DEMO-0406-2022 Office Use Only
DEMOLITION APPLICATION
Permit#:�'�`�,� ' 12."- zd�.� 1
11 �.
Permit Fee:$ t
rinm ntQccnsbun• Invoice#:
Iti)1y7t
742 Bay Road,queensbury,NY 12804 N""
Flood Zone? Y N Reviewed By: y
P:518-761-8256 www.gueensbu[y.net r
rl
Demolition Location: )9 [I.rK N-en eye Tax Map ID#. Tj 5
f - L3
**AN ASBESTOS REPORT IS REQUIRED WITH ALL Lqc
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? T7or71`_
2. Type of structure to be demolished:
a. Residence ✓ d.Storage Building
b. Garage e.Other:
c. Business R
LG. �-
3. What type of utjlities are connected to the structure:
a. Gas ✓ f.Well Water Pump II JUN 2.9 202Z
b. Fuel Oil g. Public Sewer
c. Propane h.other TOWN OF OUc`ENSSURY
I d. Electric � i.None BUiI DING&CODES
e. Public Water Y
4. Have ALL utilities(water,electric,etc.)been disconnected? Yes ✓ No
ADDITIONAL INFORMATION:
1. Two inspections are required: an inspection to determine that utilities are
i disconnected, and a final inspection after the structure is removed and the site is
cleaned up and graded.
2. Twenty-four(24) hour notification is required for inspections.
3. Workers' Comp insurance information is required to be submitted with this application.
i -
Declaration:I acknowledge that no structure(s)will be removed from the parcel until the demolition application has
P been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a
permit has been issued.
1 have read and agree to the above:
PRINT NAME: p';rr)C4S06j0,(
SIGNATURE: 1 s tI.le') ' c DATE:
L
DarnoMion App a6on Revised June 2022
Ai
CONTACT INFORMATION:PLEASE PRINT LEGIBLY OR TYPE,PLEASE INCLUDE AN EMAIL
• Applicant:
iVame(s): rrinA i rl Cal' fi fl 1IY1Gid01,�m Q i i(hci l ar
Mailing Address,C/s/z: u-eeoShL, 8'
Cell Phone: r-)f.?,3(p( 1-7 5-9- Land line:
Email: coy-y-in CL becLL-k:Ly 9-7 A►�Ct f f .COM
i
• Primary Owner(s):
Name(s): ('r'na i m Q,r + �' i ma ourvt ' 'nnagti
Mailing Address,C/s/z: 1� f� rl� ue t�nenShur� dV�f 12d�
Cell Phone:� a� Land Line: y
Email: Q rrin& beau a aMCL f). Ci'M
1
Check if all work will be performed by property owner only
• Contractor�List all additional contractors on the back of this form)
Contact Name(s): j C,k C+)C43e
Contractor Trade: .Oe_M( -oc1 C r
Mailing Address,C/s/z: ao _ a( n (e S a1po
Cell Phone: 9 3(o l 3(0 5 Co Land Line:
Email: Vl ifha e hui li pffiaGP rr (`6m
**Workers'Comp documentation must be submitted with this application**
Contact Person for any questions regarding this project: OC rl na pm C�nrin r- + Q- ✓>7
Cell Phone: ( l 'a 3- m Land�Ur� Qj i rnam)ar!
Email: -tv'�`r�C� U
4 xY
APRlication
Revised June 2021
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indica!»:a the plaps and specifications are in
full compliance with the Building Codes of
New York State.
Nationalgrid TfDVJN OF QDEENSSIJRY
300 Erie Boulevard West BUILDING & CO ES DEPT.
Syracuse,New York 13202 Reviewed Q17
y:
Date: __(0k1
DATE 6/29/2022
RE: Service Removal for Building Demolition.
This letter is to confirm that,per your request,National Grid has confirmed electrical
service and meters have been removed from 19 Park Ave., Queensbury. The work was
processed on work request#30609331. If you have any questions or need further
assistance,please feel free to contact us at 800-260-0054.
