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2007-682 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20070682 Date Issued: Monday, November 19, 2007 This is to certify that work requested to be done as shown by Permit Number P20070682 has been completed. Tax Map Number. 523400-288-016-0001-003-000-0000 Location: 1412 STATE ROUTE 9 Owner. JOLLEY ASSOCIATES Applicant: JOLLEY ASSOCIATES This structure maybe occupied as a: Demolition By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, 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 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070682 Application Number. A20070682 Tax Map No: 523400-288-016-0001-003-000-0000 Permission is hereby granted to: JOLLEY ASSOCIATES For property located at: 1412 STATE ROUTE 9 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 Value Owner Address: JOLLEY ASSOCIATES 54 LOWER WELDEN St Demolition ST. ALBANS, VT 05478-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency S B COLLINS INC BOX 671 ST ALBANS, VT 05478-0000 Plans &Specifications 2007-682 DEMOLITION OF BUSINESS &CANOPY $20.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Sunday,November 09, 2008 (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 of Que busy; ,.Ffiday.November 09, 2007 SIGNED BY ��� � for the Town of Queensbury. z Director of Building&Code Enforcement . . . .. � ......... ........ .3OFFlOB USE ONLY I', , + TAX MAP NO. PERMIT NO, FEE PAI ;i + r , Permission Is hereby granted to the above named Applicant to demolish the bullding(s) + + descdbed herein as set forth in the Application below, rr + ' rr Director of Building&Codes Date ; ..............................1:.................,.....: APPUCA.TZON FOR.DEMOLMON PERMIT: Fill in applicable spaces and submit two(2)plot plans,drawn to scale,showing lot boundaries with dimensions and adjacent roads 1 streets. Show all existing structures on the property and indicate which are to be demolished. Indicate on the plot plan the location of all utilities. APPLICANTiBUILDER: (�t°� lrJ(�OWNER: C"r'F'f � ADDRESS: .r< C�7( Sit}!b.K-� (�i" ADDRESS; 015'Vi7r�Q PHONE NOS. �3 0�-S L 7 EJt(J16 PHONE: PERSON RESPONSIBLE FOR WORK: C4rrZ E— ��?R--C W i PHONE: LOCATION OF DEMOLITION: WHERE WILL DEMOLITION MATERIAL SE DISPOSED? L?ta%*^4 �',i AQS4K- ASBESTOS INFORMATION: / ✓ Is there any asbestos within the building to be demolished? YES NO ✓/ ✓ If YES,our office needs the following information: o Name of fine removing the asbestos: o License number'offirm: o Indicate where the asbestos material will be disposed: NOTE:A copy of Asbestos RemovaiReaort must be filed with our office before demolition begins. STEUCTURE INFORMATION, ✓ indicate which structure(s)will be demolished: RESIDENCE,.,_,_, GARAGE BUSINESS Size of structure: �� X `f STORAGE BLDG.w OTHER, / Y(00 ��� ✓ ✓ Number of stories: l / ✓ Foundation type: FULL CELLAR CRAWL SPACE— SLAB ✓ Foundation: WILL BE REPLACED�WILL NOT BE REPLACED ✓ Structures(s); WILL BE REPLACED �-�WILL NOT BE REPLACED U_TILITIE.8INFORMATION; ✓ indicate utlllbas for this structure: GAS -f ELECTRIC `L PROPANE PUBLIC WATER_ ONSITE WELL-WATER PUMP __ PUBLIC SEWER Have you notified the Town Water Dept,for public water and public sewer disconnect? YES✓NO— Have all utilitles been disconnected: YES, NO__ QUESTIONS4 CJLLLret$$S6OR'EIAAIL ggdosgausenshunr.nn ,• j �� VISIT OUR wEBSITE FOR MORE INFORMATION SIGNATURE OF APPLICANT All Ink Ma Tlntm of Queensbunj■Community Development Office-742 Bay Road,Queensbulij,NY 12804 3uamdoZQnaa d4TUn=00 LE"Sr"t5 xea 4Z OT a3M LQoz![E/o1 Zoo/Zoo® Queensbury Building & Code Enforcement Residential 'nal Inspection Office No. (518)761-8256 Arrive: pm art: a Date Inspection request received: Inspector's Initi 4 NAME: U �L e. v4 S SGc. ,,--T-e_S MIT#: C) LOCATION: TE: TYPE OF STRUCTURE: I CA— Comments Yes No N/A Building Number/Address visible from road Chimney Height/"B"Vent/Direct Vent Location Fresh Air Intake 3 inch Plumbing Vent through roof minimum 6 inches Roof Complete/Exterior Finish Complete Platform at all exterior doors Guards at stairs,decks,patios more than 30 inches above grade Guard at stairwell at 34 inches or more Guard at deck,porches 36 inches or more Handrail Termination at Newell Post or Wall Interior/Exterior Railings 34 inches to 38 inches Interior Handrails @ stairs 2 or more risers Grade away from foundation 6 inches with 10 feet 6 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18 inches above grade Interior privacy/trim/doors/main entrance 36 inches Bathroom/Kitchen watertight Safety glazing/Window in stairwells safety glazing Interior Smoke Detectors: Every level: Every Bedroom: Outside every bedroom area: Inter Connected: Battery backup: Carbon Monoxide Detector Attic access 30 inches x 22 inches x 30 inches(height)in accessible area Crawl Spaces 18 inch x 24 inch access, 1 s . ft.