ABS_GA_61-851_02_99F.pdf

Building #:

b(-' ~ S-/

RAVENNA ~ NH:trrTICfl l'IJ\Nl' BUlIDING SlM \ARY SHEEr

FORM B

Sheet No. L of i sample # 0 Drawing # Revision # occuPied Floor # Material Encapsulated Friable Corxlition Quantity

A Room # or 1-5* Area Type Description/ Enclosed (I-Best Amount Unit pipe

{ IJ:x:.'ition 5-Worst Dia

We-sr R" ~

# ()f\ ACM(jl)\ tsro'2. 1 {Vo t(\$7~{ ~r..v- l)ehuyv.;JS·t£'( 2 rJO 2- N&i" 001 tJ " tJ'()

Ifl ~ I J 2. Ye-s 3 ') ~Lz

I /I ~N AIAe}- /I,1~r J/~ .

AcH. "00> ~ L1 II / j l,Jrqf f!)vis~~ ~ 7-- NCJ L 2) -r-t (~ (s,lvtlP- IW(rl') w.t - i-~li,~~nJ~ (II II goo AcM(jr)4 t/ \ 6~ EPGT',-00Ol (00 ) ~W4:! Fe~'IfliA't','~e

W 1~7t~ UtLclut/ Au'-'\00(' \ I \ \ rE~L ~ ~Cld~ () No ) '-8~~ Pt7.1

A~N'S tO~~Sof SDJr1-f vJe-.,J--rl II () 0 Z &~2 ~-c2 i ACM\I000 [\.-(..\.t .Mt£..-._-

~M~VL

I1)(,Ivdec!' /11 ()j1 ~ ,1 \'1 ! ( I ( (9 (!) -ACM

~( Z C\~ iob)' \ J 1I -;OU7~f- .' ~ .~ Jt IooB N I I () () ~ Ac1'--\II D&(J~

;-'-f~ n I ( ~ ~0lJT1-j {,l~ f000... J \\ () <9 '> '~d(J) -rt AcM I~5 ce(k~ i j I I-

Cormnents:

If I f ! I caulk 5·LtAe. 2 /v'f) s !~, (\1 i}\tr eM

OlD tJ

Building No: Floor No:

Drawing No: -./5l:t).Z,J---Room No:

__...1..!'-L-.....",~Evaluator: _Date: elahJ-_

0Jr:rent CCIrlitioo. of A£:B4:

Present

EVidence of deterioration of delamination from underlying surface

EVidence of Physical Damage

EVidence of Water Damage f\:JtEnbal I:or l'uture lJi:::..·1"Jxr-~

IHmage or Erosioo. of A£:B4:

Proximity of Air Plenum or

Direct Air stream Visibility, Accessibility (to

Wilding occupants and maintenance personnel), and degree of activity X.

(air movements, vibration, movement of Wilding occupants)

O1ange in Building Use 'l

OCCUpied Uncx:::cupied

ICUrrent OCCUpancy

Building No: Floor No:

Drawing No: Room No:

Date: Evaluator:

On:rent a:nlition of ACD4:

Present Absent

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

.f'Oteiri::i.a: :tar F'.r-...ure Di..sbn:i::JiID:

IHmage or Erosion of ACD4:

Proximity of Air Plenlllll or Direct Air stream )( Visibility, Accessibility (to ' building cccupants and maintenance personnel), and degree of activity

(air movements, vibration, movement of building occupants) )<

O1ange in Building Use V, OCCUpied Unoccupied

ICUrrent OCCUpancy

C.I- 851__Building No: Floor No:

Drawing No: Room No:

Date: Evaluator:

_.........-::....a....J----.:~-'-----_ ti'

On::I:ent Ccnliticn of AaIf

Present Absent

Evidence of deterioration of delamination from underlying surface )(

Evidence of Physical Damage Jt Evidence of water Damage

V, ...

RJ-t:err-w.a.l far Future nist:::Urilarx:e

IHmage or EI:1:sian of AaIf

Proximity of Air Plenrnn or

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

(air movements, vibration, movement )( of tuilding occupants)

Olange in Building Use \c, OCCUpied Unoccupied

CUrrent OCCUpancy IV I.-----~-r----

RAVENNA ARMY MM::tITTICN PI.Mn' ASI3ESl.US BULK SAMPLE CWUN-oF-aJSICOY REXXlRD

:FC>hM E

I.al:oratory Name: FS 1 YilTS5vf?6H Control Number:

Date samples Collected: B! J \ ) 91 Date ReceiVed in Lab: q -II -q I sampler's Name: yY1ICHfrfU, T. br<o~ Name:

sampler's Signature: Me2:c~Signature:

sample Field sample I.al:oratory Identification No: bUI LV JAlt; -It c'o \- 8S- J Identification No:

&1~t)51 - OD \ /8 c9~5

" " - D 0'"2. /Bd3b I( Ii -003 /8 J.37

II -oa4 /8;)38 II II 18;;)3q-00'5 \1 II ,. ---OOb 18:JLfo

II \1

-Dlo /8;)L/V

Disposition: __X__ samples DispJsed of

____ Delivered to <Mner or Agent

Receiver's

Signature: Date Received:

RAVENNA, ARoff MotroNITIOO PIANl'

Builclin3' SUnmary Sheet

Fann A

Building ill: _---->0_'.!...-1~---ljj""",,-~=--..J.)______ SUrvey Date:

Building Type (Use):

Number of People/ Percentage of Time:

Area:

Inspection Team (Names):

Drawing Numbers:

(14-2Year of Construction:

SUnInaIy Data

Total Square

Fooi:::a·ge BuildiI..g:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms:

samples Taken: 10

Q.A. samples Taken: o Type of C'alst:ructian:

(Cleek Applicable)

----t- WO<X1 Frame ~ steel Frame __ ~~~ ~W~~Co~~

--A- Transite Siding

Comments: ~ C()(Yfbsr!lCM,) }2.C6F (25 2-00 fr'2) J

Portion of Building Not Inspected. (square feet):

Reason:

I'

RAVENNA ~ NoM::NITIrn Pl:..8Nl'

BOIK SlIMPI.E ANALYSIS

~D

LaJ:oratory Name: Ps \ plrrSWR6 H8u\LDH'-t6 4f..~, -~ I ID Number: * (p\ - ~-I -OC) I lab Nurnl:er: q oq roie; ~ \jJ~ ID Technique: PLOO DlS&-SJCN .5TBIN 1Ntl

Gross 5anple Descr-iption: \~=1iYU9 Materials Present: bf\::>\4z=r V'X~L~

-+PI.

*Esti.m3.ted f\Percent in sample: _-="'?>=(Y_~-,--'S _

AsCestos : # Ye;

Qrrysotile I 10-~s

Amosite I crocidolite I Anthophlyllite I Tr~~lite/ActinOlitel

Non-.;;Sbestcs FiJ:ers: y~ ;

Glass FiJ::ers

Mineral W<X)l cellulose -r;0 ~(P t>

Synthetic Fil:ers I other

Non-Fibrous Component

*Percentage is Visually Estimated Analysts Canments yuA ~

Date: /¢.aj1 J

>Ii~ <-.tR .. ; ~e.r \; c l r\ 1/

/37-'

I..al:oratory Name: Ps \ ~ 1~WRG ;_---:80= \LD' N6 -#=- ~ l-eoS-!

ID Nurnt:er: -tt: G--0\ -002..

lab Nurnt:er: 1c; (; \is ~lp

ID Technique: PLM QISpa?SJCN STAIN/Nt;

Gross sample Description: ~~1&-" )~J tril'!""'l SM"'wX'

Materials Present: ---LMJ..W..,l",-O~Q~\!\~):J.,G,,-- _

*Estimated Percent in sarnole: o 1\ k Ast:estos : tJ \) Orrysotile I Arnosite I crocidolite I Ant..~ophlyllite I Trernolite/ActinOlitej

Non- Asbes+"..os FiJ:e.rs· Y{./ Glass Fibers "6 0 -'1J5

Mineral Wool cellulose ~~~

Synthetic Fil:ers I other

Non-Fibrous CoJnt:x:lnent

*Percentage is Visually Estimated Analysts Comments

Date: r I

~/J!d

/37

I..ab:Jratory Name: PS 1 Pl1TSWR6 H 8uILD\N6 4F-Co '-~S-J ID Numter: #- Col -~) - ccg

Lab Numter: '10 q h 7 b \~?-?>]

ID Technique: PLIY\ DISS?tX-S:JDN .5TBIN rNt;

Gross 5a1I;Jle cescription: J~D9ct1Q~, (J>~ ~Wo!~,\lJ j , j., Materials Present: TA13- Ncr VJR.i\f

*Estimated. ~t in 5anple: \_~_<:>,,---- _

Astestos: YP (

Qrrysotile I \-3 (~ tJ;v~ ~l

Arrosite

Crocidolite

Anthophlyllite

'ITe."1'lOlitelActinolite

Nen-Asbestos Fibers: Ye';

Glass Fibers

Mineral Wool cellulose "n~ ~q-b

Synthetic Fibers other

Non-Fibrous Comp:ment N<A, *Percentage is Visually EstilIlated Analysts Comments

Date: /(J/)3j11

~jJ0

I.a.roratory Name: PS I £'IJT5EDR6 H .8U\LD\N6 4F- C9\-55J ID Nurnl:er: -::: ~ I - bS"1 -00 1 lab Nurnl:er: q0 q (P 7 ~ Jt3 ;r;R( ID Technique: PL 00 DISt€£..9 DN .5J1j1 N rNt;

Gross saIrple Description: ~12~, f,kfn<A ! ~/vJbh

Materials Present: CO.l\-II tJS - G. ~TO'> pf\1\JJY...

.k.

*Estirnate:i~cent in sample: _-:..\'_3-<-- _ V'

¥Asl:estos: y~.;

C1ll:ysotile I /-3 Amosite I Q:"ocidolite I Anthophlyllite I Trernolite/ActinOlite!

