BOTH-000422-2016 TOWN OF QUEENSBURY
`�...+` 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000422-2016 Date Issued: Tuesday, October 11, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000422-2016
has been completed.
Tax Map Number: 316.9-1-27.1
Location: 271 BIG BAY RD
Owner: Beth Portuese,THOMAS PORTUESE
Applicant: Beth Portuese
This structure may be occupied as a: Demo of porch and living room area
Asbestos report received and attached 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 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-825+6
BUILDING PERMIT
Permit Number: BOTH-000422-2016
Tax Map No: 316.9-1-27.1
Permission is hereby granted to: Beth Portuese
For property located at: 271 BIG BAY RD
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
Type of Construction
Owner Name: Beth Portuese Demolition $0.00
Owner Address: 271 BIG BAY RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Demo of porch and living room area
Asbestos report received and attached
$ 0.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,July 1,2017
(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 Towno bury; �]V�Jed e d , J 6, 2016
SIGNED BY: //Q/ for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building &c Codes O
ffice use only
eceived
DEMOLITION PERMIT APPLICATION ermit#: L-�2_Z4�„
NO WORK MAY COMMENCE UNTIL_ PERMIT IS ISSUED Fee ------ �rtiW t c�. —T—
Provide
)— ----
Provide 2 plot plans drawn to scale, showing lot boundaries with dimensions and adjacent roads 1 streets. Show all existing structures
on property and indicate which areto be demolished, Indicate the location of all utilities
r -lam
Date Demolition Location
Tax Map ID _Ii L_—l__l_yZ77
APPLICANT ——— AQ�22Se OWNER
Address � d _�? __-- Address
Phone LU--------- Phone -2�g ----_------_
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: � , ______________________Phone:
I. Person Responsible for Work U tj
2. Where will demolition material be disposed?
3. All buildings to be demolished require an Asbestos Survey
4. Any building substantiate damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our offic6-2—ho—re demolition begin
a) Is there any asbestos In the building to be demolished ____ Yes _ No
b) If Yes, our office needs the following information ____ Yes ___— No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished Residence ___ Garage _ _ Business
_—_Storage Bldg. Other a +
b) Size of Structure x �
c) Number of Stories
d) Foundation Type a s
e) Foundation
f) Structure(s) �AJa L%
7. Utilities Information
a) Indicate utilities for this structure ___ Gas _ Electric ___ Propane ___ Public Water ___Public Sewer
___ on-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? ____ Yes ____ No 1,
b) Have all utilities been disconnected? ____ Yes ____ No C 'c fib morn
8. Signature
Print Name: -- _ o _ -------- Date ,b
Signature: — — ----------- ---------------- ----- Date — -- — --
Town of Queensbury Building & Codes • Demolition Permit -December 2014
1�
e
Ing. FILE COPY
Q L
N tTi
ENVIRONMENTAL SIRVICES
REPORT OF PRE-DEMOLITION ASBESTOS SURVEY
0
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Location of Inspection: 271 Big bay Rd. Queensbury NY O` >
s 0 0
Ch = im 0
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L ,—� 41
Client: Mansfield Custom Homes M GL. N Q
PO Box 6
Greenfield Center, New York 12833
Alpine Project#: 16-18539-A
Date(s) of Inspection: February 3, 2016 1�L �16
Date of Report: February 11, 2016
Materials or Area Inspected: Entire House
Asbestos Materials found: Joint compound,foundation coating
Materials Assumed Present and to Contain Asbestos:
Shower mastic-Kitchen bathroom
Non-Asbestos Materials Tested: Linoleum, 12" tile & mastic, ceramic floor tile grout and
mortar, wallboard mastic, wallboard, paneling mastic,
wood stove brick mastic, drywall, textured ceiling,
concrete block mortar, sink sound deadener, cove base
mastic, window caulk, siding vapor barrier, roof vapor
barrier, roof shingles.
Inspection Performed By: Alpine Environmental Services, Inc.
438 New Karner Road
Albany, New York 12205
Inspector(s): Matthew Fiore(Cert#04-04675)
NYSDOL Certified Asbestos Inspector
Scope and Purpose
This report is intended to document a pre-demolition asbestos inspection, of the structure
located at 271 Big bay Rd., Queensbury, NY.This inspection was performed on February 3, 2016
February 2016 271 Big Bay Rd.
