Bldg 63-837 HAZMAT Report.pdf

RAVENNA ~ ~rn PIANl'

BUIlDING SlH'.~ SHEEI'

FUR-I n

Building #: G3 - '017 Sheet No. L of _\_ sample # 0 Drawing.# Revision # OCCUpied Floor # Material Encapsulated Friable Condition Quantity

A Room # or 1-5*

Area Type Description/ Enclosed (I-Best Amount Unit Pipe

Loca.tion 5-Worst Dia

~6.st tt-CM ~r'\ De~ld(fler 2 ft,c.t--1t:)0\ ~ lS'OO' '2.\ NO No 2 (0(&J:l\sL&e.. G~d _.

002 N 11 l , 'I M~...: 2 I \) Yes ~ ~ FtZ J

~t-- le..t.r aknbr- !uJ> [..1(" \ I ~,.,.,00" rJ I ( e4ts~<L lJrof ~M. ~<t(01.~~1\~~ 2 (\)0 ~S- 2) ft (S/, i\CH

~1=S' ~+-~

004 rJ ' ( , ( ~b~io; Flr-e... l":>a.\" { No 3 w~tJ t'-l'" . ACM

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~~~fRpAS!

Wb J 11 } f ~\ka~

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1" It'JLNtsldp \Gl\: JJ;>0\ 0

No L 6<1'2- ~fz ACM

I f \\ \ , t)(\ ~~ '/r)cJJJ ~ I)OOg tJ l/ C) 000 1 !\CM.50 0l1Y_12 f)if a:bov0 +o+£l,). :_

~n ~o...>k- 00'\ ~ \ \ (I II I f 0 1- II ftc

~O\J--rt/ )) 0 DC ~O

Comments:

RAVENNA, Amorl »MJNI.TIOO PI.ANl'

Buil<linj SUIImary Sheet

Fann A

Building ill:

Building Type (Use):

Number of People/ Percentage of Time: ob

Area:

Inspection Team (NaIreS): J!Jjkf&- &-roh; fYlli1 O.e\ CmL~ Drawing Numbers: I SOO -~l

Year of Construction:

SUIImary Data

Total Square

Footage Building:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms: -b--+,--+-/~-samples Taken: ----q'-------------

Q.A. samples Taken: (j Type of CCIlst:ructicn:

(Cleek Applicable) i' Wocd Frame ~ steel Frame ~ Masonry Reinforced Concrete -=:)Z-"""7 Transite Siding

Comments: Pre f(J ~~mN gOOf (2s;?PD> l=T )

Portion of Building Not Inspected (square feet):

Reason:

Lal:oratory Name:

ID Numl::er:

lab Nu:rnter:

ID Technique:

GrosS,Sample Description: ~!~~:Wl#

Materlals Present: 6 ~n1~~~

*Estirnated perce.~in sarrple: -...:::~=--o_--=:)-='5 _

Ast:estos: '-\.<,..)

/ /sQrrysotile .~--::>I Amosite crocidolite

Anthophlyllite

Tre."IlOlitelActinolite

Non-.z"sbestcs Fibe:'s: '\{~

Glass Fil:::ers

Mineral wool cellulose 4':> -'5 D

Synthetic Fil:ers other

Non-Fibrous CornfxJnent N~

*Percentage is Visually Estimated Analysts Comments

Date:

~/~/i/- An,,11~f '. Ste\Je ~(f I;c.k

Lal:oratory Narre: fS \ plrr.sBURG H 8U \LD\ N6 *- fa :s."837 ID Numl::er: -tt- (","5 -co'?7 ~ CO L

LabNuml::er: '70 976C}... 1'33~~

ID Technique: PL !Y\ DlS~ DN 'sIBl N rNt1

Gross sample Des=iption: l-lc"""~1 (I~i G~ Materials Present: __ f\.'-l)~C;:l.-:..;.m..L0::::.-D~D"'-l..:,;1 _

*Estimated percen~ sample: _~O",-- _

KAsl:::estOS: tJewb D~£L1W

Qu:ysotile I Arnosite crcx:::idolite I

Tre.T'QOlitejActinolite

Non-Asl:::estos Fi.J:ers·. ~ lJ ItS

Glass Fi.J:ers ~-~

Mineral Wool cellulose l-~

Synthetic Fi.J:ers other

Non-Fibrous Component ~'l\

*Percentage is Visually Estimated Analysts Comments

Date: !()Oy/t;I

~-(z;p I~ (~

I..al::.oratory Name:

ID Numl:::er:

Lab Nurnl:::er:

ID Technique: eLM Q!St=€£.-S->DN ..5TBIl\l rNt;

Gross sample I:escription: ~I ~-+-IbMw~~,:-::./4J;Jv.=' _...... =

Materials Present: -rAi2- DUCT S"J ~

*EstiJnated percen~ sample: _.J-1_~_3 _

Qrrysotile /-- 3

Arrosite erocidolite

'ITemolitelActinolite

Non-Asbestos FiJ:ers: ~ ~c, Glass Fibers

I cellulose ~)--10

Synthetic Fibers other

Non-Fibrous Component jJ~

*Percentage is Visually Estimated Analysts Comments

Date:

Lal:orato:ryName:

ID Numl:er:

lab Numl:er:

ID Tedmique: PL ro DlSt€e-SJ DN .5TBIN INfl

Gross 5arrple Description: \~o,pu}SV':) (\W"< ~l V0d~

Materials Present: Corrll tJb - bA-LBfis,TOS f~

*Estilnated Per~in sample: _9....-:......-:.·1"----r'---_~_1o _

Asl:estos: '\~ Clrysotile '*-I (fi\ ~ t;u 1. ,~jkl_ 'iAh) l-61J

" Arnosite

Crocidolite

TremolitelActinolite

~rnn-Asbestos Fibers: i~ Glass Fi..l:ers

Cellulose l-'\D\, Synthetic Fi..l:ers other

Non-Fibrous Cornp:>nent ]\\~

*Percentage is Visually Estimated Analysts Comments

Date: /0,0<11'1/

~/ii!d

I..a1:xJratoryNarne:

m Numl:er:

Lab Numt:er:

m Technique: PL fY\ DISe?-SJ DN ;SIBI N INft

Gross sample Description: t~~1N~~-,--!1/-'-""'-0,1'\'-- _

Materials Present: i12Pv0sITE. ~B@) Q£.l?R \ S

*Estilnate::l PerSin sample: __4,-J_/_-~S,-b _

Olrysotile ~~--s:O

Arnosite

Crocidolite

TrenolitelActinolite

Nor.-~.sbP..s+-os FiJ:ers: '\0 Glass FiJ::ers cellulose S--/D

Synthetic Fi.l:ers other

Non-Fibrous Component r<~

*Percentage is Visually EstiJnated

Ial:oratory Name: Ps 1 Pl1T.5WR6 H Bu\LD\N6 #=-~3-~37 ID NuInter: #' "3=$3J -cof.LJ lab Number: r DC; 7C' .;l. ("6 S'J:h ID Technique: PLfYj DISt?£X-SlDN STAIN INti

GroSs sample Des=iption: ltViY'j!dtt.<"'0 &~, &') Materials Present: __Cfu=-+-,-,)-,,-LkJ~f\X;c...:::::::..t-- _

*Estimated Percent In sample: --.1Ji!-.....::'.... _5I<-..juO':-=" ltEAs1:estos: "\0

Ouysotile ,1-3I \c,-\S1J Amosite� crccidolite�

Anthophlyllite�

TrernolitejActinolite�

Ncn-.a.sbestos Fibers: '\,t~

Glass Fibers�

Mineral Wool� cellulose� 1-\0'(0 Synthetic Fibers other

Non-Fibrous Component r'\A

*Percentage is Visually Estimated Analysts Comments

Date: /q4y/9/

~lif&, Lal:oratory Name:� In Numt:er:� lab Numter:� In Technique: pL N\ DlS~eN .5TB\ N ,l\Jt1

Gross sample Description: 4ruJ~)~\~ Materials Present: YAf: ffLr o~ {Xxj« *E.stiJnated. percen~ID sample: l-~

Asl:::estcs : '\~ Qrrysotile [-3� Arnosite� crocidolite�

Anthophlyllite�

TremolitelActinolite�

NQ'1-~..sbestos Fibers: '\ (>

Glass Fibers

Mineral Wool cellulose '5 DJ5S Synthetic Fibers�

Other�

Non-Fibrous Component ~ \J\

*Percentage is Visually Fst:iJnated

I.al:oratory Name: ~l Zi:r~~~H~---=8U\LD\ N6 -'F- ~ '3 ~~ '3 7 ID Nurnl::::er:

L3b Nt.nnber: q 0 970~ !~3G\Lf ID Technique: PL rf\ DlS~DN SIBI N INt1

Gross sample Description: ~fM~/~b

Materials Present: \fftR. F8.-:T O~ P:J(J/C

*EstiIrate::l Percent in sample: /- 3

'*'Asl:estos: '\ \:)

