asbestos report DEC 0 3 '2020 x
Qu" ES&T FILEOpy
( Quality` Environmental Solutions&Technologies,Inc.
PRE-DEMOLITION SURVEY REPORT-
FOR
ASBESTOS-CONTAINING MATERIALS (ACM)
Prepared for:
WILLIAM BOSY
P.O. Box 1
Lake George, NY 12845
at
RESIDENTIAL HOUSE
53 Assembly Point Road
Lake George, NY 12845
September 29, 2020
Ya
QuES&T Project #Q20-3588
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Oualiiyenv.com
VUE-JS&T
Quality Environmental Solutions&Technologies,Inc.
September 29,2020
William Bosy
P.O.Box 1
Lake George,NY 12845
ATTN:Wf11nam Bosy
Via E-mail: 111001&aol,com
Re: 53 Assembly Point Road,Lake George,NY 12845
Pre-Demolition Asbestos Inspection
QuES&T Project#Q20-3588
Dear Mr.Bosy,
Attached is the Pre-Demolition Inspection Report for Asbestos-containing Materials(ACM)identified
throughout interior and exterior areas included within the above-referenced location(s)by Quality
Environmental Solutions &Technologies,Inc. (QuES&T). The inspection included visual assessment
and representative sampling for the detection of ACM in compliance with the requirements of Title 12
NYCRR Part 56-5.1.
As per 12 NYCRR Part 56-5.5.1(g),upon receipt of this report,Building Owner's must provide:
1) One(1)copy of this completed report shall be retained by the Owner for a period of"life of building"plus
thirty(30)years.
2) One(1)copy shall be submitted to the local Municipality if work permits are required.
3) One(1)copy shall be kept onsite during any demolition,renovation,remodeling,repair or addition
activities.
The attached report summarizes the inspection protocol and inspection results for your review. QuES&T
believes this report accurately reflects the material condition existing in the functional spaces at the time
of our inspection.
Should you wish to discuss this matter further or require additional information concerning this submittal,
please contact us at(845)298-6031. QuES&T appreciates the opportunity to assist Mr.William Bosy in
the environmental services area.
Sincerely,
Louis N. Johnson HI
Technical Services
NYS/AHERA Inspector/Project Designer
&Management Planner Cert.#AH 08-05954
EPA Lead Inspector/Lead Risk Assessor
NYC DEP Asbestos Investigator Cert.#137330
NYS Mold Assessor Cert.#MA-00532
Cc. averre(@qualityciiv.com
QuES&T File
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualityenv.com
r
4
Y �
t �
QuES&T
Quality Environmental Solutions&Technologies,Inc.
TABLE OF CONTENTS
I. Introduction Page 1
H. Inspection Summary Page 2
III. Identified Asbestos-containing Materials(ACM) Page 3
IV. General Discussion Page 4
V. Transmittal of Building Survey Information Page 5
VI. Abatement Required Page 6
VII. Disclaimers Page 7
Appendix A ACM Location Drawings&Photos
Appendix B Sample Locations&Results
Appendix C Personnel Licenses&Certifications
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualiiyenv.com
t
. A
Pre-Demolition Asbestos Survey William Bosy
OuES&T Project#020-3588 (a,53 Assembly Point Road,Lake GeoriZe.NY 12845
1. INTRODUCTION:
Quality Environmental Solutions&Technologies,Inc.(QuES&T)performed a Pre-Demolition Asbestos Survey,
in conformance with Title 12 NYCRR Part 56-5.1,on September 18,2020 for Mr.William Bosy.The survey
included a visual inspection assessment for Presumed Asbestos-containing Materials(PACM)and suspect
miscellaneous Asbestos-containing Materials(ACM)throughout interior and exterior locations.No previous or
existing sample results or findings were utilized in this inspection.
QuES&T established functional spaces based either on physical barriers(i.e.walls,doors,etc.)or homogeneity of
material.Within each functional space identified,a visual inspection was performed using reasonable care and
judgment,to identify and assess location,quantity,friability and condition of all accessible installed ACM building
materials observed at the affected portion of the building/structure.
Limited localized demolition of building surfaces was performed,as part of this survey,to access concealed
surfaces. No disassembly of installed equipment was conducted as part of this inspection. ACM concealed within
structural components and equipment interiors or that is accessible only through extensive mechanical or structural
demolition may not have been identified as part of this survey. When any construction activity,such as demolition,
remodeling,renovation or repair work,reveals PACM or suspect miscellaneous ACM that has not been identified,
as part of this survey,all construction activities shall cease in the affected area.
The survey included both visual inspection of accessible spaces and representative sampling of suspect building
materials for ACM. Samples collected were analyzed by a laboratory approved under the New York State
Department of Health Environmental Laboratory Approval Program(NYSDOH ELAP). Samples were analyzed in
the laboratory by Polarized Light Microscopy(PLM),Polarized Light Microscopy-NOB(PLM-NOB)and/or
Quantitative Transmission Electron Microscopy(QTEM),as required. Sample collection and laboratory analysis
were conducted in compliance with the requirements of Title 12 NYCRR Part 56-5.1,29 CFR 1926.1101 and
standard EPA&OSHA accepted methods. Samples consisting of multiple layers were separated and analyzed
independently in the laboratory.
Certified QuES&T personnel(Appendix C),Mr.Louis N.Johnson III(Cert.#AH 08-05954),performed visual
assessments throughout the above-mentioned locations. A total of seventy-two(72)samples of installed and
accessible suspect building materials were analyzed by a laboratory approved under the NYSDOH ELAP. Eighteen
(18)samples were analyzed using Polarized Light Microscopy(PLM)for friable materials;Twenty-seven(27)
samples were analyzed using Polarized Light Microscopy(PLM-NOB)for non-friable organically bound materials;
and twenty-seven(27)samples were analyzed by Confirmatory-QTEM following negative-determinations using
PLM-NOB protocols.
EAWROAVENTAL CONSULTING& TRAINING
Page I of 7
Pre-Demolition Asbestos Survey William Bosy
ODES&T Proiect#020-3588 na 53 Assembly Point Road Lake George,NY 12845
II. INSPECTION SUMMARY:
A visual inspection was performed,and homogenous material types were established based on appearance,color and
texture.The findings presented in this report are based upon reasonably available information and observed site
conditions at the time the assessment was performed. The findings and conclusions of this report are not meant to
be indicative of future conditions at the site and does not warrant against conditions that were not evident from
visual observations or historical information obtained from others.
Representative bulk sampling was performed on suspect building materials for laboratory analysis using PLM,
PLM-NOB,and/or QTEM. The following is a summary of installed building materials sampled:
• Ceiling Materials—12"x 12"Ceiling Tiles,Textured Coating,Sheetrock&Joint Compound.
• Wall Materials—Wall Paneling,Brick&Mortar,Sheetrock&Joint Compound,Cementitious Block&
Mortar.
• Floor Materials—Linoleum Sheet Flooring,Adhesives,Fiberboard,Flooring with Vapor Barrier,
Staircase Treads and Carpet Mastic.
• Insulation Materials—Loose Fill Insulation.
• Roofing Materials—Rolled Roof,Asphalt Shingles and Tar Paper Vapor Barrier.
• Miscellaneous Materials—Misc.Caulking and Window Glazing Compound.
ENVIRONMENTAL CONSULTING& TRAINING
Page 2 of 7
Pre-Demolition Asbestos Survey William Bosy
OuES&T Project 4020-3588 A 53 Assembly Point Road,Lake George,NY 12845
III. IDENTIFIED ASBESTOS-CONTAINING MATERIALS(ACM):
IDENTIFIED ACM
53 ASSEMBLY POINT ROAD
LAKE GEORGE.NY 12845
(Refer to Appendix A for details)
KEY: ACM=Materials containing greater than 1%of asbestos;
LF=Linear Feet;SF=Square Feet;PACM=Presumed Asbestos-containing Materials;
Friable=ACM capable of being released into air, and which can be crumbled,pulverized,powdered, crushed or exposed
by hand-pressure.
