ABS_DAA_2818_02_99.pdf

D A T E s i T I M E

B L D G

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D R A W I N G

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R A W I M G

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A R E A S A M P L E D

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M i S r D A T E

B L D G

N O

T I M E

D R A W I N G

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I B U L K

S A M P L E

NO

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S A M P L E D

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RAVENNA, ARMY AMMUNITION PLANT

Building Sunmary Sheet

Farm A

Building ID: Survey Date:

Building Type (Use):

Number of People/

Percentage of Time:

Area:

Inspection Team (Names):

Drawing Numbers:

Year of Construction:

Total Square

Footage Building:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms:

Samples Taken:

Q.A. Samples Taken:

Qhsux a

-ZZ-\,-2o\

Sunmary Data

Jik

Type of Construction:

(Check Applicable)

Wood Frame

Masonry

Transite Siding

Steel Frame

Reinforced Concrete

Comments:

Portion of Building Not Inspected (square feet):

Reason:

u i l d i n g

R A V E N N A A R M Y A M M U N I T I O N P L A N T

B U I L D I N G S U M M A R Y S H E E T

F O R M B

S h e e t N o o f

S a m p l e

D r a w i n g

R e v i s i o n O c c u p i e d F l o o r

R o o m

A r e a

M a t e r i a l

T y p e

D e s c r i p t i o n

L o c a t i o n

E n c a p s u l a t e d o r

E n c l o s e d

F r i a b l e C o n d i t i o n

B e s t

W o r s t

Q u a n t i t y

A m o u n t U n i t P i p e

D i a b y hr -x i n

I X M K f- 1-

Ft

A

FT

n\ e r i.

o b o i

N

M K

Pf c f o

F t

A J

C o m m e n t s cc e.

■2

R A V E N N A A R M Y A M M U N I T I O N P L A N T

B U H D I N G

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

B u i l d i n g

S h e e t

N o

F O R M B

S a m p l e o o

0 A

D r a w i n g

R e v i s i o n

O c c u p i e d F l o o r

R o o m

A r e a

M a t e r i a l

T y p e

D e s c r i p t i o n

L o c a t i o n

E n c a p s u l a t e d o r

E n c l o s e d

F r i a b l e

M o

C o n d i t i o n

B e s t

W o r s t

Q u a n t i t y

A m o u n t U n i t

A

P i p e

D i a

C o m m e n t s

RAVENNA ARMZ AMCKITICW PLMfT

RISK ASSESSMENT SHEET

FORM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator: re

FACTOR FOR 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

X

Potential fear Future DisLurrance

Damage or Erosion of ACEM

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

V

Unoccupied

Current Occupancy

Building No:

Drawing No:

Date:

RAVENNA ARMY AMMDNTTCCN PLANT

RISK ASSESSMENT

FORM C

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

Poteniiai ful- FiitiiLX: DistmrLancs

Damage or Erosion of ACEM

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

X

Date:

RAVENNA ARMY AMMQNITXCN PLANT

RISK ASSESSMENT SHEET

c

Floor No:

Room No:

Evaluator:

(Sf

FACTCR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACBH

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

X rear ^lATiire

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

X

Current Occupancy X

RAVENNA ARMY AMMUNITION PLANT

FORM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

tsi

EACTCfR PCR ASSESSING POEENTIAL FIBER RELEASE

Current Ccnditicn of ACBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage y

X

X il tar FuLurt. 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

Unoccupied

Current Occupancy i

X

RAVENNA ARM5T AMMDKTTION PLANT

FORM C

Building No:

Drawing No:

Date:

. H

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 y

X ar Future Disturbance

Damage or Erosion of ACEM

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

Date:

RAVENNA ARM* AMOtELTON PLANT

RISK ASSESSMENT

FORM C

Floor No:

Room No:

Evaluator:

/?A

EACKJR FOR ASSESSING POfTEWEEAL FIBER RELEASE

Current Condition of ACBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage k iclzl far Pature Disturbance

Damage or Erosion of ACEM

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 y

X

Date:

RAVENNA AEMZ AMOJITION PIANT

RISK ASSESSMENT

KSM C

Floor No:

Room No:

Evaluator: p 15

PCR ASSESSING POrENTIAL FIBER RET.EASE

Current Condition of ACEH

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

X

V far Riture 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 y

V

Current Occupancy V

Date:

RAVENNA ARMY AMMCNTTION PLANT

RISK ASSESSMENT SHEET

FORM C

Floor No:

Room No:

Evaluator: PS.