Qu:ysotile / I~ ]

Amosite crocidolite I Anthophlyllite

Trernolite/Actinolite

Non-Asl:estos Fi.bers: '\\)

Glass Fibers

Mineral Wool cellulose $h -'0

Synthetic Fibers other

Non-Fibrous Comp:ment ~\A

*Percentage is Visually Estimated

RAVENNA ~ MHHITICN PIANl'� BOlK SMWI.E N::W.1lSIS�

:FCR1: D�

Laboratory Name: PS 1 PITISWR<5 H 8U \LD' N6 4t- b '3 -~'3 7 ID NLmll:er: -it (?~~1 -()Q~ lab Nurnl:er: qo9 CC IF 315 ID Technique: PL IY\ D6t£¥?--9DN SIBI N INt;

Gross 5aItple Description: dmtrJ/~{,~ ~ l-f.aterials Present: TA1C R2LT aN I=OG R.

*Estimate::i Perce.'1t in sample: 1/3 ifAsbe.stoS: '\-0 Qu:ysotile /-')�

Amosite� crocidolite� I Anthophlyllite�

TremolitejActinolite�

N'()n-AsCe-~os Fibers: '-\ \':::l�

Glass Fibers�

Mineral Wool� cellulose t'~ -,))-� Synthetic Fi.bers� other

Non-Fibrous Component (\\~

*Percentage is Visually Estimated Analysts o:mnents

/oai!91Date:

N' f>: (I t?.!24. otce..s S> to WeM- R "'" r==

_� 1- ! : 47b I "fjj . __ ...~5i '/@.r PIl.\V\\- Bv% \-de / PO,5100- ~",~bi!5/-ds. ~'Ai~ (A~ _ fu bUv\\cl~~_ pu\~~tc-r, :

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6)J(;)~ ~ ~~ as (j~ ~ 'l LonL.~o}W. ~er r,.f) if) IlH -w.r ~ r~ '4-co~\J ',Su~ Ov~ <:J¥Nt0� ~o uY\£'V7 & ~~ wi ~ \t)S~/

~ ')-C?J2> '7 -Building No: Floor No:

Drawing No: (::;en. ~ I Room No: fS'{1fTzR,t((C ~ 8u)~

Date: 8/ Z0 fcu Evaluator: 'M'fb, CUrrent CCntiticn of A£:B4:

Present Al:Eent

Evidence of deterioration of� delamination from underlying� surface� ~ Evidence of Physical Dama.ge K Evidence of Water Dama.ge V

Potentia1 far Future oi.stu:rl:mDe

Il3mage ar Erosicn of A£:B4:

Proximity of Air Plern.nn or Direct Air stream X Visibility, Accessibility (to� Wilding occupants am maintenance� personnel), am degree of activity� (air movements, vibration, movement of Wilding occupants) ;X O1an3'e in Building Use '{

OCCUpied Unoccupied

I=ent~ I X T~~~~

( S\ Building No: G3~ 93J Floor No:

Drawinj No: ,150t .7-1 tDu!Room No: ~ ~) Zd )~) rvrre;yDate: Evaluator:

On:rent CCn:titicn of A(D{

Present ~t

Evidence of deterioration of� delamination from urxierlyinj� surface� 'xl Evidence of Physical Damage A Evidence of Water Damage XJ

IUt:enti.al. for Future n:isturl:mre� Dmnage or Erosicn of A(D{�

Proximity of Air Plenum or� Direct Air stream ~

Visibility, Accessibility (to� l::uilding occupants and maintenance� persormel) , and degree of activity� (air movements, vibration, movement ~ of l::uilding occupants)�

Cllange in Building Use ~

OCCUpied Unoccupied

ICUrrent OCCUpancy

Building No: (o"?'~~37 Floor No: ( ) J

Drawing No: ~5()O ,(LI Room No: tti1sj rzOO (Y\.;

Date: Evaluator:nJ26I~) M1I}1 I

On:rent Onlitian of AL:D4:

Present Al:6ent

Evidence of deterioration of� delamination from underlying� surface�

Evidence of Physical Damage

Evidence of Water Damage

Potent.:i..al. for Future Di.stu:rl:Jan:E remage or Erasion of AL:D4:

Proximity of Air Plenum or V� 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

OCCUpied Unoccupied

ICUrrent OCCUpancy I

DATE: tl&!J TIME:

BLDG NO.: "- '

DRAWING NO.:

I' BULK SAMPLE NO.:

.1iI.............~~MR::E~~A~~L;~~

SAMPLED BY: -=:H,&(l' GN)H

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