Approximate
Location Material Quantity Friable. Condition
FIRST FLOOR
Bathroom Ceiling/Soffits, Non-ACM Sheetrock w/ACM 50 SF Yes Good
Throughout Joint Compound
Bathroom Walls,Throughout Non-ACM Sheetrock w/ACM 240 SF Yes Good
Joint Compound
Kitchen Walls,Throughout,Behind Non-ACM Sheetrock w/ACM 320 SF Yes Good
Wood Paneling Joint Compound
Bedroom&Closet Walls, Non-ACM Sheetrock w/ACM 400 SF Yes Good
Throughout,Behind Wood Paneling Joint Compound
Entry Area Walls,Throughout, Non-ACM Sheetrock w/ACM 360 SF Yes Good
Behind Wood Paneling Joint Compound
Living Room Walls,Throughout, Non-ACM Sheetrock w/ACM 360 SF Yes Good
Behind Wood Paneling Joint Compound
Pantry/Closet Area Walls, Non-ACM Sheetrock w/ACM 240 SF Yes Good
Throughout,Behind Wood Paneling Joint Compound
SECOND FLOOR
No Identified ACM Upon Analysis of Samples Collected
ROOF&EXTERIOR
No Identified ACM Upon Analysis of Samples Collected
Note: Sheetrock w/ACMjoint compound is assumed behind all woodpaneling wall systems throughout the first floor.
Destructive sampling and removal of multiple wood paneling would have been required;house was currently active during time
of inspection.
ENVIRONMENTAL CONSULTING& TRAINING
Page 3 of 7
Pre-Demolition Asbestos Survey William Bosy
OuES&T Project#020-3588 lad 53 Assembly Point Road Lake George NY 12845
IV. GENERAL DISCUSSION:
All construction personnel as well as individuals who have access to locations where asbestos containing materials
(ACM)exists should be informed of its presence and the proper work practices in these areas.Conspicuous labeling
of all ACM is suggested to ensure personnel is adequately informed.Personnel should be informed not to rest,lean
or store material or equipment on or near these surfaces and not to cut,saw,drill,sand or disturb ACM.All removal,
disturbance,and repair of ACM should be performed in compliance with Title 12 NYCRR Part 56 by persons
properly trained to handle ACM.Facility custodial and maintenance personnel should receive training
commensurate with their work activities;as defined in 29 CFR 1910.1001.
The fmdings presented in this report are based upon reasonably available information and observed site conditions at
the time the assessment was performed.Conditions may have changed since that time and the findings and
conclusions of this report are not meant to be indicative of future conditions at the Site.This report does not warrant
against conditions that were not evident from visual observations or historical information obtained,or conditions
that could only be determined by physical sampling or other intrusive investigation techniques that are outside the
proposed scope of work.
ENVIRONMENTAL CONSULTING& TRAINING
Page 4 of 7
Pre-Demolition Asbestos Survey William Bosy
OuES&T Proiect#020-3588 Cad 53 Assembly Point Road Lake George,NY 12845
V. TRANSMITTAL OF BU11L DING SURVEY INFORMATION:
As specified in Title 12 NYCRR Part 56 5.1 (g),information derived from this building survey shall be immediately
transmitted by the building owner or his/her agent to the commissioner through the Department's Division of Safety
and Health,Asbestos Control Bureau,and to the local government entity charged with issuing a permit for such
demolition under applicable State or local laws or,if no such permit is required,to the town or city clerk where the
building is located.
V1. ABATEMENT REQUIRED:
ENVIRONMENTAL CONSULMYG& TRAINING
Page 5 of 7
Pre-Demolition Asbestos Survey William Bosy
OuES&T Project#020-3588 A 53 Assembly Point Road Lake George NY 12845
As specified in Title 12 NYCRR Part 56-5.1 (h)and(i),"If the building/structure asbestos survey finds that the
portion of the building/structure to be demolished,renovated,remodeled,or have repair work contains ACM,
PACM,suspect miscellaneous ACM assumed to be ACM,or asbestos material,which is impacted by the work,the
owner or the owner's agent shall conduct,or cause to have conducted,asbestos removal performed by a licensed
asbestos abatement contractor in conformance with all standards set forth in this Part. All ACM,PACM,suspect
miscellaneous ACM assumed to be ACM,or asbestos material impacted by the demolition,renovation,remodeling
or repair project shall be removed as per this Part,prior to access or disturbance by other uncertified trades or
personnel. No demolition,renovation,remodeling or repair work shall be commenced by any owner or the owner's
agent prior to the completion of the asbestos abatement in accordance with the notification requirements of this
Part...All building/structure owners and asbestos abatement contractors on a demolition,renovation,remodeling,or
repair project,which includes work covered by this part,shall inform all trades on the work site about PACM,
ACM,asbestos material and suspect miscellaneous ACM...Bids may be advertised and contracts awarded for
demolition,remodeling,renovation,or repair work,but no work on the current intermediate portion of the project
shall commence on the demolition,renovation,remodeling or repair work by any owner or agent prior to completion
of all necessary asbestos abatement work for the current intermediate portion of the entire project,in conformance
with all standards set forth in this Part."
Prior to conducting demolition or construction work at the building,all ACM affected/impacted by such activities
shall be removed utilizing a licensed asbestos abatement contractor and NYSDOL/EPA/NYC certified personnel
prior to construction/demolition activities. All work conducted should be in accordance with all legal requirements,
including but not limited to U.S.Environmental Protection Agency(EPA)National Emissions Standards for
Hazardous Air Pollutants(NESHAP)[40 CFR Part 61],New York State Industrial Code Rule 56 Asbestos
Regulations(ICR 56)and Chapter 1 of Title 15 of the Rules of the City of New York Regulations,as applicable.
Advance notification of the asbestos project to the USEPA,NYSDOL,and NYCDEP may be required.
All suspect building materials not sampled during this survey should be considered ACM until these materials are
sampled and analyzed for ACM in the laboratory. Concealed ACM:In addition to the ACMs identified at the site,
there is a possibility that concealed ACM may exist at the subject facility.As such,if any concealed suspect ACM is
encountered during future construction related activities,the work should immediately stop. Prior to resuming the
work,the suspect ACM should either be 1)Sampled by an appropriately-certified asbestos professional and
submitted to an Approved NYSDOH ELAP laboratory for asbestos analysis or 2)Presumed to be ACM(PACM)
and removed by a licensed asbestos abatement contractor for disposal in accordance with all applicable regulations.
ENVIRONMENTAL CONSULTING& TRAINING
Page 6 of 7
Pre-Demolition Asbestos Survey William Bos
Y
QuES&T Proieet#020-3588 nu 53 Assembly Point Road Lake Georse,NY 12845
VIL DISCLAINMRS
It should be noted that the information contained within this report is based solely upon site observations and the
results of laboratory analysis for samples collected by QuES&T. These observations and results are time
dependent,subject to changing site conditions and revisions to Federal,State and Local regulations. QuES&T
warrants that these findings have been promulgated after being prepared in general accordance with generally
accepted practices in the abatement industries.QuES&T also recognizes that inspection laboratory data is not
usually sufficient to make all abatement and management decisions.
Due to the potential for concealed Asbestos-containing Materials(ACM)or other regulated materials,this report
should not be construed to represent all ACM or regulated materials within the site(s). All quantities of ACM or
other regulated materials identified,and all dimensions listed within this report are approximate and should be
verified On-site.
