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asbestos documentation
C:T.MALE ASSOCIATES Engineering,Surveying,Architecture,Landscape Architeclure &Geology,0.P.C ARI 5O.Century Hilbrve,Latham,NY 12110 FAS =518.786.7400 FAX 518.786.7299 ctmale@ctmale.com November 26,2019 FILE COPY Frank Trombetta M.T.Associates 247 North Main Street Rutland,Vermont 05701 NOV 26 2019 ‘TOWN OF QUEETBUILDING ENSBURY Re:Asbestos Abatement Project Closeout Report Interior ~Former Restaurant -1477 Route 9,Queensbury,NY CTM Project No.:19.9352 Mr.Trombetta; Please find enclosed documentation for the abatement of asbestos containing materials from the interior of the former restaurant located at 1477 Route 9 in Queensbury,New York,‘These documents include C:T,Male’s NYSDOL license,Project Monitor certifications,Project Monitor logs,and air sample results for the project.This project included the removal and disposal of approximately 40 Sq.Ft,of asbestos containing floor tile from the kitchen storage area and approximately 30 Sq,Ft,of asbestos containing ceramic tile adhesive from the dining room fireplace at the above referenced structure. ‘The clearance air sample data,in conjunction with C.T.Male’s final clearance visual inspections, provide documentation of satisfactory completion of the abatement project.The abatement project was completed in accordance with the applicable portions of 12 NYCRR Part 56, The abatement work started on November 19,2019 and was completed on November 22,2019 by Jackson Demolition Service,Inc.of Schenectady,NY.Contractor closeout documentation, including waste disposal manifests,should be provided by the contractor under separate cover. ene TOWN OF QU Sincerely,BUILDING &C CT.MALE ASSOCIATES Reviewed By:ile Lf oS.____Gee Michael F.Sawyer Managing Industrial Hygienist 288.-1-59 DEMO0-0771-2019 MT Associates 1477 State Rte 9 Demolition of Commercial Building Civ Engineering «Environmental Senices «Survey Services *Land Services +Architecture « Energy &Building Systems Services »Electrical Engineering New York State =Departmient of Labor: Division of Safely and Health License and Gentficate Unit State Campus,Building 12 ‘Albany,NY_12240 ASBESTOS HANDLING LICENSE GT.Male Associates Engineering,Surveying,FILE NUMBER:99-0722 ‘Architecture &Landscape Architecture &Geology,LICENSE NUMBER:28050) DPC.LICENSE CLASS:RESTRICTED DATE OF ISSUE:10/17/2019 50 Century Hill Drive EXPIRATION DATE:10/31/2020 Latham,NY 12110 Duly Authorized Representative —Daniel Reilly! This li@ehse 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 Patt $6).Itis subject to suspension or revogation Tor a (1) serious Violatiowf slate,federal or local laws.with regard 16 the conduct of an asbestos project;or (2)demonsttated lack of responsibility in the conduct of any job involying asbestos or asbestos material This ligenstis Valid only for,the Contractor named dbove and this license ‘oF @ photocopy must be prothinently displayed at the asbestos project worksite»,This license verifies thatall 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 Stato Department of Labor. CAM hake 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 01,2020 Issued April 01,2019 CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance with and pursuant to section 502 Public Health Law of New York Stato 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 AIR AND EMISSIONS All approved subcategories and/or analytes are listed below: Miscellaneous Asbestos 40 CFR 763 APXANo.Il YAMATE AGARWAL GIBB, NIOSH 7402 Fibers NIOSH 7400 A RULES: Serial No.:59675 Property ofthe New York State Department of Heath.Carticates aro valid only atthe address ‘shown,must be conspicuously posted,ad are printed on secure paper.Comiinved aceedtaton depends ‘on successful ongoing partspaion in he Program.Consumers are urged 0 cal (518)485-5570 to Vly ho laboratory's accreditation status. C.T.MALE ASSOCIATES ENVIRONMENTAL SERVICES FIELD LOG pate:{1 hali4 Time On-Site:_OYUS.Time Off-Site:_\ORO Project Name:|@\.ASK Project No.:i Contractor /Supervisor:jumber of Workers: Description of Daily Work Area:“Ewe Olace GM) Materials Being Abated:Flag Wn|C-evermac tr Malang Technician Name:_G.Devgan.ae_Observations:‘os ¥SMOuS O4US:Monsey aves orake,IMF 24.4 Queda Medias 10 seb 0850:{|samples oe and vonnimd, OO:Mondey clos cv sowpinith enuiouaurl |deporte,ereYvnlossparc)-gv OMSLAton ter collecsS savQues/eapipvett 1oa0*,Money depouke Sey CHA \120h,Monsey avrier al Cra,enol Shite C.T.MALE ASSOCIATES ENVIRONMENTAL SERVICES FIELD LOG Date:Ze gaufey THiS Ste:_FOE Time of-site:_/,2 30 Project Name:1499 C4 S.9 CPreerghec Project No:/9 93e72 Contractor /Supervisor:Number of Workers: Description of Daily Work Area: Materials Being Abated: Technician Name:Eotuds,.pea Observations: ;74 ;Bhat +bertars Chas BY 2Aop WA sapnip L1 Did?Cole Cponta LM obo ~SelahWieLL75-39 han ae opfpsee “Lugs 40 aN satdus portcosse yo ssa spe Poem ou au sssanog geen Uoys pode ae Sones ee “TERING "6LOTIOZIT 1 “Paekjeuy avec] “OH ‘A Auuoy_ <q pozkjeny *pa96tZ# TeuDs “edoosassI THE |SPOWN ‘sndukIG we Sus 2pG/¢1/8 "TH BN58 PoIRW (VIOOPL HSOIN AE ontff anyon ae Ou ye (W430) sqduos 3s prroeD oq ouRND 27g (1) ssa10N Bupsoday 4 sseyoujoog ueig pets *wone207 wy 4 oo! ° ° ° eu sods 80 4 :seyouroog yueig ge :uone907 sh oo ° ° ° ever 20d86 1614) rr) ‘inqnsen Anu quod - vAKO *4ONIEDOT ‘yoo0> ze e 0 v8 so 66 9048616; 20 ainqnsen Ava wold - YMO :4oneso7 v00'0> wo s ool 70 so 66 eLeHiLL sodseieiy so ‘ainqusen Aqua qos - vMO "uoHeSeT 9000 ss sv. oor 48 so 66 8u pOdSBLELLE ¥0 ‘onjdas.s iv - vA woneDe7 6000 ez a oot +09 9 66 eueii e0g86 16141 £0 ‘0eidesis I¥- val *woneDO7 y00'0 > 9 s oot v8 99 ee eu zoaset6i zo ‘opidau.s iv - vial :UoHRD07 Li00 eee vo oo eueuY Lodseiehit 40 WML—(oosieqi4) (zuuysieqi4) S184 SIA eyali0g # alduies WUE #ejduies ‘u09 sieqly Alsued 48414 ere Psuewy punouSyoeg ‘aniseypy S1Wes8D /QI J00|,4 - eoe|deu|4 / UaYoy.y - AInqsuseNd ‘6 “ei L/L ‘seleloossy “LW ‘z9¢6'61. synsey Jeq14 (Wd) AdoososoyIy ysesjU0D aseyd soqetoossy 9 SIN “L.