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DEMO-0140-2021 Office Use Only DEMOLITION APPLICATION Permit#:� Permit Fee:$ Itob Town of(Zueensbury Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.clueensbury.net Flood Zone? Y N Reviewed By: i Tx. G:vtms�LXN , ivy( Demolition Location: Tax Map ID#: �3� . �a — a .' ��• **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** DEMOLITION INFORMATION: 1. Where will demolition material be disposed? Tile4 An ilani42 ` 2. Type of.structure to be demolished: a. Residence d.Storage Building❑ b. Garage❑ e.Other: CiP c. Business❑ y S i1z, ~ 3. What type of utilities are connected to the structure: ��sQR z 3 2� � 1 a. Gas❑ f.Well-Water Pump❑ b. Fuel Oil❑ g. Public Sewer❑ . TOWN OF QUEE�SB C. Propane ❑ h. Other BUILDING& CODESRY d. Electric❑ I. None e. Public Water❑ 4. Have ALL utilities(water,electric,etc.) been disconnected? Yes�( No❑ ADDITIONAL INFORMATION: 1. Two inspections may be required: an inspection to determine that utilities are disconnected, if necessary, and a final inspection, after the structure is removed and the site is cleaned up and graded. 2. Twenty-four(24) hour notification is required for Inspections. 3. Workers' Comp insurance information is required to,be submitted with this application. Declaration:I acknowledge that no structure(s)will be removed from the parcel until the demolition application has been reviewed and approved by the Town of Queensbury Building&Code.Enforcement and Zoning Departments and a permit has been issued. I have read and agree to the above: PRINT NAME: SIGNATURE: DATE: Demolition Application Revised December 2020 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: } Name(s): -%O�t<� � i Mailing Address, C/S/Z: � k ry-6-4wp CiQxA Cell Phone: Land Line: 5(�• 3US- `(��q Email: - r_ 11 1 '(_Ol.�j (-@ q,��f. L6W I&A-J. �OY� f Mof. ( '0,6bLt,.I ('i�-FS• co 04 v Primary Owner(s): Name(s): Q_DCV- tt.I'1 , LLC, l 0 ka iS AtatJe- Mailing Address; C/S/Z: L .t eQ0312 4 'O i2 cic- medI :C,v1 11e- i NL( ( -I l L t Cell Phone: Land Line: Email:. C0.S, QA A.� -� I.�.C',2J• C on'. ❑Check if all work will be performed by property owner only • Contractor: (List all additional contractors:on the back of this form) Contact Name(s): C Randal l �XCG� u&-�'o ji Contractor Trade: . f)(C&jA.�k a L I.S )'.t CA b -1< Mailing Address,C/S/Z: (q3 (A.)0get k�cAe k.(l to-&- �-•�e , .0(26 AJ l� Cell Phone: Land Line: 5-1g� 9 _ Y �a la 'fS Email: **Workers' Comp documentation must be submitted with this application** QW&,4s4(A-4ey Contact Person for any questions regarding this project: Cell Phone: Land Line: _ DD �(P-:5-- 9'CC�q L:L, Email: cow, Demolition Application Revised December 2020 Experience is the solution 314 North Pearl Street♦Albany,New York 12207♦ (513)434-4546♦ Pas:(513)434-0591 EMarch 30, 2021 Mr. Chris Abele MAR 3 � Abele Builders 2 � 14 Corporate Drive TOWN OF Clifton Park,New York 12065 BUILDING&BCODESRY Phone: (518) 365-4989 tE-m0 - 0 KO -M?—( VIA E-MAIL: Chris@abelebuilders.com RE: Visual Inspections—7 Polk Road, Queensbury,NY Adirondack Project No.: IH-21-357 Dear Mr. Abele: Adirondack Environmental Services, Inc. (Adirondack)was pleased to provide a Visual . Inspection for the abatement of asbestos containing material on the roof of#7 Polk Road in Queensbury,NY. A survey conducted by Adirondack in November, 2020 indicated the roofing tar paper had asbestos containing material(ACM). Martin Environmental of Schenectady,NY,the abatement contractor, was contracted to abate the material. The abatement work was completed March 26,2021. By prior agreement Adirondack mobilized to the site on the afternoon of March 