ABS_GA_69-854_02_99F.pdf

RAVENNA, ARMY MoIIDNITIOO PIANl'

BuildinJ SUIIJnary Sheet

Farm A

Building ill: _b_q-,---~_C;_4 SUrvey Date: t-2CJ -o..., Building Type (Use): )W~t: 1)?d..reh19u-X

Number of People/ Percentage of Time: ob

Area:

Inspection Team (Names):

Drawi.ng' Numbers:

Year of Construction:

,,~.. ,... ' ' SUllmuy Data

Total Square Footage Building: _rm~ asaDo ft_d _

Floors: \

Basements/Crawl Spaces:

Fan/Boiler Rooms:

samples Taken:

Q.A. samples Taken:

'IYPe of CCIlsb:uct.icn:

(Cleek Applicable)

~ steel Frame __ Masonry Reinforced Concrete ~ Transite siding

+- Wood Frame

Coiments: _f1C!t\ ¥;kbn R.a&"!J C~'5,cm Ii)J As Ix~ .s W&;:rE- .> I?::ekD oJ BUlf DJ~

Portion of Building Not Inspected (square feet) :

Reason:

RAVENNA ARMY AM-1t~rn PIl\Nl' BUllDnK; SlMlARY" SHEEr

FORM B

Building #: 6q-~~Lr Sheet No. _\_ of ~ sample # 0 Drawing # Revision # ()c:nJpied Floor # Materii.\l Encapsulated Friable Corrlition Quantity

A Room # - or 1-5*

Area Type Description/ Enclosed (l-Best Amount Unit pipe

Loc::<:;.tioIl 5-Worst Dia

\ - f..

~CM( >o~srr\~ j\Cv---r00 ( ~ tslfL~\ NO ~rr- 0 ~ 1 tPII-\J\

,,;-Ae.... ~t f#t1-S ~5 1\ t( ( I I ( AcmOUl ~ dt~it,(-' L- NO 2- (V()

00') tJ '( I ( I ( r'\~ 1( L ~5 ~ 4' ~f.2 .

~+- :R'ks-~ fIre-t,1I\ Il"ar I~()rJ "II \( ACCYCOlt 2 2r:~~ t'Jrttf' ~M~I'1~I~tV No ~ Ff we.-s\-- ~~ waJ\

00S' IN (l ~"" ~~ ee~~~ \ rJ{) ) ~tJI ~e- . f\C~ ) 1\ 1,{)IA~C.,,: ~ .J...--C:,~P.t"'»{ I w~r 1<w.-~~-( 6i~

~coat; IN '\( 1( ~ ~~ D rJo c;- ~~U! ~t~ I

~A~·~' iM"'Inc.. ~_V!~LI

I~

~Sk .- vJObt ~

II 1, IV\F ACf'-A(!jfJ7 \ ( O~ 0 No ~ 6\2 ~t~~~~~.D -i2.~

~f. h\Mlt-ll6~+t '2 "/hC(<A/)~I~! . I1/ (,-C"-.-AVO<B ,fV '\ It ~(f~ 0 No abt·1Vf~ .~':oJ'1,.~ \~ -..(~ l- _'-J; , ~S~ ) ) ~\- ;1Jor1'~ I ('fff\ tI h I( ~ 0 rJC )I t\.l~lr\i' ()~ 2

CoImnents:

RAvmNA ARMY N.'K..INITICN PIANI' BUilDING SlM'ARY ~

F'<:JR1 "B

Building #: b~- ~-)4 Sheet No. LOf Z sample # 0 Drawing # Revision # OCCUpied Floor # Materii3l Encapsulated Friable condition Q,lantity

A Room # - or 1-5* Area Type Description/ Enclosed (l-Best Arrount Unit Pipe location 5-Worst Dia f:a~+ be.~A () (0 I~ lSOO,2\ ffJo ~a.u.\k:. rJ(~~ .fattb V"1 ~~

IAlA.Klc\,ct D[C)o("'C, 0 No ) -. , Wl""f n

Comments:

Building No: Floor No: _

Drawing No: _ (~5CCJ -r--=L---I.\ _ RCXlIl\ No: _~Or? 6F- bl(X;

Date: Evaluator: ~~----=-pjr;;J~9J--

OlnenL Ccn:litian of Mm

Present Absent

Evidence of deterioration of delamination from underlying surface 'F Evidence of Physical Damage ~ l"' Evidence of Water Damage y

Potential for Future D~ n:mage or Erosian of Mm

Proximity of Air Plenum or Direct Air stream X.

