Bldg SD21 HAZMAT Report.pdf

RAVENNA, ARMY AMMUNITION PLANT

Building Summary Sheet

Form A

Building ID:

-H-+

Survey Date:

Building Type (Use): S£U* <2£ Office U-ffi

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:

PAUL &fe>gjv\ / H\KW(&L

(a. K

Sunmary Data

Ye?

A/O

Type of CCnstrtiction:

(Check Applicable)

Comments:

Wood Frame

Masonry

Transite Siding

Steel Frame

Reinforced Concrete

Portion of Building Not Inspected (square feet):

Reason:

R A V E N N A A R M Y M i H E H C N

P I A N T

B U H D I N G

S U M M A R Y S H E E T

F O R M B

B u i l d i n g

S h e e t N o.

of

_J_

S a i r p l e o o

OA

D r a w i n g r<if

R e v i s i o n O c c u p i e d o

F l o o r

P o o m

A r e a l b r

I f e t e r i a l

T y p e

D e s c r i p t i o n

L o c a t i o n

C&d-zi f*)

M a n y U M J L s o Z J

E n c a p s u l a t e d o r

E n c l o s e d

OO

F r i a b l e

AJy

C o n d i t i o n

B e s t

W o r s t fz3

Q u a n t i t y

A m o u n t

U h i t

L J a s

F t

P i p e

D i a

C o m m e n t s

R A V E N N A f i F m A M M U N I T I O N

E L f t N T

B U U D I N G

S L M M A R Y S H E E T

F O R M B

B u i l d i n g

S h e e t

N o z o f z

S a m p l e

D r a w i n g

E t e v i s i o n

O c c u p i e d

F l o o r

R o o m f t r e a

M a t e r i a l

T y p e

D e s c r i p t i o n

L o c a t i o n

C A f i t A

C j X a

E n c a p s u l a t e d o r

E n c l o s e d

F r i a b l e

C o n d i t i o n

B e s t

W o r s t i

Q u a n t i t y

M o u n t

L

U n i t

P i p e

D i a

C o m m e n t s

RAVENNA ARM* AMMUNITION PLANT

RISK ASSESSMENT

FORM C

Building No:

Drawing No:

Date:

Floor No:

Room No: _(>

Evaluator:

Potential fcsr rucure Discuriance

Damage or Erosion of ACBM

Low

Occupancy

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACHI ^6

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

A/

J

High

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 V

Current Occupancy

Occupied . Unoccupied

Building No:

Drawing No:

Date:

RAVENNA ARMY AMOtETICN FIANT

RISK ASSESSMENT SHKhT

FORM C

Floor No:

Room No:

Evaluator:

Is*

FACTOR FCR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM^'' f«

Present al far Tiitu^a Disturbance

Damage or Erosion of ACEM

Lew

Occupancy

Occupied

Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

V

High

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 y

X

X

Unoccupied

Current Occupancy A

RAVENNA ARMY AMOHTION PLANT

FORM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

l toe Fature Disturbance

Damage or Erosion of ACEM

Low

Oocx^ancy

Occupied

FACTOR 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

High

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

AC 4

X

RAVENNA AEWY AMMUNITION PLANT

KESK ASSESSMENT

FCEM C

Building No: ST> XV ^

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

Potential, far Future Disturbance

Damage or Erosion of ACEM

Low

Occupancy

Occupied

FACTOR 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 y

V X

High

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

Building No:

Drawing No:

Date:

RAVENNA ARMY AMMWTTrON PIANT

RISK ASSESSMENT

FORM C

Floor No:

Room No:

Evaluator:

tst

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACBM Mb

Present Absent

M

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

Potential far Future Disturber*

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

Occupied Unoccupied

RAVENNA ARMY AMOECTTON PIANT

FORM C

Building No:

Drawing No:

Date:

f Floor No:

Room N

Evaluator:

Ptftential for Future Discurba.-ica

Damage or Erosion of ACEM

Low

Occupancy

Occupied

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACBM ~^

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

High

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 y

RAVENNA ARMY AWKNTTEON PIANT

PCKM C

Building No:

Drawing No:

Date:

Floor No:

Room No:

Evaluator:

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACEM ,A/0

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage rtA-

Y

Potential fear Future

Damage or Erosion of ACEM

Low High

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

/VA-

Occupancy

Occupied Unoccupied

RAVENNA ARM* AMQJTTION PLANT

RESK ASSESSMENT

FORM C

Building No:

