DEMO-0677-2022 r
Office Use Only
DEMOLITION APPLICATION Permit#:
Permit Fee: $
Toivn of Queensbury
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensburV.net Flood Zone? Y Reviewed Bv. __Q
Demolition Location: 42 Old Assembly Pt. Rd, Lake George NY Tax Map ID #: 239.12-2-11
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? A c:= C1- ,,yo 2i 4,vv �f�•�-^� �
2. Type of structure a demolished: S4.�tTro�
a. Residen ✓ d. Storage Building n®
b. Garage e. Other: f(. E
c. Business iL�
C EL
3. What type Q ilities are connected to the structure: �I NOV 0 7 2022
a. Gas L_1 f. Well-Water P ✓a
TOWN OF OUEE NSBURY
b. Fuel Oil g. Public Sewer BUILDING& CODES
c. Propan ✓ h. Othe
d. Electric ✓ i. None
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes F�T No F
ADDITIONAL INFORMATION:
1. Two inspections are required: an inspection to determine that utilities are
disconnected, and a final inspection after the structure is removed and the site is
cleaned up and graded.
2. Twenty-four (24) hour notification is required for inspections.
3. Workers' Comp insurance information is required to be submitted with this application.
Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application has
been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a
permit has been issued.
I have read and agree to the above:
PRINT NAME: f-[,wD
SIGNATURE: Lyz 4&�� DATE: /f 1A6-1
—
Demolition Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: Cl�n1 Ntcu� o�h GP
Name(s): ('GM Qvi x-6-x4
Mailing Address, C/S/Z: 9rvok&,voJk RA , &19,4er-�rd , A1y
Cell Phone: (57 0) 3"�-6 '�-6 �'2 Land Line: C P e,) 223 V— o 3�
Email: @
• Primary Owner(s):
Name(s): Jeffrey and Nancy Randles
Mailing Address, C/S/Z: 82 E. Claremont Drive,Voorheesville, NY 12186
Cell Phone: 518 894-1821 Land Line: N/A
Email: jeffrey.randles@ymail.com
❑ 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): ca1,�
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
"Workers' Comp documentation must be submitted with this application"
Contact Person for any questions regarding this project: cxn.r /'✓lam- �(
Cell Phone: Land Line:
Email:
Demolition Application Revised June 2022
Y'
P.0.Sox 1024
SPECTRV,q Menedody.NV 12301
(518)346-6374(Phone)
Environmental flssociates, Inc. (518)346-4062(Pax)
EXCEEDING OUR CLIENTS EXPECTRTIONS OF EXCELLENCE' www.4spedmm"m
ASBESTOS PRE-DEMOLITION
SURVEY/INSPECTION
:(-,'U8E:
�
FOR NOV 2022
TOWN O� ENSSURYBUfLDfCODES
BUILDING
42 OLD ASSEMBLY RD.
LAKE GEORGE, NY 12845
SPECTRUM PROJECT NO.: 22-470
SEPTEMBER 21, 2022
PREPARED FOR:
JEFF RANDLES
42 OLD ASSEMBLY RD.
LAKE GEORGE, NY 12845
Environmental Consulting&Management Services-Health&Safety Training-Laboratory Services
TABLE OF CONTENTS
SECTION I - INTRODUCTION
SECTION II -LIMITATIONS
SECTION III -ASBESTOS SAMPLING SUMMARY
ATTACHMENTS - TABLE 1-ASBESTOS SAMPLING RESULTS
- TABLE 2-ASBESTOS FINDINGS
-LOCATION MAPS
-LABORATORY REPORTS
-LICENSING AND CERTIFICATION
SECTION -INTRODUCTION
On September 14,2022, Spectrum Environmental Associates,Inc. (Spectrum) conducted a survey
for the presence of asbestos containing materials at the building located at 42 Old Assembly Rd in
Lake George, NY. Mr. Jason Teagle (Asbestos Inspector #00-07983) conducted this inspection
following procedures and guidelines commonly used and accepted by federal and state regulations.
The objective of the survey was to identify the presence and approximate locations and quantities
of suspect and/or confirmed asbestos containing materials.
An initial walkthrough of the designated areas was conducted by an experienced asbestos inspector
to observe and record materials used in the construction of the building. The inspector proceeded
by assessing floors, walls, ceilings, surfacing materials, thermal systems insulation, roofing
materials and other miscellaneous materials with the potential to contain asbestos. From
observations, the inspector prepared a listing of building materials that are suspected to contain
asbestos. The inspector selected these materials for inclusion in the inspection through
professional experience and an understanding of the historical uses of asbestos. Generally
speaking,if a building material within a structure could contain asbestos,the material was included
in the inspection.
Materials included in the survey were identified and recorded with respect to grouped
homogeneous sampling areas. Representative bulk material samples were collected from locations
within each homogeneous sampling area. Sampling information was recorded on chain of custody
forms for documentation. Samples were individually preserved within a container and transported
to an independent laboratory for asbestos analysis.
Laboratory analysis of asbestos samples via polarized light microscopy(PLM)and/or transmission
electron microscopy(TEM)was conducted by AmeriSci of New York,New York(ELAP# 11480,
NVLAP#200546-0). Sample analysis was conducted as follows:
• "Friable"Asbestos Samples—PLM
• "Non-Friable" Organically Bound (NOB)Asbestos Samples—PLM and, if negative, TEM
for confirmation as required under NYSDOH-ELAP regulations.
SECTION II-LIMITATIONS
The information provided in this report was compiled from field and laboratory data obtained
during the site visit. Observations noted and recorded are intended to represent the conditions that
existed at the subject site at the time and date that the observations were made.
Spectrum has not conducted its own analytical,but has utilized an independent NYS-DOH ELAP
approved laboratory to provide the analytical results contained in this report. All discussions,
findings, and conclusions are based on information that Spectrum received and understood to be
factual.
Determinations of suspect asbestos containing materials within the building were subject to the
accessibility of individual areas or spaces. Spectrum accepts no responsibility for the content of
the building materials within areas or spaces that were unknown to us or not reasonably accessible.
Spectrum assumes no liability for any buildings that were not identified by the client that may fall
under state or federal regulations.
All quantities of ACM provided in this report are provided as required by law and are believed to
be accurate. If this report is to be used for bidding purposes, field verification of quantities is
recommended by the abatement contractor prior to bidding.
Conclusions and recommendations provided in this report are based on the assumption that
materials identified are homogeneous throughout their application.
This report has been compiled for the exclusive use of Jeff Randles,his successors and/or
assigns. This report and its contents represent confidential information and should not be
duplicated without the expressed permission of Jeff Randles,his successors and/or assigns. This
report should only be reproduced in its entirety to ensure all the appropriate information is
provided.
The building owner is Jeff Randles and may be reached at 42 Old Assembly Rd in Lake George,
NY.
SECTION III—ASBESTOS SAMPLING SUMMARY
The results of the sampling are provided in Table 1 (Asbestos Sampling Results) and the asbestos
findings are provided in Table 2 (Asbestos Findings) of the Attachments. The laboratory results
and sample location map(s) are also provided in the Attachments.
ATTACHMENTS
TABLE I-ASBESTOS SAMPLING RESULTS
TABLE 2-ASBESTOS FINDINGS
. LOCATIONMAPS
LABORATORYREPORTS
LICENSING AND CERTIFICATION
TABLE 1 - ASBESTOS SAMPLING RESULTS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Sample# Description Location/Area PLM Results TEM Results
%Type) %Type)
O1 Sheetrock Rm 106 Closet NAD NA
02 Sheetrock Rm 003 South Wall NAD NA
03 Joint Compound Rm 106 Closet NAD NA
04 Joint Compound Rm 003 South Wall NAD NA
05 2x2 Ceiling Tile Rm 005 Stored Goods NAD NAD
06 2x2 Ceiling Tile Rm 101 South End(Above Ceiling) NAD NAD
07 Ceramic Tile Grout Rm 108 NE Corner NAD NA
08 Ceramic Tile Grout Rm 108 NE Corner NAD NA
09 Fiber Board Exterior NE Fagade NAD NA
10 Fiber Board Exterior NE Fagade NAD NA
11 Door/Window Caulk North Facade Anthophyllite<0.25% Anthophyllite 1.9%
12 Door/Window Caulk South Fagade Anthophyllite<0.25% NAPS
13 Cobblestone Pattern Sheeting Rm 006 Stairs NAD NAD
14 Cobblestone Pattern Sheeting Rm 006 Stairs NAD NAD
15L1 White Floor Tile Rm 101 Under Wood Plank Floor Chrysotile 3.1% NA
15L2 Mastic Rm 101 Under Wood Plank Floor NAD Chrysotile Trace
Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos.
NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet
TABLE 1 - ASBESTOS SAMPLING RESULTS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Sample# Description Location/Area PLoM Results TEM Results/o Type) /o Type)
16 White Floor Tile w/Mastic Rm 101 Under Wood Plank Floor NAPS—Floor Tile NAZ-Mastic
17 Ceramic Tile Adhesive Rm 108 NAD NA
18 Ceramic Tile Adhesive Rm 108 NAD NA
19 12x12 Self Adhesive Floor Tile Rm 005 NAD NAD
20 12xl2 Self Adhesive Floor Tile Rm 005 NAD NAD
21 Sink Basin—White Rm 107 Anthophyllite<0.25%. Anthophyllite 4.2%
22 Sink Basin—White Rm 107 Anthophyllite<0.25% NAPS
23 Foundation Tar North Facade NAD NAD
24 Foundation Tar South Facade NAD NAD
25 Penetration Sealant Rm 106.Closet NAD NAD
26 Penetration Sealant Exterior South Facade NAD NAD
27 Old Shingles Roof—Near Peak NAD NAD
28 Old Shingles Roof—Near Peak NAD NAD
29 Felt Paper Roof—Near Peak NAD NAD
30 Felt Paper Roof—Near Peak NAD NAD
31 New Shingles Roof -East End NAD NAD
Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos.
NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet
TABLE I - ASBESTOS SAMPLING RESULTS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Sample# Description Location/Area PLM Results TEM Results
%Type) %T e
32 New Shingles Roof—East End NAD NAD
33 Laminate Flooring Rm 005 NAD NAD
34 Laminate Flooring Rm 005 NAD NAD
Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos.
NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet
TABLE 2 - ASBESTOS FINDINGS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Limitations:
The following limitation/conditions were noted as part of the survey:
• OSHA requires that an employer not expose its workers above the PEL and therefore specific
training, work practices and/or respiratory protection may need to be a consideration when
handling materials that are less than one percent.
• The inspection was performed in accordance with New York State Industrial Code Rule 56
Section 5.1. A copy of 56-5.1 is available upon request. It is the responsibility of the owner
or its agent to forward a copy of this report to the local government entity charged with issuing
a permit for such demolition, renovation,remodeling or repair work under applicable State or
local laws as well as to the NYS Department of Labor Asbestos Control Bureau. Spectrum
will not send this report to the NYSDOL without written permission from its client due to the
sensitive nature of the information present in this report.
• This report reflects the conditions found at the date and time of the inspection(s). Conditions
of the area and.materials may change due to external events, forces or influences. Re-
inspection of the area may be required prior to the start of any work if an extended period of
time has passed or if disturbances have occurred.
• If materials not sampled in the survey are uncovered during renovation/demolition,per
ICR56 work should stop and those materials should be assessed before work continues. Also
per ICR 56, a copy of the survey report should be submitted to the local agency issuing the
demolition permit and a copy should be kept on site during the demolition phase of the
project.
• This survey is for the future demolition of the structure. Per NYSDOL, if the project does
not proceed within approximately 6 months, the structure should be visually re-inspected to
confirm that no addition materials have been added and that the existing conditions of the
identified ACM is still the same.
• Spectrum did not inspect any exterior area below grade. Foundation sealers,buried piping and
other items may exist below grade which may contain asbestos.
SF—square feet,LF—linear feet,ea—each
TABLE 2 - ASBESTOS FINDINGS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Material Sample Location/Area Estimated Quantity* Condition/Damaged
Door/Window Caulk North Fagade —3801f Good
White Floor Tile Under Wood Plank Floor —1,800 sf Good
Sink Basin—White Rut 107 —4 sf Good
*Quantities of identified ACM are estimates only and should be field verified prior to bid by the contractor or confirmed as part of an RFP or
design specification.
Please see the limitation listed above.
Asbestos%by PLM*-please refer to the PLM Bulk Asbestos Report for the method used.
All asbestos locations on drawings are approximate. All quantities are estimated and must be field verified prior to use as part of a
bidding document. Materials may extend or be hidden behind or within other materials or structural members. Any contractor or
other user of this report is required to physically confii-in the quantities and verify measurements of materials to be removed, to be bid
for removal, or for any other purpose. Contractors are responsible to physically visit the site and confirm all quantities for bidding
purposes.
Definitions:
NAD—No Asbestos Detected
NA—Not Analyzed
NA'— SOF- and SM- must be analyzed by ELAP 198.8 orequivalent effective 5/6/16
NAZ —Insufficient Material for Preparation
N/A—Not Applicable(quantities are not provided for negative materials
TBD—To Be Determined(quantification was not possible as the scope of work was notprovided)
NAPS—Not Analyzed/Positive Stop
SF—square feet,LF—linear feet,ea—each
22-470(9-14-22)
Roof&Basement-42 Old Assembly Rd.
Pre Demolition Bulk Sample Locations-NTS
4-1
TE11L
22-470(9-14-22)
1st floor-42 Old Assembly Rd.
Pre Demolltion'Bulk Sample Locations-NTS
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AmeriSci New York
AMERI SCI NEW 117 EAST ST.
YORK, NYY 10 10016
TEL:(212) 679-8600 • FAX:(212)679-3114
PLM Bulk Asbestos Report
Spectrum Environmental Associates, Inc. Date Received 09/15/22 AmeriSci Job # 222092243
Attn: Bill Massman Date Examined 09/19/22 P.O. #
P.O.Box 1024 ELAP # 11480 Page 1 of 7
RE: 22-470; 42 Old Assembly Rd., Entire Structure
Schenectady, NY 12301
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
1 222092243-01 No NAD
1 Location:Rm. 106 Closet-Sheetrock (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown/White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20%, Non-fibrous 80%
2 222092243-02 No NAD
1 Location: Rm. 003 South Wall-Sheetrock (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20%, Non-fibrous 80%
3 222092243-03 No NAD
1 Location:Rm. 106 Closet-Joint Compound (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
4 222092243-04 No NAD
1 Location: Rm. 003 South Wall-Joint Compound (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
5 222092243-05 No NAD
2 Location: Rm.005 Stored Goods-2 x 2 Ceiling Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Gray, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 45.1%
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 2 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total %Asbestos
6 222092243-06 No NAD
2 Location: Rm. 101 South End(Above Ceiling)-2 x 2 Ceiling Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Gray, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 53.2%
7 222092243-07 No NAD
3 Location:Rm. 108 NE Corner-Ceramic Tile Grout (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
8 222092243-08 No NAD
3 Location:Rm. 108 NE Corner-Ceramic Tile Grout (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
9 222092243-09 No NAD
4 Location: Exterior NE Facade-Fiber Board (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 90%, Non-fibrous 10%
10 222092243-10 No NAD
4 Location: Exterior NE Facade-Fiber Board (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 90%, Non-fibrous 10%
11 222092243-11 Yes Trace (<0.25 % pc)1
5 Location: North Facade-Door/Window Caulk (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Gray/White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25%pc
Other Material: Non-fibrous 12.6%
See Reporting notes on last page
'AmeriSci Job#: 222092243 Page 3 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total %Asbestos
12 222092243-12 Yes Trace (<0.25 % pc)
5 Location:South Facade-Door/Window Caulk (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Gray/White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25%pc
Other Material: Non-fibrous 13.2%
13 222092243-13 No NAD
6 Location:Rm.006 Stairs-Cobblestone Pattern Sheeting (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 5.1%
14 222092243-14 No NAD
6 Location:Rm.006 Stairs-Cobblestone Pattern Sheeting (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 3.1%
15 222092243-151_1 Yes 3.1%
7T Location:Rm. 101 Under Wood Plank Floor -White Floor Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Chrysotile 3.1 %
Other Material: Non-fibrous 10.7%
15 222092243-151_2 No NAD
7 Location: Rm. 101 Under Wood Plank Floor -Mastic (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.8%
16 222092243-16 NA/PS
7T Location: Rm. 101 Under Wood Plank Floor -White Floor Tile W/Mastic"Insufficient
Mastic For Preparation"
Analyst Description:Bulk Material
Asbestos Types:
Other Material:
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 4 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total %Asbestos
17 222092243-17 No NAD
