asbestos report c t
ARCHITECTURE
111111th, 11, ENGINEERING
ENVIRONMENTAL
LAND SURVEYING
CEBV
LIMITED ASBESTOS SURVEY REPORT
MAY 292019
TOWN OF QUEENSBURY
BUILDING&C ODES
Project Location:
Shop# 194
221 Corinth Rd.
Queensbury, NY
FILE COPY
Prepared for:
Mr. Jeremy Lawless
Project Manager, Stewart's Shops TOWN OF QUEENSBURY
2907 Rt. 9 BUILDING DEPARTMENT
Ballston Spa, NY 12020 Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
Prepared by: TOWN OF QU , S
GYMO Architecture, Engineering, & Land Surveying D.P.C. BUILDING &
18969 US Route 11 Reviewed By:
Watertown, NY 13601
Date:
(315) 788-3900 ww.gymopc.com w
309.13-2-25 DEMO-0350-2019
Strewart's Shops Corporation
221 Corinth Rd
Demolition of commercial building
GYMODPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900
www.g ymopc.corn
,
t'
)0 ARCHITECTURE
xp* C
ENGINEERING
41
ENVIRONMENTAL s
11111r to
LAND SURVEYING
Edward G.011ey,Jr.,AIA
January 23, 2018 PatrickJ.Scordo,PE
Ryan G.Churchill,PE
Scott W.Soules,AIA
Mr.Jeremy Lawless Brandy W.Lucas,MBA
2907 Rt. 9 Hayward B.Arthur III,MPS,IE
Ballston Spa, NY 12020 Howard P.Lyndaker III,PLS
RE: Limited Asbestos Survey Gregory F.Ashley,PLS
Shop#194 Thomas H.Ross
221 Corinth Rd.,Queensbury,NY In Consultation
Leo F.Gozalkowski,PLS
Stephen W.Yaussi,AIA
Dear Mr.Lawless,
As requested, GYMODPc completed a Limited Asbestos Survey at the above referenced site. Our NYS
Certified Asbestos Building Inspector, John Phelps Cert # 09-08578, visited the site on January 12,
2018 and collected samples of materials suspected of being asbestos containing. These samples were
sent to Paradigm Environmental Services for laboratory analysis. Based on laboratory analysis of the
samples collected, none of the samples tested positive for the presence of asbestos.
If you have any questions pertaining to this report, please contact me directly at(315)788-3900.We thank
you for the opportunity to work with you on this project.
Sincerely,
0 Architecture, Engineering & Land Surveying, D.P.C.
,.. 6L,A 11 `1;irs------—
(GYM
Dixie Thompson
Environmental Solutions Coordinator
Attachment A: List of Materials Sampled
Attachment B: License and Certifications
Attachment C: Asbestos Bulk Sample Laboratory Results
Attachment D: Drawing
Attachment E: Photos
GYMODPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601(315)788-3900
www.gymopc.com
ATTACHMENT A
LIST OF MATERIALS SAMPLED
Sample# Material Location ACM Content
1 A, B Beige Ceramic Tile Ceramic Floor Tile Throughout 0%
2 A, B Black Mastic Freezer Mastic on Floor 0%
3 A, B Brown Cove Base Cove Base Throughout 0%
4 A, B Gray Mastic Cove Base Mastic Gray 0%
5 A, B, C White Skim Coat Skim Coat Throughout 0%
6 A, B, C White Sheet Rock Sheet Rock Throughout 0%
7 A, B Black/Gray Dots Fibrous Roofing Shingle Roof Shingles 0%
8 A, B Black Fibrous Vapor Barrier Roof Vapor Barrier Under Shingles 0%
9 A, B Gray Caulk Exterior Gray Door/Window Caulk 0%
GYMOoPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900
www.gymopc.corn
ATTACHMENT B
LICENSE AND CERTIFICATIONS
GYMODPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900
www.gymopc.corn
STATE OF NEW YORK-DEPARTMENT OF LABOR
ASBESTOS CERTIFICATE
JOHN J PHELPS
CLASS(EXPIRES)
CATEC(03/18) D EEVSP(03/1&)
e ; H PM (03/18) I PD (03/18)
CERT#03-08578
;I<V#52376T193
MUST BE CARRIED ON ASBESTOS PROJECTS
tiuminimmunmIf,,
IF FOUND RETURN TO:
EYES ELK NYSDOL -- L&C UNIT
SAIR ur.0 ROOM 161A rtuiLDING 12
HST 5' OO' STATE OFFICE CAMPUS
o
—a
= v ALBANY NY 12240
=cv
New York State—Department of Labor
Division of Safety and Health
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Gymo,Architecture, Engineering & Land Surveying FILE NUMBER: 99-0170
D.P.C. LICENSE NUMBER: 29355
LICENSE CLASS: RESTRICTED
18969 US Route 11 DATE OF ISSUE: 11/16/2017
EXPIRATION DATE: 11/30/2018
Watertown, NY 13601
Duly Authorized Representative—Hayward Arthur:
This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of
the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1)
serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of
responsibility in the conduct of any job involving asbestos or asbestos material.
This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the
asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York
State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State
Department of Labor.
