ABS_GA_63-838_02_99F.pdf

RAVENNA, AR-tY M+iUNITION PIAN!'

Build.inJ SUIIJnary Sheet

Farm A

Building ID:

Building Type (Use):

Number of People/ Percentage of Time:

Area:

Inspection Team (Names): l!hie [~

Drawing Numbers: l$l)() ,-:A \

Year of Construction:

SUIImary Data

Total Square Footdge B'JiJ..cii."1g:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms:

-1-1-samples Taken: --,....0"-----

Q.A. samples Taken:

Type of O:nstructicn:

(Check Applicable)

~ Steel Frame+ Wood Frame Masonry Reinforced Concrete

~ Transite Siding

Comments:

Portion of Building Not Inspected (square feet):

Reason:

RAVENNA l\.mf{ ~lNITIrn PIANI'

BUllDIN:; S(Mt[!\RY ~

Building #:

8arrple # 0 A

D()( ~

CfJ2 ,J

C07 tJ

804 tS

FURM 13

Sheet No.

b)- g)~ --l-- of .+

Drawing # Revision # OCCupied Floor # Material Room # Area Type Description/

LcK::ation

~ Ir IL .1 tA.I~5l&e&-rJO (sCo, ~..l ~ /sovr1fO«K-fOJV.l\1l\1~~~

I( I( it

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e.9-~~

\frM;~ No~+I( II ~~ 11 ~1f\f..JJ,.pbr't<...

QeQ~ W1\ LI I ( ~~~\'t, ) I

Encapsulated Friable Corxlition Quantity or 1-5*

Enclosed (l-Best AIrount Unit Pipe 5-Worst Dia

~ rJ\'rVo 3 1$86'-) ~~I

() No 5 N& fJ f\CH

PI! I ~

~ No S ~~i. he- ' /o/l f\CG'1

(' dSd{) , ACMI , '"0 rJO 1 \". , f\:i'2 .

Comments:

Buildll1g No: bS-~3>3 Floor No:

Drawing No: (500,u{ Room No: ~)(TB2/o:L 0<: ~

Date: ~lzo(j , J Evaluator: ('iJ]§ l an:rent carliticn of A(];ft

Present Absent

Evidence of deterioration of delamination from underlying surface X Evidence of Physical Dama.ge \('

/ " X·Evidence of Water Dama.ge

:Pot:8.;-;r:: Zar Future D~

IElIlage or Erosicn of A(];ft

Proximity of Air Plenum or

Direct Air stream X Visibility, Accessibility (to b.rilding occupants and maintenance personnel), and degree of activity

(air movements, vibration, movement X of b.rildll1g occupants)

Olange in Building Use '><

OCCUpied Unoccupied

Icurrent OCCUpancy

, ST'

Building No: Floor No: __+. _

Drawing No: /500,'-\ Room No: _ ("J-d-:~~ Date: 8/zo/~ I Evaluator: --~00~~~~=T\-------arrrent a:n:liticn of AC:BI

Present Absent

Evidence of deterioration of delamination fram underlying surface )<J Evidence of Physical Darrage ~ Evidence of Water Darrage Xl

"V

Potential for Future Db~tar.ce

Darrage or Erosicn of AC:BI

Proximity of Air Plenum or y Direct Air stream

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

O1ange in Building Use 'K

10000ent Occupancy

RAVENNA AlMl »H:tITI'ICN PI.Mll'

ASBES'IOS BUIK st\MPIE QiAlli-{)F-aJS'IOOY REDJRD

~E laboratory Name: Fs \ Yll/"SEvQ c::dj Control Number:

Date samples Collected: 8 )2.0 Iq I Date Received in lab:

sampler's Name: MICHJTU T. br<O~ Name:

sampler I s signature: f!1A.,S?n. e2 -C~Signature:

sample Field sample Laboratory Identification No: bUILJ)iAJ6 *Co3-B38 Identification No:

~ S-B3 f)- 00 \ /8-39 ~~

~ S- 838 - OD1- -.:1'--'-8<:......:o=:-c..L-L7-'-- _

~3-~3&_OD3 18,3r6

__X samples Disposed. ofDiSJ?OSition: __ ____ Delivered to OWner or Agent

Receiver's /) . /1 fl Signature: pt.0Jln~~ Date Received:

;.. Q/~ (u-,<.3-'11

I of 8JEf2Y 2e ~/f1IvPL£S (11 usT I,SE c)c ~Y..TEi-2NAu:J (3'1 iT L-A;B 677 to::. ' ./'rIv pC; / .;~I

Lal::oratory Name:

ID Nurn1::er :

Lab Nurn1::er:

ID Technique:

Materials Present: GAU?~lOS \>f11\..€L COA-TlN6 *EstiJnated~cent in-=samp:..;...;..:...:.;..l....::.e~:--=:==--'---'::::=<~/=-";~~4-- _ iAsl::estos: rye s

Chrysotile t .~

<I DVI ) ..... r~e

Arnosite

Crccidolite I Ant.~ophlyllite

Tremolite/Actinolitel

Non-Asl:est--'"'S Fil:ers: yCoS

Glass Fil:ers

Mineral Wool cellulose 3-5-({

Syn~~etic Fibers other

Non-Fibrous Cornponent"v A

*Percentage is Visually Estilnated Analysts Ccmnents

Latoratory Name:

ID Number:

Lab Number:

ID Technique: PL IY\ DlS£€£.-S--l DN SIBI N {Nt;

{.AYl",;L

Gross 8aIrple Descripticn: IIr:M>}:-'C~iJJ<"'Aflbra!;; &v 1" f c v I I

Materials Present: _-=C;..:..W...>.:::<-Lb.=......;;,:..\N.~6.:L-..- _ ~o- )S- 6<*Estimated Perce.'1t in sample: t:6. r;r... I"

¥Asl:::estos: y(} Orrysotile /20 ..2 ~ '-Iv I.r- /1t.J-tL. Lh.. 'Ie-- S

Amosite

I crcx::idolite I .~thophlyllite I

TremolitelActinoliteI

Non-Asl:::e.stos Fibers: yL- 5

Glass Fibers

Mineral Wc:ol cellulose 1~1X

Synthetic Fibers

Non-Fibrous Component tV~

*Percentage is Visually Estimated Analysts Comments

LaJ:oratory Name: PS \ p\TJ5BUR6 H 8U\LD\N6 *- ~3-~~B ID Numl:er: *' ~ ~~~-O~~lab Numl:er: :I.e' O.3~J ".$.. .

ID Technique: eLrYC~S~~ g1i\IN INti

Gross SCUrple Description: ;4 m(lj' ,.,0.) ~ fj--. rEo'" '> lei 4l +- <...

Materials Present: TfU\-Ns tIES t D\ N is

*Estirrated Percent in sample: _.3_5_--_'1;....0_% _

"*' Astestos: ye.. j Qrrysotile /3S-YO% Arnosite crocidolite

Anthophlyllite

Tre.'TIOlite/ Actinolite

Glass Ffrers cellulose l~P~

Synthetic FiJ:ers

Non-Fibrous Component N A

*Percentage is Visually Fstimated Analysts Comments

Date: f2.e ~ /CF 21-7 1

Laboratory Name:

ID Numter:

Lab Numl::er:

ID Technique:

Gross sample Cescripticn: !j~",",,~c'VJJ5!/{,Vc~~~1;;;6 r {It-{.c/( 7 j

6VS

Materials Present: (.2...C() ~ vEiSRl S

*Estimated Percent in sanple: _/,;",-s-_-u_~_. _

{. Astestos: 'I( )

Qrrysotile /IS"'!- 0 /.'

Arrosite I ercx::idolite I lmthophlyllite I TremolitelActinolite'

}l'nn-Asrest:os pi b=rs: y -< S

Glass Fibers /)"')' % cellulose ju' 3.5-'}{

Synthetic Fibers other

Non-Fibrous Cornponent.tV1)

*Percentage is Visually Estimated Analysts camnents j

Building No: ~ ?>--83~ Floor No: )sf"

Drawing No: )500 I Z I Room No: 'fJbr~ ilw15J ~Date: Evaluator:

On::rent CCnlitian of AaM

Present Atsent

Evidence of deterioration of delamination from underlying )(surface

Evidence of Physical Damage '< Evidence of Water Damage 'v

:Fc"-~...ial far FubIre ni.stuJ:t::llli:ce DaIIage or Er:usian of AaM

Prox.i..mi.ty of Air Plenum or

Direct Air stream Visibility, Accessibility (to

Wilding occupants and naintenance personnel), and degree of activity y(air movements, vibration, movement of hlilding occupants)

Olange in Building Use )0, ICUrrent OCCUpancy

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