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DEMO-0692-2022 Office Use Only DEMOLITION APPLICATION Permit#: Permit Fee: $ �LQ�J— Town of Queensbury Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By: O Demolition Location: 6''O�1'', /�� Tax Map ED#: Z' 1 1 L-- 7 -35 **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** DEMOLITION INFORMATION: l 1. Where will demolition material be disposed? Allpra. Cr' Vf,4, Ca,,PAO 2. Type of structure to be demolished: J a. Residence d. Storage Building b. Garage e. Other: c. Business r 3. What type of utilities are connected to the structure: I 17 � �; a. Gas f. Well-Water Pump I' b. Fuel Oil g. Public Sewer Tl)celCE,LIP`( c. Pro ane h. Other - d. Electric i. None e. Public Water 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 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. Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application has been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a permit has been issued. I have read and agree to the above- PRINT NAME: Is �O �,u AGd, ,061 SIGNATURE: ' DATE: Demolition Application Revised June 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicants �� �1 i �f� Name(s): d 60 L.LC- 1 Mailing Address, C/S/ : � VIA ►r��G`� Cell Phone: &) " and Line: Email: 6a2n^, cnly \, • Primary Owner(s): Name(s): M Mailing Address, C/S/Z: Cell Phone: Land Line: Email: 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): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: **Workers' Comp documentation must be submitted with this application** Contact Person f an questions regarding this project: ht^i' I� � "��' Add a Cell Phone: I S Land Line: Email: Demolition Application Revised June 2022 11 lJlr�RIF-�I ielrlr:•�%Yll+-=•:k�:- F-,erleace is the se"Utic-ni �a 314 North Furl Street o AbEinv New York 12207 (518)4.34-4546 4' F@X:(518)A34-o8S1 t =r CER •—F CATS,OF ALSBESTOS D�SPERCTIOhi D,>ilain.-v/zddress#l0 oak- g,,OAD {af Speciisc Vi!ozk sea I��N n1 A M b E;ArNRoor ' <r, Abasement Company. 0yun `.1 The asbestos work area defined above has been inspected by the NYS Certified Project I y r Monitor for completeness iu accordance with she requirements of Iudustrial Code 56.This hupection_has been performed in general accordance with ASTM E1368.The Project Monitor's visual inspection was for visible visible asbestos-containing materials;dust and A� debris. By(Print Name) �A-i'►�I1'1N1E~C-�iJUz:�CLI�`� Date 11 !1 ZZ � F d By(Si s I<x, Asbestos Cerdficafion y.z(- �' 1 F, V Company Name_ j r K�rJ Ack, 6,)U1 RC)j\hV)U--JT' :5E I �5 I:- NOV 15 2022 (may TOWN OF OUEENSDUiZY 6UILDIiNG c: C0DErG J - Asbestos Survey and Bulk Sampling Pre-demolition #10 POLK ROAD QUEENSBURY, New York Inspection Date June 13, 2022 Prepared for: N oeQa\otibe oatio�oae5 °� Abele Builders 14 Corporate Drive e�u��a� Clifton Park,New York 12065 z Prepared by: George Bailey Project Manager—Asbestos Services 0 4 North Pearl St any,NY 12207 Phone:.(518)434-4546 Fax: (518)434-0891 ' 0 Adirondack Project No.: M-22-538 TOWN OF QUEENSBURY BUILDING & CODES DEPT. Reviewed y: M- - Date: �► �� � 0 Experience is the solution 314 North Pearl Streets Albany,New York 12207♦ (518)434-4546 s Fax:(518)434-0891 June 21,2020 Mr. Chris Abele Phone 518-365-4989 Abele Homes 14 Corporate Drive Clifton Park,New York 12065 chris@abelebuilders.com RE: Pre-demolition Asbestos Survey and Bulk Sampling #10 Polk Road, Queensbury,New York Adirondack Project No. IH-22-538 Mr. Abele: Adirondack Environmental Services, Inc. (Adirondack)was pleased to provide an asbestos