Eileen M.Franko, Director
SH 432(8/12) For the Commissioner of Labor
•
NEW YORK STATE DEPARTMENT OF HEALTH
WADSWORTH CENTER
Expires 12:01 AM April 01,2018
: - }: Issued April 01,2017
CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued in accordance with and pursuant to section 502 Public Health Law of New York State
MR. STEVE DEVITO NY Lab Id No: 10958
PARADIGM ENVIRONMENTAL SERVICES INC
179 LAKE AVENUE
ROCHESTER, NY 14608
is hereby APPROVED as an Environmental Laboratory for the category
ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE
All approved subcategories and/or analytes are listed below:
Miscellaneous
Asbestos in Friable Material Item 198.1 of Manual
EPA 600/M4/82/020
Asbestos in Non-Friable Material-PLM Item 198.6 of Manual(NOB by PLM)
Asbestos in Non-Friable Material-TEM Item 198.4 of Manual
Lead in Dust Wipes EPA 6010C
Lead in Paint EPA 6010C
Sample Preparation Methods
EPA 3050B
Serial No.: 55857
Property of the New-York State Department of Health. Certificates are valid only at the address
shown,must be conspicuously posted,and are printed on secure paper. Continued accreditation depends
on successful ongoing participation in the Program. Consumers are urged to call(518)485-5570 to
verify the laboratory's accreditation status.
Page 1 of 1
ATTACHMENT C
ASBESTOS BULK SAMPLE LABORATORY RESULTS
GYMODPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900
www.gymopc.corn
g
P,ARADIG,' PARADIGM 179 Lake Avenue,Rochester,NY 14608 Office:(585)647-2530 fax:(585)647-3311 I
ENVCRRN NLNT*L SCR\?cts tnc
PLM&TEM BULKASBESTOSANALYSIS REPORT
i,
via NYSDOH FLAP Method 198.1,198.4 and 198.6
Client: GYMO Job No: 0391-18
Location: Stewarts Shop Page: 1 of 3
221 Cofaith Road,Queensbury
Sample Date: 1/12/2018
PLM Asbestos PLM N TEM Asbestos TEM PLM Non-
• Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous
Client ID Lab ID Sampling Location Description Percentage Asbestos B Percentage Asbestos Fibers Type& Matrix
Percentage Material
%
01A 3482 Ceramic Floor Tile Beige Ceramic Tile None Detected 0% Not Required N/A None Detected 100%
Throughout
01B 3483 Ceramic Floor Tile Beige Ceramic Tile None Detected 0% Not Required N/A None Detected 100% I
Throughout r
02A 3484 Freezer Mastic on Floor Black Mastic Inconclusive 0% None Detected <1.0% None Detected 100%
No Asbestos tl
Detected ,
t
tI2B
3485 Freezer Mastic on Floor Black Mastic Inconclusive 0% None Detected <1.0% None Detected 100% t
No Asbestos V )'
Detected
03A 3486 Cove Base Throughout Brown Cove Base Inconclusive 0% None Detected <1.0% None Detected 100% (
No Asbestos if
Detected 3
03B 3487 Cove Base Throughout Brown Cove Base Inconclusive 0% None Detected <1.0% None Detected 100% 3
No Asbestos V
Detected
04A 3488 Cove Base Mastic Gray Gray Mastic Inconclusive 0% None Detected <1.0% None Detected 100%
No Asbestos V
Detected
04B 3489 Cove Base Mastic Gray Gray Mastic Inconclusive 0% None Detected <I.0% None Detected 100%
No Asbestos if
Detected
05A 3490 Skim Coat Throughout White Skint Coat None Detected 0% Not Required N/A None Detected 100%
05B 3491 Skim Coat Throughout White Skim Coat None Detected 0% Not Required N/A None Detected 100%
ILEY TO NOB COLUMN SYMBOLS
No Symbol in the NOB column denotes sample analyzed by ELAP Method 198.1(PLM}.
V NOB(non-friable organically bound)denotes material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted.
V denotes material analyzed by ELAP Method 198.6(PLM)per NYSDOH.This Method does not remove vermiculite and may underestimate the level of asbestos
present in a sample containing greater than 10%vermiculite.
II denotes friable material analyzed by FLAP Method 198.6(PLM)and 198.4(TEM)as noted.
X denotes sample prepped only by FLAP Method 198.6.
*•Polarized-light microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.
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,
PLM Bulk Asbestos Analysis by New York State Department of Health,FLAP Method 198.1,198.4 and 1913.6("Polarized Light Microscopy and Transmission Electron Microscopy Methods for
Identifying and Quantitating Asbestos In Bulk Samples and in Non-Friable Organically Bound Bulk Samples.")or EPA 600/M4432-020 per 40 CFS 763 and/or EPA 600/8-93/116(NVLAP Lab
Code 200530-0),
R1VLLV
ant G ELAP ID No.: 10958
Lab Code 200630.0 for PIM Analysis
PLM Dale Analyzed: 1/19/2018 TEM Date Analyzed: 1/22/2018 ---- F
`�V
Microscope: Olympus 811-2#232953 TEM Analyst:A.Voldbalclvn . m 1
*tom e . k /
Analyst: 7:Bush i, ,, ' `s, ,,e
Laboratory Results Approved By: -
Asbestos Operations Manager or Designee Mary Dohr
Paradigm Environmental Services,Inc.is not responsible fur the data supplied by an independent Inspector.National Institute of Standards and Technology Accreditation
requirements mandate that this report must not be reproduced except in full without the approval of the laboratory.This PLM report relates ONLY to the items tested.This
report must nut be used to claim product endorsement by NVLAP or any agency of the U.S.Government.Quality control data(including 950,confidence limits and laboratory
and analysis'and precision)is available upon request.