-150 s .ft.vents �h— Bathroom Fans,if no window �U Plumbing fixtures Foundation insulation Floor truss,draft stopping finished basement 1,000 s .ft. Emergency egress below grade Gas Furnace shut-off within 30 feet or within line of site Oil Furnace shut-off at entrance to furnace area Furnace/Hot Water Heater operating Low water shut-off boiler Relief Valves installed/Heat Trap/Water Temp, 110 Enclosed Stairs Sheetrock Underside minimum''/a"Gypsum Basement stairs closed rise>4 inches Garage Floor Pitched Garage fireproofing/3/a hour fire door/door closer Duct work Sealed properly Gas Logs in Sealed or Glass Enclosure Final Electrical Final Survey Plot Plan As Built Septic System/Sewer Dept.Inspection Sticker Site Plan /Variance required Flood Plain Certification,if required Okay to ism Te ] L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form revised 100405.doc * SSPECTRVM P.O.Box 1024 Schenedady.NY 12301 A (5 6 (Phone)Environmental Rssociates. Inc. (518)346-4062(Fax) Exceeding Our Clients Expectations of Excellence- www.4spectrum.com ASBESTOS SURVEY/INSPECTION FOR LAKE GEORGE XTRA MART 1462 ROUTE 9 NORTH LAKE GEORGE, NEW YORK, 12845 SPECTRUM PROJECT NO.: 07-457 OCTOBER 8, 2007 Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services TABLE OF CONTENTS SECTION I -INTRODUCTION SECTION II -LIMITATIONS SECTION III ASBESTOS SAMPLING SUMMARY ATTACHMENTS -TABLE 1 ASBESTOS SAMPLING RESULTS -TABLE 2-ASBESTOS FINDINGS -LOCATION MAPS -LABORATORY REPORTS -LICENSING AND CERTIFICATION - 12 NYCRR PART 56-5.1 SECTION I-INTRODUCTION On October 4, 2007, Spectrum Environmental Associates, Inc. (Spectrum) conducted a survey for the presence of asbestos containing materials at the property located at Route 9 North in Lake George, New York. The inspection was of the Lake George Xtra Mart only. Mr. Crommie (Asbestos Inspector#07-09607) 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 an independent 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(ELAP# 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. SECTION II-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 Jolley Associates, its successors and/or assigns. This report and its contents represent confidential information and should not be duplicated without the expressed permission of the Jolley Associates, its successors and/or assigns. The following limitation/conditions were noted as part of the survey: • The asbestos survey was not conducted according to established US EPA AHERA (Asbestos Hazardous Emergency Response Act) protocols, as required for public schools. This survey was conducted following general industry practices to identify those asbestos containing materials present in the building materials at your location. All inspection activities were, however, conducted by an AHERA certified asbestos inspector. • 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 included in this report for reference. • The building owner is Jolley Associates and may be reached at 54 Lower Welden Street,St. Albans, VT 05478 care of Mr. Carl Ruprecht 802-527-0116. SECTION III—ASBESTOS SAMPLING SUMMARY The results of the sampling are provided in Table 1 (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 Z-ASBESTOS FINDINGS LOCATIONMAPS LABORATORYREPORTS LICENSING AND CERTIFICATION NYS INDUSTRIAL CODE RULE SECTION 56-5.1 Table I—Asbestos Sampling Results Route 9 North Lake George,New York 12845 October-8-2007 Sample# Description Location/Area P LM Results TEM Results /o Type) to Type) 01 Roof 1"Layer Roof NAD NAD 02 Roof 2nd Layer Roof NAD NAD 03 Roof 3`d Layer Roof NAD NAD 04 Roof 4`h Layer Roof NAD NAD 05 Roof 5d'Layer Roof NAD NAD 06 Brick Outside Rear Wall NAD NA 07 Brick Mortar Outside Rear Wall NAD NA 08 Cement Block Outside Rear Wall NAD NA 09 Cement Block Mortar Outside Rear Wall NAD NA 10 Ceiling Tile 2'x2' Inside NAD NA 11 Ceiling Tile 2'x4' Inside NAD NA 12 Sheetrock Inside NAD NA 13 Wall Tile 1"xI" Inside Storage Room NAD NA 14 Wall Tile 1"xI"Grout Inside Storage Room NAD NAD 15 Plaster Joint Compound Inside NAD NA 16 Floor Tile 6"x6"Light Gray Inside NAD NA 17 Floor Tile 6"x6"Off Brown Inside NAD NA 18 Grout Floor Tile Inside 