This inspection report is not intended to be used as the sole basis for soliciting pricing for asbestos abatement. An
abatement plan,specification,drawing and/or Variances should be developed to identify scope,timing,phasing and
remediation means&methods for any asbestos project. The Linear and/or Square Footages(LF/SF)listed within
this Report are only approximates. Abatement Contractor(s)are required to visit the building(s)in order to take
actual field measurements within each listed location.
ENVIRONMENTAL CONSULTING& TRAINING
Page 7 of 7
QuES&T
Quality Environmental Solutions&Technologies,Inc.
Appendix Av
ACM LOCATION DRAWINGS & PHOTOS
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Oualityenv.com
53 ASSEMBLY POIfNT ROAD, LAKE GEORGE, NY 12845 - INTERIOR
t ro u,
"t
co 0? N K N
Walk Out Roof Deck o }
m xz 0 0_
to 6 >,ai
m o' a rn
O `o E o
3aU
in L9
Y Q y
J
N"I
Bedroom
CBedroom
S o
o
'^m
N
w'rrn>z e
Closet Closet Closet c 05Lf o i m 0o
NOS
W >U K LL
�p W
�Y io C X
O N
d
I U 3
Bedroom v
� 3A
C m
Bathroom c > a 9
d~ ° z oo a f0
aIn y,in M0. Wn
Closet N N ' N t'i a a
a
ONSecond Floor-ACM Locations ACM LEGEND:(see report for details)
**Drawing Not to Scale** No Asbestos-containing Materials
This Drawing Is not Intended to be used as the sole basis for sollciting pricing for NOTE (ACM)identified upon PLM&QTEMIPLM ASB-01
asbestos abatement. An abatement plan,specification,drawing and/or variances should be developed analysis.
to identify scope,timing,phasing and remediation means&methods for any asbestos project.
1
53 ASSEMBLY POINT ROAD, LAME GEORGE, NY 12845 m INTERIOR
In -o Ln
O W
N
�• ,� 0!N
Enclosed Porch m x z o z
?.
E co ai ai
— rn
2-
a
-a D w
::;..
3
:�•s ,11t dJ
N 1
Q
Y
m m
u1
J
_ �:Livin Ro
•tt•.
. b
�rK chef[=
••T.
u
c
rn
ut�
m
A nw
•ti vi
N
O�
C UI
•i
V)
v—
`SJ
•`J.• ..f�C�„, �•••,h`i` •l/ ,�:J:�7�JC"JWti' '�• � �C 7=N Obi
Closet ``� II Bathroom > M
.vr ,r, .II`.;.,.:'., ✓.. Pantry 'W c v �'^u^,
CY
[ } 0 3
� "l ;' •; :�, ;.s;i:'.}<�:.':':�:ti�i'J': �?aft? v!
6edroofn }'x ` !s`;: :4 Entry;: r,.;:;<`•. %;v:% a• :
C
O O y Q a J
N N W a d C
►, a 5
Enclosed Porch p N Q a`
a, p
® N First Floor-ACM Locations
**Drawled Not to Scale**
ACR1 LEGEND:(see report for details)
A 2
SB-0 This Drawing is not Intended to be used as the sale basis for soliciting
pricing for N. Sheelrock W/ACM Joint Compound Walls&Bathroom
asbestos abatement. An abatement plan,specification,drawing and/or variances should be developed '" Ceiling/Soffit
to Identify scope,timing,phasing and remediation means&methods for any asbestos project.
53 ASSEMBLY POINT ROAD, LAKE GEORGE, NY 12845 - EXTERIOR
in
M�
N W
p y N
Ca
Wall Out Roof Deck 0 az; a z
m a) T rn
C) o To
aU E a
v
Y N
N Y
J Ln J
2nd Floor Roof
T^ C W 2 Qqo aO
vl �" vi NOl
Canopy u z LL in..
Roof wH�`Wa
u cif n C m
Cy� a
m e 'w U
1st Floor Roof � a
�aLL
N 3
>~ a°n zm c c
In m pa Nn
d 2 N d
Enclosed Porch Roof N 0 a '`N a o,
N C
g�, � o
® N Exterior-AGM Locations ACM LEGEND:(see report for details)
**Drawing Not to Scale** No Asbestos-containing Materials
This Drawing is not Intended to be used as the sole basis for soliciting pricing for NOTE (ACM)identified upon PLM&QTEM/PLM ASB-03
asbestos abatement. An abatement plan,specification,drawing and/or variances should be developed analysis.
to identify scope,timing,phasing and remediation means&methods for any asbestos project.
4
QuES&T
Quality Environmental Solutions&Technologies,Inc.
ACM Materials
i
i
z
.Y.
t
Pantry/Closet Sheetrock Walls behind Wood Paneling
t
I
l
Outside Panty/Living Room Sheetrock Walls behind Wood Panels
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert ff 49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualityenv.com
QuES&T
Quality Environmental Solutions&Technologies,Inc.
R �-
:L :.4s` ^ice•,'.
Living Room by Staircase Sheetrock Walls behind Wood Paneling
'_ —_--t-L•}i}lki,— _; f�l xj.t�+�' if lr?� I `��_'. �1....-t( I
k'.
s�
Living Room Sheetrock Walls behind Wood Paneling
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualityenv.com
VuES&T
Quality Environmental Solutions&Technologies,Inc.
i
- i
Living Room Sheetrock Walls behind Wood Paneling
� �.l -.i". - '�'•��is fj �.'°" �' i7.'-'. - _ - ?i
1i .x' -
3
43
}
7Ow
�� a,.``:::j� - - _— .k;" -_ x?` -•s' - tea:-�kc:'==�'
Kitchen Sheetrock Walls behind Paneling
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualityenv.com
QuES&T
Quality Environmental Solutions&Technologies,Inc.
i
ram_
Entry Room Sheetrock Walls behind Wood Paneling
Bathroom Sheetrock Celing/Soffit&Walls behind Paneling
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualityenv.com
uE S&T
Quality Environmental Solutions&Technologies,Inc.
rviri-
Bathroom Sheetrock Celing&Walls behind Paneling
F
7; F E
V.
51`r
Bathroom Sheetrock Walls behind Paneling
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Qualityenv.com
QuES&T
Quality Environmental Solutions&Technologies,Inc.
s h a
q " _ l
`4 7
Ne
q
�M
- - 5
-t
}'3E
�G
y `
i ry`fin
Bedroom Sheetrock Walls behind Paneling
1
St
�i �`- � ?r
i-�
: [
f�
gx
Ilk
Bedroom Sheetrock Walls behind Paneling
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJJCP DBE Certified www.Qualityenv.com
QuES&T
Quality Environmental Solutions&Technologies,Inc.
Appendix B:
SAMPLE LOCATIONS & RESULTS
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.0ua1it3renv.coin
53 ASSEMBLY POINT ROAD, LAKE GEORGE, NY 12845 INTERIOR
Ln"t m N
"t
N 000
Walls Out Roof Deck o >• c}
'a xz 0Z
tp corT z El_oo E
UOJ
�U
Y Q Y
J m J
N
Bedroom
CBedroom
� o
u rym NLn
N 0101} b
Closet Closet Closet cl.d
l I � cw`YNa�n
N C C X
C1� N6LL
1 En 3
Bedroom #lav
Bathroom c > y 9
®atv ;~ I, � z co M
N 'in
N Ln to o. `
Zo
Closet o ° 01 rJ Q a
uo tow 'd d C
N M O a
G N Q a
V
ACM LEGEND:(see report for details)
® � Second Floor-ACM Locations
Positive ACM Sample yy
**Drawing Not to Scale** SL—01
This Drawing is not intended to be used as the sole basis for soliciting pricing for ® Negative ACM Sample
asbestos abatement. An abatement plan,specification,drawing and/or variances should be developed
to identify scope,timing,phasing and remediation means&methods for any asbestos project.
