Bldg 855 HAZMAT Report.pdf

RAVENNA, ARMY AJMUNTTTCN PIANT

Building Sunmary Sheet

Form A

Building ID: 6/ 0 ^ Survey Date:

Building Type (Use):

Number of People/

Percentage of Time:

Area:

Inspection Team (Names):

Drawing Numbers:

Year of Construction:

Total Square

Footage Building:

Floors:

Basements/Crawl Spaces:

Fan/Boiler Rooms:

Samples Taken:

Q.A. Samples Taken:

*S Wood Frame

Masonry

Summary Data

I nlijj

Type of Ccnstxucticn:

(Check Applicable)

Steel Frame

Reinforced Concrete

Comments:

Transite Siding

Portion of Building Not Inspected (square feet):

Reason:

RS7ENNA ARC AWOCCTICN PIANT

ASSESSMENT SHEET

form c

Building No:

Drawing No:

Date:

455" Floor No:

Roam No:

Evaluator:

EACICR FOR ASSESSING POTENTIAL FIBER KELE&SE

Current Condition of ACBH

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potential far Future Disturbance

Damage or Erosion of ACEM

Low

Proximity of Air Plenum or

Direct Air Stream

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

Change in Building Use

Occupancy

High

Occupied Tfnoccupied

BAVENNA AEM? AMfMZTICN PIAOT

ASSESSMENT SHEET

rcm c

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator: I *' I (^\

FACTCR K» ASSESSING POTENTIAL FIBER KELEASE

Current Condition of ACEM

Present Absent

Evidence of deterioration _ of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potential far Future Disrturiaance

Damage or Erosion of ACEM

Low

Proximity of Air Plenum or

Direct Air Stream

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

Change in Building Use

Occupancy

N/A

Hiah

Occupied TTnoccupied

Building No:

Drawing No:

Date:

RAVENNA ARM* MODHCN PLANT

RISK ASSESSMENT shkki-

FCSW C

Floor No:

Room No:

Evaluator:

f^Loort.

fATG

EACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potential far luture Disturbance

Damage or Erosion of ACEM

Low

Proximity of Air Plenum or

Direct Air Stream

Visibility, Accessibility (to building occupants and maintenance personnel), and degree of activity

(air movements, vibration, movement of building occupants)

Change in Building Use

X

Occupancy

Occupied Unoccupied

Current Occupancy X ly — — * - > o

: (7x

Dry i l3>Vt<f' r .

w

' ff Ki

(J)

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RAVENNA ARMY AMCNTTICN PLANT

ASBESTOS BOLK SAMPLE CHAINHDF-aJSTCOY RECORD

FORME

Laboratory Name:

Date Samples Collected:

Sampler's Name:

Ifcfl

Sampler's Signature:

Control Number:

Date Received in Lab: IP

Name: , Signature:

Sample Field

Identification No: -F

Sample Laboratory

Identification No:

Disposition: Samples Disposed of

Delivered to Owner or Agent

RAVENNA. AEWX AMOE[TICN PLANT

BULK SAMPLE ANALYSIS

FOFM D

Laboratory Name:

ID Number:

Tab Number:

ID Technique: o,s

Gross Sample Description:

Materials Present:

♦Estimated Percent in Sample:

/ i

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

4& 4 $® *&>

/'J rr '

Non-Fibrous Component

♦Percentage is Visually Estimate

Analysts Ccnnnents

Date:

la/

RAVENNA. ARMY AHMLHTTICN PIANT

EOLK SAMPLE ANALYSIS

D

Laboratory Name:

ID Number:

T>h Number:

ID Technique:

(o /

Gross Sample Description:

Materials Present:

OSS'

4LU*

♦Estimated Percent in Sample:

Asbestos: "v[ *\

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers: vl j^, Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component

♦Percentage is Visually Estimated

Analysts Comments

Date:

S2<!<o]HHll

■ "J O >