°O. :SWEN 1U9IID 140| eBeg VEEZLEGIZ :# Gor joSueWY C.T.Male Associates Engineering,Suveying,Architecture &Landscape Architecture,DP.C. 50 Century Hill Dive Lain,NY 2107480518-786-7259 (x) custfantsNOT:kssootatess ‘ACM ABATED.Fleortite|CeeNTFOYQocey work anc _Kiteverr_}Eiceghace evonseMbestv@__—ae AIR SAMPLE DATA prorct#JQ.9259 conectev sy_S .Oxetso7)_ pave couecre.WLSparleoe CONTRACTOR:“i Se BOCUMENT ID#_TURNAROUND:Rush 12 ie ;=cal |sae ae ee |e ee |om FIBERS FIBERS FIBERS]]{ GITERS)|FIELDS NWA AY Svepece meumes}|castes, WOR=AY Gwe genteoa _pa IWA-AA Ceca Esteed3poneEaVERDR - \ SRIOAN Cudy Vestine_O5|:A pagel =eaae |30|~bso55297 | ot aloban,| ese |jae{GaddWane 1 RECEIVED BY:(SIGNATURE)FBAve=_fibers/100field ||ETINOUISHER BY.SIGNATURE) 1|aQverson vas Tne [COMMENTS (PRINT) Standard Deviation NS YSDOTELAPEFaesolSere 007 EMAIL ALL RESULTS TO: m.sawyer@ctmale.com arogers@ctmale.com s.pierson@ctmale.com ‘SAMPLES RECEIVED MEET LAB fa ong_|SEEStg7ses9142934 — PageHor "anoay 40 0Na— ha pany 0 Fe POIMRSED (01 ‘Se ONAN 3 J on Bjsioqy ae posite se adres yp 0 TNO Sees ods SL_‘Uoday sw Soja pyeosse Jo ssa nfe pos ou az 243m =F a pau se SOGHOE UN -URIINY /1 P>Y OO SORE UOC JO HET 1Oziezt | -paeKeuy eg a me soy 8g peasy Sgr ce Imus adooEOIN ZH I>POK “eENAIO HE FOS PASI “ZH AEH PONEW (VIOOEL HSOIN ‘Suun|OR sv Ou YER (SHUE|Q 10) sojdurws 40} porelno|e> 9q yoUUED 99/8I9qL4 (1) :89)0N Supsoday, 4 ssejoujoos (ge) zea wone07 W990 so oor ° ° ° even bnaelzzi ue 1 se)0u004 (Hom) Lg cuoneDe7 v0 so oo ° ° ° euiezitt ornasizz oO fenjp o1wese9 ym woneDo7 z000> ae b oo elas 98 ve eyez eoHseizzhs 60 ‘nip o1wes09 YM :UOREDOT z000> ssz z oo eta 98 ve eueaiiy soHselzzby 80 ‘nig 21ue189 Yaal “UoReD07 200°0 > os + 01 gut 98 vob euezies doHs6Lzz44 40 ILL "ld WAN! ‘UoReD07 z00°0> ssz z oo ez 98 by euezius 90HYeIZZLL 80 iLL "1s WAN *uoREDOT 200'0 > ze e oo elzt 98 by eueeit soHs6rzzh) 0 1, 13 WAN! *u0ne907 z00'0 > wo s oor eben 98 bee woHs6lzzhb +0 aieus WMO :uone907 zo00> soz z oo eve 88 bye euezins eoHselzzb1 e0 aves vO :uoReI07 zooo> ewe e oo elt 98 ve eueziy zonselzzit zo aseUS VO :uone207 2000 > a a oor ez 98 a eveeity boHsei2: 0 WML (o9/siaqid) ( zumysieqis) HQ SPI (ssey) um) Cumyysiey))—payation #ordwes weH}d #aidwes ‘ouo9 sieqi4 Aisueg seqi3 Palsys ty uoHeNg ste Moly Ie pgueuy seULS “(any [UL J) jae, B9B\q aul - BBEsO}g “Wy - AINqsuseND ‘6 'S'N Zyl ‘6 'S'N LZyl ‘ZGE6'6L syinsey 40q14 (WOd) Adoosos91W ysesjU0D aseyd SO}EIOOSSY 8 BIEN “LD “@UIEN TAH 140 eBed SOPELLELZ :# Gor ogueWY C.T.Male Associates AIR SAMPLE DATA Engineesing,Gurveying,Architecue &Landscape Architecture,DP.C 50 Century Till Driveete 219115405 ca Bio$2 et M122 U8hesenshury ores LI J383. acmapaTen_/Ctugt Anv pate couecten.J/“2?77 ‘ABATEMENT.LAB -aa Beunesoh_oeTTRR[Tears mepe ae Ee [wie |FIRERS ]FBERS[Fines_ae : | ERA | (LITERS)|nets a “ W317 . TAT)|i“Fo lat Hh,WAS iy Ge PA fay,oO,Lh)|Bra bo A Sharad,SA 8674) W314 ‘hosed /Lh.eu0s|len 5 i513 eo TOL aaping[4]Chey |Lot Fy te _\p6a Ye 06 per>alAwee fanfeLY13013/660 (4)ose,|ea (Ss =~LL ===+4 Moe [us fe TL oy se xo VET 013 |WT ;|"Suen Tien Bh ae 6b iy 21d |a Weite Dean bervnate Ged ISR 8 yyip 120?7 a |Pid | |Pieg fir Pores ChadpSppdMo ip IP7ho||EBL wah ||_|2 yy EB |{es | cat SNQUETED BY SIGNATURE |RECEIVED By SIGNATURE)bx [ie [SOBERaeMApmoeubyas | [EME a TRIN) iu Mier|EMAIL ALL RESULTS TO: m.sawyer@ctmale.com a.rogers@ctmale.com s.pierson@ctmale.com Dey nt of Labor Andr M.Ct ,Ge s RobertaL-Reardon,Commissioner=|FILE COPY August 23,2019 C.T.Male Associates 50 Century Hill Drive Latham,NY 12110 F QUEENSBUI LDING &CODES” RE:File No.19-1142 Dear Sir/Madam: STATE OF NEW YORK DEPARTMENT OF LABOR DIVISION OF SAFETY AND HEALTH The attached is a copy of Decision,dated,8/23/2019,which |have compared with the original filed in this office and which |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 8/23/2019. Loovliids Edward A.Smith,P.E. Professional Engineer 2 (Industrial) 288.-1-59 DEMO-0771-2019 MT Associates 1477 State Rte 9 esDemolitionofCommercialBuilding STATE OF NEW YORK DEPARTMENT OF LABOR STATE OFFICE BUILDING CAMPUS ALBANY,NEW YORK 12240-0100 Variance Petition of C.T.Male Associates,P.C. Petitioner's Agent on Behalf Of MT Associates Petitioner inre Premises:Former Restaurant 1477 Route 9 Queensbury,New York 12804 Controlled Demolition with Non-Friable ACM in Place File No.19-1142 DECISION Cases 1 ICR 56 The Petitioner,pursuant to Section 30 of the Labor Law,having filed Petition No.19-1142 on August 23,2019 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 August 19,2019;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: Page 2 of 6 File Number 19-1142 Case No.1 ICR 56-11.5(b)(1) VARIANCE GRANTED.The Petitioner's proposal for removal of ACM from vacant buildings prior to being demolished at the subject premises in accordance with the attached 02-page stamped copy of the Petitioner's submittal,is accepted;subject to the Conditions noted below: THE CONDITIONS 1.Afulltimeprojectmonitorshallbeonsiteandresponsibleforoversightof the abatement contractor during all abatement activities to ensure compliance with ICR 56 and variance conditions. 2.The Project Monitor shall perform the following functions during asbestos abatement projects in addition to functions already required by ICR-56: a.Inspect of the interior of the asbestos project work area made at least twice every work shift accompanied by the Asbestos Supervisor; b.Observe and monitor the activities of the asbestos abatement contractor to determine that proper work practices are used and are in compliance with all asbestos laws and regulations; c.Inform the asbestos abatement contractor of work practices that,in the Project Monitor's opinion,pose a threat to public health or the environment,and are not in compliance with ICR-56 and/or approved variances or other applicable rules and/or regulations; d..Document in the Project Monitor Log observations and recommendations made to the Asbestos Supervisor based upon the interior/exterior observations of the asbestos project made by the PM. 3.The PM shall alert the nearest District Office of the NYSDOL Asbestos Control Bureau whenever,after the PM has provided recommendations to the Asbestos Supervisor,unresolved conditions remain at the asbestos project which present significant potential to adversely human health or the environment. 4.All generated waste removed from the site must be documented,accounted for and.disposed of in compliance with the requirements of NESHAPS and NYSDEC. 