53 ASSEMBLY POINT ROAD, LAKE GEORGE, NY 12845 - INTERIOR
Ln
m't
p 00
N d N
Enclosed Porch o-�>
®#22 E f00 ai a z
rn 3 ai
F-J A 6 01 rn
a E `o
m
�U
Y CU
Y
#9
 � in
Room #16
#15 Kitchen #2
C ® #26
u p
#20 #3 #1 ,�. rn
W•�Ol Y e)
12&014 aL 1.1 Vl C =N N
Closet Bathroom ® r 1 > LL
Pantry Fr'M w m a
024 ® m w V
N C C C X
C IN
#4
Bedroom #6
Entry c T
a
j~ 7 Go
0 611 Eno a e n
r°' do
dJ m N ,N oN U a CD
N ~a a C
Enclosed Porch #® m
ON First Floor-ACM Locations ACM LEGEND:(see report for details)
**Drawing Not to Scale** ® Positive ACM Sample CT —02
This Drawing Is not Intended to be used as the sole basis for soliciting pricing for SL
asbestos abatement. An abatement plan,specification,drawing and/or variances should be developed
to Identify scope,timing,phasing and remediatlon means&methods for any asbestos project. Negative ACM Sample
53 ASSEMBLY POINT ROAD, LAKE GEORGE, NY 12845 - 'EXTERIOR
Ln
W�
co co
#35% 934&936 N N
OIII) Z
r+! F}
Wall Out Roof Deck • 0 a°z
O o`
� L EQ
�W Y y
n J
2nd Floor Roof
4029
� o
uu' C C1 N tip N
al Oi 0\Y {O
C Oy Z01 n]
2
033 .� mc�cdx
a�
1st Floor Roof a.maLL
#30 ,n
#28
# T
CO m
a y 9
LL; Z co .0 G
a.
Enclosed Porch Roof #32 5i 14 e', P a w a 0,3
„N w o a c
a
m in
ON Exterior-ACM Locations ACM LEGEND:(see report for details)
** L
Drawing Not to Scale** Positive ACM Sample �T —O�
This Drawing is not Intended to be used as the sole basis for soliciting pricing for
asbestos abatement. An abatement plan,specification,drawing and/or variances should be developed
to Identify scope,timing,phasing and remediation means&methods for any asbestos protect. ® Negative ACM Sample
w
EMSL Analytical, Inc. EIIHSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
http://www.EMSL.cpm/manhattanlab@emst.com Project ID:
Attention: Quality Environmental Solution&Tech Phone: (845)298-6031
1376 Route 9 Fax: (845)298-6251
Wappingers Falls,NY 12590 Received Date: 09/22/2020 11:48 AM
Analysis Date: 09/26/2020-09/28/2020
Collected Date: 09/18/2020
Project: Q20-3588/WILLIAM BOSY/53 ASSEMBLY PLANT ROAD/LAKE GEORGE,NY 12845 PRE-DEMO ASB
SAMPLING
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 3588-01 Description 1ST FLOOR,LIVING ROOM/KITCHEN,ON SHEETROCK CEILING-TEXTURED CEILING
032017543-0001 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 White 1.90%Fibrous(other) 98.10%Other Inconclusive:None Detected
TEM NYS 198A NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-02 Description 1ST FLOOR,LIVING ROOM,ON SHEETROCK CEILING-TEXTURED CEILING
032017543-0002 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 White 1.70%Fibrous(other) 98.30%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-03 Description 1ST FLOOR,KITCHEN,ON SHEETROCK CEILING-TEXTURED CEILING
032017543-0003 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 White <1.00%Fibrous(other) 100.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-04 Description 1ST FLOOR,ENTRY AREA,ABOVE SPLINED NAILED-ON CEILING TILES-INSULATION
032017543-0004 Homogeneity Homogeneous.
PLM NYS 198.1 Friable 09/26/2020 Brown 25.00%Cellulose 29.00% Non-fibrous(other) None Detected
40.00%Glass
6.00%Hair
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB. Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-05 Description 1ST FLOOR,CLOSET AREA,ABOVE SPLINED NAILED-ON CEILING TILES-INSULATION
032017543-0005 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Brown 20.00%Cellulose 38.00%Non-fibrous(other) None Detected
35.00%Glass
7.00%Hair
PLM"NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
Initial report from:09/28/2020 08:27:35
ASB_193;r_0G0ir_0001 Printed 9/28/2020 12:17:45PM Page 1 of 9
EMSL Analytical, Inc. EMSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
M http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Analyzed Non-Asbestos
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 35B8-06 Description 1ST FLOOR,BEDROOM,ABOVE SPLINED NAILED-ON CEILING TILES-INSULATION
032017543-0006 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Brown 10.00%.Cellulose 15.00% Non-fibrous(other) None Detected
75.00%Glass
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-07 Description 1ST FLOOR,ENTRY AREA,12"x12"NAILED-ON,SPLINE SMOOTH-CEILING TILE
032017543-0007 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Brown/White 1.10%Fibrous(other) 98.90%Other Inconclusive:None Detected
TEM NYS 198A NOB 09/28/2020 Brown/White 100.00%Other None Detected
Sample ID 3588-08 Description 1ST FLOOR,CLOSET AREA,12"X12"NAILED-ON,SPLINE SMOOTH-CEILING TILE
032017543-0008 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Brown/White <1.00%Fibrous(other) 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Brown/White 100.00%Other None Detected
Sample ID 3588-09 Description 1ST FLOOR,KITCHEN,ON SHEETROCK WALL,NAILED-ON SPLASH GUARD-
PANELING
032017543-0009 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Brown 95.00%Cellulose 5.00%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 3588-10 Description 1ST FLOOR,KITCHEN,ON SHEETROCK WALL,NAILED-ON SPLASH GUARD-
PANELING
032017543-0010 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Brown 90.00%Cellulose - 10.00% Non-fibrous(other) None Detected
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
Sample ID 3588-11 Description 1ST FLOOR,LIVING ROOM,CEILING-SHEETROCK
032017543-0011 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Brown/Gray 12.00%Cellulose 30.00%Gypsum None Detected
58.00% 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:09/28/2020 08:27:35
ASB 198,r 0005_0001 Printed 9/28/2020 12:17:45PM Page 2 of 9
EMSL Analytical, Inc. EMSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QU ES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
., http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk'Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 3588-12 Description 1 ST FLOOR,BATHROOM,WALL-SHEETROCK
032017543-0012 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Brown/Gray 10.00%Cellulose 55.00%Gypsum None Detected
35.00%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 3588-13 Description 1ST FLOOR,BATHROOM,ON SHEETROCK CEILING/SOFFIT-JOINT COMPOUND
032017543-0013 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray None 15.00%Ca Carbonate 2.70%Chrysotile
4.00% Mica