survey and bulk sampling with analysis of suspect asbestos containing materials (ACM) in the residence at#10 Polk Road in Queensbury,NY. Attached is a summary report of the survey findings. Thank you for selecting Adirondack Environmental Services,Inc. for your asbestos management needs. If you have any questions or require further information,please feel free to contact meat (518)434-4546. Very truly yours, ADIRONDACK ENVIRONMENTAL SERVICES,INC. GEORGE BAILEY Project Manager Enclosure 0 Experience is the solution 314 North Pearl Street♦ Albany,New York 12207♦ (518)434-4546® Fax:(518)434-0891 EXECUTIVE SUMMARY Mr. Chris Abele, on behalf of Abele Builders, asked Adirondack Environmental Services Inc., (Adirondack)to perform an asbestos survey with related bulk sampling and analysis of the residence at#7 Polk Road in Queensbury,NY. The building is slated for demolition. The purpose of the sampling was to determine if the materials in the structure were asbestos containing material (ACM)which will be disturbed during the demolition. This survey is required in order to obtain a demolition permit from the Town of Queensbury. George Bailey conducted this inspection and collected samples on June 13, 2022. Samples were collected as follows: . Eighteen (18) samples representing nine (9)homogeneous materials were collected at #10 Polk Road. The materials consisted of typical building materials including roofing materials, mortars, grouting and flooring materials. By definition and law a material must contain more than 1% asbestos to be classified as ACM. Two(2)of the materials sampled contained greater than(>) 1% asbestos and was therefore classified as asbestos containing material(ACM). The materials included linoleum tile in the kitchen and bathroom. The remaining materials sampled and analyzed all contained less than (<) 1% asbestos and are therefore classified as non-asbestos containing(NAC) materials. BULK SAMPLE COLLECTION The survey included all observed suspect materials in each of the camp. The inspector, George Bailey, is a NYS certified asbestos inspector. Samples were collected in compliance with NYS ICR56 and EPA's Asbestos Hazard Emergency Response Act(AHERA). A unique sample identification number was given to each homogeneous building material after samples were collected. Bulk sample locations from homogeneous sample areas were selected at random. The number of samples collected for each suspect material was based on the presumed ACM(PACM)type and quantity as required. Samples were placed into sampling containers and submitted to Adirondack's lab under chain of custody documentation. Asbestos Bulk Sampling—#10 Polk Road Adirondack Project No.IH-22-538 I I P a g e 1 1 Experience is the solution 314 North Pearl Street♦ Albany,New York 12207 a (518)434-4546♦ Fax:(518)434-0891 METHODOLOGY Samples were either analyzed by NYS ELAP methodology via PLM(Polarized Light Microscopy),PLM/NOB (Polarized Light Microscopy/Non-Friable Organically Bound), or TEM (Trans Electron Microscopy)based on material type as dictated by state regulations. A stop at first positive analysis protocol was followed for each homogeneous set. Samples were submitted to Adirondack for standard turnaround. See Attachments for laboratory, company and personnel certifications. Adirondack is fully accredited for bulk sample analysis under the Environmental Laboratory Approval Program(ELAP) administered by NVLAP No. 200552-0 and the New York State Department of Health,ELAP No.10709. RESULT SUMMARY Materials must contain more than 1% asbestos