ABS_DAA_A9_02_99F.pdf

RAVENNA, AR-ri AZ-tIDNITIOO PIAN!'

BuildinJ SUIInlary ~

Farm A

Building ill: _H----l..±_-_q--l.....- SUrvey Date: 3'-22-(\\

Building Type (Use):

Ntnnber of People/ Percentage of Time:

Area:

Inspection Team (Names):

Drawing Ntnnbers:

fVJ,I,!r 52 Cnd"\.)

tSVO_'</ ml....l-l.cIC...t4h,l..AJaei..4'\~6::.-;:::[-l~~~

Year of Construction:

SUIInlary Data

Total Square Gcg 1~'1, !-t/ Fcx...·tage DuildiJ~':

Floors: t (

Basements/Crawl Spaces:

Fan/Boiler Rooms:

samples Taken: --=-o-u,..------- Q.A. samples Taken:

Type of o::nst:ructicn:

(Cleek Applicable)

---:--T' Wocxi Frame Steel Frame ~ Masonry Reinforced Concrete __ Transite Siding comments: CONl~())SdJO(\ rOO-h"!J (643d?)

iUiA12rw bUY7..lfvG I~ Ms,IJ('(\d) loBE f\C ra !

Portion of Building Not Inspected (square feet) :

Reason:

RAVENNA ARfi MHNITICN P.IANl'

RISK ASSF~ SHEEr

:F'C:H! C

A~IBuilding No: Floor No:

Drawinq No: Rcom No: EXTE?:RJ W_.IUO, 3) Evaluator:Date: 8 zz.!cr I rnT61

FACIDR FOR AS.SESSIN:; :F<:JrENrI:AL F.IB:ER ~

CUrrent ca:diticn of .AC:fM

Present Al:sa1t

Evidence of deterioration of delamination from underlying surface X Evidence of Physical Damage ~

Evidence of Water Damage K' Pat:errt:ial for Future Di.sb.n±an::::2

Da:nEge. or &osicn of N:lH

LaN Qicm

Proximity of Air Plenum or Direct Air stream y Visibility, Accessibility (to bJilding oxupants and maintenance personnel), and degree of activity

(air m::wements, vibration, movement Y-of 1::.uilding occupants)

O1ange in Building Use y cx:eupancy

CcClmie:j Unoccupied lCUrrent <JcaJpancy x

RAVENNA Amfi MM:lUTICN PIANI'

RISK ~ ffiERl'

R:.9t C

Building No: ~ A-Oj Floor No: ~(Ukf? ~

I( IIDrawing No: Room No:('5~ f, I Date: Evaluator:~~2~~r

FACIOR FOR .ASSESSING roI'ENl'IAL FIBER RELEASE an:rent CCDlitiCll of AC:DI

Present Absent

Evidence of deterioration of delamination from underlying surface X_ Evidence of Physical Damage K Evidence of Water Damage X

Pot:ent:ia.l for Fubn:e D:ist::w:ba.oce rHmage or ErusiCll of AC:DI

Low High

Proximity of Air Plentnn or

Direct Air stream X Visibility, Accessibility (to ..

Wilding occupants and maintenance personnel), and degree of activity

(air movements, vibration, movement of Wilding occupants) ~

C1ange in Building Use ~

OCCUparq

OCCUpied Unoccupied

[CUrrent Occupancy ;z

RAVElOO\ AIM{ NHmTICN P.I.ANl'

RISK ~ SIEEl'

FC.'!f'M C lSIA-9Building No: Floor No:

/500,");

DraW~ No: Room No: 5 1O~J1~£ ARett tsi~l\ql YV1T&;Date: Evaluator:

FACIOR FGR ASSESSJR; ror:ENl'IAL FIBER :RELEASE

CUrrent Cc:rrlitic:n of ACfM

Present Absent

Evidence of deterioration of delamination from urxierlying surface "r Evidence of Physical Damage y Evidence of Water Damage X-

Potential for :F\rbIre Di.sturl:ance DanBge or Erosic:n of .AcrM l.cM H:iBh

Proximity of Air Plenum or

Direct Air Stream K Visibility, Accessibility (to

OOilding occupants and maintenance personnel), and degree of activity

(air movements, vibration, movement Xof OOilding cx::cupants)

Change in Building Use y Qcalpalq

OCCUpied Unoccupied

10000ent exxupancy I K I art ~t!:r~~~~1J~~~

I

RAvmNA ARMY MM:HIT.ICN PIAN.l'

RISK ~ SIEEI'