FACTOR FOR 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 y

V rocential far Future DisturLanae

Damage or Erosion of ACEM

Low

Ocxxpancy

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. ARMY AMKMEEICN FLAWT

ASBESTOS BULK SAMPLE CHAIN-OF-<USTODY RECORD

POEM E

Laboratory Name: P^i

Date Samples Collected:

Sampler's Name:

Sampler's .qignature•

Disposition:

Receiver's

Signature:

Control Number:

Date Received in Lab:

J. |/a. L iJ

Samples Disposed of

Delivered to Owner or Agent

Date Received:

of

<--O '

ZB-

7PH

[ft-ol

• oo in Sample Laboratory ^ ^-O^lo identification No:

- 9-9/

RAVENNA. ARMY. 2MYENTEICN PLANT

ASBESTOS BULK SAMPLE CHAIN-OF-COSTODY RECORD

FCEM E

Laboratory Name:

Date Samples Collected:

Sampler's Signature:

Control Number:

Date Received in Lab: <\~2-

Sample Field

Identification No:

o Sample Laboratory

D identification No:

Disposition:

Receiver's

Signature:

X Samples Disposed of

Delivered to Owner or Agent

Date Received:

I OF EV5PV

,3V A

Offv p.r

EAVENNA AEMY AMMUnXCN PLANT

BULK SAMPLE ANALYSIS

FCKM D

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

■» -f ft -Oo

H Zgrlg)

Gross Sample Description:

P Materials Present: ' i

*Estimated Percent in Sample:

Asbestos: ye f if-

Qirysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Ncn-asbestos Fibers: u

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component c + /4r\ ^ I

♦Percentage is Visually Estimated

Date:

RAVENNA ARC AMMOtTTICN PLANT

D

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

"ZR-la-m

Gross Sanple Description:. —

Materials Present:

♦Estimated Percent in Sample:

Asbestos: V ? f

Chrysotile

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component N ot

♦Percentage is Visually Estimated

Analysts Comments

ELftNT

BOIK SAMPLE ANAIXSIS

D

Gross Sample Description:

Materials Present: T, Same>le:

73<\s>ou h

-9

•Estimated Percent in Sample:

Asbestos:

Chrysotile

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Non-Fibrous Component

•Percentage is Visually Estimated

Analysts Comments C*

NNA AE«y AWCNTEICN PLANT

FOR* D

ID Number:

T^th Number:

ID Technique: "Pi

Gross Sample Description:

Materials Present:

•Estimated Percent in Sample

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Mon-Asbestcs Fibers:

Synthetic Fibers

Non-Fibrous Component

•Percentage is Visually Estimated

RAVENNA ARM* AMCNTTICN PLANT

D

Laboratory Name:

ID Number:

T^v> Number:

ID Technique:

Gross Sample Description:

Materials Present:

•Estimated Percent in Sample:

Asbestos:

— l^o

Tremolite/Actinolite

Non-Asbestos Fibers:

Synthetic Fibers

•Percentage is Visually Estimated

Date: !d

EAVENNA ARMY AMtOOTICN PLANT

FCKM D

Laboratory Name:

ID Number:

]>h Number:

ID Technique: rA

Gross Sanple Description:.

Materials Present:

■ii^Ja

*Estimated Percent in Sairple:

Asbestos:

Chrysotile

O- 3

Aracsite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Mon-Asbei=tcs Fibers:

•Percentage is Visually Estimated

Analysts tf^

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component kavenna aemy ahmcniticn plant bolk sample analysis d

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

Gross Sample Description:

Materials Present:

•Estimated Percent in Sample:

Asbestos:

Chrysotile

Crocidolite

Anthophlyllit

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Cellulose

Synthetic Fibers

Non-Fibrous Component

♦Percentage is Visually Estijrated

Analysts fSh

Date: ro-7-

RAVENNA. ARMY AMHCNITICN PLANT

BOLK SAMPLE ANALYSIS

FCtEM. D oratory

IDl Lab Number:

ID Technique:

*<b fi

Gross Sample Description:

Materials Present: .

•Estimated Percent in Sample:

Asbestos:

Crocidolite

Anthophlyllite

Treroolite/Actinolite

Non-Asbestcs Fibers:

Synthetic Fibers

Non-Fibrous Component

♦Percentage is Visually Estimated

Analysts ^

KAVENNA ARMZ AMCNTTICN PLANT

FCfM D

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

H m

Gross Sairple Description:

Materials Present:

<J/ a h

*Estimated Percent in Sample:

Asbestos: \i<?JT

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Iremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component

♦Percentage i^Visually Estimated

Analysts ^^t

Date: \ r>-eavenna szm ahmkehot piani

BCIZ SAMPLE ANALYSIS

HMD

Laboratory Name:

ID Number:

T*h Number:

ID Technique:

- 18-

H 8U\LD^ 1^ %- ^Z8~ \8

61 n flfA

Gross Sample Description:.

Materials Present:

mJ MWa> r?,Ty-3./vvvMMi»ui>

•Estimated Percent in Sairple:

Asbestos:

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

5--7%

Non-Fibrous Component J fa.

*Percentage is Visually Estimated

Analysts Comments

Date: \ ^ mJJ. r-LL