0391-18.xism 1/22/2018
•
. i
PARADIGM,{` PARADIGM 179 Lake Avenue,Rochester,NY 14608 Office.(585)647-2530 Fax:(585)647-3311 ,
*41,44411001 EKVIROKKEHT AL SERVlCtS, !lit.
PLM&TEM BULK ASBESTOS ANALYSIS REPORT
via NYSDOH ELAP Method 198.1,198.4 arid 198,6
Client: GYM[ Job No: 0391-18
Location: Stewarts Shop Page: 2 of 3
221 Cofaith Road,Queensbury
Sample Date: 1/12/2018
PLM Asbestos PLM N TEM Asbestos TEM PLM Non-
Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous
Client ID Lab ID Sampling Location Description Percentage Asbestos B Percentage Asbestos Fibers Type& Matrix
Percentage Material
% l
l
05C 3492 Skim Coat Throughout White Skim Coat None Detected 0% Not Required N/A None Detected 100%
06A 3493 Sheet Rock Throughout White Sheet Rock None Detected 0% Not Required N/A Cellulose 5% 95%
.
06B 3494 Sheet Rock Throughout White Sheet Rock None Detected 0% Not Required N/A None Detected 100%
Q6C 3495 Sheet Rock Throughout White Sheet Rock None Detected 0% Not Required N/A Cellulose 3% 97%
O7A 3496 Roof Shingles Black/Gray Dots inconclusive 0% None Detected <1.0% Fiberglass 10% 90%
Fibrous Roofing No Asbestos >f
Shingle Detected
Q7B 3497 Roof Shingles Black/Gray Dots Inconclusive 0% None Detected <1.0% Fiberglass 20% 80%
Fibrous Roofing No Asbestos V
Shingle Detected
08A 3498 Roof Vapor Barrier Black Fibrous Inconclusive 0% None Detected <1.0% Fiberglass 10% 90%
Under Shingles Vapor Barrier No Asbestos T/
Detected
08B 3499 Roof Vapor Barrier Black Fibrous Inconclusive 0% None Detected <1.0% Fiberglass 20% 80%
Under Shingles Vapor Barrier No Asbestos V
Detected
09A 3500 Exterior Gray Gray Caulk Inconclusive 0% None Detected <1.0% None Detected 10%
Door/Window Caulk No Asbestos V
Detected
09B 3501 Exterior Gray Gray Caulk Inconclusive 0% None Detected <1.0% None Detected 100%
Door/Window Caulk No Asbestos V
Detected
KEY TO NOB COLUMN SYMBOLS
No Symbol in the NOB column denotes sample analyzed by FLAP Method 198.1(PLM}.
if NOB(non-friable organically bound}denotes material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted.
V denotes material analyzed by FLAP Method 198.6(PLM)per NYSDOH.This Method does not remove vermiculite and may underestimate the level of asbestos
present in a sample containing greater than 10%vermiculite.
#f denotes friable material analyzed by CLAP Method 198.6(PLM)and 198.4(TEM)as noted.
X denotes sample prepped only by SLAP Method 198.6.
**Polarized-light microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.
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.
PLM BulkAsbestos Analysis by New York State Department of Health,SLAP Method 198.1,198.4 and 198.6("Polarized Light Microscopy and Transmission Electron Microscopy Methods for
Identifying and Quantitating Asbestos in Bulk Samples and in Non-Friable Organically Bound Bulk Samples"Jor EPA 600/M4-82.020 per 40 CFR 763 and/or EPA 600/R-93/116(NVLAP Lab
Code 200530-0),
oi
EAVOAf
Emma ' ELAP ID No.: 10958
Lab Code 200530-0 for PIN Analysis '..,,
PLM Date Analyzed: 1/19/2018 TEM Date Analyzed: N/A / ."--- ,,
'G \
Microscope: Olympus BH-2##232953 TEM Analyst:N/A >.�'t--..,...._.... .'"
Analyst: 7:Bush q '
Laboratory Results Approved By:
Asbestos Operations Manager or Designee Mary Dohr
Paradigm Environmental Services,Inc.is not responsible for the data supplied by an independent inspector.National Institute of Standards and Technology Accreditation
requirements mandate that this report must not be reproduced except in full without the approval of the laboratory.This PLM report relates ONLY to the Items tested.This
report must not be used to claim product endorsement by NVLAP or any agency of the U.S.Government.Quality control data(including 95%confidence limits and laboratory
and analysts'and precision)Is available upon request.
0391-18.xlsni 1/22/2018
CHAIN OF CUSTODY FOR BULK ASBESTOS ANALYSIS
77179 Lake Avenue,Rochester,New York 14608 Office:585-647-2530
PARADIGM 1815 Love Road,Grand Island,New York 14072 Office:716-775-5777
" "'" Client: Contact: OFFICE USE ONLY
BRAD ARTHUR
GYMO -,d
� Phone Number: Email Address for Data: Job#: L t ` - 1
(315)788-3900 ENVIRONMENTAL@GYMOPC.COM .