78.30% 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 3588-14 Description 1ST FLOOR,BATHROOM,ON SHEETROCK WALL-JOINT COMPOUND
032017543-0014 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray 5.00%Cellulose 15.00% Ca Carbonate 3.80%Chrysotile
76.20%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 3588-15 Description 1ST FLOOR,KITCHEN,ON SHEETROCK WALL-JOINT COMPOUND
032017543-0015 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 White None 97.00%Non-fibrous(other) 3.00%Chrysotile
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-16-Brick Description 1ST FLOOR,LIVING ROOM,FIREPLACE-BRICK&MORTAR
032017543-0016 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Red 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 3588-16-Mortar Description 1ST FLOOR,LIVING ROOM,FIREPLACE-BRICK&MORTAR
032017543-0016A Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Black 20.00%Ca Carbonate None Detected
4.00%Mica
21.00%Non-fibrous(other)
55.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Initial report from:09/28/2020 08:27:35
AS13_198x_0009_0001 Printed 9/281202012:17:45PM Page 3 of 9
EIVISL Analytical, Inc. EMSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
M 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 3588-17-Brick Description 1ST FLOOR,LIVING ROOM,FIREPLACE-BRICK&MORTAR
032 0 1 7543-00 1 7 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Red 80.00%Non-fibrous(other) None Detected
20.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-17-Mortar Description 1ST FLOOR,LIVING ROOM,FIREPLACE-BRICK&MORTAR
032017543-0017A Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray 25.00%Ca Carbonate None Detected
30.00%Non-fibrous(other)
45.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-18-Sheet Flooring Description 2ND FLOOR,BATHROOM,FLOOR,ON WOOD-LINOLEUM SHEET FLOORING,
ADHESIVE&PARTICLE BOARD
032017543-0018 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Beige 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Beige 100.00%Other None Detected
Sample ID 3588-18-Adhesive Description 2ND FLOOR;BATHROOM,FLOOR,ON WOOD-LINOLEUM SHEET FLOORING,
ADHESIVE&PARTICLE BOARD
032017543-0018A Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Yellow 100.00%Other None Detected
Sample ID 3588-19Sheet Flooring Description 2ND FLOOR,BATHROOM,,FLOOR,ON WOOD-LINOLEUM SHEET FLOORING,
ADHESIVE&PARTICLE BOARD
032017543-0019 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Beige 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Beige 100.00%Other None Detected
Sample ID 3588-19-Adhesive Description 2ND FLOOR,BATHROOM,FLOOR,ON WOOD-LINOLEUM SHEET FLOORING,
ADHESIVE&PARTICLE BOARD
032017543-0019A Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Yellow 100.00%Other. None Detected
Initial report from:09/28/2020 08:27:35
AS6_198x 0009_0001 Printed 9/28/2020 12:17:45PM Page 4 of 9
EMSL Analytical, Inc. EMSLOrder: 032017543
307 West 38th Street New York,NY 10018
Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
http://www.EMSL.r-om/manhattaniab@emsl.com Project ID:
'test Report:Asbestos Analysis of Bulk(Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 3588-20-Flooring Description 1ST FLOOR,KITCHEN,FLOOR,ON WOOD-FLOORING&VAPOR BARRIER
032017543-0020 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Gray 100.00%Other Inconclusive:None Detected
Final Residue<1%of original subsample
TEM NYS 198.4 NOB 09/28/2020 Gray 100.00%Other None Detected
Sample ID 3588-20-Vapor Barrier Description 1 ST FLOOR,KITCHEN,FLOOR,ON WOOD-FLOORING&VAPOR BARRIER
032017543-0020A Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Black 100.00%Other None Detected
Sample ID 3588-21-Flooring Description 1ST FLOOR,KITCHEN,FLOOR,ON WOOD-FLOORING&VAPOR BARRIER
032017543-0021 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Gray 100.00%Other Inconclusive:None Detected
Final Residue<1%of original subsample
TEM NYS 198A NOB 09/28/2020 Gray 100.00%Other None Detected
Sample ID 3588-21-Vapor Barrier Description 1ST FLOOR,KITCHEN,FLOOR,ON WOOD-FLOORING&VAPOR BARRIER
032017543-0021A Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 0 9/2 812 0 2 0 Black 100.00%Other None Detected
Sample ID 3588-22 Description 1ST FLOOR,REAR ENCLOSED PORCH,FLOOR,ON WOOD-CARPET MASTIC
032017543-0022 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Yellow 100.00%Other None Detected
Sample ID 3588-23 Description 1ST FLOOR,FRONT ENCLOSED PORCH,FLOOR,ON WOOD-CARPET MASTIC
032017543-0023 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Yellow 100.00%Other None Detected
Initial report from:09/28/2020 08:27:35
AS0_'19Sx_0009_000-1 Printed 9/28/2020 12:17:45PM Page 5 of 9
. EMSL Analytical, Inc. EMSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
M 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 3588-24 Description 1ST FLOOR,BATHROOM,ALONG TUB/SHOWER PERIMETERS-CAULK
032017543-0024 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-25 Description 1ST FLOOR,BATHROOM,ALONG TUB/SHOWER PERIMETERS-CAULK
032017543-0025 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-26 - Description STAIRCASE,ON WOOD STAIRCASE TREADS-RUBBER TREADS
032017543-0026 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
Final Residue<1%of original subsample
TEM NYS 198.4 NOB 09/28/2020 Black 100:00%Other None Detected
Sample ID 3588-27 Description STAIRCASE,ON WOOD STAIRCASE TREADS-RUBBER TREADS
032017543-0027 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
Final Residue<1%of original subsample
TEM NYS 198A NOB 09/28/2020 Black 100.00%Other None Detected
Sample ID 3588-28-Block Description EXTERIOR,CRAWLSPACE FOUNDATION WALL-CEMENTITIOUS BLOCK&MORTAR
032017543-0028 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray 15.00%Ca Carbonate None Detected
3.00% Mica
22.00%Non-fibrous(other)
60.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-28-Mortar Description EXTERIOR,CRAWLSPACE FOUNDATION WALL-CEMENTITIOUS BLOCK&MORTAR
032017543-0028A Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray 20.00%Ca Carbonate None Detected
4.00%Mica
26.00%Non-fibrous(other)
50.00%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:09/28/2020 08:27:35
ASD_998x 0009_0001 Printed 9/28/2020 12:17:45PM Page 6 of 9
EMSL Analytical, Inc. EMSL Order: 032017543 .
