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DEMO-000464-2017 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 ww Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: DEMO-000464-2017 Date Issued: Monday, June 4, 2018 This is to certify that work requested to be done as shown by Permit Number DEMO-000464-2017 has been completed. Tax Map Number: 308.18-1-63 Location: 28 NORTH CHURCH LN Owner: John Mossing Applicant: Tech East Fire and Water Restoration This structure may be occupied as a: Demo of interior of house only, due to fire (asbestos report received). Additional asbestos report is required for fire By Order of Town Board damaged garage prior to permit being closed out. TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the 4t property owner of the responsibility for compliance with Site Plan, Y Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: DEMO-000464-2017 Tax Map No: 308.18-1-63 Permission is hereby granted to: Tech East Fire and Water Restoration For property located at: 28 CHURCH LN In the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Tyne of Construction Owner Name: John Mussing Demolition-Residential $0.00 Owner Address: 28 CHURCH LN Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Tech East Fire and Water Restoration 28 Emerick LN Albany,NY 12211 Plans&Specifications Demo of interior of house only,due to fire (asbestos report received).Additional asbestos report is required for fire damaged garage prior to permit being closed out. $30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 2,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the /expiration date. Dated at the To Quee ury; O // W y,August 2,2017 SIGNED BY: N� �•V! for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only DEMOLITION APPLICATION Permit#: LETwIQ 1 Permit Fee:$ 30 Town o(Qoeens ury Invoice:#: 2.0 Pb 742 Bay Road, Queensbury, NY 12804 P:518-761-8256 www.oueensbury.net Demolition Location:o�9W 1_m/ 64/4 Tax Map ID#: ��066 **ASBESTOS REPORT IS REQUIRED FOR STRUCTURES BUILT PRIOR TO 1974** CONTACT INFORMATION: AUG 0 1 2011 • Applicant: Name(s): �/ 57' f>'C Mailing Address, C/S/Z: ;2 9-- & Cell Phone: 0/8i' ) 5?VV 7�f9)_ Land Line: Email: 49 TFire a-Alel eah7 • Primary Owner(s): Name(s): ( Ohn Mailing Address, C/S/Z: a f( 1.-Mi Cl -c-/ 6%- av�s e Cell Phone: _( ;V8- 37VO Land Line: _( ) Email: • Contractor: / :Business Name: /G S71 Contact Name(s): /Mlle f/wai7`i>` Mailing Address, C/S/Z: 2�?- 4!p/e,,%ce /iv /j fww le7 Zw/ Cell Phone:_( S/� ) 9//y 70,2 Land Li e: _( S/oc ) Al2 3 o6 L Email: Contact Person for Buildin & Code Compliance:///� ii 1_9_xkf Cell Phone: _G5/J ) &!Z-7L�"fa Land Line: _(s/,rr- Email: /lJ/f'ivusfv � 7elirrCrioi-Uirn Demolition Application Revised June 2017 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? Az '—F- 2. Type of structure to be demolished: a. Residence�,�11leno1- b. Garage 0 c. Business_ d. Storage Building_ 3. What type of utilities are connected to the structure: a. Gas P or-,,-- b. Fuel Oil_ c. Propane_ d. Electric,l e. Public Water f. Well-Water Pump g. Public Sewer_ h. Other i. None_ 4. Have ALL utilities been disconnected? Yes Na� ADDITIONAL INFORMATION: 1. Two inspections may be required: an inspection to determine that utilities are disconnected, if necessary, and a final inspection, after the structure is removed and the site is cleaned up and graded. 2. Twenty-four(24) hour notification is required for inspections. Declaration: I acknowledge that no structure(s) will be removed from the parcel until the demolition application has been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a permit has been issued. I have read and agree to the above: PRINT NAME:/4ZX�� SIGNATU • DATE: d� Demolition Application Revised June 2017 SPECTRVM Stlinneerad�:A`9!?.90r (518).746-6374(Phone) Environmental Rssociates. Inc. (5l8)34fl-W*2(fax) 'CAC IMAM One C11L*FV t'xP[nld]10.%1 nr Cd1e21WL' www4spedruma-vin 308.18-1-63 DEMO-000464-2017 Mossing, John 28 N. Church Ln. Demo (due to fire) asbestos report recvd ASBESTOS RENOVATION SURVEY/INSPECTION r)r� r FOR lY AUG 0 1 2017 I STRUCTURE 28 N CHURCH STREET QUEENSBURY, NY 12804 SPECTRUM PROJECT NO.: 17-371 JULY 279 2017 PREPARED FOR: TECHEAST FIRE & WATER RESTORATION INC. 28 EMERICK LANE LOUDONVILLE,, NY 12211 Environmentat ansalting&Managementservices • Health&Safety Training • laboratory Services TABLE OF CONTENTS SECTION I - INTRODUCTION SECTION H -LIMITATIONS SECTION III -ASBESTOS SAMPLING SUMMARY ATTACHMENTS -TABLE 1-ASBESTOS SAMPLING RESULTS -TABLE 2-ASBESTOS FINDINGS -PHOTO ALBUM -LOCATION MAPS -LABORATORY REPORTS -LICENSING AND CERTIFICATION SECTIONI-INTRODUCTION On July 20, 2017, Spectrum Environmental Associates, Inc. (Spectrum) conducted a survey for the presence of asbestos containing materials at the structure located at 28 N Church St in Queensbury,NY. Mr. Chris Patti and Mr.Michael DeRuyter(Asbestos Inspector#04-06597 and 17-27607 respectively)conducted this inspection following procedures and guidelines commonly used and accepted by federal and state regulations. The objective of the survey was to identify the presence and approximate locations and quantities of suspect and/or confirmed asbestos containing materials. An initial walkthrough of the designated areas was conducted by an experienced asbestos inspector to observe and record materials used in the construction of the building. The inspector proceeded by assessing floors, walls, ceilings, surfacing materials, thermal systems insulation, roofing materials and other miscellaneous materials with the potential to contain asbestos. From observations, the inspector prepared a listing of building materials that are suspected to contain asbestos. The inspector selected these materials for inclusion in the inspection through professional experience and an understanding of the historical uses of asbestos. Generally speaking,if a building material within a structure could contain asbestos,the material was included in the inspection. Materials included in the survey were identified and recorded with respect to grouped homogeneous sampling areas. Representative bulk material samples were collected from locations within each homogeneous sampling area. Sampling information was recorded on chain of custody forms for documentation. Samples were individually preserved within a container and transported to anindependent laboratory for asbestos analysis. Laboratory analysis of asbestos samples via polarized light microscopy(PLM)and/or transmission electron microscopy(TEM)was conducted by AmeriSci of New York,New York(FLAP# 11480, NVLAP#200546-0). Sample analysis was conducted as follows: • "Friable"Asbestos Samples—PLM • "Non-Friable"Organically Bound(NOB)Asbestos Samples—PLM and, if negative,TEM for confirmation as required under NYSDOH-ELAP regulations. SECTIONII-LIMITATIONS The information provided in this report was compiled from field and laboratory data obtained during the site visit. Observations noted and recorded are intended to represent the conditions that existed at the subject site at the time and date that the observations were made. Spectrum has not conducted its own analytical, but has utilized an independent NYS-DOH ELAP approved laboratory to provide the analytical results contained in this report. All discussions, findings, and conclusions are based on information that Spectrum received and understood to be factual. Determinations of suspect asbestos containing materials within the building were subject to the accessibility of individual areas or spaces. Spectrum accepts no responsibility for the content of the building materials within areas or spaces that were unknown to us or not reasonably accessible. Spectrum assumes no liability for any buildings that were not identified by the client that may fall under state or federal regulations. All quantities of ACM provided in this report are provided as required by law and are believed to be accurate. If this report is to be used for bidding purposes, field verification of quantities is recommended by the abatement contractor prior to bidding. Conclusions and recommendations provided in this report are based on the assumption that materials identified are homogeneous throughout their application. This report has been compiled for the exclusive use of TechEast Fire&Water Restoration Inc., its successors and/or assigns. This report and its contents represent confidential information and should not be duplicated without the expressed permission of the TechEast Fire & Water Restoration Inc., its successors and/or assigns. The building owner representative is TechEast Fire&Water Restoration Inc. and may be reached at 28 Emerick Lane in Loudonville,NY. SECTION III—ASBESTOS SAMPLING SUMMARY The results of the sampling are provided in Table I (Asbestos Sampling Results) and the asbestos findings are provided in Table 2 (Asbestos Findings) of the Attachments. The laboratory results and sample location map(s)are also provided in the Attachments. ATTACHMENTS TABLE I-ASBESTOS SAMPLING RESULTS TABLE 2-ASBESTOS FINDINGS PHOTOALBUM LOCATIONMAPS LABORATORYREPORTS LICENSING AND CERTIFICATION NYS INDUSTRIAL CODE RULE SECTION 56-5.1 TABLE I — ASBESTOS SAMPLING RESULTS 28 N Church St Spectrum Project# 17-371 Date Sampled: July 20, 2017 Sample# Description Location/Area PLM Results TEM Results T %Type) O1 Sheetrock Kitchen NAD NA 02 Sheetrock Living Room NAD NA 03 Joint Compound Kitchen NAD NA 04 Joint Compound Living Room NAD NA 05 Popcorn Ceiling Kitchen Chrysotile<0.25% NA 06 Popcorn Ceiling Living Room Chrysotile<0.25% NA 07 Popcorn Ceiling Upstairs hallway Chrysotile<0.25% NA 08 2x2 Ceiling Tile Basement NAD NAD 09 2x2 Ceiling Tile Basement NAD NAD 10 1x2 Grout Kitchen Floor NAD NA 11 1x2 Grout Kitchen Floor NAD NA 12 30 Tile Bathroom Floor NAD NA 13 30 Tile Bathroom Floor NAD NA 14 3x3 Adhesive Bathroom Floor Chrysotile 7.7% NA 15 3x3 Adhesive Bathroom Floor NAPS NA 16 30 Grout Bathroom Floor NAD NA Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos. NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet TABLE 1 — ASBESTOS SAMPLING RESULTS 28 N Church St Spectrum Project# 17-371 Date Sampled: July 20, 2017 Sample# Description Location/Area PLM Results TEM Results /o Type) /oType) 17 3x3 Grout Bathroom Floor NAD NA 18 Insulation Attic NAD NA 19 Insulation Attic NAD NA 20 Shingle Roof NAD NAD 21 Shingle Roof NAD NAD 22 Tar Paper Roof NAD NAD 23 Tar Paper Roof NAD