26 to conduct a visual inspection of the abatement process. The inspection was considered satisfactory and the inspector signed the abatement supervisor's log book to that effect. The inspection was performed by George Bailey of Adirondack,NY State DOL Certification #06-09450. Due to delays by the DOL certification renewal has been completed and will be effective through October,2021,but identification"hard cards"have not been issued. The current certification—"half sheet" is included in the attachments. Additionally,Adirondack completed a Certificate of Asbestos Visual Inspection. Copies of those certificates are attached to this report. 0 Attachment A includes the Certificate of Asbestos Visual Inspection. Attachment B includes personal certifications, includi he current"half sheet". TOWN OF QU Y BUILDING & ® T. Reviewed By FILE COPY Date: Visual Inspection—7 Polk Road Adirondack Project No.IH-21-357 11 P a -e . . 11 Experience is the solution 314 North Pearl Street e Albany,New York 12207♦ (51 S)434-4546♦Fax:(513)434-0391 Thank you for selecting Adirondack Environmental Services, Inc. for your asbestos management needs. If you have any questions or require further information,please feel free to contact me at (518)434-4546. Very truly yours, ADIRONDACK ENVIRONMENTAL SERVICES,INC. Digitally signed by: George Bailey Date: 2021 .03.30 12:34:23 -04'00' George Bailey Asbestos Project Manager—Industrial Hygiene and Safety Services Attachments Visual Inspection—7 Polk Road Adirondack Project No.IH-21-357 2 P a a e 0 Experience is the solution 314 North Pearl Street♦ Albany, New York 12207♦ (518)434-4546s Fax:(518)434-0891 Attachment A VISUAL INSPECTION CERTIFICATE t ( ` c, Erperience is the solution ff 314 North Pearl Street0 Albany,New York 12207w (518)434-4546E Fax:(518)434-0891 fit cERTIncATr OF ASBESTOS VISUAL IIqsPEcTYo-N :•;��. f Building/Address E e.S i J e n C e— 7 �m(k RJ. do e-er s(n ur'y AV f; ff, i�..f _ flr Pf Specific Work Area f� Abatement Company Markn &U i ro,1)vn e-4,LQ Sen c.es r: The asbestos work area,defined above,has been inspected by the NYS Certified Project Monitor for completeness in accordance with the requirements of Industrial Code 56.This i= r inspection.has been performed in general accordance with ASTM E1368.The Project f Monitor's visual inspection was for visible visible asbestos-containing materials,dust and �r>t debris. fir_ By(Print Name) 6e-de2l er P_)nL f:U Date Z LP By(Signature) z &1 t . :�. 1 Asbestos Certification O 94go Exp 16�Z-6 2 / t I Company Name Q i'ro pJizc/` rjG I � I � Il I 0 Experience is the solution 314 North Pearl Street♦ Albany, New York 122076 (518)434-4546® Fax:(518)434-0891 Attachment B PERSONNEL AND COMPANY CERTIFICATIONS A !I I STATE OF NEW YORK-DEPARTMENT OF LABOR r 7 A58ESTOS CERTIFICATE Li " GEORGE H BAILEY ` CLASS(EXPIRES) f t C ATEC(10/20) D INSP(10/20) H PM (10/20) I' MUST BE CARRIED ON ASBESTOS PROJECTS unumimeumixn® f Y Illlllllfllllflllllllld Illli IF FOUND RETURN TO: m EYES BRO NYSDOL - L&C UNIT RerR BRO ROOM 161A BUILDING 12 h HGT 51 091, STATE O o FFICE CAMPUS —o ''_240 =N , �o i. G l I l �i F liog, • ;r New York State Department of Health Certificate of Asbestos Safety Training fr This form is the official record of successful completion of a New York State accredited asbestos safety training-course, f Certificate No. / ' Yi Icr co_ ...L�.- �.r-..^,.!,±'F„n_hi�``:;13C,y:G n'T'.`l.}'=�'.� •.t,;✓ ;`;>i �.)��i. Name of Trainee(print)-. NYS Depart.of Motor Vehicles IDI(DIvfV ID) =l Signature of Trainee Telephone Number- Date of Birth' Address r3 � I U�_� i•�i'���'�.,',�� '�yti l_,);.•i••t,.•� J•_�i. _. { ��� �-•�i~j 1•--fi..l` .