occupied

High

X

RAVENNA N9tt AMMGNHICN PIANT

BULK SAMPLE ANALYSIS

FC&M D

CD I flSb

PLM

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

Gross Sample Description:

Materials Present:

•Estimated Percent* in Sample:

^Asbestos:

1024, C3Trysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component \jf\

•Percentage is Visually Estimated

Analysts Comments

Date:

RAVENNA. MK£ AMQCCIICN PLANT

FCEM D

Laboratory Name:

ID Number:

1>h Number:

ID Technique:

1b

PLM

Gross Sample Description

Materials Present:

•Estimated PercentVin Sample:

^Asbestos:

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component M p\

♦Percentage is Visually Estimated

Analysts Canments

Date: hi

RAVENNA. ARMZ AMCKEEICN PLANT

BULK SftMPLE ANALYSIS

FCKM D

Laboratory Name:

ID Number:

T^h Number:

ID Technique:

Gross Sample Description:

Materials Pr«2sent: /

♦Estimated

^Asbestos:

in Sample: ^Q-tofr '<

Chrysotile

Anvosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fliers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component

♦Percentage is Visually Estimated

Date: ft/ftfa

RAVENNA. AESff AMMDNTEtCN PLANT

D

Q07 2 3-5

— Ask? < S> o«^ Laboratory Name:

ID Number:

Lab Number:

3D Technique:

Gross Sample Description: _££

Materials Present: r\ff&C llv£

♦Estimated

*Asbestos:

in Sample:

Cnrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component KlA

♦Percentage is Visually Estimated

Date : til & fa

RAVENNA AH4Y AMOCCEKU PLMfT

PCRi D

1?>~?—

Laboratory Name: _

ID Number:

T^h Number:

ID Technique:

Gross Sample Description: ft/Ch"

0 <-r" \ Materials Present:. ._ h 9& XAJCo) fsTlok.)

; \fJ-wjL

♦Estimated Percent in Sanple: nO~yO

^Asbestos:

Chrysotile

Anosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

KM??*

Non-Fibrous Component MA

♦Percentage is Visually Estimated

Date: ■/13 hi

RAVENNA. ARMY AMMCKETICN PLANT

EDLK SAMPLE ANALYSIS

FCKM D

Laboratory Name:

3D Number:

Lab Number:

3D Technique:

103.6

Gross Sample Description: Mbm&.CjjLnSuS , ])V.

Materials Present: . , .

•Estimated PercentVin Sample:

^Asbestos: •

V*.

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

\S-7d9o

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component V$A

♦Percentage is Visually Estimated

RAVENNA AiaCf AMOOTJCN PLANT

FORM D

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

g iption: #OGross Sanple Description: #Om&<?f<>yTC<J

Materials Present:

Percent^n♦Estimated

$Asbestos:

Sample: So

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

■1-3 7c

Non-Fibrous Component

MA

♦Percentage is Visually Estimated

RAVENNA ARMY AMMDKTEICN PLANT

FCEM D

Laboratory Name:

3D Number:

Lab Number:

ID Technique:

I

W^ '37 l*AC

Gross Sample Description:

Materials Presejit:

♦Estimated Percent^in Sample:

-jffAsbestos:

\-3 %

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Iremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component *KV/\

♦Percentage is Visually Estimated

Date: ft } l7 111

V.

p.r.

- fC

: /?' fit.

fiL

RAVENNA AIMY MtOOTICN PLANT

ASBESTOS BGLK SAMPLE CHAIN-OF-COSTCOY EECCKD

Laboratory Name: ?$\ Control Number:

Date Samples Collected: Date Received in Lab:

Sampler's Name: rMCUftELT. (-&C*) ~ Name:

Sampler's Signature: ^KfrLiM 7~^A^Signature:

Disposition:

Receiver's

Signature:

iMAjuaav T

Samples Disposed of I \^

Delivered to Owner or Agent

Sample Field

Identification No:

1O2lc~ OOi

" - 002

* - Oo3

» - Oc^-

' - CCo

OZ(n

Sample Laboratory

Identification No:

/5cW7

1501*1

Date Receivedived: P | I