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 Route 9 North Lake George,New York 12845 October-8-2007 Sample# ' Description Location/Area PLM Results TEM Results %Type)'' %Type) 19 Concrete Inside/Outside 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 2—Asbestos Findings Route 9 North Lake George,New York 12845 October-8-2007 Material Location/Area Estimated Quantity Condition/Damaged None Identified SF—square feet,LF—linear feet,ea-each SPECTRVq S P.O.Box 1024 Schenectady.ram'12301 'nvirOnmental gssv 7ates, Inc. (S 346-6 (Phone) A (518)346-4062(Fax) 'Exceeding Our Clients Expectations of Excellence' um .4spectrum.com Project Number: 0 r7 ~ q J ^ H 7 y�ienist: b QU�TQ� C (`0 A-% M J Job Site/Building:LAfC'e- Ceuro G ,�C r4 &Z - Room/Work Area: a _ I �- _. �;-gT . . -- -6--- ;74 -----0* 7?,14 r w_ � J3 5�►,t`ea 1`� Rsbestos cF Lead Consulting • Laboratory Services • Safety&Health Tmming • Site Rssessments Amer Sci New York 117 EAST 30TH ST. A1V1'E'RI Sell NEW YORK, NY 10016 TEL:(212)679-8600•FAX: (212)679-3114 PLM Bulk Asbestos Report Spectrum Environmental Associates, Inc Date Received 10/05/07 AmeriSci Job# 207101743 Attn: Bill Massman Date Examined 10/07/07 P.O. # P.O.Box 1024 ELAP# 11480 Page 1 of 4 RE:Mobile Gas Station Schenectady, NY 12301 Client No. / HGA Lab No. Asbestos Present Total % Asbestos 01 207101743-01 No NAD Location: Roof 1 st Layer, Roof (by NYS ELAP 198.6) by Ivan H.Reyes on 10/07/07 Analyst Description: Black,Homogeneous, Fibrous,Bulk Material Asbestos Types: Other Material: Fibrout glass 1 %, Non-fibrous 26.1 % 02 207101743-02 No NAD Locatiom'Roof Znd Layer,Roof (by NYS FLAP 198.6) by Ivan H. Reyes on 10/07/07 Analyst Description: Black,:Homogeneous, Fibrous,Bulk Material Asbestos Types: Other Material. Fibrous glass 2%, Non-fibrous 12.7% 03 207101 743-03 No NAD Location: Roof 3rd Layer,Roof (by NYS ELAP 198.6) by Ivan H.Reyes on 10/07/07 Analyst Description: Black,:Homogeneous, Fibrous, Bulk Material Asbestos Types: Other Material: Fibrous glass 1 %, Non-fibrous 12.8% 04 207101743-04 No NAD Location! Roof 4th Layer, Roof (by NYS ELAP 198.6) by Ivan H. Reyes on 10/07/07 Analyst Description: Black'$ Homogeneous, Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 1 % 05 207101743-05 No NAD Location: Roof 5th Layer.Roof (by NYS FLAP 196.6) by Ivan H. Reyes on 10/07/07 Analyst Description: Black, Homogeneous, Fibrous, Bulk Material Asbestos Types: Other Material: Fibrous glass Trace, Non-#ibrcus 2.1 % See Reporting notes on last pagb AmeriScl Job* 20T1017143 Page 2 of 4 Client Name: Spectrurh Environmental Associates, Inc. PLM Bulk Asbestos Report Mobile Gas Station Client No. / HGA Lab No. Asbestos Present Total %Asbestos 06 207101143-06 No NAD Location: Brick,Outside Rear Wall (by NYS ELAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: Brown, Homogeneous,Non-Fibrous,Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 07 207101743-07 No NAD Location: Brick Mortar, Outside Rear Wall (by NYS FLAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: Grey, Homogeneous, Non-Fibrous, Cementitious, Bulk Material Asbestos Types: Other Material: Non-fitirous 100% 08 2071017 43-08 No NAD Location: Cement Block,Outside Fear Wall (by NYS ELAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: Grey, Homogeneous,Non-Fibrous,Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 09 207101743-09 No NAD Location: Cement Block Mortar,Outside Rear Wall (by NYS ELAP 198,1) by Ivan H. Reyes on 1=7107 Analyst Description: Grey, Homogeneous, Non-Fibrous, Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 10 20710'743-10 No NAD Locatloo: Ceiling Tile 2'xT,inside (by NYS FLAP 198,1) by Ivan H. Reyes on 10/07/07 Analyst Description:White, Homogeneous,Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 45%, Fibrous glass 30%, Non-fibrous 25% 11 207101743-11 No NAD Loea06n: Ceiling Tile 2'x4', Inside (by NYS ELAP 198.1) by Ivan H. Reyes on 10107/07 Analyst Description:White, Homogeneous, Fibrous, Bulk Material Asbestos Types: Other Material, Cellulose 50%, Fibrous glass 30%, Non-fibrous 20% See Reporting notes on last page AmeriSci Job#: 207101743 Page 3 of 4 Client Name, Spectrum Environmental Associates, Inc. PLM Bulk Asbestos Report Mobile Gas Station Client No. / HGA Lab No. Asbestos Present Total % Asbestos 12 207101743-12 No NAD Location: Sheetrock, Inside (by NYS FLAP 196.1) by Ivan H.Reyes on 10/07/07 Analyst Description- Tan/Off White.Homogeneous, Fibrous; Bulk Material Asbestos Types: Other Material: Cellulose 18%, Fibrous glass 2%, Non-fibrous 