Queensbury,New York
Structure Description
The building inspected was a one story wood structure with a concrete block basement and a
attached garage over a slab on grade. The floors consist of carpet, linoleum and ceramic tile
over plywood. The walls and ceilings are mostly drywall with wood paneling on the majority of
walls. The roof was asphalt shingle. The electrical wire was observed to be plastic coated. Only
non-insulted piping was observed in the basement. A hole was put in the basement concrete
block wall and no vermiculite insulation was observed.
Results of Asbestos Inspection
TABLE 1.Asbestos Containing Materials—271 Big Bay Rd. Queensbury NY
Homogeneous Estimated Estimated
Location Substrate Condition Friable Sample#
Area Dimensions Quantity
Joint 1st Floor 20' x 45' &
Compound Residence/ Drywall Good 20'x 25' 4200 Sq Ft Yes 01-02
Breezeway
Coating Exterior Concrete Good 25'x 45' 1040 Sq Ft No 16-02
Foundation Block
Shower Mastic Kitchen Concrete Good 9' x 8' 72 Sq Ft No Assumed
(Assumed Present) Bathroom
TABLE 2. Non-Asbestos Containing Materials—271 Big Bay Rd. Queensbury NY
Homogeneous Location Sample#
Area-Non Asbestos
Linoleum Kitchen/Kitchen Bathroom 15-01, 15-02
12"Tile & Mastic Back Bathroom 14-01, 14-02, 13-01, 13-02
Ceramic Floor Tile Grout And Mortar Family Room 05-01, 05-02, 06-01, 06-02
Wallboard Mastic Back Bathroom/Shower 04-01, 04-02
Wallboard Back Bathroom/Shower 09-01, 09-02
Paneling Mastic Throughout 11-01, 11-02
Wood Stove Brick Mastic Family Room 10-01, 10-02
Drywall Throughout 02-01, 02-02
Textured Ceiling Family Room 03-01,03-02
Mortar Concrete Block 07-01,07-02
Sink Sound Deadener Kitchen 08-01, 08-02
Cove Base Mastic Throughout 12-01, 12-02
Caulk Windows 17-01, 17-02
Vapor barrier Siding 18-01, 18-02
Vapor barrier Roof 19-01, 19-02
Shingles Roof 20-01, 20-02
Page 2
438 New Karner Rd.Albany,New York 12205-Phone:(518)250-4047
February 2016 271 Big Bay Rd.
Queensbury,New York
Conclusion
According to 12 NYCRR 56, the building owner (or owner's agent) is required to transmit this
asbestos inspection report to any local government permit issuing agency (i.e. building
department)for any demolition,renovation or remodeling.
In addition, if this inspection is for the purposes of demolition, the building owner (or owner's
agent) is also required to transmit this inspection report to the Asbestos Control Bureau, New
York State Department of Labor, Room 157, Building 12, State Office Campus, Albany, NY,
12240.
This inspection report is also required to be displayed on site during all related construction
work if asbestos is found.
Disturbance/Abatement of any asbestos containing materials, as well as air monitoring, must be
performed by a NYS DOL licensed contractor, in accordance with state and federal regulations
(NYS DOL ICR 56 and US EPA 40 CFR).
If I can be of any further assistance to you on this matter, please contact me at(518) 250-4047
Ext 315. MattF@AlgineEnv.com
Sincerely,
Alpine Environmental Services,Inc.