5.All non-friable flooring and/or mastic materials shall be removed as per all the provisions of ICR 56-1.1.7,AV-A-3 and this variance. Removal ofall Friable ACM,Tran: Page 30f6 File Number 19-1142 {Cement Boat Other Not ACM Prior to Controlled Demolition 6.All friable ACM,non-friable transite/cement board (using intact methods as long as the matrix of transite material has not been disturbed in accordance with the submitted petition),and other non-friable ACM that will likely become crumbled,pulverized,or reduced to powder during controlled demolition at the subject premises shall be removed in accordance with ICR 56 and this variance decision,including obtaining satisfactory clearance air results for all regulated abatement work areas (as necessary),prior to the commencement of this controlled demolition asbestos project.REMOVALS SHALL ONLY BE DONE IF WORKER SAFETY IS NOT ENDANGERED DOING SO.OTHERWISE,FULL COMPLIANCE WITH ICR 56-11.5 IS REQUIRED. Secure the Work Site 7 The entire controlled demolition area and all surrounding portions ofthe 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. 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 9. 10. 11. 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 at the reduced barrier. Entry/Exit of all persons and equipment shall be through one designated and secure “doorway”in the barrier or fence,which shall provide an adequate and appropriate means of egress from the work site. 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 Page 4 of 6 File Number 19-1142 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 12. 13. 14, 15. 16. lite 18. 19. 20. 21. 22, The provisions of 56-11.5 shall be followed for controlled demolition removals,except as modified by this variance. Decontamination system enclosures and areas shall be constructed and utilized as per the requirements of 56-7.5(d)and 56-11.5. 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. No dry disturbance or removal of asbestos material shall be permitted. Wastewater shall be confined within the controlled demolition area.Water may be allowed to accumulate in basements during demolition activities. 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. In areas where ACM is removed,a drop cloth,made of six (6)mil fire retardant polyethylene sheeting shall be placed and adequately sized on the ground near the work area to prevent spread of any ACM remnants. All demolition debris,structural members,barrier components,used filters and similar items shall be considered to be asbestos containing materials/asbestos contaminated waste and treated accordingly. In addition to the requirement of Subpart 58-4,9(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. Daily abatement air monitoring is required only on days when abatement or support activities such as ACM disturbance or cleaning activities are performed. The contractor shall observe,at a minimum,the following waiting (settling/drying)periods:Demolition -2 hrs. Page 5 of 6 File Number 19-1142 23.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. 24.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. Site Soil Cl up: 25.The site where the demolition occurred shall be assessed and cleaned up as follows. 26.Soil cleanup shall include,all visible asbestos or suspect asbestos debris. Soil removal shall meet ASTM 1368 (latest edition),Section 9.1.1-9.1.5 inspection criteria. 27.No pieces of ACM shall be present on top of the soil. 28.—Visibly contaminated soil or soil suspected of being contaminated shall be removed down to the level where no visible contamination is noted. 29.The Project Monitor shall record the results of his/her inspection on the Project Log. 30.After abatement of the asbestos,all plastic sheeting and tape will be treated as contaminated material and properly disposed of asbestos waste at the end of the project. 31.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 14.A copy of this DECISION and the Petitioner's proposals shall be conspicuously displayed at the entrance to the personal decontamination enclosure, Page 6 of 6 File Number 19-1142 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 November 23,2019. Date:August 23,2019 ROBERTA L.REARDON id A.Smith,P.E. Professional Engineer 2 (Industrial) PREPARED BY:Mark G,Wykes,P.E. Professional Engineer 1 (Industrial) REVIEWED BY:Edward A.Smith,PE. Professional Engineer 2 (Industrial) New York State Department of Labor 191142 Division of Safety and Health -Engineering Services Unit Building 12 ,Room 159 State Office Campus Albany,N.Y.12240 Petition for an Asbestos Variance To apply for an asbestos variance the Project Designer must: ‘©Complete all of the information on pages one and two of this asbestos variance request.Please type or print. ‘Sign and date page two of the certification and all of the attachments. ‘=Send two copies of the petition and all attachments,with your $350 fee,to the address at the top of this page. ©Make your check or money order payable to the Commissioner of Labor. *Optional:To speed up the process you may include a self-addressed,stamped,express-mail envelope. 1a,Is this petition related to a safety or health emergency?Yes No b.ifyes,explain: 2a.Name of Petitioner,(Property Owner):MT Associates b,Street Address:217 North Main Street c.City:Rutland d.State:VT e.Zip:05701 {.Telephone Number:(g.Fax Number:(- h.Peftioner's Federal Employee Identification Number (FEIN) 3a.Petitioner's Agent (Asbestos Contractor)Firm Name:C.T.Male Associates.P.C. b.Street Address:50 Centurv Hill Drive ©.City:4.State:NY e.Zip:12110 f.Telephone Number:Lathan,518 )265 -3119 g.Fax Number:(518)786-7299 4a.Asbestos Contractor License No.29050 b.Name of Firm: 5.Building Description: a.Affecting premises known as:Former Restaurant b.These premises are situated on the __North,X East,West side of _Street,_/ c.County of et _d.Street Ad e.City Queensbury f.State:NY g.Zip 12804 hh.Is building occupied?Yes NoPeareeaaaxVane mans Contractors and some Staff present j.Approximate area (square feet)of building:4000 k.Number of stories or height in feet:1 i.What is within 25 feet of all four sides (North,South,East,West)of buildir ..Sidewalk,alley,land,anotherMeansotawercadewalearaPakageoelic 