NAD Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos. NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet TABLE 2 — ASBESTOS FINDINGS 28 N Church St Spectrum Project# 17-371 Date Sampled: July 20, 2017 Limitations: The following limitation/conditions were noted as part of the survey: • OSHA requires that an employer not expose its workers above the PEL and therefore specific training, work practices and/or respiratory protection may need to be a consideration when handling materials that are less than one percent. • The inspection was performed in accordance with New York State Industrial Code Rule 56 Section 5.1. It is the responsibility of the owner or its agent to forward a copy of this report to the local government entity charged with issuing a permit for such demolition, renovation, remodeling or repair work under applicable State or local laws as well as to the NYS Department of Labor Asbestos Control Bureau. Spectrum will not send this report to the NYSDOL without written permission from its client due to the sensitive nature of the information present in this report. • A copy of 56-5.1 is available upon request. • This report reflects the conditions found at the date and time of the inspection(s). Conditions of the area and materials may change due to external events, forces or influences.Re- inspection of the area may be required prior to the start of any work if an extended period of time has passed or if disturbances have occurred. • All asbestos locations on drawings are approximate. All quantities are estimated and must be field verified prior to use as part of a bidding document. Materials may extend or be hidden behind or within other materials or structural members. Any contractor or other user of this report is required to physically confirm the quantities and verify measurements of materials to be removed,to be bid for removal, or for any other purpose. Contractors are responsible to physically visit the site and confirm all quantities for bidding purposes. • The fire damaged room was not in the scope of the survey. • This survey is for renovation of the structure. • Spectrum did not inspect any exterior area below grade. Foundation sealers, buried piping and other items may exist below grade which may contain asbestos. SF—square feet,LF—linear feet,ea—each TABLE 2 — ASBESTOS FINDINGS 28 N Church St Spectrum Project# 17-371 Date Sampled: July 20,2017 Material Location/Area Estimated Quantity* Condition/Damaged 30 Adhesive Bathroom Floor 49 sf Good *Quantities of identified ACM are estimates only and should be field verified prior to bid by the contractor or confirmed as part of an RFP or design specification. Please see the limitation listed above. SF—square feet,LF—linear feet,ea—each PHOTO ALBUM /TOZ `OZ Aln f :uoil:)adsul jo a}ea ZLE-LZ # 1:)afoad wnjl:)@dS •Duff `S@IeiDossd IeIuauauoainu3 wnal:)adS Aq IS qDjnqD N SZ jo wnqld oloqd uoilD@dsu l solsagsb pazrsaa £8SZ09'Z'bZTOST ZOZS£'T OZLOLTOZ paz?Saa SL91709ZbZTOST bSTSET OZLOLTOZ paz'rSaa E8EL09'ZbZTOST £bTS:ET OZLOLTO'Z pazgSaaT98609ZbZTOST 9ETS£I OZLOLTOZ j x LOCATION MAP(S) 17-371 26 6N Church Street Queensbury i 341.0 Ft= i 264.0 Ft2 120.0 FN (8,9)2x2 Ceiling Tile WTS Pictorial Representation Only (6)Popcom z (2)Sheet (5)Popcorn Ceiling (4)Joint (1)Sheetrod< (3)Joint Compound (10,11)1x2 Grout 140.0 Ft' Fire Damaged Room Living room Kitchen 299.0 Ft' Taken on Fxterior (20,21)Roof Shingle (22,23)Tar Paper 143.0 FN Dining room 17-371 28 N Church St Queensbury NTS Pictorial Representation Only (12,13)3x3 Tile (14,15)3x3 Adhesive (16,17)3x3 Grout Bathroom 9 M.2 Ft' 44.0 FE' f 106.8 Ftp u �j Bedroom 2 Bedroom 3 i (18,19)AtEic CnsuCation i Bedroom 1 (7)Popcom Ceiling i i 144.4.Ft= 176.0 FE' Master Bedrooms I L 17-371 28 N Church Street Queenshury NTS Pictorial Representation Only LABORATORY REPORTS AmeriSci New York 117 EAST 30TH ST. AMERI SCI NEW YORK, NY 10016 TEL:(212)679-8600•FAX:(212)679-3114 PLM Bulk Asbestos Report Spectrum Environmental Associates, Inc Date Received 07/22/17 AmeriSci Job# 217074442 Attn: Bill Massman Date Examined 07/25/17 P.O. # P.O.Box 1024 ELAP # 11480 Page 1 of 5 RE: 17-371; 28 N. Church St. Schenectady, NY 12301 Client No. / HGA Lab No. Asbestos Present Total % Asbestos 1 217074442-01 No NAD 1 Location: Kitchen-Sheetrock (by NYS ELAP 198.1) by Bella J. Chernis on 07/25/17 Analyst Description: GreyrTan, Homogeneous, Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 20%, Non-fibrous 80% 2 217074442-02 No NAD 1 Location: Living Room-Sheetrock (by NYS ELAP 198.1) by Bella J. Chernis on 07/25/17 Analyst Description: Grey/Tan, Homogeneous, Fibrous, Bulk Material Asbestos Types: Other Material: Cellulose 25%, Non-fibrous 75% 3 217074442-03 No NAD 2 Location: Kitchen-Joint Compound (by NYS ELAP 198.1) by Bella J. Chemis on 07/25/17 Analyst Description: White, Homogeneous, Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 4 217074442-04 No NAD 2 Location: Living Room-Joint Compound (by NYS ELAP 198.1) by Bella J. Chernis on 07/25/17 Analyst Description: White, Homogeneous, Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 5 217074442-05 Yes Trace (<0.25 % pc) 3 Location: Kitchen-Popcorn Ceiling (EPA 400 PC) by Bella J. Chernis on 07/25/17 Analyst Description: White, Homogeneous, Fibrous,Bulk Material Asbestos Types:Chrysotile <0.25%pc Other Material: Cellulose 2 %, Non-fibrous 98% See Reporting notes on last page AmeriSci Job#: 217074442 Page 2 of 5 Client Name: Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report 17-371; 28 N. Church St. Client No. / HGA Lab No. Asbestos Present Total % Asbestos 6 217074442-06 Yes Trace (<0.25 % pc) 3 Location: Living Room-Popcorn Ceiling (EPA 400 PC) by Bella J. Chemis on 07/25/17 Analyst Description:White, Homogeneous,Fibrous,Bulk Material Asbestos Types:Chrysotile <0.25%pc Other Material: Cellulose 2%, Non-fibrous 98% 7 217074442-07 Yes Trace (<0.25 % pc) 3 Location: Upstairs Hall-Popcom Ceiling (EPA 400 PC) by Bella J-Chemis on 07/25/17 Analyst Description: White,Homogeneous, Fibrous,Bulk Material Asbestos Types:Chrysotile <0.25%pc Other Material: Cellulose 1, Non-fibrous 99% 8 217074442-08 No NAD 4 Location: Basement-2 X 2 Ceiling Tile (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description: Beige,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 55.9% 9 217074442-09 No NAD 4 Location: Basement-2 X 2 Ceiling Tile (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description: Beige, Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 43.8% 10 217074442-10 No NAD 5 Location: Kitchen Floor-1 X 2 Grout (by NYS ELAP 198.1) by Bella J. Chemis on 07/25/17 Analyst Description: Grey, Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 11 217074442-11 No NAD 5 Location: Kitchen Floor- 1 X 2 Grout (by NYS ELAP 198.1) by Bella J. Chemis on 07/25/17 Analyst Description: Grey, Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% See Reporting notes on last page AmeriSci Job#: 217074442 Page 3 of 5 Client Name: Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report 17-371; 28 N. Church St. Client No. / HGA Lab No. Asbestos Present Total %Asbestos 12 217074442-12 No NAD 6 Location: Bathroom Floor-3 X 3 Tile (by NYS ELAP 198.1) by Bella J. Chemis on 07/25/17 Analyst Description: Brown, Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 13 217074442-13 No NAD 6 Location: Bathroom Floor-3 X 3 Tile (by NYS ELAP 198.1) by Bella J. Chemis on 07/25/17 Analyst Description: Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 14 217074442-14 Yes 7.7 % 7 Location: Bathroom Floor-3 X 3 Adhesive (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description:Tan,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types:Chrysotile 7.7% Other Material: Non-fibrous 23.2% 15 217074442-15 NAPS 7 Location: Bathroom Floor-3 X 3 Adhesive Analyst Description: Bulk Material Asbestos Types: Other Material: 16 217074442-16 No NAD 8 Location: Bathroom Floor-3 X 3 Grout (by NYS ELAP 198.1) by Bella J. Chemis on 07/25/17 Analyst Description:Grey,Homogeneous,Non-Fibrous,Cemenfifious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 17 217074442-17 No NAD 8 Location: Bathroom Floor-3 X 3 Grout (by NYS ELAP 198.1) by Bella J. Chernis on 07/25/17 Analyst Description: Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% See Reporting notes on last page AmeriSci Job#: 217074442 Page 4 of 5 Client Name: Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report 17-371; 28 N. Church St. Client No. / HGA Lab No. Asbestos Present Total % Asbestos 18 217074442-18 No NAD 9 Location: Attic-Insulation (by NYS ELAP 198.1) by Bella J. Chernis on 07/25/17 Analyst Description: Brown, Heterogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 85%, Fibrous glass 10%, Non-fibrous 5% 19 217074442-19 No NAD 9 Location: Attic-Insulation (by NYS ELAP 198.1) by Bella J.Chemis on 07/25/17 Analyst Description: Brown, Homogeneous, Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 80%, Fibrous glass 12%, Non-fibrous 8% 20 217074442-20 No NAD 10 Location: Roof-Shingle (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description: Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Fibrous glass 2%, Non-fibrous 30.3% 21 217074442-21 No NAD 10 Location: Roof-Shingle (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description: Black,Heterogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Fibrous glass 1 %, Non-fibrous 33.2% 22 217074442-22 No NAD 11 Location: Roof-Tar Paper (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description: Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Fibrous glass 3%, Non-fibrous 31.7% 23 217074442-23 No NAD 11 Location: Roof-Tar Paper (by NYS ELAP 198.6) by Bella J. Chemis on 07/25/17 Analyst Description: Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Fibrous glass 1 %, Non-fibrous 17.4% See Reporting notes on last page AmeriSci Job#: 217074442 Page 5 of 5 Client Name: Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report 17-371; 28 N. Church St. Reporting Notes: Analyzed by:Bella J.Chemis NADINSD=no asbestos detected;NA Tot analyzed;NAIPS=not analyzed/posi8ve stop,(SOF-V)=Sprayed On Fireproofing containing Vermiculite; (SM-V)=Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis by EPA 600/M4-82-020 per 40 CFR 763(NVLAP 200546-0),ELAP PLM Method 198.1 for NY friable samples,which includes the iden86cation and quantitation of vermiculite or 198.6 for NOB samples or EPA 400 pt at by EPA 600/14-82-020(NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials. NAD