80% 13 207101743-13 No NAD Location: Wall Tile 1"xl", Inside Storage Room (by NYS FLAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description.White, Homogeneous,Non-Fibrous,Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 14 207101743-14 No NAD Location: Wall Tile 1"xl"Grout, Inside Storage Room (by NYS ELAP 198.6) by Ivan H. Reyes on 10/07/07 Analyst Description: Yellow, Homogeneous, Non-Fibrous, Bulk Material Asbestos Types: Other Material. Non-fibrous 50.6% Comment: Appears To Be Adhesive 15 207101743-15 No NAD Location: Plaster Joint Compound, Inside (by NYS FLAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: White, Homogeneous, Non-Fibrous, Bulk Material Asbestos Types: Other Material: Cellulose Trace, Non-fibrous 100% 16 207101743-16 No NAD Location: Floor Tile 6"x6"Light Gray, Inside (by NYS ELAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: Grey, Homogeneous,Non-Fibrous,Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% See Reporting notes on last page AFneriSci Job#: 207101743 Page 4 of 4 Client Name: Spectrum Environmental Associates, Inc, PLM Bulb Asbestos Report Mobile Gas Station Client No. J HGA Lab No. Asbestos Present Total % Asbestos 17 207101743-17 No NAD Location: Floor Tile 6"x6"Off Brown, Inside (by NYS ELAP 198,1) by Ivan H. Reyes on 10/07/07 Analyst Description: Brown, Homogeneous, Non-Fibrous,Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 18 207101743-18 No NAD Location: Grout Floor Tile,Inside (by NYS ELAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: OffWhite, Homogeneous, Non-Flbrous, Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% 19 207101743-19 No NAD Location: Concrete, Inside/Outside (by NYS FLAP 198.1) by Ivan H. Reyes on 10/07/07 Analyst Description: Grey,Homogeneous, Non-Fibrous, Cementitious, Bulk Material Asbestos Types: Other Material: Non-fibrous 100% Reporting Notes: Analyzed by: Ivan H_Reyes 'NAD/NSD=no asbestos detected:NA=not analyzed;N PS=not analyzed/positive stop;PLM Bulk Asbestos Analysis by EPA 6001M4-82-020 per 40 CFR 763(NVLAP Lab Code 200646-0),ELAP PLMMethbd 198.1 for NY friable samples or 198.E for NOB samples(NY FLAP Lab 11311480); 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 ran 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 lab,This PLM report relates ONLY to the items tested.AIHA Lab it 102843, Reviewed By' END OF REPORT AmenSci Job#: 2071 G1 743 Page 1 of 2 Client Name: Spectrum Environmental Associates, Inc. Table I Summary of Bulk Asbestos Analysis Results Mobile Gas Station Sample Heat Acid Insoluble AmariSci HG Weight Sensitive Soluble Non-Asbestos "Asbestos%by "Asbestos%by Sample Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLMIDS TEM 01 01 0.273 08.1 4.8 27.1 NAD NAD Location, Roof 1st Layer,Root 02 02 0.163 81.6 3.7 14.7 NAD NAD Location: Roof 2nd Layer,Roof 03 03 0.130 83.1 3.1 13.8 NAD NAD Locatisan: Root 3rd Layer,Roof 04 04 0.487 98.2 0.8 1.0 NAD NAD Location; Roof 4th Layer,Root 05 05 0.237 9&2 1.7 2.1 NAD NAD I rN dtk-v. Rent rith 1_ayer.Roof 06 06 — — — NAD NA location; Brick,Outside Rear Wall 07 07 — — — ---- NAD NA Location: Brick Mortar,Outside Rear Wall 08 08 --- --- -- --- NAD NA Location: Cement Block,Outside Rear Wall 09 09 -- — — -- NAD NA ,Location: Cement Block Mortar.Outside Rear wail 10 10 — — --- -- NAD NA Location: Ceiling Tile 2W,Inside 11 11 — -- -- --- NAD NA Locatim: Ceiling Tile 2'x4'.Inside 12 12 — — ---- -- HAD HA Location; Sheetrock,Inside 13 13 --- — ---- -- NAD NA location: Wall Tile 1"x1",Inside Stowage Room 14 14 0.411 40.6 8.8 50.6 NAD NAD Location; Wall Tile 1"x1'Grout,inside Storage Room Is is ---- ---- — — NAD NA Location: Plaster Joint Compound,Inside 16 16 —.- — -- NAD NA Location: Floor Tile 6rx8"Light Gray,Inside See Reporting notes on last page rviiGriQui %rvU if: Page 2 Of 2 Client Name: Spectrum Environmental Associates, Inc. Table I Summary of Bulk Asbestos Analysis Results Mobile Gas Station Sample Heat Acid Insoruble AmeriSci HG Weight Sensitive Soluble Mon-Asbestos "Asbestos%by Asbestos%by Organic% Inorganic PLM/DS TEM Sample# Client Sampia# Area (gram) 9 rga °Y6 Inorganic% 17 17 — -- — — NAD NA Ucadon; Floor Tile V xV Off Brown,Inside 18 18 -- --- — --- NAD NA Locabon: Grout Floor Tile,Inside 19 19 — -- — — MAD NA Locafian: Canorete,Inside 1 Outside Analyzed by:Marik Peysakhov '5::�� ;Date Analyzed 1WI07 "Quantitative Analysis(SemUFull);Bulk Asbestos Analysis-PLM by EPA 600lM4-82-020 per 40 CFR or FLAP 198.1 for New York friable samples or ELAP 198.6 for New York