6.Order To Comply or Notice of Violation.Attach copy. a.Issued to:Owner Asbestos Contractor Operator Other b.Name on Order or Notice:c.Date issued:t / d.List the Industrial Code Rule (ICR)citations given on the Order to Comply or Notice of Violation: 7.Ifa variance has been granted previously for work closely resembling this project list: a.Variance number:b.Date variance granted:i / ‘SH 752 (0208)1 wotl:Ad 4 A,2ate typed or printed page for each work area and work procedure.Sign and date each page. 8.Work Area Description Table:Attach additional tables and scale drawings of work area and pictures,as needed. Work Exterior|WorkRoom|Type of Quantity of|Condition of Friability of|Type of Containment ‘Area or Area Asbestos ACM ‘ACM (level of||ACM (full,24ayer tent,single Designation|Interior|Dimensions|Containing damage)(non-friable|layer tent,open-air,etc.) Material (ACM)or friable) ‘See Attached, Letter 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 Letter 10.Hardship Description:Whats 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 Letter 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. 2.Will proposed abatement methods render non-friable ACM material friable?Yes No 'b.What proposed abatement method,increased engineering conirols and detailed procedures will be used to compensate for the relief being sought?(Le.Increased negalive air rate,negative pressure glovebag,negative pressure glovebox,high temperature ¢lovebag,intact component removal,etc.)Include sufficiently detailed procedures to complete the proposed work. See Attached Letteroo — Project Designer Certification |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. \certify that the information contained in this petition is true and accurate. 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 or«if there are violations of Article 30 of the New York State Labor Law or New York State regulations. {give the Commissioner of Labor permission to provide all of my companies records for Unemployment Insurance (U.1,)reports and contributions to employees of the New York State Department of Labor.This includes information about withholding,wage reporting,U.I.returns,U.L.registration,New Hires,and all records of U.I.delinquencies.This information may only be used for goverment 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. 42 a.Project designer name (print):Michael F.Sawyer m.sawyer@ctmale.com, b.Project Design Asbestos Contractor firm name:_C.T.Male Associates,P.C. c.Street:_50 Century Hill Drive d.City:__Latham.e.State:NY_f.Zip:12110 __ g.Phone:(543 )7g6 7480 h.Designer certificate number:_AH-88-06552 i.Expiration Date:gq __/.30_/19 j.Design Firm Asbestos Contractor License Number_29050.k,Expiration Date: jo _/31_19.| 41 a.Project designer signature:kfSng — b.Date:_08 /19;19 ‘SH 752 (0208)2 191142 C.T.MALE ASSOCIATES Engineering,Surveying,Architecture,Landscape Architecture &Geology,D-P.C.CRIFeI (4) 50 Century Hill Drive,Latham,NY 12110 I (fe) 518,786,7400 FAX 518.786.7299 www.ctmale.com el August 19,2019 Mr.Edward Smith,PE New York State Department Of Labor Engineering Services Unit Building 12,Rm.154 State Office Campus Albany,NY 12240 Re:Site-Specific Variance Petition -Incidental Disturbance Former Restaurant Building -1477 Route 9,Queensbury,NY Mr.Smith: The following is a petition for variance or other relief of the requirements per Industrial Code Rule 56 for asbestos abatement activities in the above referenced building. Incidental Variance Request: Building:Former Restaurant Building 1477 Route 9 Queensbury,NY Similar Variance Requests:NA ‘Type and approximate quantities of materials scheduled for abatement and affected by variance request: Compromised floor with asbestos containing sheet flooring -60 sq ft Other ACM not included in this Variance Petition: ©9'x9'floor tile -40 sq ft ©Ceramic Tile Adhesive -30 sq ft Anticipated Variance Closure Date:8/31/20 Project Description,Requested Relief and Suggested Methods The former restaurant is to be demolished to make way for future development.This building has been vacant for many years.The vast majority of the building is slab on grade,while the area in question is on a wood floor that is rotted out and hanging over a crawlspace area. CCivd Engineering +Environmental Services «Survey Services +Lond Services «Architecture « nergy &Building Systems Services «Eleclical Engineering 491142 C.T.MALE ASSOCIATES August 19,2019 Page -2 The idea is to abate the non friable floor tile and ceramic tile adhesive prior to demolition activity.There were no friable materials located.See the attached aerial views.We intend to demolish only the front right quadrant of the building where the bathrooms are located under ICR-56-11.5.Once this is done and has been cleared by the full time Project Monitor,the remainder of the asbestos free building will be demolished as a non-asbestos project. Proposed Work Plan Work shall proceed as follows: *Floor tile and ceramic tile adhesive will be removed per “normal”ICR-56 abatement requirements.«The Contractor will have a remote “large”project decon on site.The contractor personnel will don appropriate PPE. ©The Contractor will perform demolition of enough of the building to remove the compromised bathroom floors under ICR-56-11.5. ¢All debris in this area will be removed. The Project monitorwill perform final visual inspection to conform that this area of the building has been completed. ©Once final visual has passed,the remainder of the building will be demolished as anot asbestos project. ©Due to the non-friable nation of the sheet flooring in the bathroom,the waste generated during the small portion of the building being demoed under ICR-56- 115 does not need to be disposed of as RACM,but will be disposed of properly. We request relief as follows: NNo relief is requested per se.This is merely notice that these procedures will be followed. Please do not hesitate to call me at 786-7480 with any questions or if you need any further information. Sincerely, C.T.MALE ASSOCIATESeSaeMichaelF.Sawyer Managing Industrial Hygienist Petitioner /NYSDOL Designer #AH 88-06552 Untitled Map Write a description for your map. cd % 1477US.9 Untitled Map ' al Seine, Legend Write a description for your map. m6 Area of Bathrooms with ACM Sheet Flooring, ‘Cannot be safely abated prior to dem activity July 2019 ella]Asbestos Containing B )Material Surveyele Former Restaurant 1477 Route 9 Town of Queensbury Warren County,New York Prepared for:- NOV 26 2019 M.T.Associates Attn:Frank Trombetta 217 North Main Street Rutland,Vermont 05701 Prepared by: CT.MALE ASSOCIATES 50 Century Hill Drive Latham,New York 12110 288.159 DEMO-0771-2019 (618)786-7400 MT Associates FAX (518)786-7299 1477 State Rte 9 Demolition of Commercial Building C.T.Male Project No:19.9352 ‘Unauthorized alteration of addition to this document ea violation of the New York ©Copyright 2019 ‘Sate Education Law. C.T.MALE ASSOCIATES ASBESTOS CONTAINING MATERIAL SURVEY Former Restaurant 1477 Route 9 Queensbury,NY TABLE OF CONTENTS 1.0 INTRODUCTION... 