to be considered asbestos containing material. Two materials,both linoleum, contained greater than 1% and was therefore classified as asbestos containing material(ACM). Note: The primary sample numbers"represent a continuation of the sequence used while surveying#3 Polk Road,which was done just prior to the survey for#7 Polk Road. ACM Sample % Asbestos Field Estimate Condition Potential for Sample Location (F,NF) Total Disturbance 04-07, 08: 16% Contact:high Linoleum kitchen Chrysotile, 155 SF Good Vibration:high NF Air Current:high 08-15, 16: 20.3% Contact: high bathroom Chrysotile, 15 SF Good Vibration:high Linoleum NF Air Current:high F—Friable,NF—Non-friable Materials sampled that contained less then< 1% asbestos are classified as non-asbestos containing(NAC) and included the following: Sample No.and Description ACM Sample Location Condition 01-01, 02: Asphalt shingles South facing roof,NE Comer Good, some weathering 02-03, 04: Tar Paper South facing roof,NE Comer Good, some weathering 05-09, 10:Drywall Boiler Room,Living Room Good 06-11, 12: Joint Compound Comers—Boiler Room,Living Room .Good 07-13, 14: Ceiling Board Kitchen Some damage 09-17, 18: Brick Mortar Dining Room chimney,2nd floor chimney Good 10-19,29: Stone Mortar Living Room Hearth Good Asbestos Bulk Sampling—#10 Polk Road Adirondack Project No.IH-22-538 2 P a.-e 0 Experience is the solution 314 North Pearl Street Albany,New York 12207® (518)434-4546♦ Fax:(518)434-0891 Note:No samples were collected or recorded as 03-xx,xx. Material was originally intended for sample but in reality was not present. OBSERVATIONS • Since complete demolition is a potential outcome all suspect material needed to be sampled • The building is in older, somewhat weathered condition but is in reasonably good condition. • The roof is in good condition. • The building has no basement. • No pipe insulation or pipe fitting insulation was observed. RECOMMENDATIONS • All ACM must be removed by a licensed asbestos abatement contractor prior to any activity which would disturb the material. • Maintain a copy of this report on-site during any asbestos abatement or demolition project as per NYS ICR56-5(g) (3). • Additional bulk samples may be needed for suspect materials that were not evaluated during this inspection due to inaccessibility. This would include any windows which, though assumed to be homogeneous,may be questioned for any reason. • Feel free to contact Adirondack if you require further asbestos management services. Attachment A contains the laboratory results with chain of custody documentation. Attachment B contains company and personal certifications. Asbestos Bulk Sampling—#10 Polk Road Adirondack Project No.IH-22-538 3 1 P a g e Adirondack 0 Experience is the solution 314 North Pearl Street Albany, New York 12207s (518)434-4546♦ Fax:(518)434-0891 Attachment A LABORATORY RESULTS AND CHAIN OF CUSTODY AIHA-LAP,LLCAccredited#100307 Experience is the solution NYSDOH#10709 314 North Pearl Street ♦Albany,New York 12207 Bulk Asbestos Report (800)848-4983 ♦_(518)434-4546♦ Fax(518)434-0891 Project: Asbestos Pre-Reno Survey Abele Homes ProjLocation: 10 Polk Rd Assembly Point Date Sampled: 06/13/2022 14 Corporate Drive Date Received: 06/13/2022 Clifton Park, NY 12065 PLM Analyzed: 06/14/2022 by KTT Attn. ***AES IH Dept*** TEM Analyzed: 6/20/2022 by ktt Method References: NYSDOH ELAP 198.1/198.4/198.6 ReportDate:6/20/2022 Workorder: 220613052 L a Non-asbestos PLM TEM Result Lab y Sample Identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type)r PLM Result