8 Location:Rm. 108-Ceramic Tile Adhesive (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
18 222092243-18 No NAD
8 Location: Rm. 108-Ceramic Tile Adhesive (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
19 222092243-19 No NAD
9 Location: Rm.005- 12'x 12'Self Adhesive Floor Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Dark Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.9%
20 222092243-20 No NAD
9 Location:Rm. 005-12'x 12'Self Adhesive Floor Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Dark Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 2.2%
21 222092243-21 Yes Trace (<0.25 % pc)
10 Location: Rm. 107-Sink Basin-White (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Beige, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25%pc
Other Material: Non-fibrous 59.5%
22 222092243-22 Yes Trace (<0.25 % pc)
10 Location: Rm. 107-Sink Basin-White (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Beige, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25%pc
Other Material: Non-fibrous 46.4%
See Reporting notes on last page
r
'AmeriSci Job#: 222092243 Page 5 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total %Asbestos
23 222092243-23 No NAD
11 Location: North Facade-Foundation Tar (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 45.3%
24 222092243-24 No NAD
11 Location:South Facade-Foundation Tar (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 38%
25 222092243-25 No NAD
12 Location:Rm. 106 Closet-Penetration Sealant (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.8%
26 222092243-26 No NAD
12 Location:Exterior South Facade -Penetration Sealant (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.5%
27 222092243-27 No NAD
13 Location:Roof-Near Peak-Old Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 15.7%
28 222092243-28 No NAD
13 Location: Roof-Near Peak-Old Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 20.2%
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 6 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total %Asbestos
29 222092243-29 No NAD
14 Location:Roof-Near Peak-Felt Paper (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 16.6%
30 222092243-30 No NAD
14 Location:Roof-Near Peak-Felt Paper (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 16.4%
31 222092243-31 No NAD
15 Location: Roof-East End- New Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 14.8%
32 222092243-32 No NAD
15 Location: Roof-East End-New Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 15.5%
33 222092243-33 No NAD
16 Location:Rm.005-Laminate Flooring (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow/Brown, Heterogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 1.9%
34 222092243-34 No NAD
16 Location:Rm.005-Laminate Flooring (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow/Brown, Heterogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.1%
See Reporting notes on last page
r
'AmeriSci Job#: 222092243 Page 7 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Reporting Notes:
(1) Sample prepared for analysis by ELAP 198.6 method
Analyzed by:Bo Sun .�jJ .�.� Reviewed by:Karol H.Lu
Date:9/19/2022
*NAD/NSD=no asbestos detected;NA=not analyzed;NA/PS=not analyzed/positive stop,(SOF-V)=Sprayed On Fireproofing containing Vermiculite;
(SM-V) =Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis using Olympus,Model BH-2 Pol Scope,Microscope,Serial#:229003,by
Appd E to Subpt E,40 CFR 763 quantified by either CVES or 400 pt ct as noted for each analysis(NVLAP 200546-0),ELAP PLM Method 198.1 for NY
friable samples,which includes the identification and quantitation of vermiculite,or ELAP 198.6 for NOB samples,or EPA 400 pt ct by EPA 600-
M4-82-020(NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound
materials. NAD or Trace results by PLM are inconclusive,TEM is currently the only method that can be used to determine if this material can be
considered or treated as non asbestos-containing in NY State(also see EPA Advisory for floor tile,FR 59,146,38970,8/1/94)National Institute of Standards
and Technology Accreditation requirements mandate that this report must not be reproduced except in full without the approval of the Iab.This PLM
report relates ONLY to the items tested.RI Cert AAL-094,CT Cert PH-0186,Mass Cert AA000054,NJ Lab ID #NY031.
END OF REPORT
AmeriSci Job#: 222092243 Page 1 of 3
Client Name: Spectrum Environmental Associates, Inc.
Table I
Summary of Bulk Asbestos Analysis Results
22-470; 42 Old Assembly Rd., Entire Structure
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos 'Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic%
PLM/DS TEM
01 1 1 --- ---- -- --- NAD NA
Location: Rm. 106 Closet-Sheetrock
02 2 1 -- -- -- --- NAD NA
-Location: Rm.003 South Wall-Sheetrock
03 3 1 -- -- — -- NAD NA
Location: Rm.106 Closet-Joint Compound
04 4 1 -- -- — — NAD NA
Location: Rm.003 South Wall-Joint Compound
05 5 2 0.212 19.0 36.0 45.1 NAD NAD
Location: Rm.005 Stored Goods-2 x 2 Ceiling Tile
06 6 2 0.198 15.2 31.7 53.2 NAD NAD
Location: Rm.101 South End(Above Ceiling)-2 x 2 Ceiling Tile
07 7 3 --- ---- --- --- NAD NA
Location: Rm.108 NE Corner-Ceramic Tile Grout
08 8 3 -- --- -- -- NAD NA
Location: Rm.108 NE Corner-Ceramic Tile Grout
09 9 4 -- -- — -- NAD NA
Location: Exterior NE Facade-Fiber Board
10 10 4 -- -- — -- NAD NA
Location: Exterior NE Facade-Fiber Board
11 11 5 0.166 20.1 67.2 10.7 Anthophyllite<0.25 Anthophyllite 1.9
Location: North Facade-Door/Window Caulk
12 12 5 0.168 21.0 65.8 13.2 Anthophyllite<0.25 NAPS
Location: South Facade-Door/Window Caulk
13 13 6 0.244 80.1 14.7 5.1 NAD NAD
Location: Rm.006 Stairs-Cobblestone Pattern Sheeting
14 14 6 0.187 80.6 16.3 3.1 NAD NAD
Location: Rm.006 Stairs-Cobblestone Pattern Sheeting
15L1 15 7T 0.246 19.5 66.7 10.7 Chrysotile 3.1 NA
Location: Rm.101 Under Wood Plank Floor -White Floor Tile
15L2 15 7 0.036 44.8 54.4 0.7 NAD Chrysotile Trace
Location: Rm.101 Under Wood Plank Floor -Mastic
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 2 of 3
Client Name: Spectrum Environmental Associates, Inc.
Table I
Summary of Bulk Asbestos Analysis Results
22-470; 42 Old Assembly Rd., Entire Structure
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
16 16 7T 0.270 18.5 69.9 11.7 NA/PS NA
Location: Rm. 101 Under Wood Plank Floor -White Floor Tile W/Mastic"Insufficient Mastic For Preparation"
17 17 8 -- -- - - NAD NA
Location: Rm. 108-Ceramic Tile Adhesive
18 18 8 -- -- - -- NAD NA
Location: Rm. 108-Ceramic Tile Adhesive
19 19 9 0.216 20.7 78.5 0.9 NAD NAD
Location: Rm.005-12'x 12'Self Adhesive Floor Tile
20 20 9 0.232 21.0 76.9 2.2 NAD NAD
Location: Rm.005-12'x 12'Self Adhesive Floor Tile
21 21 10 0.169 24.4 16.0 55.3 Anthophyllite<0.25 Anthophyllite 4.2
Location: Rm.107-Sink Basin-White
22 22 10 0.196 24.0 29.6 46.4 Anthophyllite<0.25 NA/PS
Location: Rm. 107-Sink Basin-White
23 23 11 0.328 24.4 30.2 45.3 NAD NAD
Location: North Facade-Foundation Tar
24 24 11 0.201 23.6 38.3 38.0 NAD NAD
Location: South Facade-Foundation Tar
25 25 12 0.253 13.5 85.7 0.8 NAD NAD
Location: Rm. 106 Closet-Penetration Sealant
26 26 12 0.227 13.4 86.1 0.5 NAD NAD
Location: Exterior South Facade -Penetration Sealant
27 27 13 0.227 31.2 53.1 15.7 NAD NAD
Location: Roof-Near Peak-Old Shingles
28 28 13 0.303 31.3 48.4 20.2 NAD NAD
Location: Roof-Near Peak-Old Shingles
29 29 14 0.116 42.4 41.1 16.6 NAD NAD
Location: Roof-Near Peak-Felt Paper
30 30 14 0.113 81.9 1.8 16.4 NAD NAD
Location: Roof-Near Peak-Felt Paper
31 31 15 0.287 21.7 63.5 14.8 NAD NAD
Location: Roof-East End-New Shingles
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 3 of 3
Client Name: Spectrum Environmental Associates, Inc.
Table I
Summary of Bulk Asbestos Analysis Results
22-470; 42 Old Assembly Rd., Entire Structure
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by "Asbestos%by
Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
p Client Sample# )
32 32 15 0.261 21.9 62.6 15.5 NAD NAD
Location: Roof-East End-New Shingles
33 33 16 0.180 37.3 60.7 1.9 NAD NAD
Location: Rm.005-Laminate Flooring
34 34 16 1.549 92.8 7.1 0.1 NAD NAD
Location: Rm.005-Laminate Flooring
Analyzed by:Khaalid W.Perine Reviewed by:Karol H.Lu
Date:9/19/2022 q�—,
**Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by Appd E to Subpt E,40 CFR 763 or NYSDOH ELAP 198.1 for New York friable samples or NYSDOH ELAP 198.6 for New York NOB samples;
TEM(Semi/Full)by EPA 600/R-93/116(or NYSDOH ELAP 198.4,for New York samples).Analysis using Hitachi,Model H7000-Noran 7 System,Microscope,Serial#:747-05-06.NAD= no asbestos detected
during a quantitative analysis;NA=not analyzed;Trace= <10/o;(SOF-V) =Sprayed On Fireproofing containing Vermiculite;(SM-V) =Surfacing Material containing Vermiculite;Quantitation for beginning
weights of<0.1 grams should be considered as qualitative only;Qualitative Analysis:Asbestos analysis results of"Present'or"NVA= No Visible Asbestos"represents results for Qualitative PLM or TEM
Analysis only(no accreditation coverage available from any regulatory agency for qualitative analyses):NVLAP(PLM)200546-0,NYSDOH ELAP Lab 11480,NJ Lab ID #NY031.