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

(air movements, vibration, movement Y-of l::uilding occupants)

Change in Building Use Y:

OCCUpied Unoccupied

I Current 0CCUp:mcy 1 _

~~J~~

Building No: 10 9- t'J4- Floor No: I r Drawing No: Room No: WBT g,O(trn

Date: Evaluator: 1Y)!4= 0Irrent o:n:liticn of A(HoI

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Da1rege

Evidence of Water Da1rege

Proximity of Air Plenum or

Direct Air stream

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

(air movements, vibration, movement of blilding occupants)

Olange in Building Use

OCCUpied Unoccupied

Icurrent OCCUpancy

Building No: Floor No: ,-----------'-I_~r _ Drawing No: Room No: ~~

Date:

Present Absent

Evidence of deterioration of delamination from underlying surface X Evidence of Physical Damage X Evidence of Water Damage y

Potential for FubIre Di.st::uri:E.Ix:

Damage or Erosicn of ~

Proximity of Air Plenum or

Direct Air stream X Visibility, Accessibility (to l:uilding occupants and maintenance personnel), and degree of activity X(air movements, vibration, movement of l:uilding occupants)

Olange in Building Use X

Occupied Unoccupied

IQrrrent OCCUpancy

G--)F\SiE {iJ 13~5 ~ D«w1S J I rLt<N/J£€s w/ Gttsl\£IS

N',f;?: {\~ o{ce.s ~ ~ W€&f- R""

1- ! : 47/6 I 'K (jj ___ _ _. .__ _ ---- ---~----~5i- "~r_pO-\Vj\- B~l-Jc /poS5lblo- '3,,,,!bi>p!-o-s ~'MJ, o.~ ..

____ o -tk bUv\\cl~~ pu-~~~tc-rL-------- _ ;

1 ___________~ _3__fCOll5_L+.e .boeuJ o<rowJ--- 6VCl' Idlf\~- per/~e :k<=; _

~ 1M to-l _u ~'\h OJ'-\&Qhh;. fttl\Ll s .

___ __ _~__<6! __ IOk[\6!:_5"&\h~ vJ I~ WJry-L~~' IS ~UJpe-c.+-.

j :J6T'A1- _ 5<A)~+- ULulk~~ +h p~~h c9vt-r bt.<.i J.Jil'\~ __ ,_ ..__ ._ ~ ["'ral\ ~ t-t~ otebrJS DcA~ I~ e.- 8 Ie? l.U'"Iu\- C~J 1afclCul J1)/7

;t\CM Roof Mr\s ~l1 oJDlLVI~.

6~-93~ '- 5~ as a15o~ but-;

- 3> ~c t M,uLt, C(:, 0" e;kki.J.M;~ cl Ie. r ~ .....J.e>-\- Q <9"-=-"

5/)MiL Pre ~\ ~ asJ:e+- 6/\ c:k~ U/'~d \t t'e \ ...-J

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J/S / <6~ -bu.'\ \\:A~ :s C,J(( ctp«IceJ.eJ w/ 0.. 5f rtJ...,!-:& 1'1

Mt1 5tA.5~-+- ~CVVl e/Cceprf- 2. ~~h~s J- ~1-&,;zCL.