Drawing No:

Date:

/f*Floor No:

Room No:

Evaluator: j- u>

Potential for Future

Damage or Erosion of ACHf

Low

Occupancy

Occupied

FACTOR FOR ASSESSING POTENTIAL FIBER RELEASE

Current Condition of ACBM A* ^

Present Absent

Evidence of deterioration of delamination from underlying surface

Evidence of Physical Damage

Evidence of Water Damage

High

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

A/4 f f so

00(

37- I

KAVEHNA AIMS" AWENTTICN PIANT

BULK SAMPLE ANALYSIS

H3W D

Laboratory Name:

ID Number:

Tah Number:

ID Technique:

<*=» \ H SJ>2

~ 1 A f^^ 00 J

Gross Sample Description:.

Materials Present:

•Estimated Percent in Sample:

Asbestos:

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Synthetic Fibers

Other

Non-Fibrous Coinponent

♦Percentage is Visually Estimated

Analysts Comments

-f uj ^ m<.

Date:

EAVENNA AEM3T AHKNEHCN PIANT

SAMPLE ANALYSIS

FC3W D

Laboratory Name:

ID Number:

T^h Number:

ID Technique: flV)6

Gross Sanple Description:.

Materials Present: _; 1

•Estimated Percent in Sample:

Asbestos: i^u

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:V^<

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component /-'A

♦Percentage is Visually Estimated

Analysts Comments

RAVENNA. AIW¥ fflKSmCN PLANT

BCIIK SAMPLE ANALYSIS

K3M D

Name:

ID Number:

Lab Number:

ID Technique:

m

Gross Sample Description:

Materials Present:

♦Estimated Percent in Sample:

Asbestos: V« S

Axnosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers: \j t S

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component

♦Percentage is Visually Estimated

Analysts Comments

Date: tow

RAVENNA. ARC AWMCNTTICN PLANT

BOEK SAMPLE ANALYSIS

FCKM D

Laboratory Name:

ID Number:

Lab Number:

ID Technique:

Gross Sample Description:, ft/,a

Materials Present: ^&r

^0080

*Estimated Percent in Sample:

Asbestos:

Chrysotile

Amosite

Crocidolite

Anthophlyllite

Tremolite/Actinolite

Non-Asbestos Fibers:

Glass Fibers

Mineral Wool

Cellulose

Synthetic Fibers

Other

Non-Fibrous Component Av-A.

*Percentage is Visually Estimated

Analysts Comments

RAVENNA ARMY AMMQNTTICN PLANT

ASBESTOS BULK SAMPLE CHAINHDF-CLJ5T0DY EECCBD

FORM E

Laboratory Name : P=>

Date Samples Collected:

Sampler's Name: MlCMQ&L.

Sampler's Signature: io

Control Number:

/37-/f/3d

^ 0 917/

Date Received in Lab:

Name:

1_ Signature. a paaJ

Sample Field

Identification No: A,F Sample Laboratory

Identification No:

ODZ

-OO3

Disposition:

Receiver's

Signature:

y

"^ Samples Disposed of

Delivered to Owner or Agent

Date Received: /Ui~ //

RAVENNA ARMY AMCNTTICN PLANT

ASBESTOS BULK SAMPLE OilAIN-OF-CaSTODY RECORD

FORM E

Laboratory Name:

Date Samples Collected:

Sampler's Name: ^

ZL

Sampler's Signature:

: °1?>Ofl|jC7Control Number

Date Received in Lab: z]lO\c\'Z

Name: fY) fcWft£< JT.

Signature: ^S- ^

Sample Field -, n _^ , Identification No: bulLP)AJ6 WZ)\J-~£- 1

Sample Laboratory

Identification No:

cns\

Ml ?

Disposition:

Receiver's

Signature:

Samples Disposed of

Delivered to Owner or Agent

" 4JL Date Received:

|3V A 1^3 077^ ' lnf <~-lilU

D R A W I N G N O

U L K

S A M P L E

R E A S A M P L E D t

M A T E R I A L

S A M P L E D

B Y

Mi ch ae l t q

C A H E S i B L D G

NO.:

ft

IDRAWINGNO.:

/Jf#.jo

I

BULK

S A M P L E

NO.:

A R E A S A M P L E D

MATERIAL

TYPE

S A M P L E D B Y wn hai