or Trace results by PLM are inconclusive,TEM is currently the only method that can be used to determine if this material can be considered or treated as non asbestos-containing in NY State(also see EPA Advisory for floor tile,FR 59,146,38970,8/1/94)National Institute of Standards and Technology Accreditation requirements mandate that this report must not be reproduced except In full without the approval of the Iab.This PLM report relates ONLY to the items tested.AIHA-LAP,LLC Lab ID 102843,RI Cent AAL-094,CT Cert PH-0186,Mass Cert AA000054. Reviewed By: END OF REPORT AmeriSci Job M 217074442 Page 1 of 2 Client Name: Spectrum Environmental Associates, Inc. Table I Summary of Bulk Asbestos Analysis Results 17-371; 28 N. Church St. Sample Heat Acid Insoluble AmeriScl HG Weight Sensitive Soluble Non-Asbestos "Asbestos%by "Asbestos%by Sample# Client Sarri Area (gram) Organic% inorganic% Inorganic% PLM/DS TEM 01 1 1 ---- ---- — NAD NA Location: Kitchen-Sheetrock 02 2 1 -- ---- — ---- NAD NA Location: Living Room-Sheehock 03 3 2 --- ---- — -- NAD NA Location: Kitchen-Joint Compound 04 4 2 ---- ---- -- --• NAD NA Location: Living Room-Joint Compound 05 5 3 --- --- — — Chrysotile<0.25 NA Location: Kitchen-Popcom Ceiling 06 6 3 — — — --- Chrysotile<0.25 NA Location: Living Room-Popcom Ceiling 07 7 3 --- — -- ---- Chrysotile<0.25 NA Location: Upstairs Hall-Popoom Ceiling 08 8 4 0.288 20.1 24.0 55.9 NAD NAD Location: Basement-2 X 2 Ceiling Tile 09 9 4 0.178 19.7 36.5 43.8 NAD NAD Location: Basement-2 X 2 Ceiling Tile 10 10 5 ---- — -- ---- NAD NA Location: Kitchen Floor-1 X 2 Grout 11 11 5 -- — — ---- NAD NA Location: Kitchen Floor-1 X 2 Grout 12 12 6 — — — ---- NAD NA Location: Bathroom Floor-3 X 3 Tile 13 13 6 — — -- ---- NAD NA Location: Bathroom Floor-3 X 3 Tile 14 14 7 0.136 53.7 15.4 23.2 Chrysotile 7.7 NA Location: Bathroom Floor-3 X 3 Adhesive 15 15 7 0.196 51.5 18.9 29.6 NAIPS NA Location: Bathroom Floor-3 X 3 Adhesive 16 16 8 — — — ---- NAD NA Location: Bathroom Floor-3 X 3 Grout See Reporting notes on last page AmeriSciJob#: 217074442 Page 2 of 2 Client Name: Spectrum Environmental Associates, Inc. Table I Summary of Bulk Asbestos Analysis Results 17-371; 28 N. Church St. Sample Heat Acid Insoluble AmeriSci HG Weight Sensitive Soluble Non-Asbestos "Asbestos%by •`Asbestos%by Sample# Client Sample# Area (gram) Organic% Inorganic% inorganic% PLM/DS TEM 17 17 8 — -- — —• NAD NA Location: Bathroom Floor-3 X 3 Grout 18 18 9 '— — — — NAD NA Location: Attic-Insulation 19 19 9 --- -- — ---- NAD NA Location: Attic-Insulation 20 20 10 0.229 21.4 46.3 32.3 NAD NAD Location: Roof-Shingle 21 21 10 0.368 22.3 43.5 34.2 NAD NAD Location: Roof-Shingle 22 22 11 0.219 9.1 56.2 34.7 NAD NAD Location: Roof-Tar Paper 23 23 11 0.255 10.2 71.4 18.4 NAD NAD Location: Roof-Tar Paper Analyzed by:Karol H.Lu Date Analyzed 7/26!2017 -Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by EPA 600/M4-82-020 per 40 CFR or ELAP 198.1 for New York friable samples or ELAP 198.6 for New York NOB samples;TEM (Semi/Full)by EPA 600/R-93/116(not covered by NVLAP Bulk accreditation)or ELAP 198.4;for New York samples;NAD=no asbestos detected during a quantitative analysis:NA=not analyzed;Trace= <1%;(SOF-V)=Sprayed On Fireproofing containing Vermiculite;(SM-V)=Surfacing Material containing Vermiculite;Quantitation for beginning weights of<0.1 grams should be considered as qualitative only;Qualitative Analysis:Asbestos analysis results of"Present"or"NVA=No Visible Asbestos"represents results for Qualitative PLM or TEM Analysis only(no accreditation coverage available from any regulatory agency for qualitative analyses):NVLAP(PLM)200546-0,NYSDOH ELAP Lab 11480,AIHA-LAP,LLC(PLM)Lab ID 102643. Warning Note:PLM limitation,only TEM will resolve fibers<0.25 micrometers in diameter.TEM bulk analysis is representative of the fine grained matrix material and may not be representative of non-uniformly dispersed debris for which PLM evaluation is recommended(I.e.soils and other heterogenous materials). Reviewed By: S a_ 6 P.O.8 1024 SP C Rv _ E Schenectady,NY 12307 R Environmental Associates. Inc. (515)346-6374(Phone) (575)34 (Fax) 'EXUEEDINC oUR CL/PNTX EXPPCTDTIDNS OP EXDELLENC¢• nnvtv.4spectrupectrum.com BULK SAMPLING CHAIN OF CUSTODY Rew ggmT Di4, N2 2 1 7 0 7 4 4 4 2 PROJECT INFORMATION + PmjMk Building Name: f 7-a'z/ Matrix Analysis Requested Turnaround Date SamplW: MW6ocation: 7�XO�f flk Paint PLM-FLAP 198.1 TEM-FLAP 198.4 ❑ RUSH ❑ 24 Hour PegeN Inveniget., of Arok t pc,CC��❑ Soil ❑ Wipe PLM-ELAP 198.6 ❑ ❑ 72 Hour SAMPLE IDENTIFICATION Sample ID 9: Group 4:* Material Sample Location Condition/Comment 1 .5 kcct r0cle, k;6�.en 3 z Sot..t x Emu. S 3 t� P r e•. 1.,r -3 tt hwN � f X.L G-roee'E Kito�`e.. F(aor LL:f lX�tw�rc�L F/cor /y a v, v. n 16 V G-rol.* v t¢ Unless otherwise stated please analyze each group to first(111)positive result. Fourems: CHAIN OF CUSTODY Relinquished By Date Timc Received By Date Time Method of Submittal ll Environmental Consulting & Management Services Health & Safety Training • Laboratory Services LICENSING AND CERTIFICATION SPECTRVA y 0.BAY 1024 schanettarly,NY 12301 rsrs��s-8$r4 rPyvns) Environmental Associates. Inc. 'ExCeegm;ooP c1lurs Exrecror*oxs o:Ex.xleexco 3ru�isdsyactrum.tOm State of New York— Department of Labor Asbestos Certification STATE OF NEW YORK-DEPARTMENT OF LA80R nS$BTLIS CERTiFKA+E CHRISTOPHER P PATTI MSS(EXPIRES) CATEC(01118) D IIISP(OVIA) H PM CERix Ov-6659) DMV* 9.40138164 MUST BE CARRIED ON ASBESTUS PROJECTS mnnu4m smaiaill IIII III��I I III�IIIIIII III IIS ® I8 POUND RETURN TO: < m RYES BRO NYSDOL - LLC UNIT .r e$ HAIR BRO ROOK 161A BUILDING 12 m =_'n BGT 5' 09" STATE OFFICE CARPUS ALBANY NY 12240 .r �e State of New 'York— Department of Labor Codes Certification A Asbestos Handler B Restricted Handler- Allied Trades C Air Sampling Technician D Inspector E Management Planner F Operations and Maintenance G Su ervisor H Project Monitor I Project Designer F,nviranmentalConsulting&Ala naCementServices • Nealth&SatetyTraining • LabbrntolyServices SPECTRVM V.&.r Schenectady,WY 12301 (5YS)3;6-637'1 fPlJnne) �ylIT�IJtOII7TIBftllll�f��i(JC]�1�83 rIIC. (518)316-49,62(FUN) tvt.�nv.'1s1>ect�'rnu.ton.: •EXCEEOLVO OOx L"LUXTS EXPSC7NYIOX3 OF EXC£4L4,VCS' State of New York-,- .Det)a1-trilent o:f.Lflbor Asbestos Ce"tillCa0011 STATE.)F NEW YORK-DEPARTNIENTOF L WR ActIEST+:15 CERT IFKAIE ----- MICHAEL S aERUYTER CL SS(EXPIRES) CAJEC(IU18) DINSP(111I8) A�'• FI PM (I Ills) CEai+ 17-21£o7 597311682 V-_- MUST AE CARRIED ON ASBESTOS PROJECTS II III II 15;511 Iilll hl III I I 1111111111111111111111111115 IF FOUND RETURN TO: ry EYES ENO NYSDOL - L&C UNIT Ht IR SRO ROOM 151A BUILDING 12 �n v EST S' 00" STATE OFFICE CAMPUS o ALSANY NY 12240 ==o o 'o State of New work— Department of Labor Codes Certification _ A Asbestos Handler �B T Restricted Handler- Allred Trades j I C _ Air Sampling Tecluucian D---- Inspector I E 7 'Manauernent Planner F ! - 2peratiom and Maintenance G T- — Supervisor —. bI I Project Nfonitor l i Project Designer f»rirmnrmutal ConsulfitIg 8• Serrlces • Ilealfb Lf Safefl'7'mining hnboratoll'Sert'ices New York State—Department of Labor Division of Safety and Health License and Certificate Unit State Campus,Building 12 Albany,NY 12240 ASBESTOS HANDLING LICENSE Spectrum Environmental Associates, Inc FILE NUMBER: 99-0129 LICENSE NUMBER: 29081 P.O. Box 1024 LICENSE CLASS: RESTRICTED DATE OF ISSUE: 01/26/2017 Schenectady, NY 12301 EXPIRATION DATE: 02/28/2018 Duly Authorized Representative—William L Massmann: This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a (1) serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of responsibility in the conduct of any job involving asbestos or asbestos material. This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State Department of Labor. Eileen M.Franke, Director SH 432(8/12) - For the Commissioner of Labor NEW YORK STATE DEPARTMENT OF HEALTH WADSWORTH CENTER Expires 12:01 AM April 01,2018 Issued April 01.2017 r CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance with and pursuant to section 502 Public Health Law of New York Stale MR. PAUL J. MUCHA NY Lab Id No: 11480 AMERICA SCIENCE TEAM NEW YORK INC 117 EAST 30TH ST NEW YORK, NY 10016 is hereby APPROVED as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE All approved subcategories and/or analytes are listed below: Miscellaneous .asbestos in Friable Material Item 198.1 of Manual EPA 6001M41821020 Asbestos in Non-Friable Material-PLM Item 198.6 of Manual(NOB by PLM) Asbestos in Non-Frfable Material-TEM Item 198.4 of Manual Serial No.: 56034 prooerty of the New York Stale Department of Heath. Certifcstes are yal d only at the address snnwn.most be conspicuously posted,and are printed on secure paper. Continued accreditation depends on.successful ongoing participation in the Program. Consumers are urged to call(518)485-5570 to 'renty the labcralorys aaredilati9n status. Page 1 of 1 _ I AUG 0 12017 b �{ + OWN GFQt` - -- - BUILDING & C. Reviewed 8y: �� Da`e: �� i1L v r t Rev.e =FILECOPY I D 1 !.-_.tee..-....� �.� ......._..A�-_..�......