FORM C

~rii~9 Floor No: __----1.. _Building No: l

Drawing No: IX!;) .3/ Room No: CL1}{ffi'v; fiU(f,CT. Stffi...'Y ~G:;ir\

Date: 8(7-1191 Evaluator: G\1£;

~ FOR ASSESSJ].G rorENI'IAL F1BER RE:LEASE

On:rent Ccniiticn of .AC::IM

Present Absent

Evidence of deterioration of delamination from underlying surface

YJ

Evidence of Physical Darrage \('

Evidence of Water Darrage

/ X' Potent:ial for Future Di.sturtance

Damage or Erosicn of ACBoI low High

Proximity of Air Plenlll11 or

Direct Air stream f Visibility, Accessibility (to hlilding occupants and maintenance personnel), and degree of activity

(air Irovernents, vibration, movement X of hlilding occupants)

O1ange in Building Use X 0CCUparq

Occupied Unoccupied

[current 0CCUparq ):

PI prff !t.)SV(A~n \'J!J ST0R15.D it,) Cu'{?/\~

RAVENNA ARMY NMEITICN PIMn' RISK ~ ffiEEI'

FORM C

Building No:

Drawing No:

Date:

A~~

/5'DO:-S L

8~ Evaluator: __

Floor No: \ '?-r Room No: ~(!tJ le-:7 ?-< (2., JnT7~

F1ClUR FOR .ASSESSJN; roI'ENI'IAL FI:BER RELEl\SE

Current O:n:lition of AC:Bi

Present Al::sent

Evidence of deterioration of delamination from underlying surface Evidence of Physical Damage ~

Evidence of Water Damage X futential for Future D.isturbaoc:e

Da:nBge or :El:"c:Gion of AC:Bi

IJ::M ffi,gh

Proximity of Air Plenum or

Direct Air stream

YJ

Visibility, Accessibility (to l:uilding occupants and maintenance personnel), and degree of activity

(air Irovernents, vibration, Irovernent >c of l:uilding occupants)

Olange in Building Use V oca1pClrq

OCCUpied unoccupied

Icurrent ~ I "( IL--_---' ~(P ri- (fvSLJd"rP/X\J ~U0j "~A ~4z.

RAVENNA ~ NMJUTICN PIANl' RISK ~ s:IERr

FORM C

Building No: A~J Floor No:

Jq l~

Drawing No:

Date:

V5CD ,-S.]

8\ G1 \ql Room No:

Evaluator:

bq:::l C It.. ~(:\

'('(\T6t

ThCIOR FUR ASSFSSIR; FOI'.ENI'IAL FIBER RELEASE

On:rent o::n:Iiticn of AaM

Present Affient

Evidence of deterioration of delamination from W1derlying surface y

Evidence of Physical Damage '>C'

Evidence of Water Damage X

Potential for Future D:ist::ur:barx:e IEmage or Erosicn of AaM

I.J::M Jii..9h

Direct Air stream X

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

Olange in Building Use ~

<:X:o.lpa.rq

OCCUpied Unoccupied

[CUrrent OCCUpancy

RAVENNA AlMl ~rn PIANl'

RISK ~ ffiFID'

FORM C

Building No: W A--9 Floor No: V:'\

Drawing No: I~CO·-SI Room No: ,r(l;-v,<\' s. ~OV', Date: 8\G7/0 \( Evaluator: I\~TG

FACIDR FOR ASSESSING roI'ENI'IAL FIBER RELEASE

Qrrrent Ccn:lition of ~

Present Ab3ent

Evidence of deterioration of delamination from underlying surface X

Evidence of Physical Damage X-

Evidence of Water Damage

I "- >( Potential far Future Dist:urbarx::e

IEmage ar Erosion of ~

IJ::M H:h9h

Direct Air stream X

Visibility, Accessibility (to Wilding occupants and maintenance personnel), and degree of activity (air IT()vements, vibration, movement of Wilding occupants) ><

Change in Building Use X r

OC:ct.1Bied Unoccupied

CUrrent OCCUpancy ~

?-' (\ \L-c fAfJ/ j~~~~;" etcuk~

RAVENNA ~ NM::NITICN P.IMn' RISK ~ ffiERI'

FORM C

Building No: 6-9 Floor No: \ ~)

Drawing No:

Date:

\ '-)DQ ,:s, 1 e'\'Zl )\l Room No: --=:tOO\ CR.ifS

Evaluator: __~~_~~\'n~~~4 _

ThCIOR FOR ASSESSlNG roI'ENI'IAL F'IBER RELEASE

Orrrent Ccn:liticn of ~

Present Absent

Evidence of deterioration of delamination from trnderlying surface )<

Evidence of Physical Damage X- Evidence of Water Damage K

Potential for Future Di.stur:Dance

Damage or Er:osicn of ~

I...J::M Iii..9h

Proximity of All- Plenrnn or

Direct All- stream 'x-

I Visibility, Accessibility (to b.1i.lding occupants and maintenance personnel), and degree of activity \(

(air movements, vibration, movement of b.1i.lding occtipants)

C11ange in Building Use 'v OCOIpaIq

9cg.Ipied Unoccupied

-------rl~~X=II__ l-QaT-=t ~ &,~~ ~~ OY\?'

~ l ~;}d!d ~o 6~ \Jo ~v;j,~ qt:'~ 1."'d ~l~~ ;r-\ \I}1 ~~

<,Q-j L9"1 ;:: ~ I -Y g~ I -t \ ~l (;:; slID(¥) L -Z ~ v., \l~J "1) ~<1Y).J~ ,\~l'i ,0 1 ,~\l )( ,fJ{ :w~ ~

C!JEht" \ ~8,~} 7yr\fO~ \I"OC) ~a, 5\\"()M ~

\ 'oI.J'CJ"4IMA t~S t1";f'i'O)J -z1-~ -z, \ ~'cd ~~ V_It 5

7~ V~11 \0 Y7vnQJg \)Q ~s (fle) ':s.~ c). ~o -h 1')( Q). ~s 'ry~~WYl\t

~9tt=~~ © '1'<1 ~:1'V-'l 53"6tJ.

'z:.-1-~ 879~ SJfV:)5 vQ 7~ ~'()

~~I t9[~-f- gq( (=: ~ \'tM -+JO\1> l id~)yo) s)\~ -'G ~~\ \ l~) 01,\ c;~

«i-t qz +GJ)\t: 1~ '1 , Gj 1[. x,1- -t ' '1<;;;'\.f I~l I 0 X I 1// ~ w() ~}'F1 '~J(j/~d/l~ r~&WPf('OO)j JOf'O)l'} ;(~)(O .:3'6' '7;j "'1'1 ~lZ -= ~2t'Z~ -t &tB

7j fJ f91~~' A~ J~ ~~~ ~ ~'Ott VG <W~J~M w1~ DI...U--""'T1"~X d _ .

~'11'1 ~9OfJ~ 10Jn ~o I' +z '!J 1~?

(-tDf~~"Uf)-t'')oflY).)~ ~J] <G'(ti>~ ""V\~",.Sl 'b''''l/Q) --~

~ \ft,\ \ 1,,;] d-\. '5YQ)..j' RnJ -1 Q)

~~rf'nW -z)-J }

-3'd 156 Ii \0 x· <;v~'1'70~~ ,E

-lC)\ ~o~ '4~\ lj /5 'f I L ~I +;

~ vrJ-t Ib )( I ~ -..:.-tJ_

'.. VV' -.-m 16~

1iJ $

'rf;1)1--IlJf A~ . 1- 0 )--\ "-'1 G.-7 -, ~q3 J1JJjeJ) ""1 )(J~

(wO], +)(llfj Z) fnw 0 U~ S yrvnj )\1JCV1 ~I"r \\"oM <;

'I' ~ ~~6w 3<) .,.~ V~\l QJ

'1<;1,~ ! I 01 x(f7' i a6')~O-

'l'fltLW:' \{)-~

RAVENNA ARMY ~'![fll'l'Irn PIANl'

BUlIDING ~ SfIEEI'

FtJm1. B

Building #: A-f/ Sheet No. --L of _<t-.., sample # 0 Drawing # Revision # OCCUpied Floor # Material

A Room # Area Type Description/

Location

M\~\Q~Bf)'\~ h"lVlk OD~ tvJ 16ro·")/ ~O (2.1"1 j/tsiAl-

PI02- O~

\ I 11802- IN

I ~ P,f - b0-, \-e.r

VfCt"" .>.L0. C/K~ eO) i !I MUd.If '/ b, ~ Ie ~ iid-

A

~~ OJQ4 19~~;l \Qr004 ~ \ I I, " ..... .1..1 u.~\ l~~

~,,,.nu 'I80S ~ eV<D-r ~f'lk.'I II tftlAsi +e ~M' ~I'\'t~iQ.(

(Db N II Jf c* bO\l~II . ~Sl!\\'

~ 7yJ· C6)t~007 N II 11 I I -- 1/·.-.1 Jt n~

~~O ~\,~ \MlW 19~e:JJ~

~ )1 ~ ~v..M ~ Q.\o..OO~ f {]~

, :;iIil l~1r ~ l;~~ ~\.1 ..