Client Mailing Address: Results To BRAD OR DIXIE Turn Around Time: , Page l of 3
18969 US RT 11 5 days 1 .1 "•
Date Sampled: i /�o/( Material Type/Quantity: Date Logged In: I' •i
WATERTOWN NY 13601 1 Friable x NOB x TEM Logged In By:
\%.---0( t Project Location: S' Ic 4 41, ;D... " ° ti
I (-)c) .,\ i, 2c) q/(k.tm.(,\A-y i,:t. i
Client ID Lab ID Sampling Location Color Material Size Type of Material
_
1 6 )4 I- ,6,'-:?) -( . i.s. --1c-Az_,- 4 \),7 C-- r..., I )U s CC<cAj , 4 IC-
2 i - t-}ASV, L4 �c c_ c� vU\- 6 c�:,(t ( J--� J`t-1
3 C - I�✓ r ,4 VI c',\a`Z 6s'e,. �'`v C.).. , iv tA,.,,, gv 1`C C,W'C (✓cV
C
4 Y� 01 c Zvi S�f L Nc j C 14c- ` 2 IftL,
5 \Jc ,C... i "i4'"e �ryll Ld;1 2-atM1,,,P,r,, c4. , T► c.: jr..,U� r.,•.1 'iL, 760 AN cie i,
6 ryy./ c. ,lte k-. N Li - \-ee ..� \,-,\ ,L,,,k e, ,-,ikC , x,0 J e,t6 N, 6
8 clikkcj utot ,,4cicl kCv\,-b \Q(G0Gc 4y'rr4- ...J.- 11,E fIc; i9/rr, /? f-r 1. /�'�>- 6c'Y-��.
9 c1.`G '.:Z' � (',cr, cYc.1 Ui.,r'�G,,�4.w Give �)fcy 6 4J ( �/
All samples will be analyzed by the appropriate New
Sampled By: J.Phelps Date: R n f' York Sate Department of Health methods(198.1,198.4
( /If Nsamplesand 198.6)unless EPA 600M4/82/020 per 40 CFR 763 and/or EPA 600/R-93/116 methods are requested.
Transported to Paradigm By: Date: A/f�il f 8 CHECK TO AUTOMATICALLY PERFORM TEM ON NOBS x
fedex ( I 1 or provide TEM contact name:
Received By: Date: _ TOTAL NUMBER OF SAMPLES ON ALL CHAINS OF 0
-1 6-y'Sv }/t,\ l / .y f 3 C CUSTODY:
ATTACHMENT D
DRAWINGS
GYMOoPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900
www.gymopc.corn
•
•
07AB
COOLER 01AB 08AB ROOF
04AB 05C
03AB 06C 04,0
�co
6),
S C
BACK SIDE O
NOT SAMPLED R F
A R
05AB G E
06AB E E
Z
E
R
02AB
09AB
PRE-REN./DEMO.ASBESTOS SURVEY DATE: 01/23/2018
PROJECT ADDRESS DRAFTED BY PROJECT NUMBER
111110rilir .,0441PF SHOP#194, 221
CORINTH RD. JP 2018-005V
QUEENSBURY, NY
ATTACHMENT E
PHOTOS
GYMODPc Project #2018-005V January 23, 2018
GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900
www.gymopc.com
------- -. -y -a
'ii'ri +; l It a
{S
4) ,. .� ,,,( '.f.."
i!
I , . ;��
a j c p s 1
'1
t �. 11 { _ 1tt
t b
IW[4c'— n . .�"n't4R s'# 'c- a" -'nf er„ t _ - ' s
.. 3 .1..
! ! T "
1 fit ( ;L:
� k'`
w J
w
_�^?., ."...: .' _4._.. V'' Gas' ! -
` . as
14
k
• 41 - ... jI _
g -- - 1 i1
�k� T
i s Y t". —.row» 'i 1
a 1110,
It
, ' 4 ki, . . ,,, . .i.
4,. „.„,„ ,
,J.
. „, .,..\\ ts
r
II,1 rq.� 1 Yj, '.
tt s II ['s r 1 f r: Y4 _ r _ - - .% 'L
r
fit Ra '.v o i•
t
,
ti �• i ,'t .� ',
TW4
- 1
ti d . . t. 4
,�y` ", 1
rrrrr.r. 1 vet
4 a, 4'k^ LL
p,"a
-- ' '`�, n
its -^ • ',J` _ - '
dl.f 1
4+(. 7
h
iv
Igo
-
.�
wf
4 ', t1Z-: '
r411
_ fi ,
e� R
47
r----
11110 F o
Sr
-41141
y
-. -.._ a:. 1 gel 4
I y
y
6•
fr
f
8{
-- a
R
ot- ,..-,g, t,. ,,,,,,iy: ;
' '- > 1 1-di' ! .+ �. ur rt ,-f _ j.
, ,....
,.. --. -,j....4, r ',
I' c \ �l Any Ift r F�
1pp',,t.. . ...fi 1 i s ate. S, -1 ]V `
33
ARCHITECTURE
Illti‘
ENGINEERING
, -1111111/4 ,,, li
ENVIRONMENTAL
LAND SURVEYING
ECOVEnr
E 1
ASBESTOS SURVEY REPORT ti in , L ± I2o19
I TOWN OF O[UEENSBURY
BUILDING& CODES
Project Location:
221 Corinth Road
Queensbury, NY
ec...nic 5-roxt.e.,
Prepared for:
Mr. Jeremy Lawless
Stewarts Shops
2907 Route 9
Ballston Spa, NY 12020
Prepared by:
GYMO Architecture, Engineering, & Land Surveying D.P.C.