N0e samples;TEm (SemVFull)by EPA G OJR-931116(not covered by NVLAP Bulk accreditationy;or ELAP 193.4 for New York sampler,NAD=no asbestos detected during a quantitative analysis;NA=not analyzed;Trace= <1%:QuantItation for beginning weights of 40.1 grams should be aonsfdered as qualitative only;Qualitative Analysis:Asbeslos analysis results of"Present"or"NVA=No Visible Asbestos'represents results for Qualitative PLM or TEM Analysis only(no accreditallan coverage available from any regulatory agency for qualitative analyses); AIHA Lab#102843.NVLAP Lab Code 200548-0,NYSDOH ELAP LAB ID 11480. Wamfng Note:PLM timltatfon,only TEM will resolve fibers<0.25 micrometers In diameter.TEM bunk analysis is representative of the fine grained matrix material and may not be representaUve of non-uniformly dispersed debris for which PLM evaluation is recommended(i.e.soils and other helerogenous materials}, Reviewed By: sSPECTRVtq P.O-Box 1024 Schenectady.Nr 12301 (518)346-6374(Phone) A Environmental t issociaies, Inc. (518)346-4068(Fax) 'Exceeding Our Clirnts Expeditions oP Excellence' www 4spedrum.com BULK SAMPLING CLIAIN OF UUSTa Y 7 4 3 L PttO.rF:Cr INFORMATION Pmjec,a,. p"ece NRmr Matrix Asbestos Alaaiysis Lend Analysis Turnaround Dma Sampled 9'dad avae: 6 1X Bulk PLM-ELAP 19R.r a AAS-Air ❑ RUSH race N of M ems: C,fV r�••� G ❑ Pavia PLM-ELAP 198.6 ❑ AAS-Paint ❑ 24 Hpur Caoonv»,: ❑ Soil T81v4-ET AP 198.4 0 AAS-Duat/Wipc 10 48 Hour ❑ wipe © Other ❑ Other 77 Now SAMPLE IDEN nF7CATION Lab M 4 Field M# Material Floor or Samplc Locatior AA Buii iin 1 d D -I— ly 0 ° f l 12 yc AP I'4 d Hs CAL-" i` GAA CIIAT.N OF CUSTODY Relinquished By Dafe Time Received By Date Tittle Methnd of Submittal [II Emdrnnmental Consulting& Management Services • Health&Satd y nur mmg • Laboratory Services STATE OF DEPVTME OR D � FETY en d Certiicat t BUI RESTRICTED LICE Y. NY 12240 TOS HANDLING LIC NSE Asbestos Rem o _ Permitte Contractor: SPEC AV, M NTAL LICENSE NUMBE 9 ASS P.O . DAIQF;ISSUE: Sciii e y 12301 E ; EXPJRATIQN DATE: 2 008 BusessAddres 4 w' S` enecta i ,NY Duly Authorize R to tiff, 4e 11 This license has e e ccordance* appiTe provisions,o 30 of Labor La fDr tate and of the New York S o and Re o ait�-5 bject# pensio r o r a(1)serious violation of state, e w�:ay regd 1. eaurasbes o c ro a or de d f responsibility 9\ w a'P i P t3' in the conduct of g be-swllor-asbestos mitena :v This license is valid o fo e r named above and-this license or a photocopy prom�en displayed at the asbestos project worksit e' s that all persons employed by the licens an st p ect in New York State have been issued an es t Ce t , ropriate for the type of work ,by th York State Department of Labor. _ ... ,., y o,Director SH 432(&03) FORIt3f SSIONER OF LABOR STATE OF NEW YORK-DEPARTMENT OF LABOR ASBESTOS CERTIFICATE emu: DAVI _ C . 'C,(0 8),DJ P(07/08) �. sr. #07-0 07 DMV#314960485 MUST BE CARRIED ON ASBESTOS PROJECTS IIIII III flilffll If1111111�11��1[EII I`�I IF FOUND RETURN TO: EYES BRO NYSDOL - L&C UNIT HAIR BRO ROOM 290A BUILDING 12 HGT 5' 11" STATE OFFICE CAMPUS ALBANY NY 12240 NEW YORK STATE DEPARTMENT OF HEALTH WADSWORTH CENTER RICHARD F DAINES, M.D. Expires 12:01 AM April 01, 2DC18 ` Issued April 01, 2007 al Revised May 07, 2007 CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued In accordance with end pursuanf to secfton 502 Public Nealfh Law or New York Slate MR. PAUL MUCt lA NY Lab ld No: 11480 AMERICA SCIENCE TEAM NEW YCRK INC ,EPA Lab Code:NY01378 117 FAST 30TH ST NEW YORK, NY 10015 is hereby APPROVED as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE All approved subcategories andlor analytes are listed below!, Aisceltaneous Asbestos in Friable Material EPA 6001"921020 Item 193.1 of Manual Asbestos in Non-Friable Matarial.PLM item 198.6 of Manual(NOB by PLM) Asbestos in Nan--rlable Material-71 EM ITEM 199.4 OF MANUAL aerial No.: 33653 'roperty of the New York State Department of Health Valid only at the address shown.Must be xtnsptcaousty posted.V81id certificates have a raised seal.Continued e=radttation depends on wccasaf it ongoing participation In the Program. Consumers are Urged to Cal)(518)455-557D to 'crily taboratory's aecreditstion status, United Mates Department of Comilrierce National Institute of Standards and Technology Certificate of Accreditation to lS IIEC 17025:2005 NVLAP LMJ CODE: 200546-0 .f nieriS cl New York New York, NY is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for: BULK ASJJESTOS 1+IBER ANAI.,XSIS This laboratory is accredited in accordance with the recognized International Standard ISO/IEC 17025:2005. This accreditation demonstrates technical competence fora defined scope and the operation of a laboratory quality management systern (refer to joint ISO-ILAC-IAF Communique dated 18 June 2005), ��EtiS OF rQ VW T� 2007-07-01 through 2008-0G-30 Effective dates o „C� For the Na ional Instgule of Standards and Technology er+iFs of a NVLAP-D1C(REV. ZOM09-13) ,j oY OF Co R National Voluntary a � �� Q Laboratory Accreditation P'r€ grate � - !