.~IY\Q"" ~\M WJ..t~~Pt<l"\ Qf)'\. ~ L\ ' r <..-:'.. 'Il A .l..... au&; ~~~~ (,.~ ~fA W""'" .. ~

Corrnnents :

Encapsulated Friable Condition or 1-5*

Enclosed (l-Best 5-Worst

.~ fJo ) ~5 'S 0 NO ls4

3 rJo 3

0 tJo 2

C; (tip 5~

() rJv ~ i- No

A 0 Ye> 7

QUantity

Arrount unit Pipe Dia

38) ' ..I W

4'11\

,,/tfd5 ~t- 5/1 l , ~~ v

JP i 9 11 i/",8"

I37~

\ - !-f+1 J

I(p b ~'

I I

\/LI IfU

J/q3 ~'2., I

'I40 !~

RAVENNA Amff ~CN PIANT

BUilDING SlM1ARY SH:ERI'

FORM B1ht4-q Sheet No. ---.1..- of 1...Building #:

5aIrple # 0 Drawing # Revision # OCCUpied Floor # Material Encapsulated Friable Corrlition Quantity A Room # or 1-5*

Area Type Description/ Enclosed (l-Best Amount Unit Pipe Loc:<ltion 5-Worst Dia

~e~€i~~l""\Ci.lM. ~ !A~ .

(9lD ~ t~·~\ 5~$ f~rtf1'l\ wu-e. Osot? &t\ NoJ<.rs () ~ ) it yt~rs. ~~b{P. I flu.t"f\,~ 9,\~~r 2 ' e\e.e..-4

~ () Nt) K I,t) \ \ [Ii 11 II (( SbTe, Mii~ fY\ cc;~ :> L~

Corrnnents :

rarora~~~ ~l ~lJr~~f6 H_---'8U~ \LD\N6 *- A-~ Lab Nurnl:er: q I en Td= Cl-I 3 Cjb

In Technique: PL IY\ QlSrte-SJ ON SIBI N (Nt;

Gross sample r:::escription: 110m (}J 'L/,-vJ J, LAf'''' ,0.-, ¥.aterials Present~ TA1'\Jb r t0SULfTT] Q\J *EstiIDated Pereen~ sample: -=0,--0_-~(p..:::;S_-.>_(U _

~Asbestos : Yc- ) cmysotile I&u -&5-%

Alrosite crocidolite

Anthophlyllite

TrernolitejActinolite

Non-Asl:estos FiJ:::ers: y'-5

Glass Fibers

Mineral Wool cellulose /-3"/"

Synthetic FiJ:::ers other

Non-Fibrous Carnp:Jnent/l/A

*Percentage is Visually Estimated Analysts Comments

C(fll

LabJratory Name: Ps 1 P1IT5WRb H BuILDIN6 ~ A- 9 ID Nl..m1b=r: -#; It-~ oa 2 lab Nurnt:er: '1/ 6/7 ~ .;1./3'17 ID Technique: PL D'\ DlS£Eg..SJ DN 'sIBI N rNt;

GrQSS sample D=scription: Llo/'nO;)Cl"v.J5j LYlr<..vl j ;:lhrJv~ wAde rG-r'fj(

Materials Present: P(fF I t\:),SOlAiieP<J

*E.stimated percen~in sample: S-0 - be)

.*'Aste.stos: yc-) Orrysotile 3J '-:S~ % Arnosite ..J{)_.2 S-

Crocidolite

TremolitejActinolite

Non-Asbestos Fibers: yo

Glass Fil::ers

7-/u%

Synthetic Fil::ers

Other

Non-Fibrous Component N A

*Percentage is Visually Estimated Analysts Comments

Date: d9~ /1-,kJ.q/ r.aroratory Name: PS I PI IT.sEOR6 H__8U=..:: \LD\ N6 4F- A- -9 ID Nt.1IIlrer: it: A - 9 - 003

Lab Nurnl:er: q I {) / 7~ d-./3 9 Ii ID Tedmique: PL JY\ DlS£££--SJ DN .6TBI N (Nt=;

