ABS_DAA_A-1_02_99CS.pdf

RAVENNA, ARM* ADMONITION PLANT

Building Sunmary Sheet

Form A

Building ID:

Building Type (Use):

Number of People/

Percentage of Time:

Area:

Inspection Team (Names):

Drawing Numbers:

Survey Date: V

/feleg tHLgg

Year of Construction:

Total Square

Footage Building:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms:

Samples Taken:

Q.A. Samples Taken:

Summary Data

Uc, A o

Type of Construction:

(Check Applicable)

Wood Frame

Masonry

Transits Siding

Steel Frame

Reinforced Concrete

Comments: ±J U1 flSlh -tfl) (V

Portion

Reason:

of Building

Not Inspected (square feet):

B u i l d i n g

R A V E N N A A R M Y A M M J U T T I C 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

F O R M B

S h e e t

N o o f

S a m p l e

O 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 n

/O o

P a

Al i» it r$ e z N C y O fi o

(l o

C o m m e n t s

RAVENNA ARMZ AMMWnTON PLANT

RISK ASSESSMENT

FCX&L C

Building No:

Drawing No:

Date:

A-l 3 f

Floor No:

Room No:

Evaluator: mm

FACTCR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM KJ

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

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 High —i 1

4—^

W

Occupancy

Occupied Unoccupied

Current Occupancy

RAVENNA ARMY AMMDNITION PLANT

RISK ASSESSMENT ■C3TRFH1

POEM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator : fYj

FACTOR PCR 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

V

Potential far Future Disturbance

Damage or Erosion of ACEM

Low

Occupancy

Occupied

Af* (

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

K

X

Unoccupied

RAVENNA ARMY AMMCWHION PIAOT

FORM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

FACTOR FOR ASSESSING POTENTIAI. FIBER RELEASE

Current Condition of ACBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

V

V

Potential far Future Disturbance

Damage car 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

V

Y

X

Current Occupancy A

RAVENNA ARM* AMOffTTON PLANT

RISK ASSESSMENT SHKKI'

FORM C

Building No:

Drawing No:

Date: LL

Floor No:

Room No:

Evaluator:

P~f

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

Potential fox Future Disturbance

Damage or Erosion of ACEM

Low 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

V

Occupancy

RAVENNA ARM* AMODTTCN PIANT

RISK ASSESSMENT SHEET

FORM C

Building No:

Drawing No:

Date:

Ad. Floor No:

Room No: *jl\)

Evaluator: I

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

Potential for Future Disturbance

Damage car Erosion of ACEM

Low High

Proxiinity 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

Occupancy

RAVENNA ARM¥ AMQCTTTON PLANT

FORM C

Building No:

Drawing No:

Date:

A Floor No:

Room No:

Evaluator:

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM AJ^

Present Absent

Evidence of deterioration of delaraination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potential far Future Disturbance

Damage or Erosion of ACEM

Low Slab

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

(0

I r

■ft

Occupancy

Current Occupancy X)

RAVENNA ARMZ AWOHTTON PIANT

RISK ASSESSMENT shkkt

C

Building No:

Drawing No:

Date:

A li.

Floor No:

Room No:

Evaluator:

FACTOR FCR ASSESSING PCfTENTIAL EEBER RELEASE

Current Condition of ACBM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage y

X

NT

Potential for Riture Disturbance

Damage car 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 V, RAVENNA ARMY AfMMTHCN PIAMT

RISK ASSESSMENT 5-MKKI'

FOEM C

Building No:

Drawing No:

Date: 6

Floor No:

Room No:

Evaluator:

PCR ASSESSING POi'EMl'lAL 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 cx L \

Potential for Future Disturbance

Damage or Erosion of ACEM

Low 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 f \

X Occupancy

Occupied Unoccupied

&RQOh}p \ o ktw^Ut Ceui-

U

RAVENNA AKMX AWOOTICN PIANT

BDTK SAMPLE ANALYSIS

FCEW D

iA-1 -nr> I Laboratory Name:

ID Number:

T^h Number:

ID Technique:

Gross Sanple Description:

Materials Present: Y\ r

4F •Estimated Percent^in Sample:

-^Asbestos:

Chrysotile

Crccidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Non-Fibrous Component^

•Percentage is Visually Estimated

Analysts Comments

Date:

EAVENNA AKM¥ 2MOOTICN PLANT

BOLK SAMPLE ANALYSIS

FOR* D

Laboratory Name:

ID Number:

Tab Number:

ID Technique:

j*=>t /V A-t-m7 Clic

Gross Sanple Description:, Materials Present:

f-, *Estimated Percent in Sairple:

^Asbestos:

?o-

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

7 *> %

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

IS

Non-Fibrous Component

•Percentage is Visually Estimated^-

Analysts Comments

T

BAVENNA ARC AM-CNTTICN PLANT

BOLK SAMPLE ANALYSIS

FCS3I D

Laboratory Name:

' ID Number:

Lab Number:

ID Technique:

gyllT>lM6 *-no m

Gross Sample Description:

Materials Present:

0 -A—-

•Estimated Percent^in Sample:

%■Asbestos:)/{-

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers :-/

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers i.

Other

Non-Fibrous ConponentA-'^

•Percentage is Visually Estimated

.f

EAVENNA ARM¥ AMHKTEICN KANT

BJLK SAMPLE ANALYSIS

D

A4 ID Hunter:

A-I-AO4

Gross Sample Description:

>3aterials Present:

iJ i rO o^\ I- Lr,yJl !&"'-

•Estimated Percent^ Sample: ^ M

•*rAsbestos:

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers: ycs

Glass Fibers i

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component^^ dAfcjfi^

•Percentage is Visually Estimated

Analysts Comments f /

RAVENNA AKMY AMtENHICN FIANT

BDIK SAMPLE ANALYSIS

D

Laboratory Name:

ID Number:

T^h Number:

ID Technique:

A-l — rA

Gross Sample Description: /■/>/* U

Materials Present:

•Estimated Percent in Sample:

^Asbestos :

hp oithrW.

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:y

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component

•Percentage is Visually Estimated

Analysts Comments

EAVENNA AKC AMCNTTICN ELSNT

BULK SAMPLE ANALYSIS

D

H

Gross Sanple Description: ±

Materials Present:

•Estimated Percental Sample:

^Asbestos:

/<4I/",'«- ■■( '-■ I 'A f.i

Tremolite/Actinolite

Non-Asbestos Fibers:

Synthetic Fibers

♦Percentage is Visually Estimated^

EAVENNA ARMY AMCNITICN PLANT

BOIK SAMPLE ANALYSIS

FCKM D

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

ft'

Pi

Gross Sample Description:.

Materials Present: _

•Estimated PercentHji Sample:

^Asbestos:

Chrysotile

9 uhrz.

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestcs Fibers:^;; ;

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Non-Fibrous Component,.

•Percentage is Visually Estimated

Date: (

RAVENNA AHff AMOJTTICN FLftMT

ASBESTOS BULK SAMPLE CHAIN-OF-CUSTCOY REOCKD

Laboratory Name: Pol PlTTSBJg6U

Date Samples Collected: 9>/Z&/<i/ Sampler's Name:

Sampler's Signature:

Control Number:

1/0170

Date Received in lab:

Name:

Signature:

Sample Field

Identification No:

1 -oo

A I Sample Laboratory

Identification No:

—i-co?

A-l -OOB

I-qq-7

Disposition:

Receiver's

Signature:

of

>c

A

Samples Disposed of

Delivered to Owner or Agent

Received:

U A T E

I B s i l T I M E

B L D G

N O

D R A W I N G N O

B U L K

S A M P L E

N O

A R E A S A M P l

I

M A T E R I A L

T N

D R A W I N G N O

T l

B U L K S A M P L E M o T O O l

A R E A S A M P L E D V l R

M A T E R I A L T Y P E i a r t i m e

B L D G

N O

D R A W I N G N O

B U L K

S A M P L E N O

A R E A S A M P L E D

M A T E R I A L

T Y P E

S A M P L E D

Y

D R A W I N G N O

B U L K

S A M P L E

N O