Warning Note:PLM limitation,only TEM will resolve fibers <0.25 micrometers in diameter.TEM bulk analysis is representative of the fine grained matrix material and may not be representative of non-
uniformly dispersed debris for which PLM evaluation is recommended(i.e.soils and other heterogenous materials).
S SPECTRVA P.O.Box 1024
Schenectady.NV 72301
E (518)346-6374(Phone)
d Envimnmenttal isse ates,Inc. (518)346-4062(Pax)
•EXCEEDING OUR CLIENTS EXPECrd rIONS OP EXCEL L ENCE' I www.4spectrum.com
BULK SAMPLING CHAIN OF CUSTODY OP_g,1,14)
PROJECT INFORMATION
Project Il: ,1 [V4p4*)*-
Analysis Requested Turnaround
Date Swnplcd: lluildin }] Location: �_,.�,
q 1� a 0 AS' to � =�r 1 IYC J f UC U�'L' PI.M—)I,AP 198.1Ix TFM—EI.AP 198.4 ❑ RUSH ❑ 24 Hour
Page I/ ' Of Start: Lind: Cola=� Investigator.
°� PLM—ELAP 198.E ❑ ❑ 72 Hour X.
SAMI'Lr IDTNI'ITICATION
Sample ID 4: Group#: Material Sample Location Condition
1 1 5 10 sc.
603 md h wcrl
m Urtt' . 10 c st•, -
" ?rn, DO i OL 0/
x er-11ing OOS Stbirj. S
" M, 10 End e 0 We c t
77
Oercmte 7 Ic 6(c m, 169, IVE e c rte
it 1 AI E eol'tne C
9 0 Flkq ?wa x er �, NE f'a
I"1 ( 1 &OV tjolr+t-, Cl
1 -5 COU &Ae-
A
c';✓ lh t 06 S air
J�— 7 WC.- F 001r Y►a QA .e' G
1 /► U U ri' �• it
*Unless otherwise stated please analyze each group to first(1")positive result.
Comments: # 2 A ^ o ry
CIIAIN CU '
t d he y y D to Time Received By Date Time Method of Submittal
1I
Environmental Consulting&Management Services • Health&Safety Training •Laboratory Services
S SPECTRVA P.O.Box 1024
Schenectady,NV 12301
8 (518)346-6374(Phone)
R Envimnmental t'issedates.Inc. (518)346-4062(Fax)
'ExcEEntNc Occ CLIENTS EXPECTOTIONS of EXCELLENCE' www.4spectrum.com
BULK SAMPLING CHAIN OF CUSTODY Or-3rlrl4)
PROJECT INFORMATION
Pmicct rr:a — errwr.— Analysis Requested Turnaround
Date Sampled: 44 I3uildin; ` Location: YrAe leX�f PLM—)LAP 198.1 TEM—)LAP]98.4 ❑ RUSH ❑ 24 Hour
rage n of �ee+e� mveatigat°�:J050
PLM—BLAP 198.6 ❑ ❑ 72 Hour e a
SAMPLE IDENTIFICATION
Sample ID#: Group#: Material Sample Location Condition
Z 8 e I�e Vt✓ m, I E wfne-�
nor ne
tZl 1nK sin - i c- RM, /0
M. 10
11Fnvol.60ok r0e0 e
" Sot c.r. e.
it c' - I
it 00- )I
c - n«v- hut k/
1 - v
�1 1� ,rt�.° 5�►n is e
IT '?COP - F en
Unless otherwise stated please analyze each group to first(I°)positive result
rmwnts: # 2 2 2 0 9 2 2 4 3
CIIAIN , USTODY
1' qui red By Datp Time Rece' d By Date Time Method of Submittal
1 r 1 1 r
II
III rMf ,JQSINN t•Oa
IQ
Environmental Consulting&Management Services • health&Safety Training •Laboratory Services
SPECTR P.O.Box 1024
S U� Schenectady.Nf'12301301
E
,y Environmental Rssedates. Inc. (518)346-6374(Phone)
(518)346-4062(Pax)
'EXCEEOLNG OOR CLIENTS EXPECrar/ONs OF EXCELLENCE'
www.4s.vectmm.com
BULK SAMPLING CHAIN OF CUSTODY OP-3,l/14)
PROJECT INFORMATION
Project fl:
1 Analysis Requested Turnaround
Date Sample: Building: Location: PLM—ELP198.1 ,
TEM—ELAP 198.4 ❑ RUSI 24 I Iouraa 61A Assevo Ct4w — U`�
Pago it I of r 7etat- lnvestigator.
eC,t PLM-ELAP 198.6 ❑ ❑ 721-lour
SAMPLE IDENTIFICATION
Sample ID 4: Group 4:" Material Sample Location Condition
F r c rnDOE
3 -_
i
1
*Unless otherwise stated please analyze each group to first(I")positive result
ommcnts:
# 22209 2243
t
CHAIN IS'rODY
I uis d By I Dat4 Time Rec ' ed By Dale Time Method of Submittal
' Iq
it
III 0 i` TeZq If
Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services
LICENSING AND CERTIFICATION
P.D.Box 1024
SPECTRVA Schenectady,Ala'12301
(518)346-6374(Phone)
Environmental issociates, Inc® (518)346-4062(fax)
'EXCEEDING ODR CLIENTS EXPECTRTIONS Of EXCELLENCE' www.4spectrum.com
State of New York— Department of Labor
Asbestos Certification
STATE OF 4 'YORK`-DEPARTMENT Of'LABOR ' ' 1 Y
ASBESTOS CERTIFICATE
JASON R TEAGLE
-CLASS(EXPIRES)
C.ATEC(01/23) D INSP(61/23)
H PM (01/23) 1 PD (01/23)
CER1A 00-07993
DMVL 36662743-1
MUST BE CARRIED OR ASBESTOS PROJECTS
nuwm���mmmin J
State of New York— Department of Labor
Codes Certification
A Asbestos Handler
B Restricted Handler -,Allied Trades
C Air Sampling Technician
D Inspector
E Management Planner
F Operations and Maintenance
G Supervisor
H Project Monitor
I Project Designer
Environmental Consulting&Management Services • health&Safety Training • Laboratory Services
R
New York State'--Department=orl abor—, '
/ r{ Division obf Safety and Health
License and Certificate Unit
` . , . / r .
State Caympus,°Buld1 grt 12 �1
"Albany,-NY 12240^-� �.`f ``•
,•'` �. � `' �� --- --AK- BES TOS HANDLING LICENSE
, ram �'f
Spectrum Environmental Associates, Inc: ' FILE NUMBER: 99w0129 /
f LICENSE NUMBER `,29081'
f ~z 'w
P:G-. Box',1024�' 1 ;, LICENSE CLASS: RESTRICTED--`
DATE OF ISSUE: 02/02/2022 �
( 4Schenectady,rNY 12 �� ' EXPI RATION : 02/28/202-3
44DATE
� I`:Ili` `� t. _ �,`� �i}� ��`•� i "1`�
Duly Authorized Representative!T,wiiii6m L M assmann .- ,',;,
ThishcenseJhas been issued in accord ce bvath a livable= >;ovisions o£Article!30'of the Labor Law of New York%State and o£
W! 1� y 4T 1`( Ikr.— �_ fir. F III r.t f
e New York State Codes,Rules and Regulationse:'112 NYCRRPart 56} T slsr'ubject to suspension or revocationlor a(1)
serous violation of state,federal or loc�1�aws w.rtri e a d-tosthe conduct'of an,asbestos project,or(2)demonstrated lack-of
responsibihy in the conduct of any job involving�asbestlos or,`asbbstos'matenacl:
This 1'icen4 is valid only for t ie contractor named._above and his Ireense or.aphotocopymust be:prominently displayedat
asbesto�projec orksife�This-li en's se verifies that{aIeperso-n�semployed by the licensee on an asbestos project�inN fYo'lrk
State have beem issued an Asbestos Certificate;-appropriate for thhe,type?of work-fl e`y perform,by the ew York State f!