Gross sample C€scription: ;10m r;t:. -x/J ~ /~ ~ "-v J ~ crrP,Y

Materials Present: Aern MUOQrNh

*Estimated PerA Sanple: .,.,5p,-,---'~5£:"":"-"::%..J.:.Q, i _

~t:estos: y(S

Quysotile y -5£ t'~

Arnosite erocidolite

Antb.ophlyllite

TrernolitelActinolite

Glass FiJ:ers cellulose 3-5-%

Synthetic FiJ:ers other

Non-Fibrous Corrponent ,I'o-//J

*Percentage is Visually Estimated

I.al:oratory Narre: f5 I P1TrSW!'6 H~_9J=\LD\ N6 *- A-9 10 Numl:er: #- A-~OQ±= lab Numl:er: q , () 11::J- tHY ;;l / 3 c7J 9 10 Technique: PLOO DIS~()N 5TBIN INti

Gross sample Description: &Il/OL.,e~olJ) /:1;.-4" ,/"j (I h ,..-vv 5, J I I / l

Materials Present: bQE..ECH IN 6J *Estimated percen~in 5aIrple: s<.~o_·.....;_(;,::::..-..(/_o,{_;) _

~Asl:estOS: yc-)

OU:ysotile 30 '.:»)- Arnosite 2o'~~

Tre.-rnolite/ActinoliteI

N,on-!>.sbest.os Fibers: y~ ~

Glass Fil:ers

1-lu Synthetic Fibers

Other

Non-Fibrous COmponent N A

Analysts canments

Date:

Lal:oratory Name: Ps \ YITTSEUR6 H 8U\LDlNt; 4F- A-9 ID Number: it" &- E 065 lab Number: 1/0/7:J- ;;J...1LjOO ID Technique: PLtf\ DlS£13?--SJDN f,TBIN INt;

Gross sanple r::escription: ;!rf'V'~ C M)V) h br',y J ~ , (j-yAV

Materials Present: T{2.Af\JS) TE. boAfL.,.9 *Estimated percen~ sample: ~+-_O_,v.l.----'-r _

;fAsbestos: yL- ~

Qrrysotile cf()-lI)-

Amosite crocidolite

Anthophlyllite

Tre.T£1Olite/ Actlnolite

Ncn-Asb!:>..st....'"'S Fibers: Yc./

Glass FiJ::ers

Mineral Wool cellulose (-j%

Synthetic Fi.l:ers other

Non-Fibrous Component IV~

*Percentage is Visually Estimated

Lal:oratory Name: PSI plrr.sWR6 H 8U\LD\N6 ~ A-9

ID Number: -#- a -.s - 0 D (0 lab Number: Cj / di 1:J- J.- )'-! 0 (

ID Technique: PL N\ D)S~$JDN STAIN IN?;

Gross sample Description: IJoWloAC,CJcJS [6'(1""'5 t-.../-<"J 6VA'I.t- ~~,J-.c J I i; j

Materials Present: . Bo \~ tf\JSU LA-1J W *Estimate:1 percen~b, sample: 0_0_-_6_5-_%_u _

~ Astestos: yc S

Chrysotile 00 -(;- S- "Iv

Arnosite

Cr'ocidolite I

TrernolitejActinolite

Ncn-A.c:;bestos FiJ::ers:jU

/JX

Non-Fibrous Component /JJ)

1/20 rarora:~~ ~\ A~JJ~~R6 H__---.:8U=..:: \LD'N6 ~ A-9 lab Nurnl::er: 9 / 0 I 7 do c?- I Lj 0 d-

ID Technique: Pl 00 DlS~ DN .5TBI N 11\Jt1

Gross sample Description: flom6-;u",;)J~ LAv c c "l (0/ A""(J~\1/ 7 • ..., Materials Present: Aern GzAS'f-Er

*Fstimated Perc2in sample: -,-0.::...o_-0 _ __./~(-,-=Y_.

:f Asl:estos: 1L-5

Olrysotile ;. y:,-t/oc. v ) t

Arnosite ercx::idolite

TrerrolitelActinolite

Non-l'-s~~ Fibers:(u

J -5'?:' Synthetic Fibers other

Non-Fibrous Component .I'-" 013

*Percentage is Visually Estimated Analysts Comments

Date: ciP1L-

Lal:oratory Narre: fS I PI1TSWR6 H 0JILD)N6 -IF- 4-9 ID Numl:er: -#: A- :1-CO~

Lab Numl:er: q I C; I]:;).. ,;;..} C/ D 3 ID Technique: Pl IY\ DIS£€?'-SJ ON .sIAl N INt;