Matthew Fiore
NYS Department of Labor Asbestos Inspector
Senior Industrial Hygienist
Enclosures: Results,Chain of Custody,Asbestos Handling License,Personal Certification
Page 3
438 New Karver Rd.Albany,New York 12205-Phone:(518)250-4047
EMSL Analytical, Inc. EMSL Order: 031603183
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax: (212)290-0051 1(212)290-0058 Customer PO:
http:ilwww.EMSL.com 1 manhattanlab@emsl.cam Project ID:
Attention: Matthew Fiore Phone: (518)250-4047
Alpine Environmental Services Fax:
438 New Karner Road Received Date: 216/2016 12:42 PM
Albany, NY 12205 Analysis Date: 219/2016
Collected Date: 213/2016
Project: 16-18539-A1 271 BIG BAY RD, QUEENSBURY, NY
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
sample lD 01-01 Description BEDROOM HALLWAY-JOINT COMPOUND
031603183-0001 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/9/2016 White 40.00% Ca Carbonate None Detected
5.00% Mica
55.00% Non-fibrous(other)
Inseparable paint I coating layer included in analysis
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample lD 01-02 Description NE BEDROOM-JOINT COMPOUND
0316031&7-0002 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/912016 Tan/White 55.00% Ca Carbonate 1.25°i Chrysotlle
43.75% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198,4 NOB Not Analyzed
Sample ID 02-01 Description LIVING ROOM-DRYWALL
031603183-0003 Homogeneity Homogeneous
PLM NYS 198.1 Friable 21912016 Brown/Gray 10.00% Cellulose 65.00%a Gypsum None Detected
25.00°/ Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 02-02 Description GARAGE-DRYWALL
031603183.0004 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/912016 Brown/Gray 12.00% Cellulase 65.00% Gypsum None Detected
23.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
FLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 03-01 Description FAMILY ROOM-TEXTURED CEILING
031603183-0005 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/9/2016 White 2,00%9 Cellulose 30.00% Ca Carbonate None Detected
2.00% Fibrous(other) 66.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Initial Report From:0210912016 10:04:22
Asbesfos 193x- 1.65 Printed 219/2016 10:04:23AM Page 1 of 4
EMSL Analytical, Inc. EMSLOrder: 031603183
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax: (212)290-0051 1(2'12)290-0058 Customer PC?:
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 03-02 Description FAMILY ROOM-TEXTURED CEILING
031603183-0006 Homogeneity Homogeneous
PLM NYS 198.1 Friable 219/2016 White <1.00% Fibrous(other) 65.00% Ca Carbonate None Detected
2,00% Mica
33.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 04-01 Description BATHROOM-WALLBOARD
031603183-0007 Homogeneity Homogeneous
PLM NYS 198.1 Friable 21912016 Brown/While 82.00% Cellulose 18.00% Non-fibraus(other) None Detected
Inseparable paint 1 coating layer included in analysis
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 04-02 Description BATHROOM-WALLBOARD
031603183-0008 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/9/2016 Brown/White 80.00% Cellulose 20.00% Non-fibrous(other) None Detected
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 05-01 Description FAMILY ROOM CFT-GROUT
031603183.0009 Homogeneity Homogeneous
PLM NYS 198.1 Friable 21912016 Brawn 75.00% Non-fibrous(other) None Detected
25,00% Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample IU 05-02 Description FAMILY ROOM CFT-GROUT
031603183.0010 Homogeneity Homogeneous
PLM NYS 198.1 Friable 219/2016 Brown 70.00% Cellulose 30.00% Non-fibrous(other) None Detected
sample appears to be wallboard not grout
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 158.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 06-01 Description FAMILY ROOM CFT-MORTAR
031603183-0011 Homogeneity Homogeneous
PLM NYS 198.1 Friable 21 912016 Gray 60.00% Non-fibrous(other) None Detected
40.00% Quartz
PLM NYS 198.6 VCM NotAnatyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB NotAnatyzed
Initial Report From:0210912016 10:04:22
As6cslos 19i1x- 1.6.5 Printed 21912016 10:04:23AM Page 2 of 4
EMSL Analytical, Inc. EMSLOrder: 031603183
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fav (212)290-0051 f(212)290-0058 Customer PO:
http:llwww.EMSL.com!manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Nan-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 06-02 Description FAMILY ROOM CFT-MORTAR
031603183-0012 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/9/2016 Gray 65.00% Non-fibrous(other) None Detected
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 07-01 Description CHIMNEY CONCRETE BLOCK-MORTAR
031603183-0013 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/9/2016 Gray 47.00% Non-fibrous(other) None Detected
53.00% Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 07.02 Description STAIRWELL CONCRETE BLOCK-MORTAR
031603183-0014 Homogeneity Homogeneous
PLM NYS 198.1 Friable 2/912016 Gray 48,00% Non-fibrous(other) None Detected
52.00% 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:02108!2016 10:04:22
Asbestos i98s- 1.65 Printed 2!912016 10:04:23AM Page 3 of 4
EMSL Analytical, Inc. EMSL Order: 031603183
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax:(212)290-00511(212)290-0058 Customer PO:
http://www.EMSL.com 1 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: 2/6/2016 Sample Receipt Time: 12:42 PM
Analysis Completed Date: 2/9/2016 Analysis Completed Time: 2:55 AM
Analyst(s):
4�_4 W\ ok VV q V"
Kamef Alawawda PLM NYS 198.1 Friable(6) Shahrakur Mahmud PLM NYS 198.1 Friable(8)
Samples reviewed and approved by:
James Hall,Laboratory Manager
or Other Approved Signatory
NOB=Non Friable Organically Bound NIA=Not Applicable VCM=Vermiculite Containing Material
-In New York State,TEM is currently the only method that can be used to determine if NOB materials ran be considered or treated as non-asbestos containing.