Sincerely,
Lydia Styb ESR3
Customer Connections UNY
nationalgrid
f u/V 29 �022
T B�L®&fGOP fj�ASBU
8 CODes
CLEARVU
I N S P E C T I O N S
518.832.9213 Evan@clearvuinspections.com 1 18 Blackberry Lane,Queensbury,NY 12804
Asbestos Clea
June 23,2022
JUN 2 9 2022
Corrina and Djimadoum Djimasngar TO 'W
19 Park Avenue GtiJEENSIBURY
Queensbury, New York 12804 �"g0«�6N�' CODES
Textured ceiling and window glazing materials sampled during the Asbestos Survey performed on
March 3,2022 of the single family home located at 19 Park Ave,Queensbury, NY 12804,
homogenous areas 8 &9 are deemed to be asbestos containing building material. These are is
slated to be disturbed during the demolition process of the home. Since the Asbestos Survey the
homeowner has removed the asbestos containing materials and has thoroughly cleaned the work
area(s).
In accordance with ICR 56-9.1(d), 56-9.2(e)(2)and ASTM E1368: ClearVU Inspections certifies Ryan
Wild has visually inspected the work area and all surfaces. These surfaces include but are not
limited to pipes, beams, ledges,walls,ceiling and floor. Ryan Wild, accompanied by the
homeowner,observed the contaminated areas and deems it to be complete with no visible dust,
debris, or residue apparent on any surface within the work area.
Sig V
-
_ W
Ryan Wild
ClearVU Inspections
Asbestos Handling License-282890
Asbestos Building Inspector-879660
Project Monitor&Air Sampling -883631
I,Corrina and Djimadoum Djimasngar, hereby agree the above information is correct and that I,as
the homeowner,am the sole individual who cleaned the work area.
Signed:
303.16-1-64 DEMO-0406-2022
Djimasngar, Corrina & Djimadoum
19 Park Ave
Demolition of SFD, garage and shed
7" Lucas Environmental Services) LLC
�" 75 Pleasant Ave. 99 Hill Rd.IN
�- 5chaghticoke,NY 12154 Kinston,NY 12+01
518-222-9027(O{Rce) 845-481-3329 (Branch)
06/27/2022
Djimadoum &Corrina Djimasngar,
Lucas Environmental Services, LLC located at 75 Pleasant Ave Schaghticoke, NY 12154 and 99 Hill
Rd. Kingston, NY 12401, asbestos license number 124431 completed regulated waste disposal of the
listed asbestos containing materials generated by the homeowner at 19 Park Ave. Queensbury, NY
12804. RACM waste was properly packaged and disposed of in accordance with current regulated waste
disposal regulations. Please don't hesitate to contact our office if you have any questions.
■ Regulated waste disposal of 4 fifty-five gallon waste bags containing friable asbestos containing
material.
JUN 7 9 p
TOWN Or C�'UEENSBURY
Regards, BUILDING& CODES
Kevin Mathlsen
NYSDOL Cert#06-03034
Lucas Environmental Services, LLC
office(a,lu case nv.com
518-222-9027(Albany)
845-481-3329(Kingston)
sTnrc fiF Mnwr ria�c-ld'r�li'G.+E�lf CAE t..ti1�t
JJKSFCA QRTWA"
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KEM M MAT14YSE-H
CLA554.rPtfES1
a u,ir�pau2�p
MUST NE CAhRIED ON AMSTOS PMOXCTS
1of3
P
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i REOFDER6 CO�Otnxl 6U54:rSS FOR1.tS 7-e065e2-tiW
E.P-A.AGENCY # 210275
.l, CT,MA,RI,VT,NH,ME NY GENERATORS
GENERATORS
EPA Region 2
EPA New England 290 Broadway,26th Floor EMERGENCY RESPONSE
3 Barker Drive•Wallingford.Cr W92 1 Congress Street _ New York,NY 10007-1866
(203)2_69-830n•Fax:(203)269-R60(1 Boston.MA 02114-2023 (212)637-3000 TELEPHONE
(617)918-1111 #203-269-8300
TK# ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number P.O.# GENERATOR/BUILDING OWNER
Contractor 4,164S -Z5V/• ��Ce-4114_-15S /41C-1
Address �7� �LArQ �4tZ AdMss
Cityyyy 5 6 State_ Zip city stale z
Telephone Number S2a 2n';' ei'rS'L—j Phone Number
Date Container Del.L1._2hQ—Date of Pickup GENERATING LOCATION
Type of Container l�.tbSE�
VOLUME .2g"— C1G Friable Non-Friable❑ Address/ Ah,�
MUST BE IN CUBIC YARDS City !4 � Stat 0.P
Bag Fr-' Drum❑ Wrapped❑ Other❑
Numbe
RQ, NA2212,ASBESTOS,9; Phone PG III Z�
I certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law,is not a hazardous waste as defined by 40 CFR part 261
or any applicable state law,has been property described,classified and packaged,and is in proper condition for transportation according to NESHAP standards for asbestos waste
disposal found in 40 CFR pad 61.150.