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6 , - ~S!- s~M-t 't,S "Go V~

- ~b ~f' o~ ", n "Jl.' ~ ~"c-~ bl- g~2 ',),aMt os o#Jn -:flO Jo..r lns'lk (0-\1l£[ ~66a~ r(\)~&L

--- no Jar kl-r 6V\ Nth @ u\tJG>D> 6;--?J "3 7 /, ~~ r'\J- ?l~ C?~-/S

-= \(\() he- IV\ <:>:Q'e la~ 0 \ b~ (AS L"~£

! . ~MPh;

'4~ Vl\M vq- SS-~'S«ML CG~ C)+k~

-VL-Q +ou- \J\S~~ <2 l6-y w- bOC\r-A ~~r,S~&G

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2b &~ d- rs d\rt\.N\S ~ 5> ~ PYCY\ @",,~ ~~\j,.[' ~# f"r,,"lQ. 'lkef 4-Q' ~ fZ It] /4 (3 r< Pr l tc;- (7 R 1:11 J 4(2.

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t/Lf) &JUt""!<-d t\~ I h0Jl

~~ >AJ/ lafS,f.- (KM. Qlukf vJ!)O~ HuiJJlii{ leJ-; cf- U ~ °lS

6~-fJ)rz ~ ~~ as o~ ~ 'l LJ"~oJ--w. \0.7 131 flJJ iflf/,tr' Tzu-~ o°4 -CO\A\:J ", Su~ tA.t; Q) ~~

~ 0 ~O'/).;~ e\- (:s~~ w I ~ \~ s ~ I

RAvmNA ARff MHHrI'ICN P.IANr

A.SBES"Ia:) BOI.K SAMPLE O1AIN-oF-aJSIOOY REDJRD

:E'CR-I E

(3'7-ICf 130

/ 10 l 08 LaJ:oratory Name: f:J 1 YllTS5vk'6f-} Control Nu!nt'er:

Date samples Collected: B /20!Cj I Date Received in Lab: fo r'7 -Cff sampler's NaIOO: 1"\ IC~I'r aT. 61<" ~NaIOO: PIE Y1 U Ih" V'- t?<" " sampler's Signature: 111.NJke2-c P~ Signature:

sample Field sample I..al:oratory Identification No: bUIU)JJJ0 #=09-554- Identification No:

~9-N4- -00 I al 06~

II II -CXj2 d /ObY I' 1\ -<:03 O?Job5 If h -0)'4- ~IOb0

~OD5 OiJ067

\II V\

l.t-00(, a 1065 "f

II II -COl d!OSq \/ h -COS R /070

IIII -O:Yi :;)/0; r

\ I \\ -D)O ;}[07;2, Disposition: __X__ samples Disposed. of i vered to CWner or Agent

Receiver's Signature: Date Received: ./O;/S--ct( lo)?(~r~ of EVEf2Y 2e ~;twPL£S rl~ US! /Se Gjc ~\f.m'2NAu..Y (3,/ A- lJtt3 GTJtE.R:. TfI/tf-J pC; 1 I - ----'9 laboratory Name:

ID NIlml:er:

lab Nurnter:

ID Tec..J.mique:

Gross sample C€scription: LflY'r(.d..; /J,J,b('Jeec).,)}, r;;Io,r,.n I whl./-e..

Materials Present: G ~ N\ ~Q

*Estimated percen~ sample: ...:....~_()_-..:....c;..:....S-....:..%_v _

¥ Asbestos: yC-)

Qrrysotile L/O -'-()' ;:

Amosite crccidolite I Anthophlyllite

Tremolite/Actinolite

NO:"1-Asbestcs FiJ:ers:yc.5

Glass FiJ::ers

Mineral Wool cellulose tf< 0 0<S- ;{, Synthetic Fil:ers other

Non-Fibrous Component M'tJ

*Percentage is visually Estimated Analysts Comments

RAVENNA ~ MH:NITICN PIANI'

BlJI.K SAMPLE ANALYSIS

FORM D

La!:x:lratory Name: fS 1 plrrSWR6 H BulLD\N6 #:- b~ -~s-"\ ID NuInter: -tt 0q~S-4--0C)""2.-

Lab NuInter: '110 loB a10 6ft ID Technique: eLM DISt-£W0N STBIN tNt;

Gross 5arrple Description: -Jd.2l"m' .....9.J\ f:)!:,rvJ' PVh,±~

u) , Materials ·Present: 0f'rS~r VV\~r+L

*EstiIrated Percen~ sample: .... _ 3'-L_"_~...;;.5_r:_..