�� 7� `Y r i �', rv.-" Street or PO Box (City) II=To.be:con Ieted b ;'1Eraigin. S.. ousor:`:' ::.::;;::;:; ::;:;`::;::'::_ :. .•: . rr... Provider's Name Telephone Number ATC 21�•. 3.8280 `= Address - Course 104 EAST 25TH STREET,8TH F "=3 NEW YORK,NY 10010 Location: (�,1 �. � + C) f Zip Code _ NYS DOH use on(y f' Course Title: �{ j}-�(.;' "�i` ❑ Initial Refresher ❑DOH Equivalency z Training Language:XEnglish❑Other: Exam Grade/Date: Dates of Trainin From J 'g:' .�/• / To: !L / / —0 Expires: I c that the asbestos safe trainin course F:x certify ty g given on the above date complied with both 101vYCRR Part 73 and •TSCA Title H, was consistent with'the curriculum aiid-instructors approved by the-3dey York State Department of Health,and the trainee receiving this certificate completed.tlie:training course aria suc y p'sed the examination. r TrainingDirecforZ' (Print) • ., ._ .. . idnature) STUDENT I DOH-2832(10/03) 'Optional Information z DOH Equivalency signed by NYS DOH representative only rll r. N l�� f <.f New York State Department of Health Certificate of Asbestos Safety Training 6 r This form is the official record of successful completion of a New York State accredited asbestos safety training course. • Certificate No87219 f --f b: .:com leted<ii: a >}',. ��.::_,:�::'_::;::>�c': �::�,•' e:::?;•::�i: ''' �: ;.;:..1•. is N e of Trainee rint), NYS Depart.of Motor Vehicles ID(DMV ID) ' s ��.. fit"( .� � �.�• ._.. ::��::�-� •S" , ._. I�>=� Signature Trainee Telephone Number Date of Birth' � ..� Street or PO Box) . Ci (State) C/de) Sta •Zi . �'onso~. _ 1T=To-be,C.om leted�;b` �.T:,tau► =.`S`: E •=' i Provider's Tele hone Number =� Provider's Name p ATC.,. 2;12-.3 3-8280 — f- Address Course 104 EAST 25TH STREET,8TH FL F; NEW YORK,NY 10010 Location: ' `� 0•AL Zip Code NYS DOH useonly ='+ Course Title: Initial' -Refresher DOH Equivalency Z =" Training Language:]English Other:;y p Exam Grade/Date: j'0 j V ho 1 - Expires: 1 /17- /2 1 Dates of Training:from: r 1. l� l To: 1 / I certify that the asbestos safety training course given•on the above date complied with both 10 NYCRR Part 73 and i TSCA Title U, was consistent with the curriculum and instructors approved by the New York State'Department of Health,and the trainee receiving this certificate completed the training course an,td�?suc ss y passed the examination. Training Director : ;��'ta,� �.� t 1�l t1(>�a;;,� •- (Print) (Signature) STUDENT i DOH-2832(10/03) Optional Information ?-DOH Equivalency signed by NYS DOH representative only r' • �1 F J V. ^ M. ` C �p� New York State.—Department of.Labo� - ? Division of Safety and Health, License and Certificate,Unit' ` State Campus,,Building 12t _Albany,NY_122.4.0 - ASBESTOS HANDLING LICENSE.- Adirondack Environmental Services, NUMBER: 99-0417 LICENSE NUMBER: 29646 314 North Pearl Street ca.,<;:;\z r j LICENSE CLASS: RESTRICTED- = DATE OF ISSUE: 09/21/2020 Albany, NY 12207 EXPIRATION DATE: 09/30/2021 I l'Ll Duly Authorized Representative,,--",Tara Daniels:,"=---- 1 �I ' ''j' I� .'', ` 6'i�`n.,.'•i'=-is:�;,;:-:�j�fj'�i;'1{d}:`t\it�i:I-, „ ., t _ - - This license has been issued in accordance!with applicable pro"visioris,of.'Art_icl'e':30-of the Labor Law of New York State and of the New York-State,Codes,Rules'and Regulation§''(12;NYCRR Part`56)` I[isasiiliject to suspension or revocation'for a(1) serious violation of`state,federal or local laws with,iegard•to'.the conduct''of an.astiestos project,or(2)demonstrated lack of responsibility in the,conduct of any job'involving aslestos`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'b the licensee on an asbestos.project in New York State have been issued an