Shipper's Certification:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged.
marked and labeledfplararded,and are in all respects in proper condifign for transport aecording to applicable international and national government regulations.
AUTHORIZED SIGNATURE
Transporter 1:
Name Address Telephone e
Driver: Registration#: Date:
Signature Stale/# Certification Date
I hereby certify that the contents of this shfpmenl are in all respects in the proper condition for transport according to applicable international,federal,state and local regulations.
Transporter 2: TransWaste,Inc.,3 Barker Drive,Wallingford,CT 06492 (203)269-8300
Driver: Registration#: Date:
Signature State/# Certification Date_
I hereby certify that the contents of this shipment aro in all respects in the proper condition for transport according to applicable international,federal,state and local regulations.
Transporter 3: TransWaste,Inc.,3 Barker Drive,Wallingford,CT 06492 (203)269-8300
Name Address Telephone o
Driver: Registration#: Date: }
Signature State/# Certification Date
I hereby certify that the contents of this shipment are in all respects in the proper condition for transport according to app5cable international,federal,state and local regulations.
Site . Minerva Enterprises Site ❑: Modern Landfill Site ❑: Hakes Landfill Site ❑:
Address: 9000 Minerva S.E. Address: 4400 Mount Pisgah Rd. Address: 4376 Manning Ridge Rd. '.Address:
Waynesburg,OH 44688 York,PA 17402 Painted Post,NY 14870t
Phone: 330-866-3435 Phone: 717-246-4615- Phone: 607-937-6044 Phone: t
Indicate Any Discrepancies Certification of receipt of materials covered by this manifest. '
I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate.
Name of Authorized Agent Signature Receipt Dale
2of3
!
'New=Yol p k State„'Dearttnent ofboy'
- s Division oflSafety and Health r
t License and Certificate Unity
State Campus,Building 12'
Albany,.NY_7224.0-- ✓ `.�
-ASBESTOS HANDLING LICENSE 1
Lucas-Environmental Services,LLC f =FILE NUMBER: 4-124431
-�LICENSE NUMBER: 124431-- "
+ 75-Pleagant Ave., LICENSE CLASS: FULL'`, -
/i DATE OF ISSUE: 02/03/2022
Schaghticoke,NY 121,54 �i ' EXPIRATION DATE: 02/28/2023 \
� ��• �: ,�;a ti- 1 ,--_ - ,
pl I'�i'CI 14
Duly Authorized Representativel—'.Kevin Mathiseo =
�,:r . ���'}k`J,..�_..,;%✓,_Itill„'ti<'.C,�T I '
This'licensd'has been issued m accordance;with,applicable•prov}sions•}of'Art}c1e;30'of the Labor Law of New York'State-and of j
the New Yolk-State Codes,Rules'and'Regulations(12:NYCRR Part 56) It}s{subject to suspension or revocation for a(1) r
11. + - a r,` 1, ' u. - Inc- J 1 I
serious violation of state,federal or local lawswith regard,toythe conduct'of az%asbestos project,or(2)demonstrated1ack of
responsibility in the conduct of any job involving astiesfos or:asbestos'mateiiall:, ;!
_�.�c�'•___,;�c�. v'�.t,l u,h�l;j: :•-"�'ti- '.-1 ,r yr"
This license ts,valid only for`t}ie contractor named,above I issl(tcense dr a photocopy.must-be prominently displayed'at,the
asbestos project worksite.\This license verifes that all�perso ns employed b'y',the licensee on an asbestos project in New York
State have beeWissued an Asbestos Certiticat`e,'appropriate for the type.of work they perform,by the New York State'
Department of Labor. �, - >`•\ /'
IF
r Amy Phillips,Director
SH 432(8112) For the Commissioner of Labor
3 of 3
s
16�
C Ai
V:i ninc e ,L� COPY
ENVIRDN MEN TAL SERVICES
REPORT of ASBESTOS INSPECTION
Location of Inspection: 19 Park Avenue
Queensbury, New York 12804
Client/Building Owner: Corrina and Djimadoum Djimasngar
19 Park Avenue
Queensbury, New York 12804
Alpine Project#: 22-27585-A
Material or Area Inspected: Three buildings: House, Garage, and Shed
Asbestos Materials Tested:
House: textured ceiling, and window glazing compound.