19869 US Route 11
Watertown, NY 13601
(315) 788-3900 www.gymodpc.com
309.13-2-25 DEMO-0350-2019
Strewart's Shops Corporation
221 Corinth Rd
Demolition of commercial building
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
ARCHITECTURE Y "
lithav ENGINEERING ,
ENVIRONMENTAL
LAND SURVEYING
�X 3
Edward G.011ey,Jr.,AIA
Patrick J.Scordo,PE
Ryan G.Churchill,PE
Scott W.Soules,AIA
January 28, 2019 Brandy W.Lucas,MBA
Hayward B.Arthur III,MPS,IE
Mr. Jeremy Lawless
Howard P.Lyndaker III,PLS
Stewarts Shops
2907 Route 9 Gregory F.Ashley,PLS
Ballston Spa, NY 12020 In Consultation
Leo F.Gozalkowski,PLS
RE: Asbestos Survey Stephen W.Yaussi,AIA
221 Corinth Road
Queensbury, NY
Dear Mr. Lawless
As requested, GYMODPc completed an Asbestos Survey at the above referenced site. Our NYS Certified
Asbestos Building Inspector Mitchell Blackwell Cert#17-25242 visited the site on January 15, 2019 and
collected samples of building materials suspected of containing asbestos. These samples were sent to
Paradigm Environmental Services for laboratory analysis. Based on laboratory analysis of the samples
collected, none(0) of the materials tested positive for the presence of asbestos.
A list of all materials sampled can be found in Attachment A. If other building materials are identified and
shall be disturbed, the materials shall be presumed to be ACMs until examination by an appropriately
trained &certified individual and laboratory analysis prove otherwise.
If you have any questions pertaining to this report, please contact me directly at (315) 788-3900.
Sincerely,
GYMO Architecture, Engineering & Land Surveying, D.P.C.
Dixie Thompson
Environmental Department Coordinator
Attachment A: List of Materials Sampled
Attachment B: License and Certifications
Attachment C: Asbestos Bulk Sample Laboratory Results
Attachment D: Drawing
Attachment E: Photos
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
•
•
•
ATTACHMENT A
LIST OF MATERIALS SAMPLED
Sample# Material Location ACM Content
1 A, B White Joint Compound Throughout 0%
2 A, B White Sheetrock Throughout 0%
3 A, B White 2x4 Ceiling Tile Throughout Not Breakroom 0%
4 A, B Grey/White Floor Tile Throughout 0%
5 A, B Yellow Mastic Throughout 0%
6 A, B Black Cove Base Throughout 0%
7 A, B Tan Adhesive Throughout 0%
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
ATTACHMENT B
LICENSE AND CERTIFICATIONS
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
•
New York State—Department of Labor
Division of Safety and Health
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Gymo,Architecture, Engineering & Land Surveying FILE NUMBER: 99-0170
D.P.C. LICENSE NUMBER: 29355
LICENSE CLASS: RESTRICTED
18969 US Route 11 DATE OF ISSUE: 11/21/2018
EXPIRATION DATE: 11/30/2019
Watertown, NY 13601
Duly Authorized Representative—Hayward Arthur:
This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of
the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1)
serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of
responsibility in the conduct of any job involving asbestos or asbestos material.
This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the
asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York
State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State
Department of Labor.
Eileen M.Franko, Director
SH 432(8/12) For the Commissioner of Labor
STATE OF NEW YORK-DEPARTMENT OF LABOR �,77
-
ASBESTOS CERTIFICATE
MLTCHELL A.BL.ACKWELL
CLASS(EXPIRES)
CATEC(01[19) H PM (G1/ig)
C'EPT4 ..2S(t'3
MUST BE CARRIED ON ASBESTOS PROJECTS
frifIR E%NfEp P11 A1F..
111111111111111111111 1111
• IF FOUND RETURN TO:
EYES BLU NYSDOL - L&C UNIT
a y
,7., HAIR BLN ROOM 161A BUILDING 12
•v
_rn
w9HOT 5' 05" STATE OFFICE CAMPUS
ALBANY NY 12240 1
T:k i
S
y •- -- --- .__ -NEW_YORK STATE DEPARTMENT OF H ALT i'.
_.:_ _ I�StATGRTf CENTER_'_=
-- •- - `xt Expires.112:01:CAM Aprii-01-2019
, •;'. _=_1ssued,April61,2018
- -= _= = _-- — ----_ —
i
-, - CERTIFICATE=OFAPPROVA� OR LABORATORY SERVICE__' _
__ _;_=. Issued ccatdanos with and pursuant to section_Gf�2-P bri 4leatth=Laiv of New'ork=State = --. _ _
=_ _=
• ll�r.SrEVE�EvITc� __ _. _ - —_ - Laffld'ltt :. t 9 _
- - - - - - - _-
- -PA 4ADIGM ENVIRO NMENTAL::SER JCES INC = - _
. - _ _ 179 LAKE'- A-'/ENUE- = — 71.-
_—,--= _ —--Rf NESTER_Y.:-=11&OBE r_-, __t-== _ _ -_---
-_ _ --._ is hereby APPRO PROVED as_ rF Errvlr t rr7eeifail ir�raforyfrig the ate ary =
._:
___,__ N1fiF?# AIItfiEN.TA 'AIVRLYSES._SC?Llf3AdlU- lA It ?Qt1u�`=U1fASTE
- __ _-_ --All app trued subcategories and/or-eti-alytes- 1tsfed below: _ _-_ _-
:a.