Asbestos Certificate;-appr_opriate for_the type of work they perforrn,by the New York State' Department of Labor. . J -- - -Eileen M.Franko, Director SH 432(8/12) -' For the Commissioner of Labor United States Department of Commerce National Institute of Standards and Technology Certificate of Accreditation to ISO/IEC 17025:2017 NVLAP LAB CODE: 200552-0 Adirondack Environmental Services Inc. Albany, NY is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for., Asbestos Fiber Analysis This laboratory is accredited in accordance with the recognized International Standard ISO/IEC 17025.2017. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint ISO-ILAC=IAF Communique dated January 2009). ow OF COM r 0 2021-01-01 through 2021-12-31 * ii Effective Dates s �� For the National Volunt�ry Lhborat�r rXAccn:ditation Program � z SATES OF? `J OT OF co% � ® National Voluntary Laboratory Accreditation Program �s �Q �srares SCOPE OF ACCREDITATION TO ISOJEC 17025:2017 Adirondack Environmental Services Inc. 314 North Pearl Street Albany,NY 12207-1322 Christopher Hess Phone: 518-434-4546 Email: cmhess@adkenv.com http://www.adirondackenviromnental.com ASBESTOS FIBER ANALYSIS NVLAP LAB CODE 200552-0 Bulk Asbestos Analysis Code Description 18/A01 EPA--40 CFR Appendix E to Subpart.E of Part 763,Interim Method of the Determination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600/R 93/116:Method for the Determination of Asbestos in Bulk Building Materials Airborne Asbestos Analysis _Code Description 18/A02 U.S.EPA's"Interim Transmission Electron Microscopy Analytical Methods-Mandatory and Nonmandatory-and Mandatory Section to Determine Completion of Response Actions"as found in 4C CFR,Part 763,,Subpart E,Appendix A. For the Nadpna,'1 voluntdy L boratb%Accreditation Program Effective 2021-01-01 through2021-12-31 Page 1 of 1 j I i i nationalgrid 300 Erie Boulevard West Syracuse,New York 13202 October 22,2020, RE: Service Removal for Building Demolition. I l This letter is to confirm that,per your request,National Grid has confirmed electrical service and meters have been removed from glk Mr nsb . The work was NO �Y 1processed on work request#30177269. If you have any questions or need further i assistance,please feel free to contact us at 800-260-0054. i i Sincerely, Customer Connections nationalgrid DECL' BV MAR 2 3 2021 TO WI OF QUEF_h BURY SUILDIMG&COrJES e Asbestos Survey and Bulk Sampling Pre-demolition #7 POLK ROAD QUEENSBURY, New York Inspection Date November 4, 2020 ; Prepared for: f Abele Builders 14 Corporate Drive _ Clifton Park,New York 12065 O c z Prepared by: v O George Bailey 2-n I Project Manager—Asbestos Services 90 rn nz51 OCo :i ZJMRMM ©03 i . (nC l 10 � ! o 314 North Pearl St Albany,NY 12207 Phone: (518)434-4546 Fax: (518)434-0891 Adirondack Project No.: IH-20-333 239.12-2-35 DEMO-0140-2021 Rockhurst LLC 7 Polk Dr Demolition of camp Experience is the solution 314 North Pearl Street♦ Albany, New York 12207♦ (518)434-4546♦ Fax: (518)434-0891 November 17,2020 Mr. Chris Abele Phone 518-365-4989 Abele Homes 14 Corporate Drive Clifton Park,New York 12065 chris@abelebuildets.com RE: Pre-demolition Asbestos Survey and Bulk Sampling #7 Polk Road,Queensbury,New York Adirondack Project No. IH-20-333 Me.Abele: Adirondack Environmental Services, Inc.