Garage: none.
Shed: none.
Non-Asbestos Containing Materials Tested:
House: drywall, drywall joint compound, stone mortar, concretes, brown
paper vapor barrier, self stick vinyl flooring, 1'x1' ceiling tile, wall
panel adhesive, roof shingle, and roof shingle vapor barrier.
Garage: block mortar, glazing caulk, roof shingle, and roof shingle vapor
barrier.
Shed: roof shingle, and roof shingle vapor barrier.
Date(s)of Inspection: March 3, 2022
Date of Report: March 14, 2022
Inspection Performed By: Alpine Environmental Services, Inc.
438 New Kamer Road
Albany, New York 12205
Phone(518)250-4047
March 2022 19 Park Avenue
Queensbury,New York
Asbestos containing tar coating/waterproofing has been found on the exterior of basement
walls of many buildings constructed on block or poured concrete foundations. The basement
walls of this building are a stone construction, and not likely to be coated with a waterproofing
material. There was no tar coating/waterproofing observed on the exterior of the basement walls
of this building during this inspection. If tar coating/waterproofing is discovered on the exterior of
the basement walls of this building, it must be assumed to be asbestos containing until sampled
and proven otherwise.
Quantities of asbestos containing materials were estimated and the user must field verify all
quantities.
Any suspect materials found during demolition/renovation activities that are not listed in this
report should be considered asbestos containing materials until tested and determined otherwise.
1.4 Results of Inspection
Bulk samples were collected throughout the interior and exterior of the buildings. Samples were
collected as prescribed by US EPA ASHARA protocols for the numbers and types of samples.
See the sample results section for all samples collected and the results of analysis.
1.5 Conclusion and Recommendations
The following asbestos containing materials were found at the buildings located at 19 Park
Avenue in Queensbury, New York:
Table 1A:Asbestos Containing Materials Tested: House
Homogeneous Location Substrate& Approx. Friability Condition
Material Accessibility Quantity
Ceilings
Textured Ceiling
Paint Kitchen On Drywall 90 sf Non-Friable FGood
8-01, 8-02
Exterior
Window Glazing
Compound Exterior Sashes (9 units) Non-Friable Good
9-01, 9-02
Table 1 B: Asbestos Containin Materials Tested: Garage
Homogeneous Location Substrate& Approx. Friability Condition
Material Accessibility Quantity
None
Table 1C: Asbestos Containing Materials Tested: Shed
Homogeneous Location Substrate& Approx. Friability Condition
Material Accessibility Quantity
None
Please note these quantities are only estimates and the user should field verify all quantities.
Page 3
438 New Kamer Road Albany, New York 12205 Phone: (518)250-4047
1
March 2022 19 Park Avenue
Queensbury,New York
If Alpine Environmental Services can be of further assistance on this matter, please contact Craig
Petreikis at either(518) 250-4047 ext. 313 or craigp(aD-a1Pineenv.com.
Sincerely,
Alpine Environmental Services, Inc.