�O P� StA7E5 Df SCOPE,OF ACCREDITATION T4 IS©JEC 1.7025:2005 AmeriSci New York DBA: AmeriSci Ne-,v York 1.17 E_ 30th Street New Yo*,NY 10016 Mr. Paul. Mucha Phone: 212-679-8600 Fax: 212-679-271.1 E-Mail: pmucha@a.aierisci.com URL: bttp://www.amerisci.com BULK ASBESTOS FIBER ANALYSIS (PLW NVLAP LAB CODE 200546-0 NVLAP Come Desib nation/Description 18/A01 EPA-6001T\44-82-020: interim Method for the Determination of Asbestos in Bulk Insulation Samples 2007-07-01 through 2008-06-30 Erbctive mates For fho J�afion�l`Jn� a of StHncJards end i echn�J�gy NVLAP,01.S (REV_2005-0 -19) NYS IND USTRIAL CODE R ULE SECTION 56-5.1 SUBPART 56-5 (a) Building/Structure Asbestos Survey Requirements. The asbestos survey shall Include a thorough inspection for and identification of all PACM, suspect PHASE IA: ASBESTOS SURVEY PLANNING AND DESIGN miscellaneous ACM, or asbestos material throughout the building/structure or portion thereof to be demolished,renovated,remodeled,or to have repair work. The required Inspection shall be performed by a certified asbestos inspector, 56-5.1 Asbestos Survey Requirements for Building/Structure Demolition, and,at a minimum,shall include Identification of PACM, suspect miscellaneous Renovation,Remodeling and Repair ACM or asbestos material by all of the following methods: (a) Asbestos Survey Required. An owner or an owner's agent,except the owner (1) The review of building/structure plans and records, if available, for of one and two-family dwellings who contracts for,but does not direct or control references to asbestos, ACM, PACM, suspect miscellaneous ACM or the work, shall cause to be conducted, an asbestos survey completed by a asbestos material used in construction,renovation or repair;and licensed asbestos contractor using inspectors certified in compliance with Section 56-3.2(d), to determine whether or not the building or structure, or (2) A visual inspection for PACM and suspect miscellaneous ACM throughout portion(s)thereof to be demolished,renovated, remodeled,or have repair work, the building/structure or portion thereof to be demolished, renovated, contains ACM, PACM or asbestos material. This asbestos survey shall be remodeled, or repaired. For the purpose of this Part, all PACM and completed and submitted as indicated in Subdivision(g)of this Section,prior to suspect miscellaneous ACM visually assessed shall be treated and commencing work. All such asbestos surveys shall be conducted in handled as ACM and shall be assumed to be ACM,unless bulk sampling conformance with the requirements of Subdivision(a)of this Section. Is conducted as per this Section, standard EPA and OSHA accepted methods, including multi-layered systems sampling protocols; the (b) Exemptions To Asbestos Survey Requirements: The asbestos survey subsequent analyses are performed by a laboratory that meets the required by this Subdivision (a) of this Section shall not be required for the requirements of Section 56-4.2 of this Part;and the analyses satisfies both following classes of buildings or structures: ELAP and federal requirements,including multi-layered sample analyses, (1) an agricultural building; to document non-asbestos containing material. (2) buildings or structures for which original construction commenced on or (f) Building/Structure Asbestos Survey Information. after January 1,1974; (1) The asbestos survey shall, at a minimum, identify and assess with due diligence,the locations, quantities,friability and conditions of all types of (3) A structure certified Engineer, r writing to be structurally unsound s a licensed installations at the affected portion of the building/structure relative to the Professional Engineer, Registered Architect, Building Inspector, Fire ACM,suspect miscellaneous ACM,PACM or asbestos material contained Inspector or other official of competent jurisdiction. (See Section 56-11.5) therein. The following list is not Inclusive of all types of ACMs, it only (c) Building/Structure Demolition. If a building/structure asbestos survey is