ABS_GA_69-853_02_99F.pdf

RAVENNA, Amff »tIDNITIOO PIANr

Buil<lin;J SUIIInaIy Sleet

Farm A

Building ill: ~CA.. - 2><):) SUrvey Date: q-2D--- q \

S~ k>O.l'eJ~~Building Type (Use): ---.J::O~'()r:+ Number of People/ Percentage of Time: _------==--= _

Area: Cb Inspection Team (Names): MlkL ~!, Drawing Numbers: ls-GO.'L\

Year of Construction:

SUIIInaIy Data

Total Square _.. Footage Building: .;. JAdJ\Wt----l,..£a~50/.=...lo<ldW~__

Floors: 1 , Basements/Crawl Spaces: _.,,_..._, ~~-- Fan/Boiler Rooms:

samples Taken:

~ Q.A. samples Taken:

Type of ODstructiCl1:

(01eck Applicable)

~ Wcx:xi Frame -L. steel Frame Masonry Reinforced Concrete

Vi'"Transite Siding

Comments: -Aem CDfY)fb? rnO{\) gco-=--F_(2_5-+-J_Zro_F_T'2_)_

Portion of Building Not Inspected (square feet):

Reason:

--Building No: b ~ -~51

Drawing No: {~.C[

Date: ~t91

Evidence of deterioration of delamination fram underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Floor No:

Room No:

Evaluator:

Present

X

~f~ of fJ-Ob ____61~

Absent

X ~. far :Fl..Tt·~e ::J::..s-tur".u:i.'1Ce

D:mIage or Er"Osial of A£:D4:

Proximity of Air Plenum or Direct Air stream

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

Olange in Building Use X I

OCCUpied Unoccupied

IS}0~~85~Building No: Floor No:

Drawing No: I:;CO.-z.,1 Room No: v...,ESr \<.~

Date: 8/zo01-\ Evaluator: \f'(\J<;

Olrrent Ccn:ti.ticn of Mm

Present Ahsent

Evidence of deterioration of delamination from underlying surface >1 Evidence of Physical Damage X Evidence of Water Damage X

I \

~...i<J.l far £lI.-ture O.i.:>uL:i::aac.e Damage or Erosicn of Mm

Proximity of Air Plem.nn or

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

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

Change in Building Use \-(, OCCUpied Unoccupied

ICurrent OCCUpancy

Building No: G9-g,53 Floor No:

Drawing No: ~CD.c ( Room No:

Date: Evaluator:h~~

On:rent CCntitial of ADM

Present

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Po~~ f~ Lutc:re DL-t:urmr~~

DanBge or &osial of ADM

Proximity of Air Plenum or Direct Air stream K visibility, Accessibility (to tcilding occupants and maintenance personnel), and degree of activity (air movements, vibration, movement of tcilding occupants)

O1ange in Building Use y

OCCUpied

10000ent OCCUpancy l'Jr rttt>CPdcUo Wg

Absent y /,. ~ ·x

X

Unoccupied

N' C?: I't.efd{ o{ce.s ~ 10 WeDt-- R""

1-~ : 476/~(jj -- ~5i \Ie-I"" p~\v)1- 60> l-dc >po55(b~ -- CjC\~b<?Sfo-s-_-~~_A;d~ a~

_ _-tk_ 8Uv\\ cl~~. pu\~~ -t-e-r, _ _ ___ _~._B ~_f(]V).5_l+e __ boeu-J__ ex_(C)u;xj

:lM t6-1K ~'th ~\&Q6h;, _~ _£~10J~n65: 5~'& \I\~ vJ I~ Cf)Jet L"~ .IS ~~pe-d--.