All samples examined for the presence of vermiculite when analyzed via NYS 198.1.
-NYS Guidelines for Vermiculite containing samples are available at http:Ilwww.wadsworth.orgllabcertlelepeertlformslVermiculiteinterimGuidance_Rev070913.pdf EMSL maintain:
liability limited to cost of analysis.This report relates only to the samples reported above and may not be reproduced,except in full,without written approval by EMSL. EMSL bear:
no responsibility for sample collection activities or analytical method limitations.Interpretation and use of test results are the responsibility of the client.Samples were received in
goad condition unless otherwise noted.
This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,or any agency of the federal government.This report may
contain data that is not covered by the NVLAP accreditation.
Samples amtyzed by EMSL Analyrlcal,Inc.Now York,NY NYS FLAP 11506
Initial Report From:0210912016 10:04:22
Asbesfosf98x-165 Printed 219/2016 10:04:23AM Page 4 of 4
OrderI . _ 031603183 ;ervices. Inc. Phone:(518)250-4047
438 New Karner Rd. 0�1
� 103+r ��
Albany,NY 12205 email:MattFAlpinePnv.com
CHAIN OF CUSTODY
Client: Alpine Environmental Services Project:. 271 Big Bav Rd. Queensbury NY
Project Number: 16-18539-A
Contact: Matthew Fiore Sampled By: Matthew Fiore
Phone: 518-250-4047 Date/Time Collected: 2/3/2016
Turnaround Time: 72 hr P.O. Number:
Log Sample Sample Sample Analysis Results
i No. No. Location Material
01-01 Bedroom Hallway Joint NYS Stratified PL
Compound
Joint
01-02 NE Bedroom NYS Stratified PLM
Compound
02-01 Living Room Drywall NYS Stratified PLM
I
02-02 Garage Drywall NYS Stratified PLM
03-01 Fam i(w Room Textured NYS Stratified PLM Stop at
Ceiling First Positive
03-02• Fain ily Room TexturedCeiling NYS Stratified PLM.
04-01 Bathroom Wallboard NYS Stratified PLM Stop at
First Positive
04-02 Bathroom Wallboard NYS Stratified PLM
fit
Stop af-f' {�
05-01 Family Room CFT Grout NYS Stratified PLM First Positt ue '~
05-02 Family Room CFT Grout NYS Stratified PLM
06-01 Famil% Room CFT Mortar NYS Stratified PLM Stop at ,
First Positive
06-02 Familw Room CFT Mortar NYS Stratified PLM
07-01 Chimney Concrete Block Mortar NYS Stratified PLM Stop at
First Positive
07-02 Stairwell Concrete Block Mortar NYS Stratified PLM
Relinquished By; Roeived Byb Date: ( Time:
G=
Page IofI
Paqe 1 Of 1
EMSL Analytical, Inc. EMSLOrder: 031603187
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax: (212)290-0051 1(212)290-0058 Customer PO:
http://www.EMSL.com 1 manhattanlab@emsl.com Project ID:
Attention: Matthew Fiore Phone: (518)250-4047
Alpine Environmental Services Fax:
438 New Karner Road Received Date: 2/6/2016 12:43 PM
Albany, NY 12205 Analysis Date: 2/9/2016
Collected Date: 213/2016
Project: 16-18539-A/271 B[G BAY RD, QUEENSBURY, NY
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 08-01 Description KITCHEN SINK-SOUND DEADENER
039603987-0001 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 19B.6 NOB 219!2016 Gray Inconclusive:None Detected
TEM NYS 198.4 NOB 21912016 Gray None Detected
Sample ID 08-02 Description KITCHEN SINK-SOUND DEADENER
031603167-0002 Homogeneity Heterogeneous
PLM NYS 196.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOS 2/9/2016 Gray Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Gray None Detected
Sample ID 09-01 Description BATHROOM SHOWER!WALL BOARD-MASTIC
031603187-0003 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Yellow Inconclusive:None Detected
TEM NYS 198.4 NOB 21912016 Yellow None Detected
Sample ID 09-02 Description BATHROOM SHOWER!WALL BOARD-MASTIC
031603187.0004 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/9/2016 Yellow Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Yellow None Detected
Sample tD 10-01 Description FAMILY ROOM WOODSTOVE BRICK-MASTIC