�..w.,_... f 04 i 308.18"1'63 DEMO-000464-2017 Mossing, John 28 N. Church Ln. Demo (due to fire) asbestos report recvd s7 P 0."1024 SPECTRVAf neaadr;AT 1Z301 (518)346-6374(Ph~) Envi ?nmental associates, Inc. (518)348-44062(fax) ',Exrcrpr4c Ove Via*rs Exorcrartoxx or E"xcrccrar * .4 ' PROJECT MONITORING AND AIR SAMPLING REPORT x -A,aA-U Vi EC IE UWE FOR Q OCT 1920V TOWN OF QUEENSBURY GARAGE/BREEZE U1L � °aEs & UPSTAIRS BATHROOM 28 N CHURCH LANE QUEENSBURY, NEW YORK 12804 OCTOBER 4 — 69 2017 SEA PROJECT No.: 17-479 PREPARED FOR: TECH EAST FIRE & WATER RESTORATION 28 EMERICK LANE ALBANY, NY 12211 Environmental consulting&Management Services • Health&Safety Training • Laboratory Services EXECUTIVE SUMMARY This final report is for work performed at 28 N Church Lane, Queensbury,New York. The scope of work performed by the abatement contractor involved the removal of asbestos containing materials from the following area(s): • —49 sf of floor tile and mastic upstairs bathroom • Fire damaged garage and breezeway per site specific variance 17-1152 The air monitoring performed by Spectrum Environmental Associates, Inc. was performed in accordance with New York State Department of Labor-Industrial Code Rule 56 and if applicable, any variances granted by the New York State Department of Labor. Industrial Code Rule 56 is the regulation which governs the removal of asbestos containing materials in New York State and defines the requirements for air monitoring. Air monitoring was required for this project based on the quantity of asbestos containing materials scheduled for removal. In accordance with New York State Department of Labor - Industrial Code Rule 56.4-11, "The PCM clearance air sample results shall be considered satisfactory when every clearance air sample demonstrates an airborne concentration of fibers of less than 0.01 fibers per cubic centimeter, or the established background level(s),whichever is greater." In the section of this report labeled as PCM Air Sampling Results,are all the air samples collected for this project. The sample type is listed on the top of each page by Phase with Phase IIC being Clearance (or Final) Air Samples. If you refer to air sample results, the third column from the right(the shaded column)you will find the results in fibers per cubic centimeter(f/cc). This is the column where all the results should be less than 0.01 fibers per cubic centimeter,or the established background level(s), whichever is greater. The other columns are provided due to regulatory reporting requirements and were used in calculating the results in f/cc. In addition,New York State Department of Labor-Industrial Code Rule 56 required a final visual inspection be performed by an Asbestos Project Monitor independent of the abatement contractor prior to the collection of the Clearance Samples. This was performed by Spectrum and the associated documentation is attached. Therefore, based on the final visual inspection(s) passing and the final air samples that were collected and analyzed on this project having met the New York State minimum requirement of less than 0.01 fibers per cubic centimeter, the scheduled removal areas are considered clear and may be re-occupied. This report is for the exclusive use of Tech East Fire & Water Restoration, its successors and/or assigns. This report and its contents represent confidential information and should not be duplicated without the expressed permission of Tech East Fire&Water Restoration,its successors and/or assigns. Should you have any questions concerning this report or the analytical results presented, please do not hesitate to contact our office at(518) 346-6374. ANALYTICAL PROCEDURES The sampling and analytical methods incorporated in this study are those recommended in National Institution for Occupational Safety and Health(NIOSH)Methods 7400 (NIOSH Manual of Analytical Methods(NMAM),Fourth Edition, 8/15/94)for the quantifications of airborne fiber concentrations. This method of analysis requires the use of specific procedures for the collection of the sample. A sampling pump is used to draw a known volume of air through a mixed cellulose ester filter with a pore size of 0.8 micron. The pumps are calibrated prior to sampling using either a bubble burette or a calibrated rotameter. Any particulate or fibrous materials present in the samples air are deposited onto the filter. A portion of the filter is visually analyzed at 400x magnification by Phase Contrast Microscopy(PCM). When analyzing the filter, only fibers that have a length to width ratio of at least three to one and that are at least 5 microns in total length are counted. The number of fibers on the filter is counted until 100 fields have been examined or until 100 fibers are observed, whichever comes first. At least twenty of fields per cassette are required to be examined. A field is the area covered by the microscope graticule during the counting process. The fiber concentration, fibers per cubic centimeter of air (f/cc), is calculated using a nominal value of 5.5 fibers/100 fields, a maximum possible concentration is calculated using a nominal value of 5.5 fibers/100 fields and the volume of air sampled. Maximum possible concentrations are indicated by a less than(<) sign. It is important to note that this analytical method does not differentiate between asbestos fibers and other fibers. When it is necessary to know the number of airborne asbestos fibers present, Transmission Electron Microscopy (TEM) analysis is performed. The principle of the TEM method is as follows: In the TEM analysis,the known volume of air is drawn through a mixed cellulose ester filter with a pore size of 0.45 micron. The filter with the deposited particulate and fibrous materials is then covered with a conductive coating. The coated filter is subsequently analyzed at about 20,000x magnification by morphological observation, Selected Area Electron Diffraction (SAED) and Energy Dispersive X-ray microanalysis (EDX). The result is the number of asbestos structures per cubic centimeter of air. PCM AIR SAMPLING RESULTS P.0.Box 1024 Schenectady.NY 12301 SPECTRVA (518)346-6374(Phone) Environmental flssociates, Inc. (518)346-4062(Fax) 'EXCEEDING OUR CLIENTS EXPECTBT/ONS OF EXCELLENCE' www.4spedmm com FINAL REPORT OF ANALYSIS NYS DOH E.L.A.P.# 11540 CLIENT: TECH EAST FIRE&WATER RESTORATION PROJECT#: 17-479 28 EMERICK LANE ALBANY,NY 12211 PROJECT: 28 N CHURCH LANE QUEENSBURY SAMPLE TYPE: PHASE IIB(REMOVAL) WORK AREA: FIRE DEMO(GARAGE) DATE COLLECTED: 10/4/17 DATE ANALYZED: 10/6/17 DATE RECEIVED: 10/6/17 DATE REPORTED: 10/6/17 LAB I.D. SA CLIENT # LOCATION/DESCRIPTION L.O.D. Vee f/nlnl'- 10737 1 Field Blank --- --- 0.0 10738 2 Field Blank --- --- 0.0 10739 3 Ambient 0.002 0.002 7.6 10740 4 Decon 1 0.002 0.004 15.3 10741 5 Decon 2 0.002 0.003 11.5 10742 6 OWA 1 0.002 0.003 14.0 10743 7 OWA 2 0.002 0.003 10.8 10744 8 OWA 3* 0.002 0.003 12.7 10743 9 IWA 1 0.002 0.003 14.0 ANALYTICAL METHOD: N.I.O.S.H.7400,"A" RULES PHASE CONTRAST MICROSCOPY Microscope:Olympus CX21 Phase Contrast Field Area:0.00785 nun'- BDL=Below Detection Level f/mm'-=Fibers per Square Millimeter L.O.D.=Level of Detection OVL=Overloaded with particulate f/cc=Fibers per Cubic Centimeter L.O.D.=7 fibers per mnr' OVLBI,=Fibers exceeds QC limit ANALYTICAL RESULTS DEPENDENT ON FIELD BLANKS SUBMITTED WITH SAMPLES REPORTED ANALYTICAL RESULTS ARE BASED ON SAMPLE DATA PROVIDED BY THE CLIENT a Laboratory Director, aboratory Precision(Sr): James A Capasso II Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services TR (51S)34,6-637,1(Phvne) f� (4;1,i)W6-400?(tax) 'W.Yert a,aw tfXVK Ame.rs.6 CTi71 JtY pt.I�#Gltt i Y 11• tin[w4spedram.4-ow Y AIR SAMPLING CHAIN OF CUSTODY (REV06-1s-2017) PROJECT INFORNIATION SAMPLE TYPE TYPE OF ANALYSIS TURNAROUND Project 11: 17479 Date Collected: 10/4/2017 O Phase IB(Background)0 PCM-NIOSH 7400 O RUSH Job Site/Building: 28 N Church Lane,Queensbury Q Phase IIA(Prep) O TEM-NIOSH 7402 1112 Hour Room/Work Area: Fire Demo ®Phase IIB(Removal) O TEM-AHERA ®24 Hour Rotameter#: L11 Calibration Date: 7/17/2017 p Phase IIC(Clearance) O Other 1148 Hour Collected By(Print): Michael DeRuyter p Air Quality O Other SAMPLE IDENTIFICATION Lab ID Sample Pump Result F:mm Pump Pump Rate Rate Air Adjust , No. No, No. Location On Oft' (LPM) (LPNI) Time Volume L.O.D. Count N.4E=Ne alive Air Exhaust Iu:mn lumen Un off Mia Lit Ks q00 1 F/cc 57 1 Field Blank --- --- --- --- --- --- --- 2 Field Blank --- --- --- --- 3 -3 Ambient 0858 1525 4 4 �7 ,S •'° 4 -� 7.� 1 �0 4 Decon 1 0.859 1526 4 4 5 Decon 2 0900 1527 4 4 1 . 6OWA 1 0901 152s 4 4 1D8� %/o 7 OWA 2 0902 15294 4 �7z/y 8 OWA 3* 0903 1530 4 4 %t®°,> 19 9IWA 1 0904 1531 4 4 .0 ADDITIONAL INFO CILllN OF CUSTODY Report Results to: _ Relinquished: Date: /0 q9 / ime: Phone/Fax: Received: Date: Time: Comments: Sample Log-in: Date-AX-1, ime: Sample Prep: Date: ime. Analyzed: Date: ime: QA/QC Review: Date: ime: OTr SedrrnuPnvlronmeie/v/Assvdir/es./ne,utili_es laboratories that meet the requirements set mth bvAHCR 1i)(2)(ii). Rotameters are calibrated against it Dry Cal DC-Lite Primer'Flow A4eter mnnufactmed b,BIOS International Corporation. Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services P.0.Box 1024 Schenectady.NI'12301 SPECTRVA (518)346-6374(Phone) Environmental dssociates, Inc. (518)346-4062(Pax) 'EXCEEDING OUR CLIENTS EXPECTATIONS Of EXCELLENCE' www.4spectrum.com FINAL REPORT OF ANALYSIS NYS DOH E.L.A.P.# 11540 CLIENT: TECH EAST FIRE&WATER RESTORATION PROJECT#: 17-479 28 EMERICK LANE ALBANY,NY 12211 PROJECT: 28 N CHURCH LANE QUEENSBURY SAMPLE TYPE: PHASE IIB/IIC(REMOVAL/CLEARANCE) WORK AREA: FIRE DEMO(GARAGE) DATE COLLECTED: 10/5/17 DATE ANALYZED: 10/5/17 DATE RECEIVED: 10/5/17 DATE REPORTED: 10/5/17 LAB I.D. C I EN # LOCATION/DESCRIPTION L.O.D. f/cc f/mmZ 10701 10 Field Blank --- --- 0.0 10702 11 Field Blank --- --- 0.0 10703 12 Ambient 0.002 0.003 7.6 10704 13 Decon 1 0.002 0.003 10.2 10705 14 Decon 2 0.002 0.002 7.0 10706 15 OWA 1 0.002 0.005 15.3 10707 16 OWA 2 0.002 0.004 12.1 10708 17 OWA 3* 0.002 0.003 8.9 10709 18 IWA 1 0.002 0.004 12.7 ANALYTICAL METHOD: N.I.O.S.H.7400,"A"RULES PHASE CONTRAST MICROSCOPY Microscope:Olympus CX21 Phase Contrast Field Area:0.00785 mmZ BDL=Below Detection Level f/mm'-=Fibers per Square Millimeter L.O.D.=Level of Detection OVL=Overloaded with particulate f/cc=Fibers per Cubic Centimeter L.O.D.=7 fibers per mmZ OVLBL=Fibers exceeds QC limit ANALYTICAL RESULTS DEPENDENT ON FIELD BLANKS SUBMITTED WITH SAMPLES REPORTED ANALYTICAL RESULTS ARE BASED ON SAMPLE DATA PROVIDED BY THE CLIENT A t: Laboratory Director, aboratory Precision(Sr): James A Capasso ll Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services P.O.Bvx 1024 _J SPECTRVA SchenectadyAV 12301 E (818)346-6W4(Phone) _ Leri vlmnt�nental dssociates, Inc. (618)WO-4062(Far) 'Exccenrnc OUR CLIEVrs Exvecrartoxs or CxCL'LLCNCC' wwu!4spertratmxom AIR SAMPLING CHAIN OF CUSTODY (REv06-I5-20I7) PROJECT INFORMATION -WS1 17 SAMPLE TYPE TYPE OF ANALYSIS TURNAROUND Project#: 17-479 Date Collected: 71 Phase IB(Background)®PCM-NIOSH 7400 [RUSH Job Site/Building: 28 N Church Lane,Queensbury O Phase IIA(Prep) 13 TEM-NIOSH 7402 O 12 Hour Room/W ork Area: Fire Demo O Phase LIB (Removal) 13 TEM-AHERA ' Rotameter#: Lt1 Calibration Date: 7/17/2017 R Phase HC(Clearance) 0 Other C1 48 Hour Collected By(Print): Michael DeRuyter 0 Air Quality 0 Other SAMPLE IDENTIFICATION Lab ID Sample Pump Pump Pump Rate Rate Air Adjust No. No. No. Location On Off (LPM) (LPM) Time Volume L.O.D. Count Result F/mm' NAE=Negative Air Exhaust hr.mn hr:— On Off bfin Liters /100 F/cc I �D( 10 Field Blank --- -- --- --- --- � - (� ?U2, 11 Field Blank --- --- --- --- --- --- --- 2 6 --203 12 Ambient 0744 1230 4 4 7o O 13 Decon 1 0745 1231 4 4 le) 74 14 Decon 2 0746 1232 4 4 'T� (, Jo 6 15 OWA 1 0747 1233 4 4 ?o716 OWA 2 0748 1234 4 4 9tJ Del fa,f 17 OWA 3* 0749 1235 4 4 18 I WA 1 0750 1236 4 4 ,Oll ADDITIONAL INFO CHAIN OF CUSTODY Report Results to: Relinquished: Date:AWSM Time: Phone/Fax: _ Received: Date: i /il Time: Comments: Sample Log-in: Date: gime: Sample Prep: Date: Time: Analyzed: Date: Time: QA/QC Review: Date Time: NOTE Spec/rum EnyiravmenlnlRssoclales,Ale.utilises laboratories that meet the re9uireme is setforth by AH 40 CFR 763.90(i)(2)(ii). Rotameters are calibrated against a Dry Cal DC-Lite Primary Flow Meter mant fact tred by BIOS Inten rational Corporation. Environmental Consulting&Management Services m Health&S� fety Training • Laboratory Services P.0.Box 1024 SPECTRVAI Schenectady,NV 12301 (518)346-6374(Phone) Environmental Rssociates, Inc. (518)346-4062(Fax) 'EXCEm,v.,OUR CLIENTS EXPECT.MONS OF EXCELLENCE' www.4specthnn.com FINAL REPORT OF ANALYSIS NYS DOH E.L.A.P.