Department of Labor
-� �
f , `�_ •
Amy Phillips,Director
SH 432(8/12) For the Commissioner of Labor
_N_EW YORK STATE DEPARTMENT OF HEALTH
- - WADSWORTH CENTER -
- _ Expires 12:01 AM April G1,Z02$.
=lss ed April 01, 2022
Iq
_ - CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued in accordance with and pursuant to section 502 Public Health Law of New York State
MR. PAUL J: MUCHA NY Lab Id No: 11480 -
=:=- AMERICA SCIENCE TEAM NEW YORK, INC
117f.4ST 30TH ST
NEW YORK, NY 10016
is hereby APPROVED as an Environmental Laboratory for the-category
ENVIRCIlVMENTALRNALYSES SOLID AND HAZARDOUS WASTE
All approved-subcategories andlvr.analytes are listed bdjt w.'
--_=Miscellaneous - - - -
AsbestDs-in Fna -Mateft Item 198.1 of Manual
EPA 600/M4/82/020
Asbestos irfWart-Friable Material-PLM Item 198.6 of Manual(NOB by PLM)-
Asbestos in Non-Friable-Material-TEM Item 198.4 of Manual
Serial No.: 64683 =-
Pr_W"of ft New York State Department oT Health. Cert icates are valid only at the.address
shown,must be conspicuously posted,and are printed on secure paper. Continued accreditabim depends
--on successful ortgoing_par5dpation in the Program. Consumers are urged to call(518)485-5570 to-
=-verify the laboratoys accreditaff n status. =
PAnP 1 of t - - _
L� P.0.Box 1024
spUCTRVASabenectadg NY 12301
(518)346-6374(Phone)
Environmental Eissociates, Inc. (518)346-4062(Fax)
'EXCEEDING OUR CLIENTS EXPEcmrio1Ys or EXCELLENCE www.4spedrum.com
October 19, 202217
,� '
Jeff Randles f
42 Old Assembly Point Road PoV ®, 2022
Lake George,NY 12845To
$ ;�
Jeffrey.randles(cymail.com --r,:`_jfZ
mor3
RE: Interior& Exterior—42 Old Assembly Rd.
Asbestos Condition Inspection TOWN OF QUEENSBURY
Spectrum Project Number 22-470 BUILDING & CO ES PT.
Dear Mr. Randles: Reviewed
By.
Date: �A- Z
Spectrum Environmental Associates, Inc. (Spectrum) performed a visual inspection of various
interior and exterior areas of the property located at 42 Old Assembly Point Road, Lake George,
NY on Monday, October 17, 2022. The purpose of the inspection was to visually confirm that
various confirmed asbestos materials, (Floor Tile, Caulking, and Sink Basin) has been removed.
Mr. Chris Patti, a NYS/EPA Asbestos Inspector (Cert# 04-065597), performed the visual
inspection of the interior and exterior areas and that confirmed asbestos Floor Tile, Caulking, and
Sink Basin has been removed by the home owner and no confirmed material or debris was present
at the time of the inspection. Based on the condition of the areas, Spectrum feels the job was
completed in a workman like manner by the home owner. NYS clearance criteria is not applicable
as the work was not done under NYS-ICR 56.
Should you have any questions concerning this report,please do not hesitate to contact our office at(518)
346-6374.
TOWN OF QUEENSBURY
Sincerely, BUILDING DEPARTMENT
Based on our limited examination,compliance
AeApot tT D6/?a�&r with our comments shall not be construed as
indicating the plans and specifications are in
Robert J. DeRuyter full compliance with the Building Codes of
VP of Operations New York State.
Cc: file
Attachments: Photographs
Licensure and Certification
239.12-2-1.1 DEMO-0677-2011
Randles, 3effrey & Nancy
42 Old Assembly Point Rd
Demolition of SFD
Environmental Consulting&Management Services•Health&Safety Training•Laboratory Services
As b e stos Inspectio- n. . Photo
Album o,f". .42 Old Assembly Rd .
- _ by
Spectrum Environmental Associates, Inc.
Spectrum Project # 22-470
Date of Inspection: October 17, 2022
r � �
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P.0.Box 1024
SPECTRVAf Schenectady,W 12301
(518)346-6374(phone)
Environmental flssoclates, Inc. (818)346 4062(Far)
'EXCEEDING OUR CLIENTS EXPECTATIONS Of EXCELLENCE' www.4spectminxem
State of New York—.Department of Labor
Asbestos Certification
'.STATE°,OF;N,E1yYQRE ARTMEtT;0EA8QR ,
;AS6EST05�ERTIF4CATf' f
XY55,'f"". ad:.:`':.1'(:f��?��. 7 •-
CHR4SNER°P''PATTI'
c�ATEC(o_11.23j,;D INSR(0:1�23� f;--
��MUST�B��CARItIED=.ON�ASBkS1'OSPROJ CTS�sy%.:
�Y?,'%�<°� `�IIIII IlpllllldllUl lii
IIIIIIIIIII III IIIIIIII III III
.: IF FOUND RETURN TO:
EYES SRO NYSDOL - L&C UNIT
—m
C4 HAIR SRO ROOM 161A BUILDING 12
gHGT 5' 09" STATE OFFICE CAMPUS
$ ALBANY NY 12240
=N
=o
State of New York — Department of Labor
Codes Certification
A Asbestos Handler
B Restricted Handler -,Allied Trades
C Air Sam lin Te'dinician
D Inspector
E Management Planner
F Op erations and Maintenance
G Supervisor
H Project Monitor
I Project Designer
Eli virow»eilial consulting A AlanaEement Services • lleallh A-Safell,Training • Laharatory Services
ew York State=`Depart nt of Labor' -
�i ,
Division o Safety and Health Y
License and Certificate hit/
State Cd!npus;Bwlding 12 TV,
I
Albany,.NY 12240_`�
" ASBESTOS HANDLING LICENSE', :
Spectrum Environmental Associates,�Tnc� i FILE NUMBER: 99a0129` '
�tJ •���, �rt���=� LICENSE NUMBER:'�29,d81 � �r'' •',,
" P:O. Box 1024 ' f '� �`; LICENSE CLASS: RESTRICTED `
DATE OF ISSUE: 02/02/2022
/ , jSchenec/tady,,NY 12301 r� ; �fk_ EXPIRATION DATE: 02/28%2023�
Duly Authorized Representative"William'� Massrnanri
`"J- •-�-� IEyI '��1 it '�`. . "�:'�•�:''.,;;illlii�:�.�. .,y=
. .t;f � '1t�1L1' �6; r _
This license"has been issued in accordance+With;apph_calile,provisionsho£Anccle 30'of the Labor Law of New York%S to and of
We New York State Codes Rules rand`Regutat on'`s- r2-§ORR r'56)�--IYis' 4�*ect to suspension or revocation for a(1) f�
d i ' ' fld �U l� - 4- ����:^� i Et �
serious violation of state,federal or local�aws wit regard-to,the conduct of ar sbestos project,or(2)demonstrated lack-of %
t t a :� i 1 i' / tt
~x tiaY tft�a •• Kya:�.4^rcY"' f! 5 �—
responsibility m the conduct of any job miOlvirig;asbestos or asbestos'matenal:�
This license is valid only for the contractor na Qed a ove and-th iise ortea_--photocopy must-be promin'gntly displayed at the
asbesto`p�ojectworksite. -This•li ense verges thattalLperssons-employ ed-by,�the licensee on an_asbestos,.proje'ct1inN York
State have Been issued an Asbestos Certificate;appr�riate forhe;typeof work-the'y perform,by the'New York_State r
Department of Labor.
(r` ` )( .r
Amy Phillips,Director
SH 432(8/12) For the Commissioner of Labor
P.O.Box 1024
SPECTRVA . - Sa&enedad{.NY 12301
(518)348-6374(Phone)
En ronmental Rsseciates, Inc. (518)348-4062(Fax)
'EXCEEOINC OUR CLIENTS EXPECTATIONS OF EXCELLENCE' www.4specimm.com
=FILEOPY
ASBESTOS PRE-DEMOLITION
SURVEY/INSPECTION
tLL
�FOR � 2022TOIWAEf RYLUCO�JES
BUILDING
42 OLD ASSEMBLY RD.
LAKE GEORGE, NY 12845
SPECTRUM PROJECT NO.: 22-470
SEPTEMBER 21, 2022
PREPARED FOR:
JEFF RANDLES
42 OLD ASSEMBLY RD.
LAKE GEORGE, NY 12845
Environmental Consulting&Management Services•Health&Safety Training•Laboratory Services
TABLE OF CONTENTS
SECTION I - INTRODUCTION
SECTION II - LIMITATIONS
SECTION III - ASBESTOS SAMPLING SUMMARY
ATTACHMENTS - TABLE 1-ASBESTOS SAMPLING RESULTS
- TABLE 2-ASBESTOS FINDINGS
- LOCATION MAPS
- LABORATORY REPORTS
- LICENSING AND CERTIFICATION
SECTION I-INTRODUCTION
On September 14, 2022, Spectrum Environmental Associates,Inc. (Spectrum) conducted a survey
for the presence of asbestos containing materials at the building located at 42 Old Assembly Rd in
Lake George, NY. Mr. Jason Teagle (Asbestos Inspector #00-07983) conducted this inspection
following procedures and guidelines commonly used and accepted by federal and state regulations.