031603187-0005 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Black Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Black None Detected
Initial Report From:02/0912016 14:32:50
Asbealos 198x-1.65 Printed 21912016 2:32:53PM Page 1 of 6
EMSL Analytical, Inc. EMSLOrder: 031603187
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax: (212)290-0051 1(212)290-0058 Customer PO:
http://www.EMSL.com 1 marihattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 10.02 Description FAMILY ROOM WOODSTOVE BRICK-MASTIC
031603167-0006 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Black Inconclusive:None Detected
TEM NYS 198.4 NOB 219/2016 Black None Detected
Sample ID 11.01 Description HALLWAY PANELING-MASTIC
031603187-0007 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOS 2/912016 Gray Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Gray None Detected
Sample ID 11-02 Description LIVING ROOM PANELING-MASTIC
031603187-0008 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/9/2016 Gray Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Gray None Detected
Sample ID 12-01 Description KITCHEN COVE BASE-MASTIC
031603187-0009 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Yellow Inconclusive:None Detected
TEM NYS 198.4 NOB 21912016 Yellow None Detected
Sample ID 12-02 Description KITCHEN COVE BASE-MASTIC
031603187-0010 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Yellow Inconclusive:None Detected
TEM NYS 198.4 NOB 2/912016 Yellow None Detected
Sample to 13-01 Description BATHROOM 12'TILE-MASTIC
031603187-0011 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 1196.6 NOB 2/912016 Yellow Inconclusive:None Detected
TEM NYS 198.4 NOB 21912016 Yellow None Detected
Initial Report From:02/0912016 14:32:50
Asbeslos196x- 1.65 Printed 2/912016 2:32:53PM Page 2 of
EMSL Analytical, Inc. EMSLorder: 031603187
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@emsi.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 13-02 Description BATHROOM 12"TILE-MASTIC
031603187-0012 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 196,6 VCM Not Analyzed
PLM NYS 198.6 NOB 21912016 Yellow Inconclusive:None Detected
TEM NYS 198.4 NOB 219/2016 Yellow None Detected
Sample ID 14-01 Description BATHROOM-12'TILE
631603187-0013 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 219/2016 White Inconclusive:None Detected
TEM NYS 198.4 NOB 219/2016 White None Detected
Sample ID 14-02 Description BATHROOM-12'TILE
031603187-0014 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
Not Analyzed
PLM NYS 198.6 VCM
PLM NYS 198.6 NOB 219/2016 White Inconclusive:None Detected
TEM NYS 198.4 NOB 2/912016 White None Detected
Sample ID 15-01 Description KITCHEN-LINOLEUM
031603187-0015 Homogeneity Heterogeneous
Not Analyzed
PLM NYS 198.1 Friable
Not Analyzed
PLM NYS 198.6 VCM
PLM NYS 198.6 NOB 2/912016 Tan <1.00% Glass inconclusive:None Detected
TEM NYS 198.4 NOB 2/912016 Tan None Detected
Sample ID 15-02 Description BATHROOM-LINOLEUM
031603187-0016 Homogeneity Heterogeneous
Not Analyzed
PLM NYS 198.1 Friable
Not Analyzed
PLM NYS 198.6 VCM
PLM NYS 198.6 NOB 219!2016 White 5.90% Glass Inconclusive:None Detected
TEM NYS 198.4 NOB 21912016 White/Black None Detected
Sample ID 16-01 Description FOUNDATION-COATING
031603187-0017 Homogeneity Heterogeneous
Not Analyzed
PLM NYS 198.1 Friable
Nat Analyzed
PLM NYS 198.6 VCM
PLM NYS 198.6 NOB 2/g/2016 Black 5.00% Chrysotile
TEM NYS 198.4 NOB 2/9/2016 Positive Stop(Not Analyzed)
Initial Report From:02/09/2016 14:32:50
Asbestos i98K-1.65 Printed 21912016 2:32:53PM P2
<0— EMSL Analytical, Inc. EMSLOrder: 031603187
307 West 38th Street New York, NY 10018 Customer ID: ALPI50
To[/Fax: (212)290-0051 1(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 16-02 Description FOUNDATION-COATING
031603187-0016 Homogeneity
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198,6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Positive Stop(Not Analyzed)