# 11540 CLIENT: TECH EAST FIRE&WATER RESTORATION PROJECT#: 17-479 28 EMERICK LANE ALBANY,NY 12211 PROJECT: 28 N CHURCH LANE QUEENSBURY _ SAMPLE TYPE: PHASE IIC(CLEARANCE) WORK AREA: FIRE DEMO(BATHROOM) DATE COLLECTED: 10/6/17 DATE ANALYZED: 10/6/17 DATE RECEIVED: 10/6/17 DATE REPORTED: 10/6/17 LAB I.D. C I ENTLE LOCATION/DESCRIPTION L.O.D. f/cc f/mm2 10746 19 Field Blank --- --- 0.0 10747 20 Field Blank - - --- 0.0 10748 21 OWA 1 0.002 BDL 3.8 10749 22 OWA 2 0.002 BDL 2.5 10750 23 OWA 3 0.002 0.002 7.6 10751 24 IWA 1 0.002 BDL 6.4 10752 25 IWA 2 0.002 BDL 5.1 10753 26 IWA 3 0.002 BDL 3.8 ANALYTICAL METHOD: N.I.O.S.H.7400,"A"RULES PHASE CONTRAST MICROSCOPY Microscope:Olympus CX21 Phase Contrast Field Area:0.00785 nun' BDL=Below Detection Level f/mm'-=Fibers per Square Millimeter L.O.D.=Level of Detection OVL=Overloaded with particulate f/cc=Fibers per Cubic Centimeter L.O.D.=7 fibers per mm' OVLBL=Fibers exceeds QC limit ANALYTICAL RESULTS DEPENDENT ON FIELD BLANKS SUBMITTED WITH SAMPLES REPORTED ANALYTICAL RESULTS ARE BASED ON SAMPLE DATA PROVIDED BY THE CLIENT lys Laboratory Director, Laboratory Precision(Sr): James A Capasso II Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services S P.0.Box 1Q24 SPECTRV14f StItFRFF1'ad};AT 123,01 (818)348-8374(Phone) (518),W(1-4062(Fax) EnFiriYlllMental9ssedates. Inn. wtvu�4spectrum com 'ExCEEotA,COU$&mvrs EXPEcrrlrlo.0 orExerttrNer' AIR SAMPLING CHAIN OF CUSTODY (REv06-I5-2017) PROJECT INFORMATION SAMPLE TYPE TYPE OF ANALYSIS TURNAROUND Project#: 1-479 Date Collected: 10/6/2017 p Phase IB(Background)9 PCM-NIOSH 7400 ®RUSH Job Site/Building: 28 N Church Ln 71 Phase IIA(Prep) O TEM-NIOSH 7402 O 12 Hour Room/Work Area: Bathroom O Phase IIB(Removal) 11 TEM-AHERA O 24 Hour Rotameter#: H45 Calibration Date: 7-17-2017 ®Phase IIC(Clearance) O Other 048 Hour Collected By(Print): Michael DeRuyter O Air Quality O Other SAMPLE IDENTIFICATION Lab ID Sample Pump Location Pumpffa.1, Rate Time Au L.O.D. Adjust Result F/mm' No. No. No. OnM) LPM) Volume Count NAE=Ne alive Atr Exhaust hr:mn Off Hlin Laers /100 Ftcc 19Field Blank --- --- --- --- --- - 20 Field Blank -- - - - -- - -- -- 0 - 7�"d 21 OWA 1 0700 0900 10 10 22 OWA 2 0701 0901 10 10 AD 23 OWA 3 0702 0902 10 10 o° �f 24 IWA 1 0703 0903 10 10 L !o lf, 25 IWA 2 0704 0904 10 10 �• I /e) t14-q 26 IWA 3 0705 0905 10 10 3r ADDITIONAL INFO CHAIN OF CUSTODY Report Results to:_ Relinquished: Date: d '�� Time: Phone/Fax: Received: Date: Time: Comments: Sample LogA Date: Time: Sample Prep: Date: /Time: Analyzed: Date: Time: QA/QC Review: Date Time: NOTE: lnc.utilizes laboratories that meet the requir ments set forth by AH 40 CFR 763.90(i)(2)(h). Rotmneters are calibrated against a Dry Cal DC-Lite Primary Flow Meter manu actured by BIOS International Corporation. Environmental Consulting&Management Services . Health&Safety Training • Laboratory Services SAMPLE LOCATION DRAWING(S)/MAP(S) 17-479 28 N Church Ln Queensbury NTS Phase IIB/IIC Decon 2 Decon owa 3 iwa owa Decor 1 owa 2 ambient 17-479 iwa iwa 28 N Church Ln Queensbury :1 NTS Phase IIC iwa towa owa owa -O Decon NY STATE SITE SPECIFIC VARIANCE Division of Safety and Health Engineering Services Unit Department of Labor W. Averell Harriman State Office Campus Building 12, Room 154, Albany, NY 12240 www.labor.ny.gov 518-457-1536 September 12, 2017 Spectrum Environmental Associates Inc. 2539 Albany Street Schenectady, NY 12304 RE: File No. 17-1152 Dear Sir/Madam: STATE OF NEW YORK DEPARTMENT OF LABOR DIVISION OF SAFETY AND HEALTH The attached is a copy of Decision, dated, 9/12/2017, which I have compared with the original filed in this office and which I DO HEREBY CERTIFY to be a correct transcript of the text of the said original. If you are aggrieved by this decision you may appeal within 60 days from its issuance to the Industrial Board of Appeals as provided by Section 101 of the Labor Law. Your appeal should be addressed to the Industrial Board of Appeals, State Office Building Campus, Building 12, Room 116, Albany, New York, 12240 as prescribed by its Rules and Procedure, a copy of which may be obtained upon request. WITNESS my hand and the seal of the NYS Department of Labor, at the City of Albany, on this day of 9/12/2017. Edward A. Smith, P.E. Professional Engineer 2 (Industrial) NEW YORK Department uta OiKB1u4OI of Labor STATE OF NEW YORK DEPARTMENT OF LABOR STATE OFFICE BUILDING CAMPUS ALBANY, NEW YORK 12240-0100 Variance Petition Of File No. 17- 1152 Spectrum Environmental Associates, Inc Petitioner's Agent on Behalf of DECISION Case(s) 1 John Mossing Petitioner ICR 56 in re Premises: Fire Damaged Garage & Breezeway 28 North Church Lane Queensbury, NY 12804 Controlled Demolition of Condemned Structure With Friable ACM The Petitioner, pursuant to Section 30 of the Labor Law, having filed Petition No. 17-1152 on September 12, 2017 with the Commissioner of Labor for a variance from the provisions of Industrial Code Rule 56 as hereinafter cited on the grounds that there are practical difficulties or unnecessary hardship in carrying out the provisions of said Rule; and the Commissioner of Labor having reviewed the submission of the petitioner dated September 11, 2017; and Upon considering the merits of the alleged practical difficulties or unnecessary hardship and upon the record herein, the Commissioner of Labor does hereby take the following actions: Case No. 1 ICR 56-11.5(c)(7) Page 2 of 4 File Number 17-1152 VARIANCE GRANTED. The Petitioner's proposal for controlled demolition of condemned fire damaged garage and attached breezeway with friable ACM, quantities as stated in the attached proposal, at the subject premises in accordance with the attached 14-page stamped copy of the Petitioner's submittal, is accepted; subject to the Conditions noted below: THE CONDITIONS Secure the Work Site 1. The entire controlled demolition area and all surrounding portions of the site to be utilized for demolition cleanup, staging areas and regulated abatement work areas, shall be enclosed within a barrier or fence. The intent of this barrier is to define the restricted area at the work site, alert the public to the asbestos work and associated hazards, and to prevent unauthorized entry onto the work site. 2. Signage in accordance with the requirements of ICR 56-7.4(c) shall be posted on the exterior of the work site boundary fence/barrier, to warn the public of the asbestos hazard. Establishment of Regulated Areas 3. The regulated work areas, decontamination units, airlocks, and dumpster areas shall be cordoned off at a distance of twenty-five feet (25') where possible, and shall remain vacated except for certified workers until satisfactory clearance air monitoring results have been achieved or the abatement project is complete. These areas shall have Signage posted in accordance with Subpart 56-7.4(c) of this Code Rule. For areas where twenty-five feet isn't possible, the areas shall be cordoned off as practical, and a daily abatement air sample shall be included in the vicinity of the barrier. 4. All adjacent building openings within twenty-five (25) feet of the outermost limit of the disturbance shall be sealed with two (2) layers of six (6) mil fire retardant plastic sheeting. If the owner of an adjacent building does not allow openings to be sealed as required, the asbestos abatement contractor's supervisor must document the issue within the daily project log, and have the affected building owner sign the log confirming that the owner will not allow the asbestos abatement contractor to seal the openings in the building as required. In addition, a daily abatement air sample shall be included within ten feet of the affected portion of the adjacent building. Controlled Demolition Removals 5. The provisions of 56-11.5 shall be followed for all friable and non-friable controlled demolition cleanup/removals, except as modified by this variance. Page 3 of 4 File Number 17-1152 6. Decontamination system enclosures and areas shall be constructed and utilized as per the requirements of 56-7.5(d) and 56-11.5. 7. Uncertified personnel shall not be allowed to access any regulated abatement work area, with the exception of waste hauler truck drivers. These truck drivers will be restricted to their enclosed cab, while temporarily in the regulated work area for waste transfer activities only. All equipment operators utilized for demolition or removal activities within the regulated work area must be certified in compliance with ICR 56-3.2. 8. No dry disturbance or removal of asbestos material shall be permitted. 9. Wastewater shall be confined within the controlled demolition area. 10. All generated demolition waste, debris, barrier components, used filters and similar items shall be considered asbestos containing materials/asbestos contaminated waste and treated as RACK 11. In addition to the requirement of Subpart 56-4.9(c), air monitoring within the work areas shall be conducted daily. If more than one shift daily is required to accomplish the work, air monitoring within the work area during abatement shall be performed on each shift, preferably at mid-shift timing. 12. Daily abatement air monitoring is required only on days when abatement or support activities such as ACM disturbance or cleaning activities are performed. 13. The contractor shall observe, at a minimum, the following waiting (settling/drying) periods: Demolition - 2 hrs. 14. In lieu of post-abatement clearance air monitoring in compliance with ICR- 56-9.2(d), the most recent daily abatement air samples collected during removal and cleaning operations in the regulated work area, shall be used for comparison with ICR 56-4.11 clearance criteria. All other applicable provisions of ICR 56-4 shall be followed for the duration of the abatement project. 