307 West 38th Street New York,NY 10018 CUst®rner ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
M 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 3568-29-Block Description EXTERIOR,CRAWLSPACE FOUNDATION WALL-CEMENTITIOUS BLOCK&MORTAR
032017543-0029 Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray 20.00% Ca Carbonate None Detected
35.00% Non-fibrous(other)
45.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
Sample ID 3568-29-Mortar Description EXTERIOR,CRAWLSPACE FOUNDATION WALL-CEMENTITIOUS BLOCK&MORTAR
032017543-0029A Homogeneity Homogeneous
PLM NYS 198.1 Friable 09/26/2020 Gray 25.00%Ca Carbonate None Detected
3.00% Mica
17.00% Non-fibrous(other)
55.00%Quartz
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 3588-30 Description EXTERIOR,OUTSIDE BATHROOM,ALONG WINDOW GLASS PERIMETERS-GLAZING
COMPOUND
032017543-0030 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2026 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-31 Description EXTERIOR,OUTSIDE BEDROOM,ALONG WINDOW GLASS PERIMETERS-GLAZING
COMPOUND
032017543-0031 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 White 100.00%Other None Detected
Sample ID 3588-32 Description EXTERIOR,FLAT PORCH ROOF,FIELD,BOTTOM LAYER,ON WOOD UNDER WOOD&
METAL ROOF DECK-ASPHALT SHINGLE
032017543-0032 Homogeneity Heterogeneous '
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Brown/Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Brown/Black None 100.00%Other <1%Chrysotile
Sample ID 3588-33 Description EXTERIOR,LOWER PITCH ROOF,FIELD,BOTTOM LAYER,ON WOOD UNDER WOOD&
METAL ROOF DECK-ASPHALT SHINGLE
032017543-0033 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Brown/Black 100.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 09/28/2020 Brown/Black None 100.00%Other <1%Chrysotile
Initial report from:09/28/2020 08:27:35
ASD_198:r_0009 0001 Printed 9/281202012:17:45PM Page 7 of 9
EIVISL Analytical, Inc. EMSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
M http://www.EMSL.com!manhattaniab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 3588-34 Description EXTERIOR,2ND FLOOR,PORCH DECK ROOF,FIELD BOTTOM LAYER,ON WOOD-TAR
PAPER VAPOR BARRIER
032017543-0034 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Black 100.00%Other None Detected
Sample ID 3588-35 Description EXTERIOR,2ND FLOOR,PORCH DECK ROOF,FIELD BOTTOM LAYER,ON WOOD-TAR
PAPER VAPOR BARRIER
032017543-0035 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 09/28/2020 Black 100.00%Other None Detected
Sample ID 3588-36 Description EXTERIOR,2ND FLOOR,PORCH DECK ROOF,FIELD TOP LAYER-ROLLED ROOFING
032017543-0036 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Black 100.00%Other None Detected
Sample ID 3588-37 Description EXTERIOR,2ND FLOOR,PORCH DECK ROOF,FIELD TOP LAYER-ROLLED ROOFING
032017543-0037 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 09/28/2020 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 09/28/2020 Black 100.00%Other None Detected
Initial report from:09/28/2020 08:27:35
ASD_198x_0009_0001 Printed 9/28/2020 12:17:45PM Page 8 of 9
EMSL Analytical, Inc. EMSL Order: 032017543
307 West 38th Street New York,NY 10018 Customer ID: QUES51
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
M http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above. Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 9/22/2020 Sample Receipt Time: 11:48 AM
Analysis Completed Date: 9/28/2020 Analysis Completed Time: 9:05 AM
Analvst(s):
Christopher Cernansky PLM NYS 198.1 Friable(10) Migena Shehu PLM NYS 198.1 Friable(8)
Maye Yassin PLM NYS 198.6 NOB(27) Hongyan Ran TEM NYS 198.4 NOB(27)
Samples reviewed and approved by:
James Hall,Laboratory Manager
or Other Approved Signatory
NOB=Non Friable Organically Bound WA=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 Vermiculite containing samples are available at http://www.wadsworth.org/labcertlelapcerttforms/VermiculiteintedmGuidance_Rev070913.pdf EMSL
maintains 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 bears 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 EMSL Analytical,Inc.New York,NY NYS ELAP 11506
Initial report from:09/28/2020 08:27:35
ASS_198x_0009_0001 Printed 9/28/2020 12:17:45PM Page 9 of 9
Order•ID: 032017543
QUALITY ENVIRONMENTAL SOLUTIO 1S&TECHNOLOGIES INC.
BULK SAMPLE FORM
CLIENT:WILLIAM ROSY SAMPLED BY.LOUIS N.JOHNSON ill
ADDRESS:PO BOX 1 DATE SAMPLED: 18-Sep-20
LAKE GEORGE,NY 12845
CONTACT:WILLIAM ROSY ANALYSIS METHOD.PLMINOBIOTEM as Required
PROJECT ID: 53 ASSEMBLY PLANT ROAD,LAKE GEORGE. TURN-AROUND nME: HOURS
NY,12845 PRE-DEMO ASS SAMPLING 5 DAYS
PROJECT#:020-3588 OTHER
SAMPLE# LOCATION SAMPLEDESCRIP77ON COMMENTS
LAB#
3588-01 1st Floor,Living Room/Kitchen..on Textured Coating
Sheetrock Ceiling
STOP
3588.02 1st Floor,Living Room,on Sheetrock Textured Coating AT
Ceiling FIRST
POSITIVE
3588-03 " 1st Floor,Kitchen,on Sheetrock Ceiling Textured Coating
3588-04 1st Floor.Entry Area,Above Splined Nailed- Insulation
on Ceiling Tiles
— _STOP
3588-05 list Floor.Closet Area,Above Splined Insulation AT
Nailed-on Ceiling Tiles FIRST
POSITIVE
3588.06 1st Floor,Bedroom,Above Splined Nailed- Insulation
on Ceiling Tiles
3588.07 1st Floor,Entry Area;12"x 12"Nailed-on, Ceiling Tile
Spline Smooth STOP r ;
AT
r?IRST
3588-08 1st Floor,Closet Area,12"x 12"Nailed-on, Ceiling Tile PPS rrk
Spline Smooth .
358"9 1st Floor,Kitchen,on Sheetrock Wall, PanelingI`—
Nailed-on'Splash Guard grop 3
AT -
FIRST -
3586-10 1st Floor.Kitchen,on Sheetrock Wall, Paneling POSILNE
Nailed-on Splash Guard
CHAIN OF CUSTODY(SEE LAST E)
� �
SUBMITTED BY: DATE: 2- 2d
RECEIVED BY. DATE:
PAGE 1 OF 4
Page 1 Of 4
OrdePID: 03-2017543
QUALITY ENVIRONMENTAL.SOLUTIONS&TECHNOLOGIES,INC.
BULK SAMPLE FORM
CLIENT:WILLIAM BOSY SAMPLED ay..LOUIS N.JOHNSON tit
ADDRESS: PO BOX 1 DATE SAMPLED: 18-Sep-20
LAKE GEORGE,NY 12845
CONTACT:WILLIAM ROSY ANALYSIS METHOD:PLMINOBIQTFM as Required
PROJECT ID:53 ASSEMBLY PLANT ROAD,LAKE GEORGE. TURN-AROUND TIME: HOURS
NY,12845 PRE-DEMO ASB SAMPLING 5 DAYS
PROJECT#:020-3588 OTHER
SAMPLE# LOCA77ON SAMPLEDESCRIP770N COMMENTS
Lab#
3588.11 1st Floor,Living Room,Ceiling Sheetrock
358842 1st Floor,Bathroom,Wall Sheetrock
3588.13 1st Floor,Bathroom,on Sheetrock Joint Compound
Ceiling/Soffit
3588-14 1st Floor,Bathroom,on Sheetrock Wall Joint Compound
3588-15 1st Floor,Kitchen,on Sheetrock Wall Joint Compound
STOP
3588-16 1st Floor,Living Room, Fireplace Brick&Mortar AT
(Separate by Layers) FIRST
r POSITIVE
? c9Y
i 3588.17 1st Floor,Living Room,Fireplace Brick&Mortar !
I t�A�CH
(Separate by Layers) LAYE�t -
t -) r7STOP
3588.18 2nd Floor,Bathroom,Floor,on Wood Linoleum Sheet Flooring,Adhesive& �, SAT
Particle Board rjRST
(Separate by Layers P051TiVE
BY"
3588-19 2nd Floor,Bathroom,Floor,on Wood Linoleum Sheet Flooring,Adhesive& Co EAC-H
Particle Board LAYER
(Separate by Layers)
STOP
3588-20 1st Floor,Kitchen,Floor,on Wood Flooring&Vapor Barrier AT
(Separate by Layers) FIRST
CHAIN OF CUSTODY(SEE LAST PAGE)
SUBMITTED BY' DATE:
r
r
RECEIVED BY: DATE:
PAGE 2 OF 4_
Paae 2 Of 4
Order2D: 03-2017543
QUALITY ENVIRONMENTAL SOLUTIONS&TECHNOLOGIES,INC.