(Adirondack)was pleased to provide an asbestos survey and bulk sampling with,analysis,of suspect asbestos containing materials(ACM) in the residential_carh�p ate _ Pot oadA;in Queensbury,NY. Attached is a summary report of the survey findings. Thank you for selecting Adirondack Environmental Services,Inc. for your asbestos management needs. If you have any questions or require further information,please feel free to contact me at (518)4344546. Very truly yours, - ADIRONDACK ENVIRONMENTAL SERVICES,INC. Digitally signed by: George Bailey Date: 2020.11.17 09:34:06-04'00' GEORGE BAILEY Project Manager Enclosure i 0 Experience is the solution 314 North Pearl Street♦ Albany, New York 12207♦ (518)434-4546♦ Fax:(518)434-0891 first positive analysis protocol was followed for each homogeneous set. Samples were submitted to Adirondack for standard turnaround. See Attachments for laboratory, company and personnel certifications. Adirondack is fully accredited for bulk sample analysis under the Environmental Laboratory Approval Program (FLAP)administered by NVLAP No.200552-0 and the New York State Department of Health,ELAP No.10709. RESULT SUMMARY Materials must contain more than 1%asbestos to be considered asbestos containing material. One material,tar paper, contained greater than l%and was therefore classified as asbestos containing material (ACM). Note:The primary sample numbers represent a continuation of the sequence used while surveying#3 Polk Road,which was done just prior to the survey for#7 Polk Road. ACM Sample %Asbestos Field Estimate Potential for Sample Condition Location ,N Total Disturbance 09-17, 18: Main roof and 1.9% Some Contact:high Tar Paper porch roof Chrysotile, 900 SF damage Vibration:high North side NF weathered I Air Current:high F—Friable,NF—Non-friable Materials sampled that contained less then< 1%asbestos are classified as non-asbestos containing(NAC)and included the following: Sample No.and Description ACM Sample Location 08-15, 16-Asphalt Shingles Main Roof,main_porch roof,north side 10-11, 12- Brick Mortar Chimney 11-13, 14—Linoleum flooring Bathroom 12-12,16—Ceiling Board Throughout most rooms 13-17, 18,—Linoleum flooring, Kitchen 14-19,20—Refractory brick Fire lace hearth OBSERVATIONS • The camp is in older, somewhat weathered condition but is in reasonably good condition. • The roof is in fair condition with much of it covered in moss and lichen growth. No pipes or related insulation were observed. • Unlike#3 Polk Road,there was no caulking around the chimney.The chimney was surrounded from where it meets the house by wood trim. Asbestos Bulk Sampling—#7 Polk Road Adirondack Project No.IH-20-333 2 1 1' a g c 0 Experience is the solution 314 North Pearl Street• Albany,New York 12207♦ (518)434-4546♦ Fax: (518)434-0891 EXECUTIVE SUMMARY Mr.Chris Abele,on behalf of Abele Builders,asked Adirondack Environmental Services Inc., (Adirondack)to perform an asbestos survey with related bulk sampling and analysis of the residential camp at#7 Polk Road in Queensbury,NY. The camp is slated for demolition. The purpose of the sampling was to determine if the materials in the structure were asbestos containing material(ACM)which will be disturbed during the demolition.This survey is required in order to obtain a demolition permit from the Town of Queensbury. George Bailey conducted this inspection and collected samples on November 4,2020. Samples were collected as follows: Fourteen(14)samples representing seven (7)homogeneous materials were collected at #3 Polk Road. The materials consisted of typical building materials including roofing materials, mortars, grouting and flooring materials. By definition and law a material must contain more than 1%asbestos to be classified as ACM. One(1)of the materials sampled contained greater than (>) 1%asbestos and was therefore classified as asbestos containing material (ACM).The material was the tar paper under the asphalt shingle which did not contain asbestos. The remaining materials sampled and analyzed