2.0 SITE VISIT -ASBESTOS CONTAINING MATERIALS...... 3.0 SAMPLING AND LABORATORY ANALYSIS .... 4.0|CONCLUSIONS AND RECOMMENDATIONS .. TABLES TABLE 3.0 BULK SAMPLE ANALYSIS RESULTS APPENDICES APPENDIX A C.T.MALE ASSOCIATES CERTIFICATIONS APPENDIX B LABORATORY CERTIFICATIONS APPENDIX C ACM ANALYSIS RESULTS &CHAIN OF CUSTODY APPENDIX D ACM SURVEY ABATEMENT COST ESTIMATES C.T.MALE ASSOCIATES 1.0 INTRODUCTION This report presents the findings of an asbestos containing material (ACM)survey of the former restaurant located at 1477 Route 9 in Queensbury,New York.This vacant building is a one-story,concrete block structure,with a peaked main roof and a flat rear roof. The purpose of this report was to determine whether there are asbestos containing materials in the structure prior to demolition activities.The survey included identification of suspect asbestos containing materials,quantification,and bulk sampling of suspect asbestos containing materials.Laboratory analysis was performed to determine the presence and type of asbestos in sampled materials.Any material is considered asbestos containing if it contains one percent,or more,asbestos by weight. What is known as “destructive”inspection and sampling techniques may have been used when necessary.Destructive techniques are used,where appropriate,to look behind walls,above ceilings and under floors to access any piping,sub-structures or miscellaneous materials that may exist. C.T.Male Associates,P.C.(C.T.Male)personnel conducted this ACM survey.C.T. Male possesses EPA accreditation and asbestos certification,as required by the New York State Department of Labor,as Inspectors for asbestos. C.J.MALE ASSOCIATES 2.0 SITE VISIT -ASBESTOS CONTAINING MATERIALS C.T.Male personnel visited the site on June 21,2019. ‘A walk through of the subject areas was conducted during which suspect asbestos containing materials were identified.Three major categories of suspect materials are categorized during asbestos inspections:Surfacing Materials,Thermal System Insulation (TSI),and Miscellaneous Materials.These categories are described below: Surfacing Material -Materials that are sprayed-on,trowelled-on or otherwise applied to surfaces.Examples include acoustical plaster on ceilings and/or walls, fireproofing materials on structural members,or decorative applications. Thermal System Insulation -Materials,usually found on piping,fittings, boilers,tanks,ducts or other mechanical components to prevent heat loss or gain. Miscellaneous ACM -Any other materials including,but not limited to,floor and ceiling tiles,gaskets,felts,paper products,etc.that are neither surfacing materials nor thermal system insulation. During the course of the site visit,suspect materials of similar type,texture and appearance are grouped together and considered homogeneous.Each homogeneous material is quantified and,depending on overall quantity as well as the locations of the material throughout the site,an appropriate number of bulk samples were secured. Suspect Materials Located 1x1’Ceiling Tile 2'x4’Ceiling Tile Wall Covering,Fireplace Mortar Fireplace Hood Insulation Cove Base Adhesive Cove Base Wood Adhesive 9"x9”Floor Tile VxV’Floor Tile Drywall Taping Compound Ceramic Tile Adhesive Ceramic Tile Grout Sheet Flooring Carpet Mastic Asphalt Sheet Asphalt Shingle Caulk C.1,MALE ASSOCIATES 3.0 SAMPLING AND LABORATORY ANALYSIS CT.Male’s representative collected forty-two (42)bulk samples during thesite-visit. The samples were analyzed using Polarized Light Microscopy (PLM).Non-friable organically bound materials were analyzed using the Matrix Reduction Method in conjunction with PLM based on the New York State Department of Health Environmental Laboratory Approval Program recommendations.Any negative sample analysis results by this method are then analyzed further by Transmission Electron Microscopy (TEM).Non-friable organically bound materials are bound by cements or adhesives,Examples include ceiling tile,floor tile,floor tile mastic and sheet floor covering.Scientific Laboratories Inc.of New York,New York performed analysis of the bulk samples by PLM or TEM.Table 3.0 provides a summary of analysis results. TABLE 3.0 BULK SAMPLE ANALYSIS RESULTS %ASBESTOS ‘TYPE OF Sample Location BY WEIGHT r 062119MSO1 Dining Area Throughout 1'x1’Ceiling Tile NA NAD 062119Mso2 Dining Area Throughout Vx’Ceiling Tile NA NAD 062119MS03 Dining Area Throughout 2x4’Ceiling Tile NA NAD 062119MS04 Dining Area ‘Throughout 2'xd’Ceiling Tile NA NAD NA =Not Applicable NAD =No Asbestos Detected C1.MALE ASSOCIATES Sample Location 062119MS05 Dining Area ‘Throughout Wall Covering 062119MS06 Dining Area Throughout Wall Covering 062119MS07 Dining Area Fireplace Mortar 062119MS08 Dining Area Fireplace Mortar 062119MS09 Dining Area Fireplace Hood Insulation 062119MS10 Dining Area Fireplace Hood Insulation 062119MS11 Dining Area South Wall Cove Base Adhesive NA =Not Applicable %ASBESTOS BY WEIGHT NA NA NA NA NA NA NA TYPE OF ASBESTOS NAD NAD NAD NAD NAD NAD NAD NAD =No Asbestos Detected C.1.MALE ASSOCIATES Sample Location 062119MS12 Dining Area South Wall Cove Base Adhesive 062119MS13 Dining Area South Wall Cove Base 062119MS14 Dining Area South Wall Cove Base 062119MS15 Dining Area South Wall Wood Adhesive 062119MS16 Dining Area South Wall Wood Adhesive 062119MS17 Kitchen Storage 9”x9"Floor Tile (062119MS18 Kitchen, Storage 9°x9"Floor Tile