BULK SAMPLE FORM
CLIENT:WILLIAM BOSY SAMPLED BY:LOUIS N.JOHNSON III
ADDRESS:PO BOX 1 DATE SAMPLED: 18-Sep-20
LAKE GEORGE,NY 12845
CONTACT:WILLIAM BOSY ANALYSIS METHOD: PLMINOBIQTEM as Required
PROJECT ID: 53 ASSEMBLY PLANT ROAD,LAKE GEORGE. TURN AROUND TIME: HOURS
NY,12845 PRE-DEMO ASS SAMPLING 5 DAYS
j PROJECT#: Q20-3588 OTHER
SAMPLE# LOCA77ON SAMPLEDESCRIP77ON COMMENTS
LAB#
POSITIVE
3588-21- 1st Floor,Kitchen,Floor,on Wood Flooring&Vapor Barrier BY
(Separate by Layers) EACH
LAYER,
3588-22 1st Floor,Rear Enclosed Porch,Floor,on Carpet Mastic
Wood STOP
AT
FIRST
3588-23 1st Floor,Front Enclosed Porch,Floor,on Carpet Mastic POSITIVE
Wood
3588-24 1st Floor,Bathroom;Along Tub/Shower Caulk
Perimeters STOP
AT
FIRST
3588-25 1st Floor,Bathroom,Along Tub/Shower Caulk POSITIVE
Perimeters
3588.26 Staircase,on Wood Staircase Treads Rubber Treads
STOP
AT
FIRST
3588-27 Staircase,on Wood Staircase Treads Rubber Treads POSInvi
r✓ STOP
3588-28 Exterior,CrawNpace Foundation Wall _ Cementitious Block&Mortaq --T AT
(Separate by Layers) N �, FIRST
ry •-, POSRIVE,
<y_ BY
3588-29 Exterior,Crawispace.Foundation Wall Cementitious Block&Mortal r i �i EACH
(Separate by Layers) LAYER
co
r -
3588-30 Exterior,Outside Bedroom,Along Window Glazing Compound. �' STOP
Glass Perimeters AT
CHAIN OF CUSTODY(SEE LAST PAGE)
SUBMITTED BY: DATE:
RECEIVED BY: 114A DATE
PAGE 3 OF 4
Page 3 Of 4
OrderTD: 032017'543
QUALITY ENVIRONMENTAL SOLUTIONS&TECHNOLOGIES,INC.
BULK.SAMPLE FORM
CLIENT:WILLIAM ROSY SAMPLED BY: LOUIS N.JOHNSON 111
ADDRESS:PO BOX 1 DATE SAMPLED: 18-Sep-20
LAKE GEORGE,NY 12845
CONTACT:WILLIAM ROSY ANALYSIS METHOD.PLMINOBIQTEM as Required
PROJECT ID:53 ASSEMBLY PLANT ROAD,LAKE GEORGE, TURN-AROUND TIME: HOURS
NY,12845 PRE-DEMO ASB SAMPLING 5 DAYS
PROJECT#:020-3588 OTHER
SAMPLE# LOCATION SAMPLE DESCRIPTION COMMENTS
LAB#
3588-31 Exterior,Outside Bedroom,Along Window Glazing Compound FIRST
Glass Perimeters POSITIVE
i
3588-32 Exterior,Flat Porch Roof,Field,Bottom Asphalt Shingle
Layer,on Wood Under Wood&Metal Roof STOP
Deck AT
FIRST
3588-33 Exterior,Lower Pitch Roof,Field,Bottom Asphalt Shingle POSITIVE
Layer,on Wood Under Wood&Metal Roof
Deck
3588-34 Exterior,2nd Floor,Porch Deck Roof,Field Tar Paper Vapor Barrier
Bottom Layer,on Wood STOP
AT
FIRST
3588.35 Exterior,2nd Floor,Porch Deck Roof,Field Tar Paper Vapor Barrier POSITIVE
Bottom Layer,on Wood
3588.36 Exterior,2nd Floor,Porch Deck Roof,Field Rolled Roofing
Top Layer STOP
AT
FIRST
3588.37 Exterior,2nd Floor,Porch Deck Roof,Field Rolled Roofing POSITIVE
Top Layer
cm
�1-' •N
cru r—
CHAIN OF CUSTODY(SEE LAST PAGE) 1
SUBMITTED BY:
RECEIVED BY; Af A DATE
PAGE 4 OF 4
Paqe 4 Of 4
QuES&T
Quality Environmental Solutions&Technologies,Inc.
Appendix C:
PERSONNEL LICENSES & CERTIFICATIONS
1376 Route 9,Wappingers Falls,NY 12590 Phone(845)298-6031 Fax(845)298-6251
NYS MWBD MBE Cert#49952-2006 NYSUCP DBE Certified NJUCP DBE Certified www.Oualiiyenv.com
IIlEW YORK STATE DEPARTMENT OF HEALTH
WADSWORTH CENTER
Expires 12:01 AM-April 01,_2021
Issued April 01,2020-
�f
�±21,r}Fo�}•
CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued in accordance with and pumitant to section 502 Public Health Law of New York-State
MR. JAMES HALL NY Lab Id No: 11506
EMSL ANALYTICAL, INC =
307.WEST 38TH STREET
NEW YORK, NY 10018
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 600111M4I821020
Asbestos in Non-Friabla Material-PLM Item 198.6 of-Manual(NOB by PLM)
Asbestos in lion-Fdabta Material-TEM Item 198.4 of Manual
Asbestos-Vermiculite-Containing Material Item 198.8 of Manual
Serial NO,: 61413
Proporty-of the New York State Department of(iimith, Certrftcates are valid only at the address
shown,must be corsp(ruously posted,and are printed on secure paper.•Continued accreditation depends
on successful ongoing participation in the Program. Consumers are urged to call(518)405-5570'to '
verify the-laborato ys accreditation status.
Page 11 of 1
9/22/2020• - Temporary Rules for Licensing&Certification-New York State Department of Labor
September 22, 2020 111:10 am
lnformaation on Novel C®roMvirr S
Coronavirus is still active in New York.We have to be smart. Wear a mask and maintain 6 feet
distance in public.
GET THE FACTS >
(h ttps://coronavirus.health.ny.gov/home)
e Home(http://www.labor.nygov)
Safety and Health workerprotection/safe health/DOSH MDEX.shtm)
Temporary Rules for Licensing &Certification
Temporary Rules for Licensing&Certification
This page lists temporary rules for license and certification renewals and exam postponements. (All dates
ate Subject to Changes due to ongoing COVID-19 response.)
Note: Initial written exams for Crane, Operator,Blaster, or Pyrotecb.nician have been temporarily suspended. We
anticipate resuming exams September 1,2020. You will receive an admission notice about 3 weeks prior to the
test. Check back here in case of further schedule changes.
Applications to Renew Your Crane Operator Certificate of Competence
At this time,written tests conducted by the Department of Labor to renew your Crane Operator Certificate of
Competence are postponed. If you have a Crane Operator Certificate of Competence,your Certificate is
extended by 60 days.You will receive a letter confirm-ing this extension. If you have submitted your application
and fee but do not receive an extension letter,please contact the License& Certificate Unit at(518)457-2735 or
by email at License&certificate@labor.ny_.gov(mailto:License&certificate@labor.ny_.gov_
Applications to Obtain a New Crane Operator Certificate of Competence
Practical exams necessary to obtain a new Crane Operator Certificate of Competence are currently being
scheduled regionally. You will receive an admission notice about 3 weeks prior to the exam. These exams are
not postponed at this time. Check periodically for updated exam information including possible postponements.
Exams are currently scheduled in the Utica area in August and Buffalo,NY in September.
Applications to Renew Your Blaster Certificate of Competence
In the event that the training required to renew your Blaster License is unavailable, your License is extended by
60 days provided you have submitted your application and fee. You will receive a letter confrnning this
extension. If you have submitted your application and fee but do not receive an extension letter,please contact
the License & Certificate Unit at(518)457-2735 or by email at License&certificate@labor.ny gov
(rnailto:License&certificate@labor.ny.gov)-.