all contained less than(<) 1%asbestos and are therefore classified as non-asbestos containing(NAC)materials. BULK SAMPLE COLLECTION The survey included all observed suspect materials in each of the camp. The inspector,George Bailey, is a NYS certified asbestos inspector. Samples were collected in compliance with NYS ICR56 and EPA's Asbestos Hazard Emergency Response Act(AHERA). A unique sample identification number was given to each homogeneous building material after samples were collected. Bulk sample locations from homogeneous sample areas were selected at random. The number of samples collected for each suspect material was based on the presumed ACM (PACM)type and quantity as required. Samples were placed into sampling containers and submitted to Adirondack's lab under chain of custody documentation. METHODOLOGY Samples were either analyzed by NYS ELAP methodology via PLM (Polarized Light Microscopy), PLM/NOB(Polarized Light Microscopy/Non-Friable Organically Bound),or TEM (Trans Electron Microscopy)based on material type as dictated by state regulations. A stop at Asbestos Bulk Sampling—#7 Polk Road Adirondack Project No.111-20-333 11 P a g c �^ - o Experience is the solution 314 North Pearl Streets Albany,New York 12207♦ (518)434-4546♦ Fax:(518)434-0891 RECOMMENDATIONS • All ACM must be removed by a licensed asbestos abatement contractor prior to any activity which would disturb the material. i, Although.the shingles tested as NAC they will have to be.removed in order to abate the underlying tar paper. 4 The tar paper may be considered exterior;non=friable material and can be removed without air testing.Only a visual inspection is required. • Maintain a copy of this report on-site during any asbestos abatement or demolition. project as per NYS ICR56-5(g)(3). • Additional bulk samples may be needed for suspect materials that were not evaluated during this inspection due to inaccessibility. This would include any windows which, though assumed to be homogeneous,may be questioned for any reason. Feel free to contact Adirondack if you require further asbestos management services. Attachment A contains the laboratory results with chain of custody documentation. Attachment B contains company and personal certifications. This included the current"half- sheet"certification for George Bailey's Inspector Certificate,pending arrival of the actual"hard- ! card" certificate. 4 1 Asbestos Bulk Sampling—#7 Polk Road Adirondack Project No.1H-20-333 3!P a g e Experience is the solution 314 North Pearl Street♦ Albany,New York 12207♦ (518)434-4546♦ Fax:(518)434-0891 Attachment A LABORATORY RESULTS AND CHAIN OF CUSTODY i I i j i -�0I. 10Li logl 314 North Pearl Street BULK SAMPLE DATA AND �R Albany, New York 12207 ' a ' ' 518-434-4546/434-0891 FAX CHAIN OF CUSTODY RECORD EXPERIENCE IS THE SOLUTION A full service analytical research laboratory offering solutions to environmental concerns !`:F Client Name: Address* cf Data: Send Report To: Project Name(Location): Project Manager: "�? 0) Client Phone NO: Project Number: Inspector: Client Fax No: BULK SAMPLE INFORMATION SUR f :: Lab Sample Homogenous TSI Material Analysis la No. Area No. Bulk Sample ID No./Material MIS Sample Location QIv,(LF,SF) Requested c �i rr r . :r �' ✓�l'\ 1�(.)�r f�:%:'f Ft Ore lft ��[:�"��yr�t•' Lcr -C,(? A 6U �c,CP oil C;4�. �•�� (�' r �, 1, ) !L` Turnaround Time Request: Special Instructions/Remarks 1 7 , •� ,,,y�sLY' - ❑ 1Day ❑ 3Day NormalZ�IT. 1•.