¥ Asl:estos: ., yes

O1rysotile ~\)-SS-"!.>

Amosite I crocidolite

Anthophlyllite

Trernolite/Actinolite

Glass Fi.J:ers I

Mineral Wool I cellulose I~- 7°~ Synthetic Fi.J:ers I other I

Non-Fibrous Component fI/!:J

*Percentage is Visually EstiIrated Analysts comments

I.al:oratory Narre: Ps 1 PliiSEUR6 H 8U\LD)N6 4F- t>9-~2?+-m NLIrnl::er: -f:i" (?9-B0 -003

Lab NLIrnl::er: ., (Q f7) {; ~ ( Db5 m Technique: PL 00 DISB%-SJ DN 5IBIN INt1

Gross sample Description: ijrvn "(f 0 v 4 b b r oV ~ (,.) 6I t (.

1'1'.aterials Present: __YV\..;....:....:::VD....I.=-:O:::....-.L-'-If\.)-="--b _

*Estimated Perce.~in sample: "-'IV:..:;C1....:.:w'-'"'...::....- _

*" Asbestos: tv i.) r' .!. Oa..f-c c,.t£. J Qu:ysotile

Arnosite o.-ocidolite

Tre."1'lOlitelActinolite

Non-Asbestos Fiters: yc..~

Glass Fibers ;2.0 ~y% cellulose

Synthetic Fibers

Other

Non-Fibrous CamfxJnent AI,A

*Percentage is Visually Est.ilIIated

Date: Y-~~

I.al:oratory Name:

ID Nurnl:er:

Lab Number:

ID Technique:

Gross sample lJescription: ~ 1';·f'I-I.Jd(!""~J~1 L1y C'" t:. ""

Materials Present~ fA:1< \)'V CT ~

*Estimated Perce.TJ.tln sample: _1_S-_-1.._0*Asl:estos: Yt ~

Olrysotile //5-,)..<->

Amosite crocidolite

Anthophlyllite

'ITemolite/Actinolite

Non-Asl:estcs Fil:ers: y<. S

Glass Fil:ers

Mineral Wool cellulose

Synthetic Fil:ers

JU-;S%

I j- SD~

Other I Non-Fibrous Cornfonent yV'..{1

*Percentage is Visually Estimated

I.aJ:oratory Name: e:; 1 PllliWR6 H 8UILD\N6 ~~9~S"4

ID Nurnl:er: -#: 69:es--4- -() oS"

Lab Nurnl:er: 41 cJo~ a lOG J

ID Technique: PL IY\ DJS£tX-9DN .5TIjI N INt;

Gross sample Description: !fOC-ft'1· 5c .... OJ), L-A\IUc~ ~/'tg'J,) J . S;/~ 1= J!Ltd( f J r I

Materials Present: bftL6E£.TOS USA-TING

*Estilnate:l Per~ll1 5aIrple: 5-7 'r;

i f Asbestos: ~~ S

Qrrysotile ~-7% fJeJrcA /r c.1),..I+''') fA, v(', J I crocidolite

Tre.l'l'lOlite/ Actinolite

NOl1-Asbestos FiJ:ers:ycj

Glass FiJ:::ers cellulose 1/- 3'A

Non-Fibrous Component 1\1 t.