z-7
Brian Gould
NYS Dept. of Labor Asbestos Inspector
Enclosures: Results, NYSDOL Handling License(s), NYSDOL Handling Certificate(s), NYSDOH
ELAP License(s)
Page 5
438 New Kamer Road Albany, New York 12205 Phone: (518)250-4047
EMSL Analytical, Inc. EMSL Order: 032203341
Customer ID: ALP150
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 2-01 Description Basement:Wall-Stone Mortar
032203341-0005 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/07/2022 Brown 20.00%Gypsum None Detected
65.00% Non-fibrous(other)
15.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 2-02 Description Basement:Wall-Stone Mortar
032203341-0006 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/09/2022 Gray 20.00%Ca Carbonate None Detected
40.00% Non-fibrous(other)
40.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3-01 Description Basement:Wall Above Stone-Concrete
032203341-0007 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/07/2022 Gray 15.00%Ca Carbonate None Detected
50.00% Non-fibrous(other)
35.00% Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3-02 Description Basement:Wall Above Stone-Concrete
032203341-0008 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/09/2022 Gray 20.00%Ca Carbonate None Detected
45.00% Non-fibrous(other)
35.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 4-01 Description 1 st Floor:Side Room Floor-Concrete
032203341-0009 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/07/2022 Gray 3.00%Glass 15.00%Ca Carbonate None Detected
5.00%Mica
47.00% Non-fibrous(other)
30.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Initial report from:03/09/2022 11:48:53
ASB_198x 0009_0001 Printed 3/9/2022 11:48:56AM Page 2 of 4
EMSL Analytical, Inc. EMSL Order: 032203341
Customer ID: ALP150
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above. Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 3/5/2022 Sample Receipt Time: 10:29 AM
Analysis Completed Date: 3/9/2022 Analysis Completed Time: 12:37 AM
Analvst(s):
Ghaly Hemaya PLM NYS 198.1 Friable(6) Ordep Gonzalez PLM NYS 198.1 Friable(6)
Samples reviewed and approved by:
Charles Johnson, Asbestos Laboratory Manager
or Other Approved Signatory
EMSL maintains liability limited to cost of analysis.Interpretation and use of test results are the responsibility of the client.This report relates only to the samples reported
above,and may not be reproduced,except in full,without written approval by EMSL.EMSL bears no responsibility for sample collection activities or analytical method
limitations.The report reflects the samples as received.Results are generated from the field sampling data(sampling volumes and areas,locations,etc.)provided by the client
on the Chain of Custody.Samples are within quality control criteria and met method specifications unless otherwise noted.Estimation of uncertainty available upon request.
This report is a summary of multiple methods of analysis,fully compliant reports are available upon request.All samples examined for the presence of vermiculite when
analyzed via NYS 198.1.A combination of PLM and TEM analysis may be necessary to ensure consistently reliable detection of asbestos.Polarized-light microscopy is not
consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.This report must not be used to claim product endorsement by
NVLAP of any agency or the U.S.Government.Quantitative transmission electron microscopy is currently the only method that can be used to determine if this material can
be considered or treated as non-asbestos containing.NOB=Non friable organically bound;N/A=Not applicable VCM=Vermiculite containing material.
Samples analyzed by EMSL Analytical,Inc.New York,NY NYS ELAP 11506,NVLAP Lab Code 101048.9
Initial report from:03/09/202211:48:53
ASB_198x_0009_0001 Printed 3/9/2022 11:48:56AM Page 4 of 4
EMSL Analytical, Inc. EMSL Order: 032203342
Customer ID: ALP150
307 West 38th Street New York,NY 10018
Customer PO:
Tel/Fax:(212)290-0051/(212)290-0058
http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Attention: Brian Gould Phone: (518)250-4047
Alpine Environmental Services Fax:
438 New Karner Road Received Date: 03/05/202210:30 AM
Albany, NY 12205 Analysis Date: 03/09/2022
Collected Date: 03/03/2022
Project: 22-27585-A/House: 19 Park Avenue Queensbury, New York
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 6-01 Description Kitchen:Floor At Floor Vent-Self Stick Vinyl Flooring