NA =Not Applicable %ASBESTOS BY WEIGHT NA NA NA NA NA 6.2% Not Analyzed TYPE OF ASBESTOS NAD NAD NAD NAD NAD Chrysotile Positive Stop NAD =No Asbestos Detected C.1.MALE ASSOCIATES Sample Location 062119MS19 Kitchen Storage 1x1’Floor Tile (loose) 062119MS20 Kitchen Storage Vx1’Floor Tile (loose) 062119MS21 Dining Area Throughout Drywall 062119MS22 Dining Area Throughout Drywall 062119MS23 Dining Area Throughout ‘Taping Compound 062119MS24 Dining Area Throughout Taping Compound 062119MS25 Dining Area Fireplace Ceramic Tile Adhesive NA =Not Applicable %ASBESTOS BY WEIGHT NA NA NA NA NA 2.0% TYPE OF ASBESTOS NAD NAD NAD NAD NAD NAD Chrysotile NAD =No Asbestos Detected C.T.MALE ASSOCIATES Sample Location 062119MS26 Dining Area Fireplace Ceramic Tile Adhesive 062119MS27 Dining Area Fireplace Ceramic Tile Grout 062119MS28 Dining Area Fireplace Ceramic Tile Grout 062119MS29 Dining Area Bathroom Sheet Flooring (bottom) 062119MS30 Dining Area Bathroom Sheet Flooring (bottom) 062119MS31 Dining Area Bathroom Sheet Flooring (top) 062119MS32 Dining Area Bathroom Sheet Flooring (top) NA =Not Applicable ‘%ASBESTOS BY WEIGHT Not Analyzed NA NA 3.2% Not Analyzed NA NA TYPE OF ASBESTOS Positive Stop NAD NAD Chrysotile Positive Stop NAD NAD NAD =No Asbestos Detected C.T.MALE ASSOCIATES Sample Location 062119MS33 Dining Area Throughout Carpet Mastic 062119MS34 Dining Area Throughout Carpet Mastic 062119MS35 Exterior Rear Roof Asphalt Sheet (lower) 062119MS36 Exterior Rear Roof Asphalt Sheet (lower) 062119MS37 Exterior Rear Roof Asphalt Sheet (upper) 062119MS38 Exterior Rear Roof Asphalt Sheet (upper) 062119MS39 Exterior Rear Roof Asphalt Shingle NA =Not Applicable %ASBESTOS BY WEIGHT NA NA NA NA NA NA NA TYPE OF ASBESTOS NAD NAD NAD NAD NAD NAD NAD NAD =No Asbestos Detected C.T.MALE ASSOCIATES Sample Location 062119MS40 Exterior Rear Roof Asphalt Shingle 062119MS41 Exterior Left Front Door Set Caulk 062119MS42 Exterior Left Front Door Set Caulk NA=Not Applicable %ASBESTOS BY WEIGHT NA NA NA TYPE OF ASBESTOS NAD NAD NAD NAD =No Asbestos Detected C.T.MALE ASSOCIATES 4.0 CONCLUSIONS AND RECOMMENDATIONS Based upon observations during the inspection and the laboratory analysis results,the following asbestos containing materials were located. Location ACM Located Quantity Friable/Condition Interior Kitchen Storage Area 9”x9"Floor Tile (no mastic)40.Sq.Ft.Non-Friable/Intact Dining Area Fireplace Area Ceramic Tile Adhesive 30 Sq.Ft.Non-Friable/Intact Bathroom Sheet Flooring (bottom layer)*60Sq.Ft.Non-Friable/Intact Exterior No ACM Located “The north side of the building is structurally compromised.The bathroom floor is hanging over the open crawlspace area.‘The flooring material will most likely not be able to be abated in place and at least this portion of the building will need to be demolished with asbestos in place. NOTE:All quantities are approximate.Abatement contractor will need to veri quantities prior to bid production. Per the regulatory requirements of the National Emissions Standards for Hazardous Air Pollutants (40 CFR 61),all asbestos containing materials must be removed from a structure prior to its demolition.New York State requires that if a facility is found to have asbestos containing materials,NYS Industrial Code Rule 56 (12 NYCRRPart 56) must be followed when performing any work which might disturb the asbestos containing materials.Any disturbance of asbestos containing materials,including removal,repair,encapsulation,enclosure,etc.must be conducted by trained individuals with valid asbestos certification,and in accordance with federal,state and local regulations. C.T.Male recommends that the asbestos containing materials located during this inspection and documented in this report,be removed prior to renovation or demolition activities by a New York State Licensed Asbestos Abatement Contractor,in accordance with 12 NYCRR Part 56 (Code Rule 56),OSHA 29 CFR 1926.58 and USEPA 40 CER Part 61,Subpart M (NESHAPS). C.T.MALE ASSOCIATES Per the requirements of NYSDOL Industrial Code Rule the building owner shall transmit copies of this inspection pre-renovation report to 1)the local agency charged with issuing the building demolition/renovation permit;2)the local Asbestos Control Bureau Office (Albany District,State Office Campus,Room 157,Albany,New York 12240);and 3)as required,this report is to be kept on site during any abatement activities and/or demolition,renovation,remodeling or repair activities. If you have any questions regarding this report,please contact this office at (518)786- 7400. Respectfully submitted, CT.MALE ASSOCIATESaMichaelF.Sawyer Managing Industrial Hygienist C.T.MALE ASSOCIATES APPENDIX A C.T.MALE ASSOCIATES CERTIFICATIONS CT.MALE ASSOCIATES C.T.MALE ASSOCIATES CERTIFICATIONS C.T.Male’s Asbestos Contractor’s License: License Number:29050 Expiration Date:10-31-19 Michael F.Sawyer NYSDOL Asbestos Certificate Number:AH88-06552 Inspector:09-19 Project Designer:09-19 Project Monitor:09-19 OSHA 40-HR Certified 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 C.T.Male Associates Engineering,Surveying,FILE NUMBER:99-0722 Architecture &Landscape Architecture,P.C.LICENSE NUMBER:29050 LICENSE CLASS:RESTRICTED 50 Century Hill Drive DATE OF ISSUE:10/31/2018 EXPIRATION DATE:10/31/2019 Latham,NY 12110 Duly Authorized Representative ~Daniel Reilly: 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. Toke thee Eileen M,Franko,Director SH 432 (6/12)For the Commissioner of Labor STATE OF NEW YORK -DEPARTMENT OF LABOR ‘ASBESTOS CERTIRCATE MICHAEL F SAWYER CLASS(EXPIRES) CATEC(O9/19)D INSP(03/19) EMGPL(09/19)1 PM (09/19) 1PD (09/19), M MUST BE CARRIED ON ASBESTOS PROJECTS C.T.MALE ASSOCIATES APPENDIX B LABORATORY CERTIFICATIONS NEW YORK STATE DEPARTMENT OF HEALTH WADSWORTH CENTER Expires 12:01 AM April 01,2020 Issued April 01,2019 CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordanee with and pursuant to section 02 Public Health Law of New York State 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 tom 198.1 of Manual EPA so0iMa/e21020 Asbestos in Non-Friable Materia-PLM tem 198.6 of Manual (NOB by PLM) ‘Asbestos in Non-Friable Material-TEM tem 198.4 of Manual Serial No.:59674 Property ofthe Now York State Deparment of Health.Certfcats ae val nly at the address shown,must be conspleuously posted,and ae printed on secure papor.Continued accreditation depends ‘on auccessfal ongoing patlpalion in the Program,Consumers are uroed to cal (518)486-5570 toveythelaboratory's accrediation status. eli a C.1.MALE ASSOCIATES APPENDIX C LABORATORY ANALYSIS REPORTS & CHAIN OF CUSTODY t_Ameri Sci— C.T.Male &Associates Attn:Michael Sawyer 50 Century Hill Drive P.O.Box 727 Latham,NY 12110 AmeriSci New York 117 EAST 30TH ST. NEW YORK,NY 10016 TEL:(212)679-8600 -FAX:(212)679-3114 PLM Bulk Asbestos Report Date Received 06/22/19 AmeriSciJob#—219063854 Date Examined 06/25/19 P.O.