ELAP-198.4 Status 001 A 01-01 Homogeneous, Tar/Roofing Black,Non-Friable <1% -- <1 Material NAC NAC 0 Wt%Remaining PLMMethod: ELAP 198.6 002 A 01-02 Homogeneous, Tar/Roofing <1% ------- <1% Black,Non-Friable Material NAC NAC 0 Wt%Remaining PLMMethod: ELAP 198.E 003 A 02-03 Homogeneous, Tar/Roofing ° ______ Black,Non-Friable <1% Material NAC NAC 0 Wt%Remaining - PLMMethod: ELAP 198.E 004 A 02-04 Homogeneous, Tar/Roofing ------- <i% Black,Non-Friable Material NAC NAC 0 Wt%Remaining PLMMethod: ELAP 198.6 Page 1 of 4 ReportDate:6/20/2022 Workorder: 220613052 L a Non-asbestos PLM TEM Result Lab y Sample Identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type) r PLM Result ELAP-198.4 Status 005 A 04-07 Homogeneous, Flooring 44.4%Chrysotile Tan,Non-Friable 16% ------- 16% Material ACM ACM 36.1 Wt%Remaining PLMMethod: ELAP 198.6 006 A 04-08 Homogeneous, Flooring Not Not Tan,Non-Friable Material Analyzed Analyzed 31.8 Wt%Remaining PLMMethod: ELAP 198.6 007 A 05-09 Homogeneous, Friable Material No asbestos detected White,Friable Material NAC NAC PLMMethod: ELAP 198.1 008 A 05-10 Homogeneous, Friable Material No asbestos detected White,Friable Material <1% -- <1% NAC NAC PLMMethod: ELAP 198.1 009 A 06-11 Homogeneous, Friable Material No asbestos detected White,Friable Material <1% -- <1% NAC NAC PLMMethod: ELAP 198.1 010 A 06-12 Homogeneous, Friable Material No asbestos detected <1% - <1 White,Friable Material NAC NAC PLMMethod: ELAP 198.1 Page 2 of 4 ReportDate:6/20/2022 Workorder: 220613052 L a Non-asbestos PLM TEM Result Lab y Sample Identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type)r pLM Result ELAP-198.4 Status 011 A 07-13 Homogeneous, Ceiling Tile No asbestos detected Brown,Non-Friable °<7 /° No Asbestos Detected <7% Material Inconclusive" NAC 10.2 Wt%Remaining PLMMethod: ELAP 198.6 012 A 07-14 Homogeneous, Ceiling Tile No asbestos detected Brown,Non-Friable <7% No Asbestos Detected <1% Material Inconclusive` NAC 11.2 Wt%Remaining PLMMethod: ELAP 198.6 013 A 08-15 Homogeneous, Flooring 57.1%Chrysotile 20.3% -- 20.3% Tan,Non-Friable Material ACM ACM 35.5 Wt%Remaining PLMMethod: ELAP 198.6 014 A 08-16 Homogeneous, Flooring Tan,Non-Friable Not Not Material Analyzed Analyzed 6.9 Wt%Remaining PLMMethod: ELAP 198.6 015 A 09-17 Homogeneous, Brick Red,Friable Material <1% ------- <i% NAC NAC PLMMethod: ELAP 198.1 016 A 09-18 Homogeneous, Brick No asbestos detected Red,Friable Material <7% ------- <7% NAC NAC PLMMethod: ELAP 198.1 Page 3 of 4 ReportDate:6/20/2022 Workorder: 220613052 L a Non-asbestos PLM TEM Result Lab y Sample Identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type) r PLM Result ELAP-198.4 Status 017 A 10-19 Homogeneous, Friable Material No asbestos detected Gray,Friable Material <1% ------- <1% NAC NAC PLMMethod: ELAP 198.1 018 A 10-20 Homogeneous, Friable Material No asbestos detected Gray,Friable Material <1% ------- <i NAC NAC PLMMethod: ELAP 198.1 ACM:Asbestos Containing Material NAC:Non-Asbestos Containing Material Approved by: **A negative result for an NOB sample is considered inconclusive.The following NYS ELAP Tara Daniels disclaimer applies:"PLM is not consistently reliable in detecting asbestos in floor coverings and similar Laboratory Director NOB materials. Before this material can be considered or treated as non-asbestos containing, confirmation must be made using transmission electron microscopy(TEM)". Page 4 of 4 314 North Pearl Street Albany, New York 12207 SULK SAMPLE DATA AND e ' 518-434-4546/434-0891 FAX CHAIN OF CUSTODY RECORD ' o -ra EXPERIENCE IS THE SOLUTION A full service analytical research laboratory offering solutions to environmental concerns Client Name: Address: Date: J. Send Report To: Project Na a(Location): Project Manager! Client Phone No: Project Number: Inspector: Client Fax No: BULK SAMPLE INFORMATION SUR Lab Sample Homogenous TSI Material Analysis to No. Area No. Bulk Sample ID No./Material MIS Sample Location Qly.