The objective of the survey was to identify the presence and approximate locations and quantities
of suspect and/or confirmed asbestos containing materials.
An initial walkthrough of the designated areas was conducted by an experienced asbestos inspector
to observe and record materials used in the construction of the building. The inspector proceeded
by assessing floors, walls, ceilings, surfacing materials, thermal systems insulation, roofing
materials and other miscellaneous materials with the potential to contain asbestos. From
observations, the inspector prepared a listing of building materials that are suspected to contain
asbestos. The inspector selected these materials for inclusion in the inspection through
professional experience and an understanding of the historical uses of asbestos. Generally
speaking,if a building material within a structure could contain asbestos,the material was included
in the inspection.
Materials included in the survey were identified and recorded with respect to grouped
homogeneous sampling areas. Representative bulk'material samples were collected from locations
within each homogeneous sampling area. Sampling information was recorded on chain of custody
forms for documentation. Samples were individually preserved within a container and transported
to an independent laboratory for asbestos analysis.
Laboratory analysis of asbestos samples via polarized light microscopy(PLM)and/or transmission
electron microscopy(TEM)was conducted by AmeriSci of New York,New York(ELAP# 11480,
NVLAP#200546-0). Sample analysis was conducted as follows:
• "Friable" Asbestos Samples—PLM
• "Non-Friable" Organically Bound (NOB) Asbestos Samples— PLM and, if negative, TEM
for confirmation as required under NYSDOH-ELAP regulations.
SECTION II-LIMITATIONS
The information provided in this report was compiled from field and laboratory data obtained
during the site visit. Observations noted and recorded are intended to represent the conditions that
existed at the subject site at the time and date that the observations were made.
Spectrum has not conducted its own analytical, but has utilized an independent NYS-DOH ELAP
approved laboratory to provide the analytical results contained in this report. All discussions,
findings, and conclusions are based on information that Spectrum received and understood to be
factual.
Determinations of suspect asbestos containing materials within the building were subject to the
accessibility of individual areas or spaces. Spectrum accepts no responsibility for the content of
the building materials within areas or spaces that were unknown to us or not reasonably accessible.
Spectrum assumes no liability for any buildings that were not identified by the client that may fall
under state or federal regulations.
All quantities of ACM provided in this report are provided as required by law and are believed to
be accurate. If this report is to be used for bidding purposes, field verification of quantities is
recommended by the abatement contractor prior to bidding.
Conclusions and recommendations provided in this report are based on the assumption that
materials identified are homogeneous throughout their application.
This report has been compiled for the exclusive use of Jeff Randles, his successors and/or
assigns. This report and its contents represent confidential information and should not be
duplicated without the expressed permission of Jeff Randles, his successors and/or assigns. This
report should only be reproduced in its entirety to ensure all the appropriate information is
provided.
The building owner is Jeff Randles and may be reached at 42 Old Assembly Rd in Lake George,
NY.
SECTION III—ASBESTOS SAMPLING SUMMARY
The results of the sampling are provided in Table 1 (Asbestos Sampling Results) and the asbestos
findings are provided in Table 2 (Asbestos Findings) of the Attachments. The laboratory results
and sample location map(s) are also provided in the Attachments.
ATTACHMENTS
TABLE I-ASBESTOS SAMPLING RES UL TS
TABLE 2-ASBESTOS FINDINGS
LOCATION MAPS
LABORATORYREPORTS
LICENSING AND CERTIFICATION
TABLE I - ASBESTOS SAMPLING RESULTS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Sample# Description Location/Area PLM Results TEM Results
%Type) %Type)
01 Sheetrock Rm 106 Closet NAD NA
02 Sheetrock Rm 003 South Wall NAD NA
03 Joint Compound Rm 106 Closet . NAD NA
04 Joint Compound Rm 003 South Wall NAD NA
05 2x2 Ceiling Tile Rm 005 Stored Goods NAD NAD
06 2x2 Ceiling Tile Rm 101 South End(Above Ceiling) NAD NAD
07 Ceramic Tile Grout Rm 108 NE Corner NAD NA
08 Ceramic Tile Grout Rm 108 NE Corner NAD NA
09 Fiber Board Exterior NE Fagade NAD NA
10 Fiber Board Exterior NE Fagade NAD NA
11 Door/Window Caulk North Fagade Anthophyllite<0.25% Anthophyllite 1.9%
12 Door/Window Caulk South Fagade Anthophyllite<0.25% NAPS
13 Cobblestone Pattern Sheeting Rm 006 Stairs NAD NAD
14 Cobblestone Pattern Sheeting Rm 006 Stairs NAD NAD
15L1 White Floor Tile Rm 101 Under Wood Plank Floor Chrysotile 3.1% NA
15L2 Mastic Rm 101 Under Wood Plank Floor NAD Chrysotile Trace
Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos.
NAD-no asbestos detected,NA-not applicable,PS—Positive Stop, SF-square feet,LF—linear feet
TABLE I - ASBESTOS SAMPLING RESULTS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Sample# Description Location/Area P LM Results TEM Results
/o Tye /o Type)
16 White Floor Tile w/Mastic Rm 101 Under Wood Plank Floor NAPS—Floor Tile NA'--Mastic
17 Ceramic Tile Adhesive Rm 108 NAD NA
18 Ceramic Tile Adhesive Rm 108 NAD NA
19 12x12 Self Adhesive Floor Tile Rm 005 NAD NAD
20 12x 12 Self Adhesive Floor Tile Rm 005 NAD NAD
21 Sink Basin—White Rm 107 Anthophyllite<0.25% Anthophyllite 4.2%
22 Sink Basin—White Rm 107 Anthophyllite<0.25% NA/PS .
23 Foundation Tar North Facade NAD NAD
24 Foundation Tar South Facade NAD NAD
25 Penetration Sealant Rm 106 Closet NAD NAD
26 Penetration Sealant Exterior South Facade NAD NAD
27 Old Shingles Roof—Near Peak NAD NAD
28 Old Shingles Roof—Near Peak NAD NAD
29 Felt Paper Roof—Near Peak NAD NAD
30 Felt Paper Roof—Near Peak NAD NAD
31 New Shingles Roof -East End NAD NAD
Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos.
NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet
TABLE 1 - ASBESTOS SAMPLING RES UL TS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Sample# Description Location/Area PLM Results TEM Results
%Type) %Type)
32 New Shingles Roof—East End NAD NAD
33 Laminate Flooring Rm 005 NAD NAD
34 Laminate Flooring Rm 005 NAD NAD
Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos.
NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet
TABLE 2 - ASBESTOS FINDINGS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Limitations:
The following limitation/conditions were noted as part of the survey:
• OSHA requires that an employer not expose its workers above the PEL and therefore specific
training, work practices and/or respiratory protection may need to be a consideration when
handling materials that are less than one percent.
• The inspection was performed in accordance with New York State Industrial Code Rule 56
Section 5.1. A copy of 56-5.1 is available upon request. It is the responsibility of the owner
or its agent to forward a copy of this report to the local government entity charged with issuing
a permit for such demolition, renovation, remodeling or repair work under applicable State or
local laws as well as to the NYS Department of Labor Asbestos Control Bureau. Spectrum
will not send this report to the NYSDOL without written permission from its client due to the
sensitive nature of the information present in this report.
• This report reflects the conditions found at the date and time of the inspection(s). Conditions
of the area and materials may change due to external events, forces or influences. Re-
inspection of the area may be required prior to the start of any work if an extended.period of
time has passed or if disturbances have occurred.
• If materials not sampled in the survey are uncovered during renovation/demolition, per
ICR56 work should stop and those materials should be assessed before work continues. Also
per ICR 56, a copy of the survey report should be submitted to the local agency issuing the
demolition permit and a copy should be kept on site during the demolition phase of the
project.
b This survey is for the future demolition of the structure. Per NYSDOL, if the project does
not proceed within approximately 6 months, the structure should be visually re-inspected to
confirm that no addition materials have been added and that the existing conditions of the
identified ACiVI is still the same.