# ELAP #11480 Page 1 of 7 RE:19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS01 219063854-01 No NADt 1 Location:Dining Area Throughout -1"X 1"Ceiling Tile (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Grey,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 51.4 % 062119MS02 219063854-02 No NAD 1 Location:Dining Area Throughout -1"X 1"Ceiling Tile (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Grey,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 53.7 % 062119MS03 219063854-03 No NAD 2 Location:Dining Area Throughout -2'X 4’Ceiling Tile (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Grey,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 53.8 % 062119MS04 219063854-04 No NAD 2 Location:Dining Area Throughout -2°X 4 Ceiling Tile (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Grey,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 60.3 % 062119MS05 219063854-05 No NAD 3 Location:Dining Area Throughout -Wall Covering (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:White,Homogeneous,Non-Fibrous,Bulk Material Asbestos Type: Other Material:Non-fibrous 3.9 % ‘See Reporting notes on last page ‘AmeriSci Job #:219063854 Client Name:C.T.Male &Associates PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Page 2 of 7 Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS06 219063854-06 No NAD 3 Location:Dining Area Throughout -Wall Covering (by NYS ELAP 198.6) by Jared C.Clarke on 08/25/19 Analyst Description:White,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 4.5% 062119MS07 219063854-07 No NAD 4 Location:Dining Area Fireplace -Mortar (by NYS ELAP 198.1) Analyst Description:Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Type: Other Material:Non-fibrous 100 % by Jared C.Clarke on 06/25/19 062119MS08 219063854-08 No NAD 4 Location:Dining Area Fireplace -Mortar (by NYS ELAP 198.1) by Jared C.Clarke on 06/25/19 Analyst Description:Grey,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material:Non-fibrous 100 % 062119MS09 219063854-09 No NAD 5 Location:Dining Area Fireplace -Hood Insulation (by NYS ELAP 198.1) OffWhite,Homogeneous,Non-Fibrous,Bulk Material Other Material:Non-fibrous 100 % by Jared C.Clarke on 06/25/19 062119MS10 219063854-10 No NAD 5 Location:Dining Area Fireplace -Hood Insulation (by NYS ELAP 198.1) by Jared C.Clarke on 06/25/19 COffWhite,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 100 % 062119MS11 219063854-11 No NAD 6 Location:Dining Area South Wal -Cove Base Adhesive (by NYS ELAP 198.6) Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 15.4 % ‘See Reporting notes on last page by Jared C.Clarke on 06/25/19 ‘AmeriSci Job #:219063854 Page 3 of 7 Client Name:C.T.Male &Associates PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS12 219063854-12 No NAD 6 Location:Dining Area South Wall -Cove Base Adhesive (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material ‘Asbestos Types: Other Material:Non-fibrous 55.5 % 062119MS13 219063854-13,No NAD 7 :Dining Area South Wall -Cove Base (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material Other Material:Non-fibrous 0.5 % 062119MS14 219063854-14 No NAD 7 Location:Dining Area South Wall -Cove Base (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 0.5 % 062119MS15 219063854-15 No NAD 8 Location:Dining Area South Wall -Wood Adhesive (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Yellow,Homogeneous,Non-Fibrous,Bulk Material Asbestos Type: Other Material:Non-fibrous 26.4 % 062119MS16 219063854-16 No NAD 8 Location:Dining Area South Wall -Wood Adhesive (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Yellow,Homogeneous,Non-Fibrous,Bulk Material ‘Asbestos Types: ‘Other Material:Non-fbrous 31.5 % 062119MS17 219063854-17 Yes 6.2% 9 Location:Kitchen Storage -9"X 9"Floor Tile (by NYS ELAP 198.6) by Jared C.Clarke ‘on 06/25/19 Analyst Description:Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types:Chrysotile 6.2 % Other Material:Non-fibrous 17 % ‘See Reporting notes on last page AmeriSci Job #:219063854 Page 4 of 7 .Client Name:C.T.Male &Associates PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS18 219063854-18 NA/PS 9 Location:Kitchen Storage -9"X 9"Floor Tile. Analyst Description:Bulk Material Asbestos Types: Other Material: 062119MS19 219063854-19 No NAD 10 Location:Kitchen Storage -1"X 1'Floor Tile (Loose)(by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Cream,Homogeneous,Non-Fibrous,Bulk Material ‘Asbestos Types: Other Material:Non-fibrous 11.3 % 062119MS20 219063854-20 No NAD 10 Location:Kitchen Storage -1"X 1!Floor Tle (Loose)(by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Cream,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 13 % 062119MS21 219063854-21 No NAD 1 Location:Dining Area Throughout -Drywall (by NYS ELAP 198.1) by Jared C.Clarke on 06/26/19 Analyst Description:OffWhite,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Colulose Trace,Non-fbrous 100 % 062119MS22 219063854-22 No NAD 11 Location:Dining Area Throughout -Drywall (by NYS ELAP 198.1) by Jared C.Clarke on 06/25/19 [Analyst Description:OfWhite,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Celulose Trace,Non-brous 100 % 062119MS23 219063854-23 No NAD 12 Location:Dining Area Throughout -Taping Compound (by NYS ELAP 198.1) Analyst Description:White,Homogeneous,Non-Fibrous,Bulk Material ‘Asbestos Types: Other Material:Non-fibrous 100 % See Reporting notes on last page by Jared C.Clarke on 06/25/19 AmeriSci Job #:219063854 Page 5 of 7 Client Name:C.T.Male &Associates PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS24 219063854-24 