032203342-0001 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 Brown 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 Brown None 100.00% Other <1%Chrysotile
Sample ID 6-02 Description 2nd Floor:Bedroom At Floor Vent-Self Stick Vinyl Flooring
032203342-0002 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 Brown 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 Brown None 100.00%Other <1%Chrysotile
Sample ID 7-01 Description 1 st Floor:Back Room At Stairs,Behind Wall Paneling-Adhesive
032203342-0003 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 Yellow 100.00%Other None Detected
Sample ID 7-02 Description 1 st Floor:Back Room At Stairs,Behind Wall Paneling-Adhesive
032203342-0004 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 Yellow 100.00%Other None Detected
Sample ID 8-01 Description First Floor:Kitchen Ceiling-Textured Paint
032203342-0005 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 White 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 White None 98.20%Other <1%Anthophyllite
1.80%Chrysotile
1.8%Total
Initial report from:03/10/2022 12:05:44
ASB_198x_0009_0001 Printed 3/10/2022 12:05:48PM Page 1 of 4
EMSL Analytical, Inc. EMSL Order: 032203342
Customer ID: ALP150
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
40�
hftp://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 11-02 Description Upper Roof:West End-Roof Shingle Vapor Barrier
032203342-0012 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 Black 100.00%Other None Detected
Sample ID 12-01 Description 1st Floor:Back Room Ceiling-V x I'Ceiling Tile
032203342-0013 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 White/Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 White/Yellow 100.00%Other None Detected
Sample ID 12-02 Description 1 st Floor:Back Room Ceiling-V x I'Ceiling Tile
032203342-0014 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 White/Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 White/Yellow 100.00%Other None Detected
Initial report from:03/10/2022 12:05:44
ASB_198x 0009_0001 Printed 3/10/2022 12:05:48PM Page 3 of 4
ENVIT6M-KEWtki SH RVICE.S:
CHAIN Of-CUSTODY
Client; Alpine-1 vices.Ine., i?iajeef: ffoicse: 19 Park Avenue
438'MhV Karner'R iad Vi)eh:
Albany; N`4' 1??()5 Project-Number:._22-27,, 85.-A
Contact; Brimi 60tild wSAmplc&Bv Briaii-Gotild
E-Mail: BriariG c.;AlpineE,nv.cortr Datel Time G011ected:.34_?022/"9:S0-:1 I:30
Turnaround Timet".T haurc _ _ ___ - _ :Sl ij�perTrackirig;N_urnber: 7762 U871.0011 . 'Oedex),
Lbg No: Sample Sample'L acativti Sample;Material Analysis. Results
No.. '�"Performeci',
&'0`: Kitclie1':r106r SelfS.i'iek. NYS.FLAP
AfFloor.Veni _Vinvl.Fldtiring Protocol"s
6�02 2iid'rlo6r: BecIrodni Selrstibk, NlY.S ELAP
Af,Flaor Vent Vinvl Irloui-ing. Protocols;
7=0.1 I`st.Elo.or Back Room Adlie§i;V'e NYS FLAP
At'.Si:aiis."Bhind'WC%•allPanelin� Protocols
7=02 last'Flour: Bark Itooin Adliesi've NYS ELA'P.
At Stairs,;Bel�iiicl,l'Vall,f?anelipg Vt;Qtoc6ls.
F first Floor.':'Kitchel' Textii"'d�''Paint NYS FLAP
Ceiling" Protocols_
&02 First Efonr:Kitchen en "I exiui"ed°Paint NVS""ELAP
Ceiling Protocols
9-01_ Exterior: l si Flood: Back Room Glazii-i'Y Compound NYS ELA f
:N.ortli 1Vincic��y ',F?rotoci�ls
9-�02 Exterior.2nd F,loor;. 'Glazing_Copipound NYS ELt1P.
.East Window Protocols:
.l'0-0'.l Upper R6of NVest�End. Itlbof s ingie° NY5.FLAP
Protocol'& 1,
a'U=tJ2 Ltpper Etoof::'W st"'End Roof 5hiiigle.. :NYS ELi\P
" [protocols. _ -
l !;;0:1': Upper Roof-'1NVest:End Roof'Shlrigle :NYS ELAP
Uapi BBarrier Rr.qto-cots
11-01, Upper R_6q W st:l nd Roof.Skih-gle NYS CLAP
Vapor" Barrier Protopok-
Disposition;'of Samp1ts:-Accepi Reject Explain �-
Comments:"
Reli'ncluished thy:, Recei.ved."Y . � pate; Tillie.
1 Page. o ,"_
438 NdW'Kamer Road'•;Albany; New Y&K_ 12205:o Pfione: (51$)25t)-4047. Faz`„(518)250 353.email craigpQatpineenv:com
EMSL Analytical, Inc. EMSL Order: 032203338
Customer ID: ALP150
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
hftp://www.EMSL.com/manhaftanlab@emsl.com Project ID:
Attention: Brian Gould Phone: (518)250-4047
Alpine Environmental Services Fax:
438 New Karner Road Received Date: 03/05/202210:27 AM
Albany, NY 12205 Analysis Date: 03/07/2022-03/09/2022
Collected Date: 03/03/2022
Project: 22-27585-A/Garage: 19 Park Avenue Queensbury, New York
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 1-01 Description Exterior SW Corner-Block Mortar
032203338-0001 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/07/2022 Gray 20.00%Ca Carbonate None Detected