(. f�;l `'j0 1 'I i� s,; ;• l��L� ❑ 2 Day ❑ 5 Day ❑ Other CC Report To: Relln ed by:(Sig aj re) Received by:(Signature) Dale/time �( �r zu&tzo R Iinquish by:(Signature) Received for aboratary b : t rDale/Time If-- 1, WHITE-lab Copy YELLOW-Sampler Copy if-Hill 201104105 `'� rj ReportDate:11/10/2020 Workorder: 201104105 L a Non-asbestos PLM TEM Result Lab y Sample Identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type) PLM Result ELAP-198.4 Status r 010 A 12-1 Homogeneous, Floor Tile ° ______ Tan,Non-Friable <�% Material NAC MAC 0 Wt%Remaining PLMMethod: ELAP 198.6 011 A 13-17 Homogeneous, Floor Tile ° Tan,Non-Friable <1% Material MAC MAC 0 Wt%Remaining PLMMethod: ELAP 198.6 012 A 13-18 Homogeneous, Floor Tile Tan,Non-Friable c1% _____ <1 Material MAC MAC 0 Wt%Remaining PLMMethod:• ELAP 198.6 013 A 14-1 Homogeneous, Friable Material No asbestos detected M_ Gray,Friable Material MAC MAC PLMMethod: ELAP 198.1 014 A 14-20 Homogeneous, Friable Material No asbestos detected Gray,Friable Material MAC MAC PLMMethod: ELAP 198.1 ACM:Asbestos Containing Material �� � NAC:Non-Asbestos Containing Material Approved by: **A negative result fur an NOB sample is considered Inconclusive.The following NYS ELAP Tara Daniels disclaimer applies:"PLM Is not consistently reliable In detecting asbestos in floor coverings and similar Laboratory Director NOB materials. Before this material can be considered or treated as non-asbestos containing, confirmation must be made using transmission electron microscopy(TEM)". Page 3 of 3 AIHA-LAP,LLCAccredited#100307 Experience is the solution NYSDOH#10709 314 North Pearl Street♦Albany,New York 12207 Bulk Asbestos Report (000)848-4983♦ (518)434-4546♦ Fax(518)434-0891 Project: Asb Services Abele Homes Date Sampled: l 1/04/2020 ProjLocation: #7 Polk Rd 14 Corporate Drive Date Received: 11/04/2020 Clifton Park, NY 12065 PLM Analyzed: 11/05/2020 by KAH Attn: ***AES IH Dept*** T TEM Analyzed: 11/9/2020 by ktt Method References: AYSDOH ELAP 198.1/198.4/198.6 ReportDate:11/10/2020 Workorder: 201104105 L a Non-asbestos PLM TEM Result Lab y Sample identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type) r PLM Result ELAP-198.4 Status 001 A OS-15 Homogeneous, Tar/Roofing No asbestos detected Black,Non-Friable <1% No Asbestos Detected <7 Material Inconclusive" NAC 72.8 Wt%lteinaining PLMMethod: ELAP 198.E 002 A 08-16 - Homogeneous, Tar/Roofing No asbestos detected Black,Non-Friable <11% No Asbestos Detected <1% Material Inconclusive" NAC 69.1 Wt%Remaining PLMMethod: ELAP 198.6 003 A 09-17 Homogeneous, Tar/Roofing 28.6%Chrysotile �,9% — 1.9% Black,Non-Friable Material ACM ACM 6.5 Wt%Remaining PLMMethod: ELAP 198.6 Page 1 of 3 ReportDate:11/10/2020 Workorder: 201104105 L a Non-asbestos PLM TEM Result Lab y Sample Identification Materials Fibers Asbestos of Residue Final ID a and Description Type (Percent and Type) (Percent and Type)r PLM Result ELAP-198.4 Status 004 A 09-18 Homogeneous, Tar/Rooting Black,Non-Friable Not Not Material Analyzed Analyzed 7.1 Wt%Remaining PLMMethod: ELAP 198.6 005 A 1 -11 Homogeneous, Friable Material No asbestos detected Gray,Friable Material NAC NAC PLMMethod: ELAP 198.1 006 A 10-12 Homogeneous, Friable Material No asbestos detected Gray,Friable Material <1% c1% NAC NAC PLMMethod: ELAP 198.1 007 A 11-13 Homogeneous, Other No asbestos detected Tan,Non-Friable <1% No Asbestos Detected <1% Material Inconclusive" NAC 24 Wt%Remaining PLMMethod: ELAP 198.6 008 A 11-14 Homogeneous, Other No asbestos detected <1% No Asbestos Detected e1 Tan,Non-Friable Material Inconclusive' NAC 22.9 Wt%Remaining PLMMethod: ELAP 198.6 009 A 12-15 Homogeneous, Floor Tile Tan,Non-Friable Material NAC NAC 0 Wt%Remaining PLMMethod: ELAP 198.6 Page 2 of 3 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 Adirondack Environmental Services, Inc. FILE NUMBER: 99;0417 LICENSE NUMBER: 29646 314 North Pearl Street LICENSE CLASS: RESTRICTED DATE OF ISSUE: 09/21/2020 Albany, NY 12207 EXPIRATION DATE: 09/30/2021 Duly Authorized.Representative—Tara Daniels: 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 Regulsitions(12 NYC RR 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 works ite. 