15. After removal and cleanings are complete and a minimum drying period has elapsed, an authorized and qualified Project Monitor shall determine if the area is dry and free of visible asbestos debris/residue. If the area is determined to be acceptable and the most recent daily abatement air sample results meet 56-4.11 clearance criteria, the final dismantling of the site may.begin. Page 4 of 4 File Number 17-1152 16. Usage of this variance is limited to those asbestos removals identified in this variance or as outlined in the Petitioner's proposal. In addition to the conditions required by the above specific variances, the Petitioner shall also comply with the following general conditions: GENERAL CONDITIONS 1. A copy of this DECISION and the Petitioner's proposals shall be conspicuously displayed at the entrance to the personal decontamination enclosure. 2. This DECISION shall apply only to the removal of asbestos-containing materials from the aforementioned areas of the subject premises. 3. The Petitioner shall comply with all other applicable provisions of Industrial Code Rule 56-1 through 56-12. 4. The NYS Department of Labor Engineering Service Unit retains full authority to interpret this variance for compliance herewith and for compliance with Labor Law Article 30. Any deviation to the conditions leading to this variance shall render this variance Null and Void pursuant to 12NYCRR 56-12.2. Any questions regarding the conditions supporting the need for this variance and/or regarding compliance hereto must be directed to the Engineering Services Unit for clarification. 5. This DECISION shall terminate on December 12, 2017. Date: September 12, 2017 ROBERTA L. REARDON COMMI SIONER OF LABOR By d and A. Smith, P.E. rofessional Engineer 2 (Industrial) PREPARED BY: Ravi Pilar, P.E, Professional Engineer 1 (Industrial) REVIEWED BY: Edward A. Smith, P.E. Professional Engineer 2 (Industrial) 17 1152 Note: Add a separate typed or printed page for each work area and work procedure. Sign and date each page. 8.Work Area Descri tion Table: Attach additional tables and scale drawings of work area and pictures,as needed. Work Exterior Work/Room Type of Quantity of Condition of Friability of Type of Containment Area or Area Asbestos ACM ACM(level of ACM (full,2-layer tent,single Designation Interior Dimensions Containing damage) (non-friable layer tent,open-air,etc.) Material ACM or friable u ng iter or s Assumed fire s -1r-e- amage na a Oen Air 9. ICR 56 Relief Sought: List the individual sections of ICR 56 for which relief is sought,for each work area or method used. Provide sufficient detail in an attachment. See Attached 10. Hardship Description:What is the hardship,(e.g.Limited room for decons,exhaust ducts must be longer than 25 feet,all surfaces are contaminated and cannot.be plasticized)for each work area or method used?Provide sufficient detail in an attachment.Include condemnation letter or EPA Approval letter if applicable. See Attached 11. Proposed Abatement Method Description for each work area or method used: Include scale drawings and pictures as necessary. Lack of sufficient detail will delay issuance of variance decision. a.Will proposed abatement methods render non-friable ACM material friable? Yes X No b.What proposed abatement method,increased engineering controls and detailed procedures will be used to compensate for the relief being sought?(i.e.Increased negative air rate,negative pressure glovebag,negative pressure glovebox,high temperature glovebag,intact component removal,etc.)Include sufficiently detailed procedures to complete the proposed work. See Attached Project Designer Certification I request that the Commissioner of Labor issue a variance from the requirements of Industrial Code Rule(ICR)56.This request is based on the information in this application and the attached documents. I certify that the Information contained in this petition is true and accurate. I understand that if a variance is granted it may be withdrawn by the Commissioner if: • Any of the information provided in this petition is found to be inaccurate • There are violations of Article 30 of the New York State Labor Law or New York State regulations I give the Commissioner of Labor permission to provide all of my companies records for Unemployment Insurance (UI) reports and contributions to employees of the New York State Department of Labor. This includes information about withholding, wage reporting, UI returns, UI registration, new hires, and all records of UI delinquencies. This information may only be used for government purposes regarding the licensing and certification of this company as required by Article 30 of the New York State Labor Law and the regulations of the New York State Department of Labor,and for monitoring the company's compliance with Article 30 and ICR 56. 12 a. Project designer name(print): Roberti DeRuyter b.E-mail:hdeniZer@4spe.tc rum.com c. Project Design Asbestos Contractor firm name: Spectrum Environmental Associates, Inc. d.Street: 2539 Albany Street e. City: Schenectady f. State: NY g. zip: 12304 h. Phone: ( 518) 346 - 6374 i. Designer certificate number: 09-10619 j.Expiration Date:_ nt _/ UDI- 8-k. Design Firm Asbestos Contractor License Number 29081 I. Expiration Date: 02 / 28 / 2018 13 a.Project designer signature: � �—`r- " Z b. Date: 091 11 / 2017 171152 ATTACHMENT A Background The Structure (garage and attached breezeway) located at 28 North Church 1,11. Queensbury,New York has been damaged by tire. An inspection for asbestos materials cannot be performed due to the fire damage. Therefore, the structure(garage and attached breezeway) must be demolished in accordance with Section 11.5 of the Code Rule. The letter of condemnation by the Town of Queensbury is attached. The homeowner has now decided to keep the main structure and garage/breezewav slab. After abatement is complete the slab will be used to rebuild. The main structure was smoke damaged only but the main structure-was inspected and results are attached. 9.ICR 56 Relief Sought: 56-11.5 Controlled Demolition 10.Hardship Description: The Structure(garage and attached breezeway) is fire damaged. An inspection of the structure (garage and attached breezeway)could not be performed to determine if asbestos materials are present. The structure (garage and attached breezeway)cannot be demolished in accordance with Section 56-11.5 Controlled Demolition since the homeowner's intent is to keep the main structure and garage/breezeway slab. ALS1— AWrl W_�i A x. 1:1-olit Mid Side IOVOI 1IOUSC UIRL111WL�:d 28\m Y('v -Ih ChUrch Lark Petition Qu,:I I'll urx. Y Page 1 or 171152 11.Proposed Abatement Method Description for each work area or method used: It is being proposed to follow the work methods and sequencing described below to maintain the purpose and intent of 12 NYCRR Part 56 while allowing for the practical abatement of the asbestos containing materials: • Background air sampling shall not be required. • Access will be restricted to certified asbestos personnel. Non-certified personnel will not be allowed in regulated areas. • A project monitor will be on site for the entire project to provide guidance concerning compliance with the site specific variance and ICR 56,but not to direct the contractor in the performance of its duties. This would be the responsibility of the contractor's designated supervisor. As stated in the ASTM Standard referenced in ICR 56(E1368-05,7.4.5)the ultimate caliber for the work performance and quality of the completed project is the responsibility of the contractor who performs the work. • Abatement shall be performed in accordance with 56-11.5(c)Controlled Demolition Procedures and the following. • The entire demolition area shall be considered the regulated abatement work area. This area shall be enclosed within a barrier to prevent unauthorized entry. Signage on this barrier shall be in accordance with Section 56-7.4. Orange construction fence or snow fence is acceptable for this purpose. All adjacent building openings within twenty-five(25)feet of the outermost limit of the disturbance shall be sealed with two(2) layers of six (6) mil fire retardant plastic sheeting,and the asbestos project regulated abatement work area shall extend a minimum of twenty-five(25)feet from the outermost limit of disturbance. • Entrance or exit of all persons and equipment shall be through one(1)designated and controlled"access way"in the barrier or fence,which shall provide a means of egress from the regulated abatement work area. • All decontamination areas shall be within the regulated abatement work area.An equipment decontamination area shall be cordoned off within the worksite for cleaning of heavy equipment,i.e.,backhoes,excavators,loaders,etc. The ground surface in this decontamination area shall be banked on the sides to confine the contaminated wastewater. • Equipment shall be decontaminated prior to exiting the regulated abatement work area, utilizing a pressure wash system,after which all exposed surfaces inside and out shall be wet wiped. The surface below the equipment shall be scraped or cleaned of any residual asbestos contamination.This material shall be removed and disposed of as asbestos contaminated material. • No dry disturbance or removal of ACM,PACM or asbestos material shall be permitted. • All debris generated by the demolition shall be considered to be asbestos contaminated waste (to be disposed of as RACM),except for structural members,steel components and similar non-suspect items which shall be fully decontaminated as per this Part. • The demolition waste shall be wetted on a continuous basis,that is,prior to,during and subsequent to its actual collection and removal. Fog nozzles or similar type of equipment shall be used to perform the wetting. • Piles of waste not actively being worked on,i.e. piles being added to or portions being removed or piles left over extended periods of time,shall be covered with at least one layer of six(6)mil polyethylene to retain its moisture level and to prevent fiber release. 