not summarizes typical ACMs. The certified asbestos Inspector is responsible required or performed per Subdivision (b) of this Section, and the for identification and assessment of all types ACM, PACM, suspect building/structure is certified to be unsound or slated for contracted demolition, miscellaneous ACM and asbestos material within the affected portion of the building/structure shall be assumed to contain asbestos, and shall be the building/structure: demolished per this Part,unless the building/structure is adequately certified to PACM be free of asbestos containing material. Acceptable documentation for certification shall be a previous thorough building/structure asbestos survey, (i) Surfacing Treatments: abatement records or other documentation acceptable to the Commissioner or his or her representative. (a) Fireproofing; (d) Responsibility To Comply. No exemption to the requirement to conduct an (b) Acoustical Plaster; asbestos survey shall exempt any person, asbestos contractor,property owner or business entity from the inspection or asbestos survey requirements of EPA, (c) Finish Plasters;and OSHA,and any other applicable section of this Part. (d) Skim Coats of Joint Compound. 12 NYCRR 56 Subpart 5, Page 41 12 NYCRR 56 Subpart 5, Page 42 G (ii) Thermal System Insulation: (h) Vibration Isolators; (a) Equipment Insulation; (i) Laboratory Tables and Hoods; (b) Boiler, Breeching, Boiler Rope, Duct, or Tank Insulation, Q) Chalkboards; Cement or Mortar Used for Boilers and Refractory Brick; (k) Pipe Penetration Packing or Other Firestopping Materials (c) Piping and Fitting Insulations including but not limited to, Wrapped Paper, Aircell, Miliboard, Rope, Cork, Preformed (1) Cementitious Board; Plaster,Job Molded Plaster and coverings over fibrous glass insulation. (m) Electrical Wire Insulation; SUSPECT MISCELLANEOUS ACM (n) Fire Curtains; (1) Roofing and Siding Miscellaneous Materials: (o) Fire Blankets; (a) Insulation Board; (p) Fire Doors; (b) Vapor Barriers; (q) Brakes and Clutches; (c) Coatings; (r) Mastics,Adhesives and Glues; (d) Non-Metallic or Non-Wood Roof Decking (s) Caulks; (e) Felts; (t) Sheet Flooring(Linoleum); (f) Cementitious Board(Transite); (u) Wallpaper; (g) Flashing; (v) Drywall; (h) Shingles;and (w) Plasterboard (i) Galbestos. (x) Spackling/Joint Compound; (11) Other Miscellaneous Materials: (y) Textured Paint; (a) Dust and Debris; (z) Grout; (b) Floor Tile; (aa) Glazing Compound;and (c) Cove Base; (ab) Terrazzo. (d) Floor Leveler Compound; (2) All ACM, PACM, suspect miscellaneous ACM, or asbestos material reported under Paragraph(1)of this Subdivision shall Include the location (e) Ceiling Tile; of the materials, an estimate of the quantities, types, friability and condition of the Identified materials to be treated and handled as ACM. (i) Vermiculite Insulation For the purpose of this Part, all PACM and suspect miscellaneous ACM visually assessed shall be treated and handled as ACM and shall be (g) Gaskets,Seals,Sealants(including for condensate control); assumed to be ACM, unless bulk sampling is conducted as per this 12 NYCRR 56 Subpart 5, Page 43 12 NYCRR 56 Subpart 5, Page 44 Section, standard EPA and OSHA accepted methods, including multi- renovation,remodeling or repair work shall be commenced by any owner or the layered systems sampling protocols; the subsequent analyses are owner's agent prior to the completion of the asbestos abatement in accordance performed by a laboratory that meets the requirements of Section 56-4.2 with the notification requirements of this Part. For multi-phased work,the access of this Part; and the analyses satisfies both ELAP and federal restriction for uncertified trades or personnel applies to each intermediate portion requirements,including multi-layered sample analyses,to document non- of the entire project. Upon completion of the intermediate portion of the asbestos asbestos containing material. project,other trades or personnel may access that portion of the work site. For demolition projects that are exempt from asbestos survey requirements due to (3) The building/structure asbestos survey shall also include the being structurally unsound,the demolition is considered an asbestos project and building/structure name,address,the building/structure owner's name and shall proceed as per Section 56-11.5. address,the name and address of the owner's agent,the name of the firm performing the asbestos survey and a copy of the frrm's current asbestos (1) All building/structure owners and