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RAVENNA ARfi MotUnTICN P.U\Nl' ASBES'Ia) BUlK SlIMPLE rnAm-GF-aJSIOOY REroRD

R:lRM E

137- ICf /30

Laboratory Name: .~ I PI1TSEvr;!gf-t Control Number: q I 0 107

Date samples Collecte:l: 8)

)U) , Date Received in lab: /0 - 7 -1/ sampler's Name: yY\ IC~II aT. <Sf<. 0 ~ Name: Pe t4 Ie L ---rho p1 (J So h sampler's signature: 11tv~92:c~signature: J!Q::::;~~~e~~:£l:::.:fe;~-sample Field Identification No: bUIU) 1)1)6 -#= G9-953 sample laboratory Identification No:

~/1-g~3-00 I I g 10 5 11

1\ II

~OO? d /055

II

l( -003 df05ro l\ ,1\ - Co 4 Q/o57

I( 1\

-005 ;;/058 1\

~\ -COb dr/ 0 5?

~\ II -OOr C;; I 000

II\' -ro~ c9.!Ob( (l II -exA a/0 bCA

Disposition: __X__ samples Disposed of

Receiver's signature:

of

(3,/

RAVElffiA ARMY NH"MITICN I'IANl'

BUilDING SlM~'\RY SHEEr

F'QRJI II

Building #: h0,-1;c; -S Sheet No. t Of~-- ~ sample # 0 Drawing # Revision # OCCUpied Floor # Material Encapsulated Friable Condition Quantity A Room # or 1-5*

Area Type Descri.ptionj Enclosed (l-Best Amount Unit Pipe Loc<-:.tion 5-Worst Dia

~ f\{M 0tV y\cH~ w tsW·}.\ ~"\J.S\li 1. No 2 N[00\ rJO lI:rv>t~~ ~}t.e(

1 I 1 I

1, 001.- N 1( ~ Y£5 3 ) \='tL

L.II'>.~~J>t- ~r-l"e.tr {r; I(

(gO~ tJ \ I ', 11 lJroR ~

~\ '''!xt't'l''\" ~ rJO $ 1C; ~~ A(M

OOLt iN \j 1/

Wetc.t f")~

,n':.\..to~.\L'I

~\b~ pW1L'

~~-L~o....~

5o~~~e...

I No ) ~yj ~4;}' fCM fj:J;

(j)b

N w

II

( I

I~~t- r~Ml-e ~C1I111 S~<\ e..

~s be~~U\~Qrfl,k.·)..e ..>r-- c-i ( e \-0"'\.

lJas+ ~

~ 0Wv\k. Rt- $~h.~ fo.6t-N~

~,k ~t\t\ O$(7l

C9 f)

No No

·2?ffi :~t'L fV~ (j

Ac c

007 N '/ I I tJ~~ Tltl.l ~ h Wkl.A ').0

W~~t" ~

\)000, 0 No Z b12 Ft~l c

OCfD ~

I , f I w~-\-"

I )/ v\\ ~c\\.t. N~Y

~~ 0 rJo 2 ',nc/~ ~p Ih, I aboi!f 1ota)_ p.c "'\

80C\ N \ ) I ) l.-)1;5-r fl:~\~e.- 1J

~~+NO~'

C>(80\ 0 No 1-, l-1 I , ACM

Comments:

RAVENNA. Al*{ MM:NITICN PIAN!'

BOIK ~ ~SIS ~cT ~ I~i- '~I.J6

I..ai:oratory Name: Ps I PIITSWR6 H_....,....;Bu~ILD\ N6 ~ Co 9-«)53 In NLnnl:er: * b9-8S3-6D!

lab NLnnl:er: qto /07 aI o5<-f In Technique: eLM DlS~()N f,TAIN INti

Gross sample cescription:. Lwt4<VlVnV? td~'~ l~l~~-{1

~ j \ I

Materials Presen\.L.? GI\S'f(E., MITT13c.H\L

*Esti.nated percen~in sanple: _Lf...;..;)"-.-_S_8 _

Olrysotile u5 -';0

Arnosit.e

Crocidolit.e

Anthophlyllite

Tre.rnolit.eIActinolite

Non-P_s~..stos Fibers: "\ \::)