-
Misc.eliaTteirius_— .. -- =_ _
--= Asbestos1n Friable-Ntatee1al- - -_item 198.1 of Manual _ --— _
_- = "=EPA600/M4/82/020 -
- AsbeStes la Non-Friable Materlal-PLM ,_item 198.6 of Manual(NOB by PLM) --
Asttesfc%stn on- riabie Matellat-TEM -1iem 198.4 of Manual _
__ _ Lead iiii ust Wipes _EPA 6010C _
=Lead in Paint= _ _ =EPA 6010C
Saundra reparation Methods__ —
_ = = = _ == = `EPA 3050B
•
S-eria! No.:_57637.-.. __ _ ===- _ _
=Property of ev the•N York-State oepartment of Health.1.- Certificates are valid.only at:the address _shown;must he conspicuously posted,and are printed on secure paper. otietiTh - ccr ltation—depends=--__
it ti—=
on successful ongoing participation in the Program:Consumers are urged-to call(518)485-5570-to= _ - � _=" _
-`verify the laboratoryieccredilatton status. -== == =_ _
Page▪7 of 1 == __
ATTACHMENT C
ASBESTOS BULK SAMPLE LABORATORY RESULTS
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
,e1iAr)Ic R 4.7 ice!a s 179 Lake Avenue,Rochester,NY 14608 Office:(5$5)647-2530 Fax:(585)647-3311
' ••������'��� EttVfRnHMEHTAt SERVtLES, INC.
&TEM BULK ASBESTOS ANALYSIS REPORT
via NYSDOH ELAP Method 198.1,198.4 and 198.6
Client: GYMO Job No: 0391-19/0150-19B
Location: Glens Falls National,221 Corinth Road,Queensbury,New York Page: 1 of 3
2018-005v.01
Sample Date: 1/15/2019
PLM Asbestos PLM N TEM Asbestos TEM PLM Non-
Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous
Client ID Lab ID Sampling Location Description Percentage Asbestos B Percentage Asbestos Fibers Type& Matrix
Percentage Material
1A 3149 Throughout White Joint None Detected 0% Not Required N/A None Detected 100%
Compound
1B 3150 Throughout `White joint None Detected 0% Not Required N/A None Detected 100%
Compound
1C 3151 Throughout White joint None Detected 0% Not Required N/A None Detected 100%
Compound
1D 3152 Throughout White Joint None Detected 0% Not Required N/A None Detected 100%
Compound
1E 3153 Throughout White joint None Detected 0% Not Required N/A None Detected 100%
Compound
2A 3154 Throughout White Sheet Rock None Detected 0% Not Required N/A Cellulose 5% 93%
Fiberglass 2%
2B 3155 Throughout White Sheet Rock None Detected 0% Not Required N/A Fiberglass 2% 98%
3A 3156/ Throughout/Not Break White 2'x4'Ceiling Inconclusive 0% None Detected <1.0% Mineral Wool 5% 95%
1287 Room Tile No Asbestos
Detected
3B 3157/ Throughout/Not Break White Fibrous 2`x4' Inconclusive 0% None Detected <1.0a/a Mineral Wool 10% 90%
1288 Room Ceiling Tile No Asbestos
Detected
4A 3158/ Throughout Gray/White Floor Inconclusive 0% None Detected <1.0% None Detected 100%
1289 Tile No Asbestos V
Detected
KEY TO NOB COLUMN SYMBOLS
No Symbol in the NOB column denotes sample analyzed by ELAP Method 198.1(PLM).
V NOB(non-friable organically boundjdenotes material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted.
9 denotes material analyzed by FLAP Method 198.6(PLM)per NYSDOH.This Method does not remove vermiculite and may underestimate the level of asbestos
present in a sample containing greater than 10%vermiculite.
ft denotes friable material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted.
X denotes sample prepped only by FLAP Method 198.6.
**Polarized-light microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.
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.
PLM Hulk Asbestos Analysis by New York State Department of Health,ELAP Method 198.1,198.4 and 198.6("Polarized Light Microscopy and Transmission Electron Microscopy Methods for
Identifying and Quantitating Asbestos in Bulk Samples and in Non-Friable Organically Bound Hulk Samples.")or EPA 600/M4-82-020 per 40 CFR 763(NVLAP Lab Code 200530-0),
SYINO
Lab Code 200530-0 for PLM Analysis
ELAP 10958(Rochester) ELAP 11955(Grand Island)
PLM Date Analyzed: 1/25/2019 'TEM Date Analyzed: 1/24/2019
Microscope: Olympus Hli-2 11221797 TEM Analyst: A.Dembski
PLM Analyst: T.Ma TEM Scope: Hitachi 600 AB
Laboratory Results Approved By:
Asbestos Operations Manager or Designee Mary Dofir(ELAP 1095bJ
Paradigm Environmental Services,Inc.is not responsible for the data supplied by an independent inspector.National Institute of Standards and Technology Accreditation
requirements mandate that this report must not be reproduced except in full without the approval of the laboratory.This PLM report relates ONLY to the items tested.This
report must not be used to claim product endorsement by NVLAP or any agency of the U.S.Government.Quality control data(including 95%confidence limits and laboratory
0391-19 1/24/2019
ARA15i,6 ,/v- PARADIGM 179 Lake Avenue,Rochester,NY 14608 Office:(585)647-2530 Fax:(585)647-3311
fit VtRON/4E1YSAL SERVICES, INC.