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 peribrm,by the New York State: Department of Labor. Eileen iv1.Franko, Director SH 432(8112) For the Commissioner of Labor arl I:•i New York State Department of Health Certificate of Asbestos Safety Training This form is the official record of successful completion of a New York State accredited asbestos safety training course. Certificate NoS 7 2 1 2 9 I—To be completed by Trainee Napuc of Trainee(print). NYS Depart.of Motor Vehicles ID(DMV ID)' Signature., f Trainee / Telephone Number Date of Birth' 71 6,Ts� j 5(r.._ �i L�:? r• L�r•i- :�.• ' •i1_f .1'.1 `> ;l.1 J -''(,I ••I i:.. ! l � •.i f ;'. Street or PO Box) (City) (State) Zi Code) .II—To be completed-b.•Training-S onsor'.. Provider's Name Telephone Number Am.. .2,12-3 3-8280 ' Address Course 104 EAST 25TH STREET,STH FL NEW YORK,NY 10010 Location: Zip Code X. 'L-�• rl ;. , / AW DOH Ilse oely i Course Title: ! ) f 7��;` :'.'i't .i �r z ❑ Initial Refresher ❑DOH Bgaivalency I Training Language:lT English❑Other: Exam Grade/Date: :;: Dates of Training:From: t�� / 0 To: IV 'Expires: j Li /I_, /Q I I certify that the asbestos safety training course given on the above date complied with both 10 NYCRR Part 73 and TSCA Title Il, was consistent with the curriculum and instructors approved by the New York State Department of I Health,and the trainee receiving this certificate completed the training course and,su(Assfully pa ssed the examination. Training Director : ` :;'�; ' i i•I A 1. (Print) (Signature) aTUfJENT DOH-2832(10/03) I Optional Information r DOH Equivalency signed by NYS DOH representative only ' 6 -.i .1 : .i 1:; United States Department of Commerce National Institute of Standards and Technology Certificate of Accreditat%on to 1S011EC 17025:2:005 NVLAP LAB CODE: 200552-0 Adirondack Environmental Services Inc. Albany, NY is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for. Asbestos Fiber Analysis This laboratory is accredited in accordance with the recognized Intemational Standard ISOAEC 17025:2005. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory qualify management system (refer to joint ISO-ILAC-IAF.Communique dated January 2009). 2020-01-01 through 2020-12 33 1 Effective Dates For the National Voluntary!Laborator.,�Acccedrtation.Program ���N7 OF,O04 ? m National Voluntary o� Laboratory Accreditation Program ems { &447ES of P SCOPE OF ACCREDITATION TO ISO/IEC 17025:2005 Adirondack Environmental Services Inc. 314 North Pearl Street Albany,NY 12207-1322 Mr. Sean Wells Phone: 518-434-4546 Fax: 518-434-0891 Email: swells@adirondackenvironmental.com- http://www.adirondackenvironmental.com ASBESTOS FIBER ANALYSIS NVLAP LAB CODE 200552-0 Bulk Asbestos Analysis Code Descl-iptial 18/A0I EPA--40 CFR Appendix E to Subpart E of Pail 763,Interim Method of the Determination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600/R-93/116:Method for the Determination of Asbestos in Bulk Building Materials Airborne Asbestos Analysis Code DeserUVion 18/A02 U.S.EPA's"Interim Transmission Electron Microscopy Analytical Methods-Mandatory and Nonmandatory-and Mandatory Section to Determine Completion of Response Actions"as found in 40 CFR,Part 763,Subpart E,Appendix A. For the National Volunfa L borat Accreditation Program Effecfiue 2020-01-01 through2020-12-31 Page 1 of I