TEM NYS 198.4 NOB 2/912016 Positive Stop(Not Analyzed)
Sample ID 17-01 Description WINDOWS-CAULK
031603187-0019 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 196.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 White Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 White None Detected
Sample ID 17-02 Description WINDOWS-CAULK
031603187-0020 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/g/2016 White Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 White None Detected
Sample ID 18-01 Description SIDING-VAPOR BARRIER
031603167-0021 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 219/2016 Black Inconclusive:None Detected
Final residue mass<1%
TEM NYS 198.4 NOB 21912016 Black None Detected
Sample ID 18.02 Description SIDING-VAPOR BARRIER
031503187-0022 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 21912016 Black Inconclusive:None Detected
Final residue mass<1%
TEM NYS 198.4 NOB 2/9/2016 Black None Detected
Sample ID 19-01 Description ROOF-VAPOR BARRIER
031603187-0023 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Black 7.90% Glass Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Stack None Detected
Initial Report From:02109/2016 14:32:50
Asbestos 198x-1.65 Printed 2/9/2016 2.32:5313M Page 4 of 6
EMSL Analytical, Inc. EMSL Order: 031603187
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax: (212)290-0051 1(212)290-0058 Customer PO:
http://www.EMSL.com I manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 19-02 Description ROOF-VAPOR BARRIER
031603167-0024 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOS 2/912016 Black 9.70% Glass inconclusive:None Detected
TEM NYS 198.4 NOB 21912016 Black None Detected
Sample ID 20-01 Description ROOF-SHINGLE
031603167-0025 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/912016 Black 8.80% Glass Inconclusive:None Detected
TEM NYS 198.4 NOB 2/912016 Black None Detected
Sample ID 20-02 Description ROOF-SHINGLE
031603187-0026 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 2/9/2016 Black 2.10% Glass Inconclusive:None Detected
TEM NYS 198.4 NOB 2/9/2016 Black None Detected
Initial Repoli From:02109/2016 14:32:50
Asbestos 195X- 1,65 Printed 2/912016 2:32:53PM Page 5 of 6
EMSL Analytical, Inc. EMSL Order: 031603187
307 West 38th Street New York, NY 10018 Customer ID: ALP150
Tel/Fax: (212)290-0051 1(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.
Re art Comments:
Sample Receipt Date: 216/2016 Sample Receipt Time: 12:43 PM
Analysis Completed Date: 2/9/2016 Analysis Completed Time: 4:25 AM
Analyst(s):
Shahrakur Mahmud PLM NYS 198.6 N013(25) Venisha Lazarus-flames TEM NYS 198.4 NOB(24)
Samples reviewed and approved by:
James Hall,Laboratory Manager
or Other Approved Signatory
NOB=Non Friable Organically Bound NIA=Not Applicable VCM=Vermiculite Containing Material
-In New York State,TEM is currently the only method that can be used to determine if NOB materials can be considered or treated as non-asbestos containing.
All samples examined for the presence of vermiculite when analyzed via NYS 198.1.
-NYS Guidelines for Vermtcufite containing samples are available at http:11www.wedsworth.orgllabcert/elapcerUforms/VermiculitelnterimGuidance Rev070913.pdf EMSL maintain;
liability limited to cost of analysis.This report relates only to the samples reported above and may not be reproduced,except in full,without written approval by EMSL. EMSL.bear!
no responsibility for sample collection activities or analytical method limitations.Interpretation and use of test results are the responsibility of the client.Samples were received in
good condition unless otherwise noted.
This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,or any agency of the federal government.This report may
contain data that is not covered by the NVLAP accreditation.