0 e—(o� f 28 North Church Lane � Variance Petition Queensbury,NY 71,-Y �� Page 2 of 0/0 7 171152 • Wastewater shall be confined within the controlled demolition regulated abatement work area. All wastewater shall be contained by means of trenching,ditches or other water diversion method and directed into a holding tank. Water may be allowed to accumulate in basements during demolition activities. • All demolition waste shall be placed in hard wall,closed containers or vehicles with at least two(2)layers of fire retardant six(6)mil plastic sheeting draped loosely over the sides of the load to facilitate being wrapped over the top of the load and sealed air tight prior to transport from the site.Dumpsters shall be considered to be hard wall containers.There shall be no visible emissions or water leakage from these containers. • The earth surface below the rubble or contamination areas outside the slab shall be scraped clean of any residual asbestos contamination. The dirt and debris shall be removed and disposed of as asbestos contaminated waste. • Concrete slab will be cleaned and left in place. • Final clean-up and clearance procedures for abatement shall comply with Section 56-9, except that only one stage of cleaning(final) is to be performed. Lockdown encapsulant use is not required. • The requirements of Subpart 56-10 shall apply,after all asbestos project regulated abatement work areas have been satisfactorily cleared. • All other provisions of 56-11.5 shall apply. T-7-- 016 L� 28 worth Church Lane (( 7 Variance Petition Queensbury.NY �/ ` Page 3 of 3 � �� U� �� 0 � ~� 4� ��D� �� F��\/ � �v ""^v ~^^ ��~""�^~^ ~"^^~""~` 7-12 /,xy R.nv/. 0'rc//,h,/y. NY -*vo�? September 11,2O1 MikeKwmrta TechEast Fire&Water Restoration Inc. 28 EnnerickLane Loudonville, NY12211 Subject: RE:28North Cbuvch Mike. Please consider this email wnn|liciu| condemnation n[Uhe�uru�eand u�nohrdhn�zcvay. T�u portion uftile structure iubeyond repair and needs tubedemolished. Please let no*know i[youneed anything else. DavidHat\n Director ofBuilding and Code Enforcement Town o[Queensbury 518 761-8253 "' Home (if /Vo / v/n/ Beauty— A G"vd P/x/, it, L/ r~^ ,171152 AmeriScl New York AQ 117 EAST 30TH ST. lVIERI SCI NEW YORK,NY 10016 TEL;(212)679-8640•FAX:(212)679-3114 PLM Bulk Asbestos Report Spectrum Environmental Associates, Inc Date Received 07/22/17 AmeriScl Job# 217074442 Attn: Bill Massman Date Examined 07/25/17 P.O.# P.O.Box 1024 ELAP# 11480 Page 1 of 5 RE:17-371; 28 N. Church St. Schenectady, NY 12301 Client No./HGA Lab No. Asbestos Present Total %Asbestos 1 217074442-01 No NAD 1 Location: Kitchen-Sheetrock (by NYS ELAP 198.1) by Bella J.Chernis on 07/25/17 Analyst Description:Grey/Tan,Homogeneous,Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 20%, Non-fibrous 80% 2 217074442-02 No NAD 1 Location: Living Room-Sheetrock (by NYS ELAP 198.1) by Bella J.Chemis on 07/25/17 Analyst Description:Greyrran,Homogeneous,Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 25%, Non-fibrous 75% 3 217074442-03 No NAD 2 Location: Kitchen-Joint Compound (by NYS ELAP 198.1) by Bella J.Chernis on 07/25/17 Analyst Description:White,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 4 217074442-04 No NAD 2 Location: Living Room-Joint Compound (by NYS ELAP 198:1) by Bella J.Chernis on 07/25/17 Analyst Description:White,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 5 217074442-05 Yes Trace(<0.25% pc) 3 Location: Kitchen-Popcorn Ceiling (EPA 400 PC) by Bella J.Chernis on 07/25/17 Analyst Description:White,Homogeneous,Fibrous,Bulk Material Asbestos Types:Chrysotile <0.25%pc Other Material: Cellulose 2%, Non-fibrous 98% See Reporting notes on last page tla�y e 171152 AmerlSci Job#: 217074442 Client Name: Spectrum Environmental Associates,Inc. Page 2 of 5 PLM Bulk Asbestos Report 17-371; 28 N. Church St. Client No./ HGA Lab No. Asbestos Present Total %Asbestos 6 217074442-06 Yes Trace(<0.25% pc) 3 Location: Living Room-Popcorn Ceiling (EPA 400 PC) by Bella J.Chemis on 07/25/17 Analyst Description:White,Homogeneous,Fibrous,Bulk Material Asbestos Types:Chrysotile <0.25%pc Other Material: Cellulose 2%, Non-fibrous 98% 7 217074442-07 Yes Trace(<0.25 % pc) 3 Location: Upstairs Hall-Popcorn Ceiling (EPA 400 PC) by Bella J.Chemis on 07/25/17 Analyst Description:White,Homogeneous,Fibrous,Bulk Material Asbestos Types:Chrysotile <0.25%pc Other Material: Cellulose 1, Non-fibrous 99% 8 217074442-08 No NAD 4 Location: Basement-2 X 2 Ceiling Tile (by NYS ELAP 198.6) by Bella J.Chemis on 07/25/17 Analyst Description:Beige,Homogeneous, Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 55.9% 9 217074442-09 No NAD 4 Location: Basement-2 X 2 Ceiling Tile (by NYS ELAP 198.6) by Bella J.Chemis on 07125/17 Analyst Description:Beige,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 43.8% 10 217074442-10 No NAD 5 Location: Kitchen Floor-1 X 2 Grout (by NYS ELAP 198.1) by Bella J.Chemis on 07/25/17 Analyst Description:Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 11 217074442-11 No NAD 5 Location: Kitchen Floor-1 X 2 Grout (by NYS ELAP 198.1) by Bella J.Chemis on 07125/17 Analyst Description:Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: O > f o 6 l f Other Material: Non-fibrous 100% C �—((,�`A-� See Reporting notes on last page 171152 AmeriSci Job#: 217074442 Client Name: Spectrum Environmental Associates, Inc. Page 3 of 5 PLM Bulk Asbestos Report 17-371; 28 N. Church St. Client No, f HGA Lab No. Asbestos Present Total %Asbestos 12 217074442-12 No NAD 6 Location: Bathroom Floor-3 X 3 Tile, (by NYS ELAP 198.1) by Bella J.Chemis on 07/25117 Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 13 217074442-13 No NAD 6 Location: Bathroom Floor-3 X 3 Tile (by NYS ELAP 198.1) by Bella J.Chemis on 07/25/17 Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 14 217074442-14 Yes 7.7 % 7 Location: Bathroom Floor-3 X 3 Adhesive (by NYS ELAP 198.6) by Bella J.Chernis on 07/25/17 Analyst Description:Tan,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types:Chrysotile 7.7% Other Material: Non-fibrous 23.2% 15 217074442-15 NAPS 7 Location: Bathroom Floor-3 X 3 Adhesive Analyst Description:Bulk Material Asbestos Types: Other Material: 16 217074442-16 No NAD 8 Location: Bathroom Floor-3 X 3 Grout (by NYS ELAP 198.1) by Bella J.Chemis on 07125/17 Analyst Description:Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 17 217074442-17 No NAD 8 Location: Bathroom Floor-3 X 3 Grout (by NYS ELAP 198.1) by Bella J.Chemis on 07/25/17 Analyst Description:Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material: Non-fibrous 100% c� See Reporting notes on last page 6 ( � 171152 AmeriSci Job#: 217074442 Page 4 of 5 Client Name: Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report 17-371; 28 N.Church St. Client No./ HGA Lab No. Asbestos Present Total %Asbestos 18 217074442-18 No NAD 9 Location: Attic-Insulation (by NYS ELAP 198.1) by Bella J.Chemis on 07/25/17 Analyst Description:Brown,Heterogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 85%, Fibrous glass 10%, Non-fibrous 5% 19 217074442-19 No NAD 9 Location: Attic-Insulation (by NYS ELAP 198.1) by Bella J.Chemis Analyst Description:Brown,Homogeneous,Fibrous,Bulk Material on 07/25117 Asbestos Types: Other Material: Cellulose 80%, Fibrous glass 12%, Non-fibrous 8% 20 217074442-20 No NAD 10 Location: Roof-Shingle (by NYS ELAP 198.6) by Bella J.Chemis Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material on 07!25/17 Asbestos Types: Other Material: Fibrous glass 2%, Non-fibrous 30.3% 21 217074442-21 No NAD 10 Location: Roof-Shingle (by NYS ELAP 198.6) by Bella J.Chemis Analyst Description:Black,Heterogeneous,Non-Fibrous,Bulk Material on 07/25117 Asbestos Types: Other Material: Fibrous glass 1 %, Non-fibrous 33.2% 22 217074442-22 No NAD 11 Location: Roof-Tar Paper (by NYS ELAP 198.6) by Bella J.Chemis Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material on 07/25/17 Asbestos Types: Other Material: Fibrous glass 3%, Non-fibrous 31.7% 23 217074442-23 No NAD 11 Location: Roof-Tar Paper (by NYS ELAP 198.6) by Bella J.Chemis Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material on 07/25/17 Asbestos Types: Other Material: Fibrous glass 1 %, Non-fibrous 17.4% See Reporting notes on last page 171152 AmeriSci Job* 217074442 Page 5 of 5 Client Name: Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report 17-371; 28 K Church St. Reporting Notes: Analyzed by.Bella J.Chemis 'NADNSD=no asbestos detected;NA=not analyzed;NAPS=not analyzed/positive stop,(SOF•V)=Sprayed On Fireproofing containing Vermiculite; (SM-V)=Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis by EPA 600/M4-82.020 per 40 CFR 763(NVLAP 200546-0),ELAP PLM Method 198.1 for NY friable samples,which includes the identification and quantitation of vermiculite or 198.6 for NOB samples or EPA 400 pt ct by EPA 600JM4-82-020(NY ELAP Lab 11480);Note:PLM Is not consistently reliable in detecting asbestos In floor coverings and similar non-friable organically bound materials. NAD or Trace results by PLM are Inconclusive,TEM Is currently the only method that can be used to determine if this material can be considered or treated as non asbestos-containing In NY State(also see EPA Advisory for floor tile,FR 59,146,38970,8/1194)National Institute of Standards and Technology Accreditation requirements mandate that this report must not be reproduced except in full without the approval of the Iab.This PLM report relates ONLY to the items tested.AIHA-LAP,LLC Lab ID 102843,RI Cert AAL-094,CT Cert PH-0186,Mass Cert AA000054. Reviewed By: END OF REPORT AmeriSci Job#: 217074442 Page 1 of 2 Client Name: Spectrum Environmental Associates, Inc. Table 1 Summary of Bulk Asbestos Analysis Results 17-371; 28 N. Church St. Sample Heat Acid Insoluble AmeriScl HG Weight Sensitive Soluble Non-Asbestos '*Asbestos%by "Asbestos%by Sample t3 Client Sample# Area (gram) Organic% Inorganic% Inorganic% PL.MJOS TEM 01 1 1 — — — NAD NA Location: Kitchen-Sheetrock 02 2 1 — — — — NAD NA Location: Living Room-Sheetrock 03 3 2 — -- – — NAD NA Location: Kitchen-Joint Compound 04 4 2 ---- -- — -- NAD NA Location: Living Room-Joint Compound 05 5 3 — — — — Chrysotile<0.25 NA location: Kitchen-Popcom Ceiling 06 6 3 — -- — -- Chrysotlie<0.25 NA Location: Living Room-Popcorn Ceiling 07 7 3 — --- — -- Chrysotile<0.25 NA Location: Upstairs Hall-Popcorn Ceiling 08 8 4 0.288 20.1 24.0 55.9 NAO NAD tjxzUon: Basement-2 X 2 Ceiling Tile 09 9 4 0.178 19.7 36.5 43.8 NAD NAD Location: Basement-2 X 2 Ceiling Tile 10 10 6 ---- -- — — NAD NA Location: Kitchen Floor-1 X 2 Grout 11 11 5 — — — --- NAD NA --� Location: Kitchen Floor-1 X 2 Grout ( 12 12 6 — — — -- NAD NA Q Location: Bathroom Floor-3 X 3 Tile 13 13 8 — — -- — �? NAD NA Location: Bathroom Floor-3 X 3 Tile ` 14 14 7 0.136 53.7 15.4 23.2 Chrysotile 7.7 NA Location: Bathroom Floor-3 X 3 Adhesive 15 15 7 0.196 51.5 18.9 29.6 NAPS NA \� Location: Bathroom Floor-3 X 3 Adhesive 16 16 8 — — — — NAD NA Location: Bathroom Floor-3 X 3 Grout See Reporting notes on last page ..s N AmeriSci Job#: 217074442 Page 2 of 2 Client Name: Spectrum Environmental Associates, Inc. Table I Summary of Bulk Asbestos Analysis Results 17-371; 28 N.Church St. Sample Heat Acid Insoluble AmeriScl HG Weight Sensitive Soluble Non-Asbestos '*Asbestos%by ""Asbestos%by Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM 17 17 8 — — — NAD NA Location' Bathroom Floor-3 X 3 Grout 18 18 9 — — -'"' NAD NA Location: Attic-Insulation 19 19 9 — — — — NAD NA Location: Attic-Insulation 20 20 10 0.229 21.4 46.3 32.3 NAD NAD Location: Roof-Shingle 21 21 10 0.368 22.3 43.5 34.2 NAD NAD Location: Roof-Shingle 22 22 11 0.219 9.1 56.2 34.7 NAD NAD Location: Roof-Tar Paper 23 23 11 0.255 10.2 71.4 18.4 NAD NAD � Location: Roof-Tar Paper Analyzed by:Karol H.Lu Date Analyzed 7/26/2017 "Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by EPA 600/M4-82-020 per 40 CFR or ELAP 198.1 for New York friable samples or ELAP 198.6 for New York NOB samples;TEM (Semi/Full)by EPA 600IR-93/116(not covered by NVLAP Bulk accreditation)or ELAP 198.4;for New York samples:NAD=no asbestos detected during a quantitative analysis;NA=not analyzed;Trace= <1%:(SOF-V)=Sprayed On Fireproofing containing Vermiculite;(SM-V)=Surfacing Material containing Vermiculite:Quantitation for beginning weights of<0.1 grams should be considered as qualitative only,Qualitative Analysis:Asbestos analysis results of"Present"or"NVA=No Visible Asbestos'represents results for Qualitative PLM or TEM Analysis only(no accreditation coverage available from any regulatory agency for qualitative analyses):NVLAP(PLM)200548-0,NYSDOH ELAP Lab 11480.AIHA-LAP,LLC(PLM)Lab ID 102643. Warning Note:PLM limitation,only TEM will resolve fibers<0.25 micrometers in diameter.TEM bulk analysis is representative of the fine grained matrix material and may not be representative of non-uniformly dispersed debris for which PLM evaluation is recommended(i.e.soils and other heterogenous materials). Reviewed By: J 8 S SPECTRVAf P.O.Bax 2324 Sdtenectady,NY 12331 (318)346-6374(Phone) rEadmnmental Rssedates.Inc. 'Exctsotpn (3 rB>34s-4362(Fax) o ooR CLmxrs Exveero oxs or BxeBLLvxcB• wtvev.49-406 m.com BULK SAMPLING CHAIN OF CUSTODY cam.mro7Lra14> 0 2 1 7 0 7 4 4 4 2 PROJECCINFORMATION Pro)=0: BudNK=c: Matrix Analysis Requesteduested Turnaround17-37r W )r. � st 57w :7/x0m "�tc�"m ❑ ilk ❑ Paint PLM-ELAP 198.1 TEM-ELAP 198.4 ❑ RUSH ❑ 24 Hour of �t, r �"Or*re 0, f �t'L❑Soil ❑ Wipe PLM-ELAP 198.6 ❑ ❑ 72 HourJA S pal_ SAMPLE IDENTIFICATION P-* Sample iD#: Group#:" Material Sample Location Condition/Comment Irockz*-As t.,v 1.. r M L•v. S 3 Ropcornt•� {rc L 3 4 r -� 7 `3 ti `t ti S Lxk ( =1 /� 4 :! Q',�►-ei-` F/cabs $ Gr-n-& v t• *Unless otherwise stated please analyze ench_gmup to Arai 1positive result. mments: ~ F CUSTODY v Relinquished By Date Time 'Received By Date Time Method of Submittal 1 ill Environmental Consulting & Management Services R'ealth & Safety Training Laboratory Services 07 P. S 83 Box roe) Schenectady.XV 12301 SPECTRVq B (578)848-8374(Phone) Em*onmenwt?ssociaft.Inc. (318)346-4062(Pax) Of •BrcrrDlya OBR CLYIAW BXPIM"MA'S or BXCBLLBNCr• uww.4spectj7m-cpm BULK SAMPLING CHAIN OF CUSTODY akev.07/W/2014> 01- 217074442 PROJECT INFORMATION building N&= S f Matrix Analysis Requested Turnaround DmoSmrl�&y�/� { M i Bulk ❑ Paisd PLM—ELAP 198.1 —EL.AP 198.4 ❑ RUSH ❑ 24 Hour (! I� 1 D,ge n of � tnwtigator: ❑ Soil ❑ Vrpe r PLM—ELAP 198.6 ❑ ❑ 72 Hour t�t7t, Mr 1 P SAMPLE IDENTIFICATION Sample ID!E: Group Tl:• Material Sample Location Condition/Comment e r Tom• P� �- �r -�R-A-A �Ilj 1 Q` unt• otherwlse stated pteasc nnntyre meh itroup to first(n positive result. mmems: CHAIN OF CUSTODY Relinquished By Date Time Received By Date Time Method of Submittal I xl/l ni r \Environmental Consulting & Management Services Health & Safety Training • Laboratory Services � 01 BV PROJECT MONITOR FINAL VISUAL INSPECTION(S) ' tt u.tkAx 1014 s��,efuytor�r;O,to rot ` SPECTR (s�1.K);{4ti�tr.l7a(PteanP) Etivirotnmetttallissociates. Itic, (SGY)3411-4061(Pur) 't'i l l E PIA,:OPT 0..At,A r.VA P T r a f I04%"r t.'t t t i t t'XI i.' wwty,4sto Nrutruwn+ Final Visual Clearance Checklist Project Name: Date: 28 N Church Lane Queensbury 10/5/2017 Work Area: Project Number: Garage 17-479 Material Removed: quantity Removed: Fire damage 970sf Project Monitor: Michael DeRuyter Certificate Number: 17-27607 Procedure or Activity Yes No N/A Critical Barriers Intact ✓ Negative Air Machines Running ✓ All Gross Material Removed From Work Area ✓ Length of Waiting Period Observed Visible Debris Present All Bags and mist.equipment/tools has been removed ✓ Visual Inspection per ICR 56.9.1(d) "In accordance with ICR 56-9.1 (d)the project monitor has visually inspected the work area(all surfaces including pipes,beams,ledges, walls,ceiling and floor,decontamination unit,sheet plastic,etc.)accompanied by the asbestos V/ abatement contractor's supervisor, and has observed the scope of the abatement as per the provided contract documents,and for the presence of visible dust,debris,or residue is apparent on any surface within the work area." Date of Inspection: Time of Inspection: 10/5/2017 140() Visual Inspection clear per ICR 56.9.1(d) Supervisor Logbook Signed ✓ Sampling Conducted in Accordance with ICR 56-9.2(d) or Site Specific Variance Pre-Sampling Agitation (5 minutes per 1000 ftz of floor space) On Going Agitation(1-20" Fan per 10,000 ft') ✓ Your signature certifies that the aforementioned listed items are in compliance with all state& federal rules and regulations. Signature: Date: l Environmental Consulting&Management Services • Health&safety 7Y,aining • laboratory Services P 0.1ka 10"1.4 SPECTRVM eNIN)SYhr+rerlodjs 1W,M301 346-6374(111sone) Etivirommental Rswelates, lrlc. (518)MO-400?(hrx) l:.1 rr.1-14114141 01 V%(u.rr.cr[• www,,4spedrnrnxern Final Visual Clearance Checklist Project Name: Date: 28 N Church Lane Queensbury 10/6/2017 Work Area: Project Number: Upstairs Bathroom 17-479 Material Removed: Quantity Removed: Tile and Mastic 49sf Project Monitor: Michael DeRuyter Certificate Number: 17-27607 Procedure or Activity Yes No N/A Critical Barriers Intact ✓ Negative Air Machines Running ✓ All Gross Material Removed From Work Area ✓ Length of Waiting Period Observed Visible Debris Present All Bags and mist.equipment/tools has been removed ✓ Visual Inspection per ICR 56.9.1 (d) "In accordance with ICR 56-9.1 (d)the project monitor has visually inspected the work area(all surfaces including pipes, beams,ledges, walls, ceiling and floor,decontamination unit,sheet plastic,etc.)accompanied by the asbestos ✓ abatement contractor's supervisor,and has observed the scope of the abatement as per the provided contract documents,and for the presence of visible dust,debris,or residue is apparent on any surface within the work area." Date of Inspection: —77:1Time of Inspection: 10%6/2017 0700 Visual Inspection clear per ICR 56.9.1(d) ✓ Supervisor Logbook Signed ✓ Sampling Conducted in Accordance with ICR 56-9.2(d) or Site Specific Variance Pre-Sampling Agitation (5 minutes per 1000 ft'of floor space) ✓ On Going Agitation ( 1-20" Fan per 10,000 ft') ✓ Your signature certifies that the aforementioned listed items are in compliance with all state& federal rules and regulations. Signature: Date: 10/6/2017 Environmental Consulting&Management Services •Health&Safety Training • Laboratory Services SPECTRUM ENVIRONMENTAL ASSOCIATES, INC. LICENSING AND CERTIFICATION(S) P.0.Box.10211 SPECTRVM Schenectady,AT 12301 (518)3,16-6374(Phone) Inc. (518)346-4062(Fax) ET1VIt"OI1Tt1C'lXl�f11 associates, Inc. 'L''XCEEDING OUR CI.IEYTS EXPECTjITIO:YS OF EXCELLEXCE' State of New Fork— Department of [Abor Asbestos Certification STATE OF NEW YORK-DEPARTMENT OF LABOR &CRESTOSCERTIFICATE MICHAEL S DERUYTER CLASS(FXPI RES) _ C ATEC('1{18) D INSP(11)18) H PM (11t18) MUST RE CARRIED ON ASBESTOS PROJECTS IF FOUND RETURN TO: EYES BRO NYSDOL - L&C UNIT HAIR BRO ROOM 161A BUILDING 12 ` �c N HGT 6' 00" STATE OFFICE CAMPUS ALBANY NY 12240 C Sime of New York — Department of Labor Codes Certification A Asbestos Handler B Restricted Handler -Allied Trades C 1. Air Sampling Technician I D Inspector — I Management Planner Operations and Maintenance G _ Supervisor H Project Monitor 1 , Project Designer Ftivironrnental Cotrsalting&DManagetnenl Services • lleallh&Sa!etr Training • I aboratotT Services New York State—Department of Labor Division of Safety and Health License and Certificate Unit State Campus,Building 12 Albany,NY 12240 ASBESTOS HANDLING LICENSE Spectrum Environmental Associates, Inc FILE NUMBER: 99-0129 LICENSE NUMBER: 29081 P.O. Box 1024 LICENSE CLASS: RESTRICTED DATE OF ISSUE: 01/26/2017 Schenectady, NY 12301 EXPIRATION DATE: 02/28/2018 Duly Authorized Representative—William L Massmann: This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1) serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack;of responsibility in the conduct of any job involving asbestos or asbestos material. This license is valid only,for the contractor named above and this license or a photocopy must be prominently displayed at the asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State Department of Labor. Eileen M.Franko, Director SH 432(8/12) For the Commissioner of Labor NEW YORK STATE DEPARTMENT OF HEALTH WADSWORTH CENTER Expires 12:01 AM April 01,2018 Issued April 01, 2017 it CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance with and pursuant to section 502 Public Health Law of New York State MR. JAMES A. CAPASSO II NY Lab Id No: 11540 SPECTRUM ENVIRONMENTAL ASSOCIATES INC 2539 ALBANY STREET SCHENECTADY, NY 12304 is hereby APPROVED as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES AIR AND EMISSIONS All approved subcategories and/or analytes are listed below: Miscellaneous - Fibers NIOSH 7400ARULES -Serial No.: 56066 Property of the New York State Department of Health. Certificates are valid only at the address shown,must be conspicuously posted,and are printed on secure paper. Continued accreditation depends on successful ongoing participation in the Program. Consumers are urged to call(518)485.5570 to - verity the laboratory's accreditation status. Page.I of 1