(LF,SF) Requested I Gi lc N ,ill t&6 Ili �6 0I-62 I` I it F 62'o 'r Ie .air 5?1J+ 37 5�� �•'lI S� r. IF 0-5 7,0 67 ISO E s . t �' ()l� G � �r-1—V C/ 1 it III v ` � It y I rLA �a APIP tl 6�- I`Z n it v��f t 1!t 2 Lf PLry1 rr Turnaround Time Request: Special Instructions/Remarks ❑ 1 Day ❑ 3 Day )Q Normal F/ f ❑ 2 Day ❑ 5 Day ❑ Other CC Report To: 711,qq uished (Sign ure) Received by:(Signature) Date/Time ' ' had by:(Signs re) Received for Laboratory by: Date rime - IN WHITE-Lab Copy YELLOW mpler Copy PINK.-.Generator Conv _. F � 1 1 11 ! 1 � II�Illlllllle � � b°Zia III I I�' I II III _ 220613052 T. t Alb North Pearl Street BULK SAMPLE DATA AND Albany, New York 12207 1 0 • ® , 518-434-4546/434-0891 FAX CHAIN OF CUSTODY RECORD m EXPERIENCE IS THE SOLUTION A full service analytical research laboratory offering solutions to environmental concerns F Client Name: Address: Date: Send Report To: Project Nettie(Location): Project Manager: 2 Client Phone No: Project Number: Inspector: Client Fax No: BULK SAMPLE INFORMATION SUR Lab Sample Homogenous TSI Material Analysis 10 No. Area No. Bulk Sample IB No./Malarial MIS Sample Location Qty.(LF,SF) Requested v PLdy ( ��1 'e V -M t OF M < 11 =- la J� I h �. "`—• P�� 5s� C . ARb F I NMI s�? fE L{F�V fT ✓T •'�P1 t ss' Turnaround Time Request: Special Instructions/Remarks '<a ❑ 1 Day ❑ 3 Day C Normal ❑ 2 Day ❑ 5 Day ❑ Other 3 CC Report To: ' R 'quishad b . Sign lure) Received by:(Signature) Dale/Time Relinqu'§he y;(Signatu e) Received for Laboratory by: Date/rime )41 az ' ' rg WHITE-Lab Copy YELLOW-Sa ter Copy PINK-Generator Copy =r f fx A ' g !! • f �p r. p Experience is the solution 314 Nortb Pearl Street•Albany,New York 12207• (518)434-4546•Fax(518)434-0891 TERMS, CONDITIONS &LIMITATIONS All service rendered by the Adirondack Environmental Services,Inc.are undertaken and all rates are based upon the following terms: (a) Neither Adirondack Environmental Services, Inc., nor any of its employees, agents or sub-contractors shall be liable for any loss or damage arising out of Adirondack Environmental Services, Inc.'s performance or nonperfor- mance,whether by.way of negligence or breach of contract,or otherwise, in any amount greater than twice the amount billed to the customer for the work leading to the claim of the customer. Said remedy shall be the sole and exclusive remedy against Adirondack Environmental Services,Inc.arising out of its work. (b) All claims made must be in writingwithin forty-five(45)days after delivery of the Adirondack Environmental Services,Inc.report regarding said work or such claim shall be deemed or irrevocably waived. (c) Adirondack Environmental Services, Inc, reports are submitted in writing and are for our customers only. Our customers are considered to be only those entities being billed for our services. Acquisition of anAdirondack Environmental Services, Inc. report by other than our customer does not constitute a representation of Adiron- dackEnvironmental Services,Inc. as to the accuracyofthe contents thereof: (d) In no event shall Adirondack Environmental Services, Inc., its employees, agents or sub-contractors be responsible for consequential or special