® Spectrum did not inspect any exterior area below grade. Foundation sealers, buried piping and
other items may exist below grade which may contain asbestos.
SF—square feet,LF—linear feet,ea—each
TABLE 2 - ASBESTOS FINDINGS
42 Assembly Rd.
Spectrum Project#22-470
Date Sampled: September 14, 2022
Material Sample Location/Area Estimated Quantity* Condition/Damaged
Door/Window Caulk North Fagade 380 If Good
White Floor Tile Under Wood Plank Floor 1,800 sf Good
Sink Basin—White Rm 107 —4 sf Good
*Quantities of identified ACM are estimates only and should be field verified prior to bid by the contractor or confirmed as part of an RFP or
design specification.
Please see the limitation listed above.
Asbestos %by PLM*-please refer to the PLM Bulk Asbestos Report for the method used.
All asbestos locations on drawings are approximate. All quantities are estimated and must be field verified prior to use as part of a
bidding document. Materials may extend or be hidden behind or within other materials or structural members. Any contractor or
other user of this report is required to physically confirm the quantities and verify measurements of materials to be removed, to be bid
for rei-nOVal, Or for any Other pL11J)OSL. Contractors are responsible to physically visit the site and confirm all quantities forbidding
purposes.
Definitions:
NAD—No Asbestos Detected
NA—Not Analyzed
NA'— SOF-V)and SM-V)must be analyzed by ELAP 198.8 orequivalent effective 5/6/16
NA'- —Insufficient Material for Preparation
N/A—Not Applicable(quantities are not provided for negative materials)
TBD—To Be Determined(quantification was not possible as the scope of work was notprovided)
NAPS—Not Analyzed/Positive Stop
SF—square feet,LF—linear feet,ea—each
22-470(9-14-22)
Roof&Basement-42 Old Assembly Rd.
Pre Demolition Bulk Sample Locations-NTS
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22-470(9-14-22)
1st floor-42 Old Assembly Rd.
Pre Demolition Bulk Sample Locations-NTS
z;�
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177
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12 - - - _
AmeriSci New York
AMERI SCI 117 EAST
NEW YORK, NYY 10016
TEL:(212)679-8600 • FAX:(212) 679-3114
PLM Bulk Asbestos Report
Spectrum Environmental Associates, Inc. Date Received 09/15/22 AmeriSci Job # 222092243
Attn: Bill Massman Date Examined 09/19/22 P.O. #
P.O.Box 1024 ELAP # 11480 Page 1 of 7
RE: 22-470; 42 Old Assembly Rd., Entire Structure
Schenectady, NY 12301
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
1 222092243-01 No NAD
1 Location: Rm. 106 Closet-Sheetrock (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown/White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20%, Non-fibrous 80%
2 222092243-02 No NAD
1 Location: Rm. 003 South Wall-Sheetrock (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20%, Non-fibrous 80%
3 222092243-03 No NAD
1 Location: Rm. 106 Closet-Joint Compound (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
4 222092243-04 No NAD
1 Location: Rm. 003 South Wall-Joint Compound (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
5 222092243-05 No NAD
2 Location:Rm. 005 Stored Goods-2 x 2 Ceiling Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Gray, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 45.1%
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 2 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
6 222092243-06 No NAD
2 Location: Rm. 101 South End (Above Ceiling)-2 x 2 Ceiling Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Gray, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 53.2%
7 222092243-07 No NAD
3 Location: Rm. 108 NE Corner-Ceramic Tile Grout (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
8 222092243-08 No NAD
3 Location: Rm. 108 NE Corner-Ceramic Tile Grout (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
9 222092243-09 No NAD
4 Location: Exterior NE Facade-Fiber Board (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 90%, Non-fibrous 10%
10 222092243-10 No NAD
4 Location: Exterior NE Facade-Fiber Board (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 90%, Non-fibrous 10%
11 222092243-11 Yes Trace (<0.25 % pc)
5 Location: North Facade- Door/Window Caulk (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Gray/White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25% pc
Other Material: Non-fibrous 12.6%
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 3 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
12 222092243-12 Yes Trace (<0.25 % pc)
5 Location: South Facade-Door/Window Caulk (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Gray/White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25% pc
Other Material: Non-fibrous 13.2%
13 222092243-13 No NAD
6 Location:Rm.006 Stairs-Cobblestone Pattern Sheeting (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 5.1%
14 222092243-14 No NAD
6 Location: Rm.006 Stairs-Cobblestone Pattern Sheeting (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 3.1%
15 222092243-15L1 Yes 3.1%
7T Location: Rm. 101 Under Wood Plank Floor -White Floor Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Chrysotile 3.1 %
Other Material: Non-fibrous 10.7%
15 222092243-15L2 No NAD
7 Location: Rm. 101 Under Wood Plank Floor -Mastic (by NYS ELAP 198.6) .
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.8%
16 222092243-16 NA/PS
7T Location: Rm. 101 Under Wood Plank Floor -White Floor Tile W/Mastic"Insufficient
Mastic For Preparation"
Analyst Description:Bulk Material
Asbestos Types:
Other Material:
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 4 of 7
Client Name: Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
17 222092243-17 No NAD
8 Location: Rm. 108-Ceramic Tile Adhesive (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
18 222092243-18 No NAD
8 Location: Rm. 108-Ceramic Tile Adhesive (by NYS ELAP 198.1)
by Bo Sun
on 09/19/22
Analyst Description:White, Homogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
19 222092243-19 No NAD
g Location: Rm. 005- 12'x 12'Self Adhesive Floor Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Dark Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.9%
20 222092243-20 No NAD
9 Location:Rm.005- 12'x 12'Self Adhesive Floor Tile (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Dark Brown, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 2.2%
21 222092248-21 Yes Trace (<0.25 % pc)
10 Location: Rm. 107-Sink Basin-White (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Beige, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25%pc
Other Material: Non-fibrous 59.5%
22 222092243-22 Yes Trace (<0.25 % pc)
10 Location: Rm. 107-Sink Basin-White (ELAP 400 PC)
by Bo Sun
on 09/19/22
Analyst Description:Beige, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:Anthophyllite <0.25%pc
Other Material: Non-fibrous 46.4%
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 5 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
23 222092243-23 No NAD
11 Location:North Facade- Foundation Tar (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 45.3%
24 222092243-24 No NAD
11 Location:South Facade- Foundation Tar (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 38%
25 222092243-25 No NAD
12 Location:Rm. 106 Closet-Penetration Sealant (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.8%
26 222092243-26 No NAD
12 Location:Exterior South Facade -Penetration Sealant (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.5%
27 222092243-27 No NAD
13 Location:Roof-Near Peak-Old Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 15.7%
28 222092243-28 No NAD
13 Location: Roof- Near Peak-Old Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 20.2%
See Reporting notes on last page
AmeriSci Job#: 222092243
Page 6 of 7 ,
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
29 222092243-29 No NAD
14 Location: Roof-Near Peak- Felt Paper (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 16.6%
30 222092243-30 No NAD
14 Location: Roof-Near Peak-Felt Paper (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 16.4%
31 222092243-31 No NAD
15 Location: Roof-East End-New Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22 .
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 14.8%
32 222092243-32 No NAD
15 Location: Roof-East End-New Shingles (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 15.5%
33 222092243-33 No NAD
16 Location:Rm. 005- Laminate Flooring (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow/Brown, Heterogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 1.9%
34 222092243-34 No NAD
16 Location: Rm. 005-Laminate Flooring (by NYS ELAP 198.6)
by Bo Sun
on 09/19/22
Analyst Description:Yellow/Brown, Heterogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 0.1%
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 7 of 7
Client Name:Spectrum Environmental Associates, Inc.
PLM Bulk Asbestos Report
22-470; 42 Old Assembly Rd., Entire Structure
Reporting Notes:
(1) Sample prepared for analysis by ELAP 198.6 method
Analyzed by:Bo Sun Reviewed by:Karol H.Lu
Date:9/19/2022
`NAD/NSD=no asbestos detected;NA=not analyzed;NA/PS=not analyzed/positive stop,(SOF-V) =Sprayed On Fireproofing containing Vermiculite;
(SM-V) =Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis using Olympus,Model BH-2 Pol Scope,Microscope,Serial#:229003,by
Appd E to Subpt E,40 CFR 763 quantified by either CVES or 400 pt ct as noted for each analysis(NVLAP 200546-0),ELAP PLM Method 198.1 for NY
friable samples,which includes the identification and quantitation of vermiculite,or ELAP 198.6 for NOB samples,or EPA 400 pt ct by EPA 600-
M4-82-020(NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound
materials. NAD or Trace results by PLM are inconclusive,TEM is currently the only method that can be used to determine if this material can be
considered or treated as non asbestos-containing in NY State(also see EPA Advisory for floor tile,FR 59,146,38970,8/1/94)National Institute of Standards
and Technology Accreditation requirements mandate that this report must not be reproduced except in full without the approval of the Iab.This PLM
report relates ONLY to the items tested.RI Cent AAL-094,CT Cent PH-0186,Mass Cert AA000054,NJ Lab ID #NY031.