Samples analyzed by EMSLAnalylical,Inc.Now York,NY NYS ELAP 11506
Initial Report From:0210912016 14:32:50
Asbestos 198x- 1.65 Printed 21912016 2:32:53PM Page 6 of 6
o,raerID•' 031603187
ruyuic uaaruvaauaouaa,Jervices,Inc. Phone: (5 18)250-4047
4384New Kamer Rd. J
Albany,NY 12205 � 1 � l 0� email:MattF@AlpineEnv.com
CHAIN OF CUSTODY
Client:Alpine Environmental Services Project:. 271 Big Bay Rd. Queensbury NY
Project Number: 16-1.8539-A
Contact: Matthew Fiore Sampled By:Matthew Fiore
Phone: 518-250-4047 Date/Time Collected:2/3/2016
Turnaround Time:72 hr P.O.Number:
Log Sample Sample Sample Analysis Results
No. No. Location Material
08-01 Kitchen Sink Sound Asbestos j,6 01 Stop at
Deadener NYS Protoco First Positive
08-02 Kitchen Sink Sound Asbestos
Deadener NYS Protocol
09-01 Bathroom Mastic Asbestos Stop at
Shower/Wall Board NYS.Protocol First Positive
Bathroom Asbestos
09-02 Shower/Wall Board Mastic NYS Protocol
10-01. Family Room Mastic Asbestos Stop at
Woodstove Brick NYS Protocol First Positive
10-02 Family Room Mastic Asbestos -
Woodstove Brick - NYS-Protocol.- -
s 11-01 Hallway Paneling Mastic Asbestos Stop at
NYS Protocol 'First Positive
11-02 Living Room Paneling Mastic Asbestos
NYS Protocol
12-01 Kitchen Cove Base Mastic Asbestos Stop at
NYS Protocol First Positive
12-02 .1Kitchen Cove Base Mastic Asbestos
NYS Protocol
13-01 Bathroom 12"Tile Mastic Asbestos Stop at
NYS Protocol First Positive
13-02 Bathroom 12"Tile Mastic Asbestos
NYS Protocol
I4-01 Bathroom 12"Tile Asbestos Stop r
NYS Protocol First Posfve m:x
`o' rn
I4-02 Bathroom 12"Tile Asbestos -=
NYS Protocol '??
15-01 Kitchen Linoleum Asbestos Stop at
NYS Protocol First PosAtive
c
15-02 Bathroom Linoleum AsbestosNYS protocol
16-01 FoundationCoating Asbestos Stop at
NYS Protocol First Positive
Page 1 of 2
2
"- �� Paqe 1 Of
0 r-de r YD. '031603187,,services,Inc. 01404510
Phone: (51S)250-4047
UNew Kamer Rd.
Albany,NY 12205 email:MaftF@AlpincEnv.com
16-02 Foundation Coating Asbestos
NYS Protocol
17-01 Windows Caulk Asbestos Stop at
NYS Protocol First Positive
17-02 Windows Caulk Asbestos
NYS Protocol
18-01 Siding Vapor Asbestos Stop at
Barrier NYS Protocol First Positive
18-02 Siding Vapor Asbestos
Barrier NYS Protocol
19-01 Roof Vapor Asbestos Stop at
Barrier NYS Protocol First Positive
19-02 Roof Vapor Asbestos
Barrier NYS Protocol
Asbestos Stop at
20-0I Roof Shingle
NYS Protocol First Positive
20-02 Roof Shingle Asbestos
NYS Protocol
Relinquished By: Received By: Date: Time:
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Page 2 of 2
Page 2 Of 2
New York State,-7'. epartment otLabor
Division of Safety and Health.
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Alpine,Environmental:Services, Inc. -0320FILE NUMBER: 00.,
LICENSE NUMBER: 29095 '
438 NewKarner:Road LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 07/10/2015 ."
A(bany,NY 12205 EXPIRATION DATE: 07/3fi266
Duly Authorized'Representative='.Craig Petreikis
Law of New
This license has been
issued m acd6tdanee with Apphcable i is dns of Attid a of the Labor Xork Sta'(e and of .
tt`e GoYk l�ew� State Lades,Rules tudRegulahotis f 121 ,CRR Part%) It U�stiWect to suspension or revocatton'for a(1)
secfaiis i iodation of'state,federal o A,66al laws A,,b rega;dktgt,the cpmduct gEa�.as_t stos proj$ct,or(2}demonstrated lac ;of
responsibility m the conduct of any'Job-mvolvmg asbestos or asbestos material
Thik license is vali'il only for the contractor.nai6 q,,aibove and this.lieense or' :photocopy.must be_grommeritly displayed at the
asbestos protect worksite`;Tlus-lieense verifies that�all persons.employed liy the licensee on awasbestos protect in New York
State have lieextissued an Asbestos Certificate,appropriate for`fhe type'of work-they perform,by the New York State
Department of U6or
lix.;0!1
Eileen M.Franko, Director
SH 432(8112) For the Commissioner of Labor
i
STATE OF NEW YORK-DEPARTMENT OF LABOR L �(
ASFzS aOS C.EPVICAl�
MATTHEW J FIORE
T ASS(EXPIRES)
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