asbestos abatement contractors on a handling license, the names of the certified Inspector(s) performing the demolition,renovation,remodeling,or repair project,which Includes work survey and a copy of the current asbestos handling certificate for each covered by this Part,shalt inform all trades on the work site about PACM, inspector utilized, the dates of the asbestos survey, a listing of ACM,asbestos material and suspect miscellaneous ACM assumed to be homogeneous areas Identifying which ones are ACM, all laboratory ACM at the work site. analyses reports for bulk samples collected,and copies of the appropriate certifications for the laboratory used for analysis of samples taken during (1) Bidding. Bids may be advertised and contracts awarded for demolition, the asbestos survey, remodeling,renovation, or repair work, but no work on the current intermediate portion of the project shall commence on the demolition,renovation,remodeling (g) Transmittal of Building/Structure Asbestos Survey Information. One (1) or repair work by any owner or agent prior to completion of all necessary copy of the results of the building/structure asbestos survey shall be immediately asbestos abatement work for the current intermediate portion of the entire transmitted by the building/structure owner as follows: project,in conformance with all standards set forth in this Part. (1) One(1)copy of the completed asbestos survey shall be sent by the owner Q) Unidentified and Unassessed Asbestos. When any construction activity,such or their agent to the local government entity charged with issuing a permit as demolition, remodeling, renovation or repair work,reveals PACM or suspect for such demolition, renovation, remodeling or repair work under miscellaneous ACM that has not been identified by the asbestos survey per this applicable State or local laws. Part,or has not been Identified by other inspections as per current OSHA or EPA requirements,all activities shall cease in the area where the PACM or suspect (2) The completed asbestos survey for controlled demolition(as per Subpart miscellaneous ACM is found and the Asbestos Control Bureau shall be notified 56-11.5)or pre-demolition asbestos projects shall also be submitted to the by telephone by the building/structure owner or their representative,followed with appropriate Asbestos Control Bureau district office. a written notice in accordance with the notification requirements of this Part. Unassessed PACM or suspect miscellaneous ACM shall be treated and handled (3) The completed asbestos survey shall be kept on the construction site with as ACM and assumed to be ACM,unless proven otherwise by standard EPA and the asbestos notification and variance,if required,throughout the duration OSHA accepted methods, including multi-layered systems sampling protocols; of the asbestos project and any associated demolition, renovation, subsequent analyses performed by a laboratory that meets the requirements of remodeling or repair project. Section 56-4.2 of this Part; and the analyses satisfies both NYS ELAP and (h) Removal Required. If the building/structure asbestos survey finds that the federal requirements,including multi-layered sample analyses,to document non- portion of the building/structure to be demolished,renovated,remodeled,or have asbestos containing material. repair work contains ACM, PACM, suspect miscellaneous ACM assumed to be ACM, or asbestos material, which is impacted by the work, the owner or the owner's agent shall conduct, or cause to have conducted, asbestos removal performed by a licensed asbestos abatement contractor in conformance with all standards set forth in this Part. All ACM, PACM, suspect miscellaneous ACM assumed to be ACM, or asbestos material impacted by the demolition, renovation,remodeling or repair project shall be removed as per this Part, prior to access or disturbance by other uncertified trades or personnel. No demolition, 12 NYCRR 56 Subpart 5, Page 45 12 NYCRR 56 Subpart 5, Page 46 to � c�s�-•—� A,5K 4cil v -- uV TOWN OF QUEENSBUF3Y BUILDING & C T. / /,• , e� '/ LINE OENf\ / /-z- � �S�D� `'A' NEW CONCRETE CURB i ISLAO IV OAS M2 LINE OF -3' IV ,PROPOSED RETAINING SITE AREA = 65.211 sq. ft. i� WALL ® , LINE OF PROPOSED i � GAS .- CONOPY �P \\ /; IV �\ \ _ s NEW PioLURB �iPEosED / ? � ° ' °yp \ CONCRETE C-STORE i ?t' 4j; .,.�•.., ' / 6 a I GI C)upR`J N5,EY -1 t10C1n 212 4'14 794C Mom PhonF EXISTING SITE 1412 STATE ROUTES (LAKE GEORGE) 65,211 +/— sq. ft. SITE Scale 1!f=40f 212 404 7241 Main Fax