damages of ` any kind or in any amount. (e) No deviation from the terms set forth herein shall bindAdirondack Environmental . Services,Inc.unless in writing and signedbyaDirectorofAdirondackEnvironmental. Services,Inc. (f) Results pertain only to items analyzed. Information supplied by client is assumed to be correct. This information may be used on reports and in calculations and Adirondack Environmental Services, Inc. is not responsible for the accuracy of this information. (g) Payments by Credit Card/Purchase Cards are subject to a 3%additional charge. Albany,NY Adirondack' 0 Experience is the solution 314 North Pearl Street♦ Albany,New York 122070 (518)434-4546♦ Fax:(518)434-0891 Attachment B PERSONNEL AND COMPANY CERTIFICATIONS i r rr Y I ' o 01213 006065550 33 � mFI R " - I H � cj N to C3+ (.1 p dr� � •�+ pl E ... " a I • I I I — — _- _ __ _— — _-�4-T,. n'_m'�c,n+r.��,T''U".Y.y..1• ,'Ya4P.'".t,r ,T�y,w•^r,ti.vi"•�Rti4F '1' ffw:ti�'i;,. � 'k`;lh!:'},vawVf;f_ _—'rr—.,'i'n:^_ •J'.r"" _ — _ _ ::15'+ "rV` r b 4 b ,�•Y...t e"kL .W &� -vi ,.4'� .4�,�e;,of".•.,�.f+:'h 3: 'S:y'1'y MY 4}° :4 n eS.. 'S°'M . 'h^••u �' W' }V� 1 V .fit++� J+I i4fl -i' e'uHn", 4 .e•V:n' E °c f d e,.w�§. i4,..1 57�..•.'+,'J.a'�4.v':��..+w^r �ti 4ar;:++,:' <a., °:�'ti�i .w Y! ;�:.A,•:r f. n S1`.P+,, .fit•Dn .} u.r°4.uA �.2 h�. .4 s Y ..1>k".,. aa,, 'S.r a* • New York State Department of health Certificate of Asbestos Safety Training This form is the official record of successful completion of a New York State accredited asbestos safety training course. i Certificate No.8 I—To be completed by Trainee Name of Trainee(print) NYS Depart. of Motor Vehicles ID(DMV ID)' Signature of Trainee Telephone Number ; Date of Birth' Address' _ -(Street or PO Box) (City) State) (Zip Code) II—To be completed b Training S onsor 'Provider's Name,r T Number Address 2539 A ttreet Schenec r12304 Zip Code 518 46-6374 NYS DOH use only Course Title, ❑Initial ❑ Refresher ❑ DOH Equivalency 2 Training Language: ❑"English❑ Other: Exam Grade/Date: Dates of Training:From: ir'; / <', /.�j To: "� /` fl /.%j .Expires: I certifythat the asbestos safe training course •ty g given on the above date.complied with both 10 NYCRR Part 73 and TSCA Title Il, was consistent with the curriculum and instructors approved by the New York'State Department of Health,and the trainee receiving this certificate completed the training course and successfully passed the examination. Training Director': '( I ( (Print). (Signature) STUDENT DOH-2832(10/03) 'Optional Information z DOH Equivalency signed by NYS DOH representative only New York State Department of Health Certificate of Asbestos Safety.Training This form is the official record of successful'completion of aMw York State accredited asbestos safety training course. ;+ ,a. Certificate No� ( 3 I—To be completed by Trainee Name of Trainee(print) NYS Depart. of Motor Vehicles ID(DMV ID)' Signature of Trainee _�, Telephone Number Date of Birth' Address Street or PO Box) (City) (State) (Zip Code) II—To be completed by Training Sponsor Provider's Name Telephone Number _..SPECTRUM E NVIRONMENTAL ASS Address• 2539 Al ncy treet Zip Code Schenect 2304 �. 