Gross sample Description: ;4M0'7CrvJ j jyc YC-Lf!..- !;:; kv/,.5 en t.r- 1'- ri

V 7 I 7/ 7

Materials Presen~ T~SITlZ-.. wA-u.- b0¥2S)

*Esti.rna.ted Perce.~ sample: ... _td_'tJ_·0.:..::'J;....:X~t-J i Asl:estcs: : ... yo Qrrysotile ~- '1>-% Amosite

TremolitejActinolite

Ncr.-!'..st:estos Fil:ers: j'> cellulose /j"!u

Non-Fibrous Component fVA

*Percentage is Visually Estimated

I.abora:~~ ~1 ~l~.§~~G H Eu\LD\N6 *- A -~ lab Nurnl:er: cz 10 77 do ;l / Lj 0 LJ .

ID Technique: PLIY\ DlSB:X-$JDN .5TBIN rNti

Gross sample Description: Ho;"-0Ja..C'<.I...J~i F16-rl.i vy , tdhlt-e-.

Materials Present: Aern H07JNb D()CT LJ rvER

*Estimated PerC81~ sanple: ....;...lv_-_?_)_JI_ _ Q

-*Asl:estos: ) e.. 5

Orrysotile 7iJ - 7)-~~ crccidolite

TrernolitejActinolite

Non-Asl:e.....e::tos Fil::ers: !Cs

Glass Fil::ers cellulose 5-7/.

Non-Fibrous Component tv A

*Percentage is Visually Estimated Analysts COmments

I.atorai~~ ~l ~11T~~g:6 H &J\LD\N6 *- A-9

Lab Nurnl:er: q (0 I 7;+. ,;L I Lf 05

ID Technique: PLOO DlS~SJ()N 5TBIN rNt1

Gross 5aIIple C€scription: [f..> .......:y,.,'VJ, F,l:,dV.J CJ~d ..

j

Materials Present: lD I Q.E I~Q!\)

*Estimated percen~in 5anple: .Lln(Jl¥-..<.JnelL-.L.:lrldedm&.+>-~4L _

·tAsr:estos: rJO AJ{ Dth.J-c (/'""'

Qrrysotile

Cr'ocidolite

TrernolitelActinolite

Non-Asl:estos Fibers: "Ie.)

Mineral Hool

~-~t::

Non-Fibrous CorrytX:ment NA

RAVENNA MMY MH:NIT.ICN PIANI'

BULK SAMPLE ANALYSIS

~D

Latoratory Narre: fS I !I1T5BOR6 H 8U\LD\N6 #:- A-9

ID Number: *" K-~/l

Lab Number: Q/oJ7.?- c?t I '7 Oh

ID Technique: PL IY\ Distee-SJDN .sIBI N rNt;

Gross sample Description: \!olY)~.:f ,...~J;. Lr'l e,,'<-~, (:,6 YI/v \ ~tl J~

Materials Present: GAS~ M~!j1

*EstJ..rnated. Percentt sample: ~nt ~ _ fAstestos : fJJ r./.l \Je1e<..fc ~L

Chrysotile

Amosite crocidolite I Anthophlyllite

Tre.'tlOlite/ Actinolite

Non-Asbestos Fil:e.r"s: y-<- S

&0 -~'fi Synthetic Fi1:ers other

Non-Fibrous Corriponent IV ~

*Percentage is Visually Estimated Analysts camments

RAvmNA ARorl MH:m.T.Irn PIAN!'

ASBES'lDS l3UIX ~ rnAIN-oF-aJSroDY REXDRD

FQI;ME /37-!9J36

_ q/o/7~ laboratory Name: Control Number:pc, I Pi lTr::[!Gfi Date samples Collected: 8 9/ ~ 8[2;El Date Received in Lab: 10 -/0 j sampler's Name: yY\ICKPrU T. bl<01i::lName: p /H2L"Tho M/'~~" sampler's signature: 111vlke2-C Signature: ~t.f~ sample Field A Q sample Laboratory Identification No: BUI LD JN6 -#= -'" J Identification No:

a13q1 q 1'100

------JA-~aL .B.. LtH!_.J ._ __A,,---q - 00I d. 1LjO;J

_--=--6-,---9 - roB d I LI{'l_~ k-t-009 C}7! L}oL!

Disp:>sition: ___ samples Disp::>sed of

___ Delivered to Owner or Agent

Receiver's Signature: ~~~ Date Receivcn:

of eJ£(2Y '2e ~f11;YPLES 11~ usT //Sf<:- c)c

13'1 it utt3 677 ree TfI/'tfJ pC; J ,;