Glass Fibers

Mineral Wool cellulose 50-:;$

Synthetic Fibers other

Non-Fibrous Component }J\A

*Percentage is Visually Estimated

Analysts Comments Qv- '

~te:

Lal:oratory Name: Ps 1 PITT512URb H 8U\LD)N6; #:- 0~-~53 ID Numt:er: #: ~:d - Bs3 -OY"2.

lab Number: q I OJ b7 ,;( /0 5 ~

ID Technique: f'L IY\ OlS~ ON -STAIN (Nt;

Gross sample cescription: ~MJQ{rr,Qtn-? !..I~LJJ-. CAL ~ )1' )T1~-------

Materials Present: 'M_V-:.;D:-;D............,If\~)L.J.,,6~ -=U:...- _

*Estimate:::1 Percen~ sample: --'0"---- _

JfAsl:estos: ~ 0 ~

Chrysotile

Amosite crocidolite

Anthophlyllite

TremolitejActinolite

Non-Asbestos Fibers: ,\'J

Glass FiJ:ers L60-1s"J Mineral Wool

./cellulose ~'J

Synthetic FiJ:ers

Non-Fibrous Component N\f\

*Percentage is Visually Estimated Analysts Comments

Date: /005/1 j

~/rletlc/

I.atoratory Name: fS 1 plrr.sWR6 H 8U\LD)N6 ID Numt:er: *' 169-953-003 lab Numt:er: q 10/01 a / D5(.'

ID Technique: eLM DlS~()N -STAIN 1Nt1

Gross sample Description: kf></\ i-.J;/JI"" s1e-" I ).rt;f])v'''

Materials Present: -rA--(L \)vc-, V-..Rl\?

*Estimated perlin 5arrple: _-'-\/--'=3:

~ b q-~53 iAsl:estos : ~()

Ollysotile

Arnosite

I l- l::> crocidolite

Anthophlyllite

TrernolitejActinolite

Non-Asl::estos Fibers: "'\V

Glass Fibers

Mineral wool cellulose ~o~i..DS

Synthetic Fibers other

Non-Fibrous Component ~\~

*Percentage is Visually Estimated.

Analysts Comments

Date:

Latoratory Name: fS \ P\lT~EOR6 H 9.JILD\N6 #:- 09-85'3, ID Number: -it" (d) - frS3 ~ 6~

Lab Nurnl::er: ~ tD to/ 0< 1657 ID Technique: PLIY\ DlS~DN .5TBIN (Nti

Gross sample Description: ~yJ\ {IMt..- i ~t1;u/' / ~nff' J6,W

Materials Pr~ GAi BI?.-c...n)s, CO A-ll 1'JG, *Estirl'ated Percent in sample: -,3,,-·~)_· _ iAsl:estOS: '\~ Qrrysotile j'J

Arnosite

Crocidolite

Tremo1itejActinolite

Non-Asbestos Fibers: '-\-0 cellulose l'~/~

Non-Fibrous COnq::onent J\\\4

*Percentage is Visually Estimated

I.aJ:oratory Name: PSI PIU.sEDR6 H8U\LD' N6 #=- b9- ~ S-s ID Nurn1:er: -t:t- G:, " - 9 53 -005

Lab Nurn1:er: 1/ 0 I 07 ~ J 0 SOb ID Technique: PL ill DIS£€?£..l eN 'sIBI f\l rNt;

Gross sample Description: h/l1i1{lrt4nv:; Iffitk~J (}1d:;

Z; 'I Jfjf

Materials Present: -rrutt\)S I DE.. Dill~ S

*Estimatec1 percen~ sample: __~_tj'--,i_:s_J _

-+-Ast:estos : "\~ Cllrysotile f{r'l)~I erocidolite

TremolitelActinolite

Non-Asbestos Fibers:

'\0 Glass Fil:ers

Mineral wcol cellulose 'fJ)

Synthetic Fil:ers

Non-Fibrous ComJ;xJnent N'f\

*Percentage is Visually Estimated.