PLM& TEM BULK ASBESTOS ANALYSIS REPORT
via NYSDOH ELAP Method 198,1,198.4 and 198.6
Client: GYMO Job No: 0391-19/0150-191
Location: Glens Falls National,221 Corinth Road,Queensbury,New York Page: 2 of 3
2018-005v.01
Sample Date: 1/15/2019
PLM Asbestos PLM N TEM Asbestos TEM PLM Non-
Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous
Client ID Lab ID Sampling Location Description Percentage Asbestos B Percentage Asbestos Fibers Type& Matrix
Percentage Material
%
4B 3159/ Throughout Gray/White Floor Inconclusive 0% None Detected <1.0% None Detected 100%
1290 Tile No Asbestos V
Detected
5A 3160/ Throughout Yellow Mastic Inconclusive 0% None Detected <1.0% None Detected 100%
1291 No Asbestos .J
Detected
5B 3161/ Throughout Yellow Mastic Inconclusive 0% None Detected <1.0% None Detected 100%
1292 No Asbestos V
Detected
6A 3162/ Throughout Black Cove Base Inconclusive 0% None Detected <1.0% None Detected 100%
1293 No Asbestos i
Detected
6B 3163 Throughout Black Cove Base <1.0%Residue N/A N/A N/A N/A N/A
Remaining.PLM
and TEM Not
Reuuired.
7A 3164/ Throughout Tan Adhesive Inconclusive 0% None Detected <1.0% None Detected 100%
1294 No Asbestos
Detected
7B 3165/ Throughout Tart Adhesive inconclusive 0% None Detected <1.0% None Detected 100%
1295 No Asbestos i
Detected
KEY TO NOB COLUMN SYMBOLS
No Symbol in the NOB column denotes sample analyzed by FLAP Method 198.1(PIM).
Y NOB(non-friable organically bound)denotes material analyzed by FLAP Method 198.6(PLM)and 198.4(TEM)as noted.
"V denotes material analyzed by ELAP Method 198.6(PLM)per NYSDOH.This Method does not remove vermiculite and may underestimate the level of asbestos
present in a sample containing greater than 10%vermiculite.
if denotes friable material analyzed by FLAP Method 198.6(PLM)and 199.4(TEM)as noted.
X denotes sample prepped only by FLAP Method 198.6.
**Polarized-light microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials.
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.
PLM Bulk Asbestos Analysis by NewYnrk State Department of Health,ELAP Method 198.1,198.4 and 198.6("Polarized Light Microscopy and Transmission Electron Microscopy Methods for
Identifying and Quantitating Asbestos in Bulk Samples and in Non-Friable Organically Bound Bulk Satnples.")or EPA 600/M4-82.020 per 40 CFR 763(NVLAP Lab Cade 200530-0),
aWaaap
Lab Code 200530-0 for PLM Analysis
ELAP 10958(Rochester) ELAP 11955(Grand Island)
PLM Date Analyzed: 1/21/2019 TEM Date Analyzed: 1/24/2019
Microscope: Olympus 8H-2#221797 TEM Analyst: A.Dentbsld
PLM Analyst: T.Ma TEM Scope: , Hitachi 600 AB
Laboratory Results Approved By:
Asbestos Operations Manager or Designee Mary Dohr tELA('1U958)
Paradigm Environmental Services.Inc.is not responsible for the data supplied by an independent inspector.National Institute of Standards and Technology Accreditation
requirements mandate that this report must not be reproduced except in full without the approval of the laboratory.This PLM report relates ONLY to the items tested.This
report most not be used to claim product endorsement by NVLAP or any agency of the U.S.Government.Quality control data(including 95%confidence limits and laboratory
0391-19 1/24/2019
. . CHAIN QCUSTODY Fi FR it ULK AS tESToS AN:ALYSIS,
7k;Pdit::-1., '•iC-179 Lake Avenue,Rochester,New York 14608 Office:585-547-2530
4;',i':''1`::::`•2t';:`,L::',1e,g:ko
1815 Love Road,Grand Island,New York 14072 Office:716-775-5777
:,,,WrI7',,I ,14v•rP,4tZ,„1;,, Client: Contact: i.t 1 ,./1 • ,,
45.,,...t tt.,;.Arig, `'4•11'• BRAD ARTBUR C:".
t'TZ,-;t44 GYMO
Phone Number: Email Address for Data: Job#: ....C)3(.; i --___.3
315)788-3900 LABS RGYMODPC.COM
Client Mailing Addreas: Results To BRAD OR DIXIE Turn Around Time: Page
18969 US RT 11
Date Sampled Material Type/Quantity: Date Logged In:a I/ '
WATERTOWN NY 13601 /- 76-19 Friable P''',..— NOB rs. TEM k Logged In ty: 'nit
irl-C" 1
Project L
I -O ‘,4 0 i Ii:inflow.