25.00% Non-fibrous(other)
55.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 1-02 Description Exterior SW Corner-Block Mortar
032203338-0002 Homogeneity Homogeneous
PLM NYS 198.1 Friable 03/08/2022 Gray 3.00%Cellulose 5.00%Mica None Detected
37.00% Non-fibrous(other)
55.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 2-01 Description Exerior:South Window-Glazing Caulk
032203338-0003 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 White 100.00%Other None Detected
Sample ID 2-02 Description Exerior.South Window-Glazing Caulk
032203338-0004 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 White 100.00%Other None Detected
Sample ID 3-01 Description Roof:SW Comer-Roof Shingle
032203338-0005 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 03/09/2022 White/Black 17.00%Glass 83.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 03/09/2022 White/Black 100.00% Other None Detected
Initial report from:03/09/2022 19:07:43
ASB_198x 0009_0001 Printed 3/10/2022 12:09:42PM Page 1 of 3
EMSL Analytical, Inc. EMSL Order: 032203338
307 West 38th Street New York,NY 10018 Customer ID: ALP150
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
http://www.EMSL.com/manhattanlab@emsl.cwm Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above. Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 3/5/2022 Sample Receipt Time: 10:27 AM
Analysis Completed Date: 3/7/2022 Analysis Completed Time: 6:46 AM
Analvst(s):
Ordep Gonzalez PLM NYS 198.1 Friable(1) l Tiquasha Thompson PLM NYS 198.1 Friable(1)
n
Kerrie Gibson PLM NYS 198.6 NOB(6) Isaac Mendez TEM NYS 198.4 NOB(6)
Samples reviewed and approved by:
Charles Johnson, Asbestos Laboratory Manager
or Other Approved Signatory
EMSL maintains liability limited to cost of analysis.Interpretation and use of test results are the responsibility of the client.This report relates only to the samples reported
above,and may not be reproduced,except in full,without written approval by EMSL.EMSL bears no responsibility for sample collection activities or analytical method
limitations.The report reflects the samples as received.Results are generated from the field sampling data(sampling volumes and areas,locations,etc.)provided by the client
on the Chain of Custody.Samples are within quality control criteria and met method specifications unless otherwise noted.Estimation of uncertainty available upon request.
This report is a summary of multiple methods of analysis,fully compliant reports are available upon request.All samples examined for the presence of vermiculite when
analyzed via NYS 198.1.A combination of PLM and TEM analysis may be necessary to ensure consistently reliable detection of asbestos.Polarized-light microscopy is not
consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.This report must not be used to claim product endorsement by
NVLAP of any agency or the U.S.Government.Quantitative transmission electron microscopy is currently the only method that can be used to determine if this material can
be considered or treated as non-asbestos containing.NOB=Non friable organically bound;N/A=Not applicable VCM=Vermiculite containing material.
Samples analyzed by EMSL Analytical,Inc.New York,NY NYS ELAP 11506,NVLAP Lab Code 101048-9
Initial report from:03/09/2022 19:07:43
ASB_198x_0009_0001 Printed 3/10/2022 12:09:42PM Page 3 of 3
I
orderID: 032!20-3,-M'
AV'-A wa-41h!,
E N Y I R 0 .11 M E.N f.,A I S-E RY I-C I
CHAIN OF CUSTODY
Client: jp�-�jk ine Erivir6ninbrital Sgr%j'cqs,. Inc. Project: Galft--r19 Park Avenue
438 N6%, Karhift R6iid Otie6-nsKirv.New York
Albariv.NY 12205 PrqjGi:t-Nuiub-0,:- 22-'17 585-A
Contact: Brian (:could Sampled 133,-.—Brian Gould
E-Mail: Bri.ijiGfPi.A-IpincEiix,,-'coiii Di.ite!Time(,,61le,.,ted:.3--',-202.2 0 3 0-I 1:3 0'-
7-2 ho6rs Sll*ilioer'l'rack-',iiig,.,,Nutiib'er:. 7.762--0871 0011 (fedexI
Log No. Sample Sample,Sample,Location Sample.We'ridl Analysis Res-tilts
Perf6iiued
1-0.1 Exteribr,SW Comer Block INIortal:: -NYS ELAP
Protocols
1-02 Exterior SW Comer Block Mortar NYS ELAP
Protocols
2i.0 I :,xtdrioi-: SouthVindow Glazing-Caulk- -Cau-lk NYS ELAP
Protocols
1:02 Exterior: Sottth-W-hTdow 'Glazine,.Catilk NYS ELAP
flrotocols-
Roof: Corner 1(pot"Sluilgle- 'NYS ELAP
Protocols
3-02 Roof. SW Comer RoofShinale NYS ELAN"
4-'01 Roof- SW Comer Roof Shiaggle NYS ELAP
Vapor Barrier Protocols
4r02 Roof: SW Corner Roof.Shiii4le NYS ELAP
V1 01-Bari*ie '
P
\.Peotocols.