RAVENNA AmY NM:NITICN PI.Nll'

BUIK SAMPI.E ANALYSIS

~D

IabJratory Name: Ps I plrrSEUR6 H 8U\LD\N6 #=- CDC) -~S3

ID Nurnl:er: it (Q't - ?J53 :COCo lab Nurnl:er: q 101 01 ~ I t7 51

ID Technique: PL IY\ DlS££e-SJ DN .sTAIN /Nf1

Gross ~le Description: ~D~ !j[)~~ . tddJOMv'!' F9'i r '

Materials Present: _---"C....LA-1~)..\".(4>'$:.-..L1..t..;N=G _

*Estilnated percen~ sample: _--:..~D_-\...-:'S'___ _

%Asl::estos : "\Q

Qrrysotile ID -\$ erocida1ite

TrernolitejActinolite

Ncr.-l>.shestos Fi.l:e.rs: ...\~ ".

Glass FiJ::ers cellulose ?:>--s Synthetic FiJ::ers other

Non-Fibrous Comp:ment j\J~

*Percentage is Visually FstiJnated .Analysts cemnents

I.al:oratory Name: Ps 1 PlJISBJR6 H 8UILD\N6 #=- Co'1-~5S ID Numl:::er: * ('29 - <053 =Qol lab Numl:::er: q I 0107 CJ )0100

ID Tedmique: eLM DISBSe-$JDN STBIl\lINt1

Gross sample Description: ~n~), +~Js:...v_\}t!v_;;--\-'._l",-[l=m;.:..JY\ _

Materials Present: T7Tt2.. F£LT ON DooR.

*EstiIrated percen~ 5a1rple: _-'-\/-=3:....- ~ _ f'Asl::estos: \\~)

Qrrysotile \/~

Amosite crcx:::idolite

Anthophlyllite

Trem:Jlite/Actinolite

Glass FiJ:::ers cellulose ~/f'J

Synthetic FiJ:::ers

Non-Fibrous Component r'ft

*Percentage is Visually Estimated

Ial:ora:~~ ~lc,§;~~~ H 9JILD)N6 -'F-~'7-~55 IabNumber: qlO/o7 d-lnfoJ

ID Tedmique: PLIY\ DtS~SJDN .5TBIN {Nt=;

Gross sanple Cescription: ~'('(1M fQrJJ.,'":2 r ~~lA\'A In\~

6 IT J

Materials Presen~ TAiZ.. EFlT~ GN MOR

*EstiIrated Percentin sample: _\'---'_-) _ l::estos:

,\" B

Chrysotile \~ ') ercx::::idolite

TrernolitejActinolite

Ncn-Asbe.....C+..os Fibers: ~$ ES

~~/ID

Synthetic Fibers other

Non-Fibrous Component J'i~

*Percentage is Visually Estimated Analysts camnents

I.aJ:oratory Name: j?S I PITISWR6 H &JILD\N6 4f-G:>9-8S3 ID Numl:er: -J:t kJq - 1:53 -cc:>1 lab Number: q I 0 I 01 a J Db ~

ID Technique: PLIY\ DlS£82--SjDN .6TBIl\lINt;

Gross 5aIl1ple I;escription: J\fu'\M')QQ,:~,) Ilr\AWJ ~)\,.rl,\5Y\ u \ \

Materials Present: 1?rf2- HclT eN \)(J()(?

*Estimate:i Percent in sample: _\-_~.::..- _

¥ Asbestos: '\-0

Orrysotile '/ ') ercx::::idolite

TremolitejActinolite

Non-~sbestos Fib=>..rs: '\0

Glass Fil::ers t.lxTO

Non-Fibrous Component

*Perce.ntage is visually Estimated Analysts camnents

Date: ID/25;/'1 j

,lvitiJ

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h.,~ll;~Ii\\ t ,PI:

.;~?! PLED By