Gte_n4,11s,fis 43.(1„1 •-?•• C.,c? ',st)11-hgg a se/4' •4bt
Client ID Lab ID Sam ling Location 1 • Color ' Material Size T,4 e of Material
.,1
AWN 7'1 .531u, I 1 15)-
' c-,... IIIIIIMNIWEEIIIIIIIIII -
I vvk:4~Q- --S-
'
MEM.: '2-5c.-.0•4'4_ ..,s1 f•i-o-e-V-N
8 flV INIMMILM) ' 4rd,-( A
11S*2\td-le °AA 7
41111211111=111. ,:y D 4-4110-c/1/4- )/k....-,1)--- .t.e/1,(A,i4e_ I -Q, .A4 2-- c'1‘....r kJ,
_
5 1111MIENIMINarliM Z- -4-str -',-' fr)°-4'N-•1-- Yeii /- 100-0-,P47---- oh ,j,
6 g a INIMI 44?ro-0,,, h.....a- Lk 4.4.C4" LICQ-44-1 XCL•
7 iminmommilijIMIAM311511 I q 0-.044,,qQ4- 41.o 5,.,1,•e_II MN.—- - Pli
8 MIIIM - - •
9
#IIIIIIIIIIIIIIIIII Mill!
Sampled By. il Date: .,
All sampler will analyzed by the approprlate New York State Department of Health methas(1901,199.4
, [-11-1? ,!Ittri 198.6)unless EPA 600/N14/82/020 per 40 CFR 763 aritlfor.gPA 6110/R43/110 methods ere requeated.
Transported to Paradi ta By: Date: CHECK TO AUTOMATICALLY PERFORM TEM ON NOBS
UPS or provide TEM contact name:
,
Received By: Date: TOTAL NUMBER OF SAMPLES ON ALL CHAINS OF Fill
.„,•% ) c, ......_11.p_caliL___ CUSTODY:
_ _ .
By signing this fonn,client agrees to Paradigm Terms and Conditions(reverse).
0 .. C},t, C)- \-- I 2,2. I).9. 07 • .,-(/(40,3
._.
, .
ATTACHMENT D •
DRAWINGS
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
ARCHITECTURE
ENGINEERING P
( i
' �- ENVIRONMENTAL ,4 `-
- LAND SURVEYING
a
h
t
=r ,s
.
a
d
i
1 Le 146
9
t. ._ gym,
t
y
t
s
E
_ a
18969 US Route tt•Watertown,New York t36ot•Tel:(315)788-3900•Fax:(315)788-0668•E-mail:gymopc@gymopc.com
ATT'ACHMENT E
PHOTOS
2018-005v.01 Architecture, Engineering, & Land Surveying, D.P.C. January 28, 2019
18969 US Route 11
Watertown, NY 13601
www.gymodpc.com
a r }
1
tt �x &
1 ' , � '
r, 1t.
`'\ 4 .
i
i
t _
e
I
. i -_ -
6 . ,.
K
't
.
. 1
_ ,_ . -.....,
.. .. '-. Ill
I^
.
..._. ,.
f.4"
. ...
• IS tri .
4* \lit; •
r
. .
..,i.
„ . . _ ....
.., -
- -- •, ....",l'' .,
. .
' '''.i.
, .
. ...--
. . . ,.
. ,. .
I ' '— ' f '..-:',, .:•••-, -7;2" ,---, '
. '' l'•!-Wseg i, • ARV'-'14.:0''''''-',-
If. Sr , •
,
., .
'1., . ' '.!,..74ENKM 4'' .'.'.*„.•‘.',....,, ..4_,,,•:..,
..- .-•. - - . •
...
„,2......i 1,• i 14'..,n,-----,;;„,,,-;:V.4-------
.., • .-1,- ,
h.' 4. ..
• .
N . .,.
,., , .. ,.,.,-_„:„. :::.,,:,:i,,,,,,,,,....,-,-• :p-:,,i'Lli
. .. .,
k, 0I-IWZ.—4
,
1t.!:r_•'-'.4';.,!'.1._ „1...t.pf
.1:.7,..,..7., ..C.:..
. --. ..-...,.-
_-.' .;4447 -il'. 'To, '_ MI'' •A.-,..weff.s.v.Tc, - ;:.
-,J.. -,-..."-,. - •A,..1*.k... - 1,-,
... - ..tf---.1f.R. I •-:°-
, it--,,,i't.' ..,- 7*'N.
i— ,..4-'__- 4-.,--
. ,
-..- .. . , • P., '
4 -
: I
-•••••-., - . , ,. ,_. n
, . i n'„,1".•
-. • ...,.. , I I,
•...... ,
itti,,,.•,,,-!..
--..-
• ,
,, •
•
,,,• ,,...,..,.. ,.....,.:,.
e '-',' ';*0 •
,
•, :• . . .
I
- -
'1111"tilr''''''-;!:::r."
.. .
. 1. .,..._ ...,,i ! ' i 1 4%,.v.,.-.•-.-.
•
tic
I
F f
*lite.
ii