518- 46r6374 NYS DOH use only Course Title: r r; f ^,I �'"'t ,'; 'r fir; ❑ Initial ❑Refresher El Equivalency z Training Language: 0 English❑Other: Exam Grade/Date: ­0 Dates of Trainin •From: / / To: / -- / g• I Expires: i / ,:_.;,/ I certify that the asbestos safety training course given on the above date-complied with both 10 NYCRR Part 73 and TSCA Title II, was consistent with the curriculum and instructors approved by the New York State Department of Health,and the trainee receiving this certificate completed the training course-and successfully passed the examination. Training Director'• (Print) (Signature) STUDENT DOH-2832(10/03) 'Optional Information 3 DOH Equivalency signed by NYS DOH representative only State-,Department=of L_ ba oi`- Division ofjSafety and Health Y r` l License and Certificatelohitl State Campus,'Building 12 Albany,,N..1224 AS EB STOS HANDLING LIC NE SE-IZ ,� Adirondack Environmerifal Services, c=�� :—FILE NUMBER:,99 041Z LICENSE NUMBER:`29646'- ` ti 31:4 North'Pearl-Street ��, 1 z LICENSE CLASS: RESTRICT j RESTRICTED—") e� ` 'f DATE OF ISSUE: 09/20%2021 Albany-,NY A2207 �� = .]fx: EXPIRATIONi DATE: 09/30/2022 } �, - Duly Authorized Representative-Tara Daniels Jam- ••` ^,; �, ;`J f�-�`, !9!I•f1Nil- i; f •r '7`` I f r^—".,I This'lice�ns"e-has been issued in accordancelwith.��pphcab),e.prouisi'ons of_.?,V 1 1"30•of the Labor Law of New YorkState`and of l i 1 t t G 4'•' it ails" —r 11l.. 1.1 ij the New-York State Codes,Rules and Regulations(12NY,CRRPart`S.ti). t is subject to suspension or revocationlfor a(1) , __:r' St th 1 f<' Ii P=111,1 9t``I at1 / +' \ j senous violation of state,federal or local laws with regardJto.�the conduct of-antasbesto s pr lyject,or(2)dem�strated lack of r 1 d x �ViL f0.n41dixi '. s %_ responsibility in the conduct of any�jobhnyolving`asbestos-or•asb'estos'rriater-gal } may' M�� ri' �c r r —.t �'� !r t I This•license is;yalid only for the contractor named:abo a and thistilicense or�a photoc)py_must be:p ominently displayed+at the asbestos projjec-orksite.~This-license veriftes thaf�all.persons_employed"byldhe licensee on an-asbesto's,project in New York State have lieem.issued an Asbestos Certificate;appropriate for the�typelof a�o�k they perform,by the Yor'k,State' j Department of Llabor. f j0 .49 N\ T -A fr4r Z Amy Phillips,Director SH 432(8/12) For the Commissioner of Labor United States Department of Commercd,.EP, National Institute of Standards and Technology Certificate of Accreditation to ISO/IEC 17025:2017 NVLAP LAB CODE: 200552-0 Adirondack Environmental Services Inc. Albany, N4' is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for: Asbestos Fiber Analysis This laboratory is accredited in accordance with the recognized International Standard ISO/IEC 17025:2017. PA This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint ISO-ILAGIAF Communique dated January 2009). 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Y��1 w!,!t!.: xv.4.0.x ..x .•x,e,..r...•`u': ♦ �4a.x.h..� National Voluntary Laboratory Accreditation Program V Q - js �j SCOPE OF ACCREDITATION TO ISO/IEC 17025:2017 J>' r� Adirondack Environmental Services Inc. r, 314 North Pearl Street ; Albany,NY 12207-1322 ; Mr.Christopher Hess Phone: 5184344546 3 Email:cmhess@adkenv.com r http://www.adirondackenvironmental.com *, ASBESTOS FIBER ANALYSIS NVLAP LAB CODE 200552-0 Bulk Asbestos Analysis r: Code Description r` 18/A01 EPA--40 CFR Appendix E to Subpart E of Part 763,Interim Method of the Determination off Asbestos in Bulk Insulation Samples r 18/A03 EPA 600/R 93/116:Method for the Determination of Asbestos in Bulk Building Materials 1 f, Airborne Asbestos Analysis 'r .rl Code Description ems: 18/A02 U.S.EPA's"Interim Transmission Electron Microscopy Analytical Methods-Mandatory and Nonmandatory-and Mandatory Section to Determine Completion of Response Actions"as found in 4C CFR,Part 763,Subpart E,Appendix A. 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