*Percentage is Visually Estimated

Date:

RAVENNA. AIHl MM:NITICN PIANI'

BUIK SAMPLE ANALYSIS

~D lalxJra=~ ~1 i11¥~~~ BulLDIN6 "'h~~4- ID Technique: PlfY\ D6~CN 'sTAIN 1Nt1

Gross Sample Description: t/Jn,pa-u,/) Hhrov$, Whl/{ J .., ~ J

Materials Present: lJ2rlo0.:....=~...::.c=5.;...!.(\C£--'L...I:::~ _

*Estirrated perC» in sample: 3 () -3~-r:

~ Asl:estos: y L.- S

Qrrysotile .3~ - Js- °h Arrosite

Croc::idolite

Anthophlyllite

Tra~lite/Aetinolite

Non-Asbestos Fibers:y" 5

Glass Fibers cellulose /- ? Yu

Non-Fibrous Comp:mentr/..1

.Analysts Comments

Lab:JratoryName:

ID Nurnl::er:

lab Nurnl::er: CJ / 0 108 J, I 0 bq

ID Technique:

Materials Present: T&2- ffLr 00 pooR.

*Estimate:1 PercfJt in sample: ...;...10_-_1_5"_"15_; _

"* As1::estcs: VL S

Qrrysotile I lv-IS' ~

Crocidolite

TremolitejActinolite

Glass Fil:ers cellulose '2AJ .,). S-~

Synthetic Fil:ers

Other

Non-Fibrous Cornp:ment,./A

*Percentage is Visually Estimate:1

Ial::oratory Name: PS I PIIT.>BORG H_----'8U:::....;: \LD\ N6 #:- ~9- ~54- ID Number: -J;t- 69 -«)54=Q0 8 lab Number: 4 10 I Cd -31 D TD

ID Tecbnique: PLIY\ DlS~()N .5TBIN INti

Gross ~le Description: 1.10 e-·t/--'" g,/\/ r; bra III L.... 7e....-e .!)

Materials Present: T8;f? EEI:t oC\J 1X;d(

*Estimate:::l Per~ sample: /-Iu:::o---I....:::).--:....%_u _

"* Asl:estos: yes Qrrysotile I 10-/5"'/..

Arnosite crocidolite

Ant."1ophlyllite

TrernolitejActinolite

Glass FiJ::ers

Mineral Wool cellulose ~u-;ZS'7D

Synthetic FiJ:ers other

Non-Fibrous Comp::ment,..vA

*Percentage is Visually Estimate:l

Date:

RAVENNA. ~ MM:NITICN PI.ANI'

BOI.K SMon?LE ANAI1lSIS

~D

Lal:oratory Name: fS I PI1T.sBJR6 H 8U \LD\ N6 4f:.. b9-§9i ID NLnnb2r: -tt- (,5-8 53:-QPII~ _

LabNLnnb2r: 41010f) a/ell ID Technique: PLIY\ DIS£'€£-$..lDN .5TF\IN 11\Jt1

Gross sample Description: l!uilrlrffVeJS,/ LAycrul/ FlbccJJs /~c/(

Materials Present: IPrf2- 8?-Lr ON DCbJ2:

*Estimated Per~in sample: /-/..>:::°'--'->0/,)"--.1-%>:::.- _

'* Ast:estos: y(. ) Orrysotile (0- f)~

AIrosite crcx::idolite

AnthophJ.yllite

TremolitejActinolite

NO!"1-Asbesi:os Fibers:Yc. )

Glass Fibers cellulose c~O -1.'5%

Non-Fibrous Component{\!A

LabJratory Name: Ps 1 plrr5WRG H 8U\LD\N6 ~ 6l-8S-4- ID Nurnl::er: it' 6j-&>L:J -a! 0 lab Nurnl::er: q I 0 I a B ~ II' 7.:2 ID Technique: PLIY\ DlSya:..SJDN 'sJ1\IN !Ntl

Gross .5aIrple Description: /!,th "Dc.A U ~ Hyc 6'_ / 0 brtJJ\ le II Iv/w6 Ve.

Materials Present: CAuL'f.1 NI....lo.(~Il _

~ "'U/)...:f*Estimated Pereen~in 5arrple: ..:..0 _

*Ast:estos: YL S

Chrysotile /9 () -1. r-~

Crocidolite

TrernolitelActinolite

Glass FiJ:ers

Cellulose j- j'X

Non-Fibrous Component tVl.)