Applications to Renew Your Mold Assessor or Mold Contractor License
Mold Refresher Courses are available at this time. Information on approved training providers is available at
littps://Iabor.ny.gov/workeLprotection/safe health/mo1d/a -roved-mold-training- -roviders.shtm
(llttps://labor.nygnv/workeiprotection/safetyhealth/mold/approved-mold-training-providers.shtm)_
Applications to Renew Your Asbestos Handling Certificate
https://,ANwi.labor.ny.govlworkerprotection/safetyhealth/temporary-rules-licenses-certifications-exanis.shtm. 1/2
9/22/26,! Temporary Rules for Licensing&Certification-New York State Department of Labor
Any person who has an Asbestos Handling Certificate (ill any category) whose certificate(hard card) expired
December 31, 2019 or later may continue to work using their existing cards until November 30, 2020. Check
this notice periodically for updated information about your Certificate's validity.
Any questions not answered on this page will be answered by staff at the]License&. Certificate Unit. Call
(518)457-2735 or email lLicense&certificate a laborj y gov(mailto:License&certificateClabonny
https://wvm.labor.ny.gov/workerprotecfion/safetyhealth/temporary-rules-licenses-certifications-exams.shtm 2/2
3/2812019 t32Gnow
jj
NEW YORK STATE
CERTIFICATION
Empire State Development's Division of Minority and Women's Business
Development grants a
Women Business Enterprise (WBE)
pursuant to New York State Executive Law, Article 15-A to:
Quality Environmental Solutions & Technologies Inc.
Certification Awarded on: March 28, 2019
Expiration Date: March 28. 2022
File ID#:WBE-49952
t4jiJl7L'�....
https://ny.newnycontracts.com/FrontPage/DiversityMain.asp?XID=6724 111
3/28/2019 62Gnow
New York State Department of Economic Development
11Ci 633 Third Avenue New York New York 10017 Tel 212 803 2414
i Us 1.1Lss fir_ 'a (i 1)'7k?,?it Web Site:www.esd.ny.gov/MWBE/html
March 28, 2019
File ID:49952
Quality Environmental Solutions&Technologies Inc.will be listed in New York State's Directory of Certified Businesses with
the following list of codes for products and services:
NAICS 541620: ENVIRONMENTAL CONSULTING SERVICES
NIGP 91843: ENVIRONMENTAL CONSULTING
https://ny.newnycontracts.com/FrontPage/DiversityMain.asp?XID=6724 2/2
a
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.
Quality Environmental"Solutions&Techno_logies, Inc; :::-FILE NUMBER: 99-0018
LICENSE NUMBER: 29085
1376 Route 9 ; LICENSE CLASS: RESTRICTED "
DATE OF ISSUE: 01/17/2020
Wappinger Falls, NY "12590 EXPIRATION DATE: 01/31/2021
Duly Authorized Representative-Lawrence J Holzapfel:= .
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 NYCRk"Part-56). -it is;"subject to suspension or revocation for a(1)
serious violation of state,federal or.local laws with regard•to the conducfof ari: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.nained:above and this license or`a'photocopy must_be'prominently displayed at the
asbestos project worksite. This license verifies that all persons.employed liy 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(8112) For the Commissioner of Labor
'(, Tl-E r!f iV Y0.RK-'LEi?i,KT :(_;f QV
-
_�i5[3E5TOS.CFRTI�ILr';IE.-: �t<Y.S i' '.
LOU S N JOHNSON Ill.
CLASS(EXPIECES).
`C ATEC(06,"M Q NSP(C16j%C)
E MQPl4661 20) H RA (, �J20) .
19G
h1UST:BE C. RR{ED`UI!`, SBCST:�S.PROJECiS- "
H81f 1111]111 W110011111 I19
IF FOUND RETURN TO:
EYES 13LU NYSDOL - L&C UNIT
�m
= HAIR BLN ROOM 161A BUILDING 12
o BGT 5' 10" STATE OFFICE CAMPUS
o
ALBANY NY 12240
CI
a
OSHA 11-602012360
w� iwAd la t '
tt+.ttd RZu.vouaa ,
This card acknowledges that the recipient has soccMUly completed:
This card issued to:
Louis Johnson III
Paul Rodriguez 9/2812 0 1 8
Trainer Name Date of Issue
Trainingln5tilutc 800-44M742
JA J C9 GduwGonCenters outreach.keeneosha.corn
OSHA recommends Outreach Training Courses as an orientation to occupational safety
and health for workers.Participation is voluntary.Workers must receive additional training
an specific havards ofdteir job.This course completion.card does not expire.
Use or distribution of this card for fraudulent purposes,including tt�
False claims o['having received Gaining,may result in prosecution a
URI
under 18 U.S.C. 1001. Potential penalties include substantial •r
criminal fines,imprisonment up to 5 years,or both. a-
To veriry this training,scan the QR code with your mobile device. V-Vtr
Rev.112016
OSHA 'J
Loul5 Johnson III
Tra r nc C:;,;,,—,
-0 6 I-LELO-a
hill\ ..........al,
and health ril 7-irkrt,Participation it olDlItAr.y.%%orl,rri mutt recei%e additional
traininr.c) lw(if'r 1,.,a r its ur it,tor j.h.This ot—mo pl,flaj r.,,j dart not c.pi—
Im.set u.tr—1.sit,m
WASTE MANIFEST
...........................................................................t......f., •..,....: - -................ ....i..................................................................... ...:�...�..�.�......
Manifest No.
- a
o
I IS I' 1111 '11111iilll
Generator Name_.a<itL►141,0*_606 ._._ __ -___ __._.____ Phone
Mailing Address � I,
Waste Generation Site Address_ 55ih_✓�y !•_.i? j_..-`_ �--__�- ��j =�.._IVY, 1Zf�`ZS
...........................................................................;...................................................................................-...............................-.................................................................................
//11.."
Transporter Name.G—fA_S�IL._!4 _-lam(-1�s� _^_.-_.____._-____.__ PhonelS_._ �' 0
Transporter Address _/�9___ ?!____�—
.....................................................................................................................................................................................................................................,.....-._..........................
.....
Disposal Site Name _�� � ! �__��� .._____.___
� /�'/ _ __ Phone
Disposal Site Address Z `f`�__ �5 _/? Cs`xIN 51/a rT �y /4f_-
APPROVAL NUMBEfi f DESCRIPTION OF WASTE CITY. � UMITS I CONTAINER49 '
' i / !
-----------
i
! 1
i
i
i
Comments/Handling Instructions
I hereby certify that I am authorized to sign on behalf of the Generator.I certify that the above named material(s)are not considered azardous and do not contain free liquids as defined
by CFR Part 261 and Part 260.The material has been properly described,classified,packaged and grope dition for transpWinacrdance with applicable laws and regulations.
arne(pr(nted).._ _ _1���_____—. Signature_. _.��C�rr� _�1_ Date
IN I
I hereby certify that the material described abb e was pick p o the 9.to and at tI cation listed above.The material was transported without incident directly from the generator
to the disposal facility named abov r too the et of wl d �f�t %,s[ described above is contained in this load.
Driver Name J- f _ _/r •r /% _ ,f�� __�__ _..__._ License Plate No,/State
Driver Signature-,. —� �✓ . cam_ __— Date
Discrepancy-- -- ----- — -- --------- ------ --- ----- - -_ .. __ _ — _ _ _- --__--
I hereby certify that the waste material indicated above has been accepted for disposal and to the best of my knowledge,the foregoing information is true and accurate.
Authorized Agent _ _ , _ _y\_ __ Signature -----C .__ U �� _.___ -__-._ Date_A_ �_� D
.................................................................................... ................................................................. ..`.................. ....................................................,....I.........................
ten.u...i�..,t�ai r....., v..r�,.,.,.r........,......r,,.... _ n:..i•.n._.....i__r•_..... r..ia.r-._,.....�,_-�•_....