Disposition 01'samoles; Accept. Reivp Explain
Comments:
Relinquished B%,: Rec'eMd 13v: Time:
17 C-oLt J
Pagt�-11 of I
1��44 ef Road Albany, N 18-Neyi Ka Nevi Yodk 1'220(t Phone: (518 4 250 .047,- Fax; (5t.8)250-dj53- email crelp 05alpincemporn
T/ 3
EMSL Analytical, Inc. EMSL Order: 032203340
Customer ID: ALP150
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
40-
http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above. Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 3/5/2022 Sample Receipt Time: 10:27 AM
Analysis Completed Date: 3/9/2022 Analysis Completed Time: 1:33 PM
Analvst(ss)):
Ordep Gonzalez PLM NYS 198.6 NOB(4) Venisha Lazarus-Bames TEM NYS 198.4 NOB(4)
Samples reviewed and approved by:
.CA
Charles Johnson, Asbestos Laboratory Manager
or Other Approved Signatory
EMSL maintains liability limited to cost of analysis.Interpretation and use of test results are the responsibility of the client.This report relates only to the samples reported
above,and may not be reproduced,except in full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method
limitations.The report reflects the samples as received.Results are generated from the field sampling data(sampling volumes and areas,locations,etc.)provided by the client
on the Chain of Custody.Samples are within quality control criteria and met method specifications unless otherwise noted.Estimation of uncertainty available upon request.
This report is a summary of multiple methods of analysis,fully compliant reports are available upon request.All samples examined for the presence of vermiculite when
analyzed via NYS 198.1.A combination of PLM and TEM analysis may be necessary to ensure consistently reliable detection of asbestos.Polarized-light microscopy is not
consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.This report must not be used to claim product endorsement by
NVLAP of any agency or the U.S.Government.Quantitative transmission electron microscopy is currently the only method that can be used to determine if this material can
be considered or treated as non-asbestos containing.NOB=Non friable organically bound;N/A=Not applicable VCM= Vermiculite containing material.
Samples analyzed by EMSLAnalytical,Inc.New York,NY NYS ELAP 11506,NVLAP Lab Code 101048-9
Initial report from:03/09/2022 14:28:18
ASB 198x 0009 0001 Printed 3/9/2022 5:09:05PM Page 2 of 2
New.Y6 k State'-Department'of.L. b&or
Division of,Safety and Health,
License and Certificate Llhit"
State Campus,"Building 12'
i Albany,..NY. 12240
-ASBESTOS HANDLING LICENSE-
Alpine Environmental Services, Inc. FILE NUMBER, 00;0320,
LICENSE NUMBER: 29095 .
438-New'Karner Road ` ` LICENSE CLASS: RESTRICTED", -
' DATE OF ISSUE: 08/04/2021 "
.'Albany,.NY 12205 e EXPIRATION:DATE: 08/3.1/2022
Duly.Authorized Representative'`=Craig Petreikis:-
This license has been issued in accor`.d'ance with'applicable'pro. isions'of Article:3,0'of the Labor Law of New Y"orkState-and of ;
the New York State Codes, Rules`and Regulati6iis;(12"NYCRR Part 56): -If is;subjeet to suspension or revocation for a(I")
serious violation,of state, federal dr"local laws wiJf ;regardjo,the conduct'ofari,asbestos project,or(2).demonstrated lack.of
responsibility in the conduct of any job.involving,asliestos or"asbestos maternal:;::
This'licens6 i§,valid only.for the contractor nat,ed;abbye and this;_license or a'photocopy must.be-'prominently displayed at the
asbestos projectworksite. Thi`saicense verifies that•all',persons employed by the licensee on anasbestos project in:New York
State have bien',issued Asbestos Certificate,appropriate_for ifi6ty
pe.of wort:they perform,by the New"York State
Department of Labor.
Amy Phillips, Director
SH 432(8112) For the Commissioner of Labor
{
57ATE QF NEIN YC)RK.-DEPARI MENT QF LABOR,
A58ESTOS;CERT1RCATE
BR1AN R GOO CD
CLA55(EXP(RES),,
C,ATEC(a,t(23)' Q:J9SP(01'/23)
-�" H,PM (01 f 23), I�PD
I
t
MUST BE.CARRIED.ON ASBESTOS PROJECTS:
_ iuiuu�a�e�mannr '