No NAD 12 Location:Dining Area Throughout -Taping Compound (by NYS ELAP 198.1) by Jared C.Clarke on o8i2s/19 Analyst Description:White,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 100 % 062119MS25 219063854-25 Yes 2%?3 Location:Dining Area Fireplace -Ceramic Tile Adhesive (EPA.400 PC) by Jared C.Clarke on 06/25/19 Analyst Description:Tan,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types:Chrysotile 2.0% Other Material:Non-fibrous 20.9 % 062119MS26 219063854-26 NA/PS 13 Location:Dining Area Fireplace -Ceramic Tie Adhesive Analyst Description:Bulk Material Asbestos Types: Other Material: 062119MS27 219063854-27 No NAD 14 Location:Dining Area Fireplace -Ceramic Tile Grout (by NYS ELAP 198.1) by Jared C.Clarke on 06/25/19 Analyst Description:Black,Homogeneous,Non-Fibrous,Cementitious,Bulk Material Asbestos Types: Other Material:Non-fbrous 100 % 062119MS28 219063854-28 No NAD 14 Location:Dining Area Fireplace -Ceramic Tile Grout (by NYS ELAP 198.1) by Jared C.Clarke on 06/25/19 Analyst Description:Black,Homogeneous,Nor-Fibrous,Cementitious,Bulk Material ‘Asbestos Types: Other Material:Non-fbrous 100 % 062119MS29 219063854-29 Yes 3.2% 15 Location:Dining Area Bathroom -Sheet Flooring (Bottom)(by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Grey,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types:Chrysotile 3.2 % Other Material:Non-fibrous 14.3 % See Reporting notes on last page AmeriSci Job #:219063854 Page 6 of 7 Client Name:C.T.Male &Associates PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS30 219063854-30 NA/PS 45 Location:Dining Area Bathroom -Sheet Flooring (Bottom) Analyst Description:Bulk Material Asbestos Types: Other Material 062119MS31 219063854-31 No NAD 16 Location:Dining Area Bathroom -Sheet Flooring (Top)(by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Description:Tan,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Materi:lon-fibrous 31.5 % 062119MS32 219063854-32 No NAD 16 Location:Dining Area Bathroom -Sheet Flooring (Top)(by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19. Analyst Description:Tan,Homogeneous,Non-Fibrous,Bulk Material Asbestos Type: Other Material:Non-fibrous 35.4 % 062119MS33 219063854-33 No NAD 17 Location:Dining Area Throughout -Carpet Mastic (by NYS ELAP 198.6) by Jared C.Clarke on 0825/19 Analyst Description:Yellow/Brown,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: ‘Other Materi: 062119MS34 219063854-34 No NAD 17 Location:Dining Area Throughout -Carpet Mastic (by NYS ELAP 198.6) by Jared C.Clarke on 06/25/19 Analyst Descr ‘ellow/Brown,Homogeneous,Non-Fibrous,Bulk Material Non-fibrous 27 % ‘See Reporting notes on last page AmeriSci Job #;219063854 Page 7 of 7 Client Name:C.T.Male &Associates PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Reporting Notes: (1)This job was -Analyzed using Motic BA310 Pol Scope S/N 1190000326 ‘Analyzed by:Jared C.Clarke. *NADINSD =no asbestos detected: (SMV)=Surfacing Material containing Ver Method 198.1 for NY friable samples,which (nchxés the identification and quantitation of vermiculte or 198.6 for NOB samples or EPA 400 pt ct by ‘ppd E to Subpt E,40 CFR 763 (NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in loor coverings and similar ‘non fiable 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 tle,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 ofthe lab.This PLM report relates ONLY to the items tested,AIHA-LAP,LLC Lab ID 102843,Rl Cert AAL-094,CT Cert PH-0186,Mass Cort ‘AA000054. 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NEW YORK,NY 10016 TEL:(212)679-8600 +FAX:(212)679-3114 PLM Bulk Asbestos Report Date Received 07/02/19 AmeriSci Job #219071274 Date Examined 07/03/19 P.O.# ELAP #11480 Page 1 of 2 RE:19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS35 219071274-01 No NAD? 1 Location:Exterior,Rear Roof -Asphalt Sheet (Lower)(by NYS ELAP 198.6) by Bo Sun on 07/03/19 Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 3.6 % 062119MS36 219071274-02 No NAD 1 Location:Exterior,Rear Roof -Asphalt Sheet (Lower)(by NYS ELAP 198.6) by Bo Sun ‘on 07/03/19 Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Materi 062119MS37 219071274-03 No NAD 1 Location:Exterior,Rear Roof -Asphalt Sheet (Upper)(by NYS ELAP 198.6) by Bo Sun on 07/03/19 Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 7.5 % 062119MS38 219071274-04 No NAD 1 Location:Exterior,Rear Roof -Asphalt Sheet (Upper)(by NYS ELAP 198.6) by Bo Sun on 07/03/19 ‘Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types Other Material:Non-fibrous 6.1 % 062119MS39 219071274-05 No NAD 3 Location:Exterior,Rear Roof -Asphalt Shingle (by NYS ELAP 198.6) by Bo Sun on 07/03/19 Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Materi lon-fibrous 11% ‘See Reporting notes on last page AmeriSci Job #:219071274 Page 2 of 2 .Client Name:C.T.Male &Associates ae PLM Bulk Asbestos Report 19.9352;Former Restaurant;Queensbury,NY Client No./HGA Lab No.Asbestos Present Total %Asbestos 062119MS40 219071274-06 No NAD 3 Location:Exterior,Rear Roof -Asphalt Shingle (by NYS ELAP 198.6) by Bo Sun on 07/03/19 Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 40.3 % 062119MS41 219071274-07 No NAD 4 Location:Exterior,Left Front Door Set -Caulk (by NYS ELAP 198.6) by Bo Sun, on 07/03/19 Analyst Description:Brown/White,Homogeneous,Non-Fibrous,Bulk Material ‘Asbestos Types: Other Material:Non-fibrous 28.5 % 062119MS42 219071274-08 No NAD 4 Location:Exterior,Left Front Door Set -Caulk (by NYS ELAP 198.6) by Bo Sun on 07/03/19 Analyst Description:Brown/White,Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material:Non-fibrous 30.9 % Reporting Notes: snayzea or Bo un peaEET pyc cn reg conn Vari(SMV)=Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis by Appd E to Subpt E,40 CFR 763 (NVLAP 2005460),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 ‘AppaEtoSubptE,40 CFR 763 (NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in floor coverings and similar ‘non-tiable 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 Roor 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 ful without the approval of the lab.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. 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