Non-il.sbest.os Fibers:

Glass FiJ::ers I cellulose j'~

Synthetic FiJ:::ers I other

Non-Fibrous Component . f-).

*Percentage is Visually Estimated Analysts Comments

Date:

/37

L3l:oratory Name:

ID NLImt:er:

lab Number:

ID Technique:

Gross sample Description:

Materials Present:

*Estimated Perce.'1t in sanple: ~ Y..!.,;O~-Y_J1-=-() _ !'*Asl:estos : '/e '5

Olrysotile I l.\o~)L

Amosite

Crocidolite

Ant.rlophlyllite I TrernolitejActinolite

Glass Fibers cellulose

Synthetic Fil:ers other

Non-Fibrous Component Iv . A

*Percentage is Visually Estimated.

rarora~~ e;jhl~h~S~~_-----"E=..::U \LD\N6 #:- 61-851 Lab Ntllnb=r: q()g~0 \~(lt?

ID Tec.hnique: PL IY\ DlS£E£.SJ CN SIBI N rN61 Gross ~le Description: ~Sll'~r::l ~~\1..-.1 I eASYJ'A

Materials Present: -rftrL F\z.t.r C:I0 Do oR..

*Estimated Perce.."t in sample: J-3 f' Asbestos: \/ e;

Qrrysotile ~3 _.- .

Amosite I crocidolite

Anthophlyllite

TrerrolitelActinolite

Nor..-l-s!::estos FiJ:ers: He~--

Glass Fil:ers qO~9~

Synthetic Fibers other

Non-Fibrous Comp:ment

*Percentage is Visually Estimated Analysts camne.nts

I.abJratory Name: Ps) P1USBJR6 H .8U\LD)N6 #=- ~\-~5\ 10 Number: -#: ~ \ -?:lS I - QCJ7 lab Number: qpq (,;, 7 b \£66H I ID Technique: eLM DISY€£-SJDN -STBIl\lINt1

Gross sample cescription:. _I~~! rJr~J.-" B.L.:.;)~:;';";..J:,-,-- _

Materials ~t: TMc ffiL-r Q'\J DooR:...

*Estirnated:ercent in sample: _'~'_3<-- _ ,tAsl:estos : ye '::>

Quysotile 1/3I Arnosite I crccidolite I

TremolitelActinolite I

Non-A.s:b=>...stos Fibers:

Glass Fil:ers I Mineral Wool I cellulose , '7 uJ Cj{ Synthetic FiJ::ers I other I

Non-Fibrous Component

*Percentage is Visually Estimated

/:3 7

LabJratory Ncure: fS I PITISBUR6 H .8U \LD\ N6 4t- b \-B5'1 ID Numl::er: -tt- '" \ -ehl-~()e

Lab Nurnl:er: qQq b7b 1'E";;?Yd:

ID Technique: PLIY\ DlS~()N ;STBIN INt;

Gross SCUPple Description: lir4<)!J1f,4l;4 , h~. (}~ d J J

Materials Present: J:AiL Fla-T V DOOR..

. ~. \_7 *Est.lmated Percent J.n 5arrple: / _

~ Asl:estos: y~ {- Qrrysotile 1/3I Arnosite

Q:'ocidolite

TremolitejActinolite

Non-Asbestcs F::J:ers: y

Glass FiJ::ers I Mineral Wool I cellulose I q 0"7> Synthetic Fi.J:ers I Other I

Non-Fibrous Component

*Percentage is Visually Estimated

/ 3 7 ~

I.aJ:oratory Name: _Ps I pliliWRG H .8U\LD\N6 4t=- ~ 1-~1 ID Nurol::er: *" 0'-~sj -009 lab Nurn1:er: q01 ~ 7~ l?d't } ID Technique: pLrY\ D6B3?--5,.)DN 5TBIN 1Nt1

Gross ~le Cescription: _1-hN.,b~J1\&.v:, (JiW-z. ~M\Il)\, Materials Present: !g?()E Qffi\?-I S

*Estimated Percent in sample: __ ..__-'"'-d O_-_;;J_~ _

Asl:::estos : I/e~ , Qrrysotile dO-(} '5

Arnosite crccidolite j

Anthophlyllite

TrernolitejActinolite

Non-Asbestcs FiJ:ers: yc- J Glass FD:ers _7- I U

- .3 D-3j Synthetic Fibers other

Non-Fibrous Component r-->. 11

*Percentage is Visually Fstilnate::i

I.aJ::orato:ry Name:

ID Nurnl:er:

lab Nurnl:er:

ID Tedmique: Pl D'\ \)S\?E£-SJ ON ;SIBI N rNt;

Gross sample cescription: '~0J1~1 (Yv~ Materials Present:

*Estimated Percent in .5amDle:

os:

Olrysotile I ~-~ Arnosite , crocidolite

Anthophlyllite I Tremo1ite/Actino1iteI

Non-Asbestos Fi..l:e!"s : y& -;

Glass FiJ:ers I Mineral Wool I cellulose ~/S Synthetic FiJ::ers other

Non-Fibrous Component

*Percentage is Visually Estimated .Analysts Ccmments

Date:

i

/tJ!)3!r1