END OF REPORT
AmeriSci Job#: 222092243 Page 1 of 3
Client Name: Spectrum Environmental Associates, Inc.
Table I
Summary of Bulk Asbestos Analysis Results
22-470; 42 Old Assembly Rd., Entire Structure
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by **Asbestos%by
Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
P Client Sample# )
01 1 1 -- -- — — NAD NA
Location: Rm.106 Closet-Sheetrock
02 2 1 -- -- -- -- NAD NA
Location: Rm.003 South Wall-Sheetrock
03 3 1 -- -- — -- NAD NA
Location: Rm. 106 Closet-Joint Compound
04 4 1 -- -- — — NAD NA
Location: Rm.003 South Wall-Joint Compound
05 5 2 0.212 19.0 36.0 45.1 NAD NAD
Location: Rm.005 Stored Goods-2 x 2 Ceiling Tile
06 6 2 0.198 15.2 31.7 53.2 NAD NAD
Location: Rm.101 South End(Above Ceiling)-2 x 2 Ceiling Tile
07 7 3 ---- — — -- NAD NA
Location: Rm.108 NE Corner-Ceramic Tile Grout
08 8 3 -- -- -- -- NAD NA
Location: Rm. 108 NE Corner-Ceramic Tile Grout
09 9 4 -- -- — -- NAD NA
Location: Exterior NE Facade-Fiber Board
10 10 4 -- -- — — NAD NA
Location: Exterior NE Facade-Fiber Board
11 11 5 0.166 20.1 67.2 10.7 Anthophyllite<0.25 Anthophyllite 1.9
Location: North Facade-Door/Window Caulk
12 12 5 0.168 21.0 65.8 13.2 Anthophyllite<0.25 NAPS
Location: South Facade-Door/Window Caulk
13 13 6 0.244 80.1 14.7 5.1 NAD NAD
Location: Rm.006 Stairs-Cobblestone Pattern Sheeting
14 14 6 0.187 80.6 16.3 3.1 NAD NAD
Location: Rm.006 Stairs-Cobblestone Pattern Sheeting
151-1 15 7T 0.246 19.5 66.7 10.7 Chrysotile 3.1 NA
Location: Rm. 101 Under Wood Plank Floor -White Floor Tile
151-2 15 7 0.036 44.8 54.4 0.7 NAD Chrysotile Trace
Location: Rm. 101 Under Wood Plank Floor -Mastic
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 2 of 3
Client Name: Spectrum Environmental Associates, Inc.
Table I
Summary of Bulk Asbestos Analysis Results
22-470; 42 Old Assembly Rd., Entire Structure
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos •'Asbestos%by "Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
16 16 7T 0.270 18.5 69.9 11.7 NA/PS NA
Location: Rm. 101 Under Wood Plank Floor -White Floor Tile W/Mastic"Insufficient Mastic For Preparation"
17 17 8 --- - - - NAD NA
Location: Rm.108-Ceramic Tile Adhesive
18 18 8 -- -- - -- NAD NA
Location: Rm. 108-Ceramic Tile Adhesive
19 19 9 0.216 20.7 78.5 0.9 NAD NAD
Location: Rm.005-12'x 12'Self Adhesive Floor Tile
20 20 9 0.232 21.0 76.9 2.2 NAD NAD
Location: Rm.005-12'x 12'Self Adhesive Floor Tile
21 21 10 0.169 24.4 16.0 55.3 Anthophyllite<0.25 Anthophyllite 4.2
Location: Rm. 107-Sink Basin-White
22 22 10 0.196 24.0 29.6 46.4 Anthophyllite<0.25 NA/PS
Location: Rm. 107-Sink Basin-White
23 23 11 0.328 24.4 30.2 45.3 NAD NAD
Location: North Facade-Foundation Tar
24 24 11 0.201 23.6 38.3 38.0 NAD NAD
Location: South Facade-Foundation Tar
25 25 12 0.253 13.5 85.7 0.8 NAD NAD
Location: Rm. 106 Closet-Penetration Sealant
26 26 12 0.227 13.4 86.1 0.5 NAD NAD
Location: Exterior South Facade -Penetration Sealant
27 27 13 0.227 31.2 53.1 15.7 NAD NAD
Location: Roof-Near Peak-Old Shingles
28 28 13 0.303 31.3 48.4 20.2 NAD NAD
Location: Roof-Near Peak-Old Shingles
29 29 14 0.116 42.4 41.1 16.6 NAD NAD
Location: Roof-Near Peak-Felt Paper
30 30 14 0.113 81.9 1.8 16.4 NAD NAD
Location: Roof-Near Peak-Felt Paper
31 31 15 0.287 21.7 63.5 14.8 NAD NAD
Location: Roof-East End-New Shingles
See Reporting notes on last page
AmeriSci Job#: 222092243 Page 3 of 3
Client Name: Spectrum Environmental Associates, Inc.
Table I
Summary of Bulk Asbestos Analysis Results
22-470; 42 Old Assembly Rd., Entire Structure
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLMIDS TEM
32 32 15 0.261 21.9 62.6 15.5 NAD NAD
Location: Roof-East End-New Shingles
33 33 16 0.180 37.3 60.7 1.9 NAD NAD
Location: Rm.005-Laminate Flooring
34 34 16 1.549 92.8 7.1 0.1 NAD NAD
Location: Rm.005-Laminate Flooring
Analyzed by:Khaalid W.Perine Reviewed by:Karol H.Lu
Date:9/19/2022
"Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by Appd E to Subpt E,40 CFR 763 or NYSDOH ELAP 198.1 for New York friable samples or NYSDOH ELAP 198.6 for New York NOB samples;
TEM(Semi/Full)by EPA 600/R-93/116(or NYSDOH ELAP 198.4;for New York samples).Analysis using Hitachi,Model H7000-Noran 7 System,Microscope,Serial#:747-05-06.NAD=no asbestos detected
during a quantitative analysis;NA=not analyzed;Trace= <1%;(SOF-V) = Sprayed On Fireproofing containing Vermiculite;(SM-V)=Surfacing Material containing Vermiculite;Quantitation for beginning
weights of<0.1 grams should be considered as qualitative only;Qualitative Analysis:Asbestos analysis results of"Present"or"NVA= No Visible Asbestos"represents results for Qualitative PLM or TEM
Analysis only(no accreditation coverage available from any regulatory agency for qualitative analyses):NVLAP(PLM)200546-0,NYSDOH ELAP Lab 11480,NJ Lab ID #NY031.
Warning Note:PLM limitation,only TEM will resolve fibers <0.25 micrometers in diameter.TEM bulk analysis is representative of the fine grained matrix material and may not be representative of non-
uniformly dispersed debris for which PLM evaluation is recommended(i.e.soils and other heterogenous materials).
SPECTRVA
P.O., sox 1024
S Schenectady,NV12301301
E (518)346-6374(Phone)
R Environmental issodates.Inc. (518)346-4062(Far)
'EXCEEDING OuR CLIENTS EXPECTOrlONS of EXCELLENCE'
wtvw.4spectrum.com
BULK SAMPLING CHAIN OF CUSTODY (IP.3/1,14)
PROJEC'I'INTORNIATION
I'mjcct Il; _��� iWrfi1T Rlbcr:
.a Analysis Requested Turnaround
Untc Snniplcd:� �� �� Ilm�ld* 1,-1 /}S•.M ` l.ucarion: �' J'YC S rl�e� Uti `
`��J ryfi' f PLM—I'sLAP 198.1 71:M—FLAP 198.4 ❑ RUSH ❑ 24 Hour
1'agc lr UI. Start: Lind: IFI'0 Invemigm,
1 �c tC PLM—L'LAP 198.6 ❑ ❑ 72 Ilour
SAIMPLE IDEWIFICATION
Sample ID 9: Group N:" Material Sample Location Condition
Om Una . 16 cost
I 11 IZm. 003 O(
i , 005 �'ecIn �
`� rn, 10 I End Iue cC I
'7 6cc• m, /Or E c cne
9 q t -0'v- 64emir NE
E e- - NE .0 e
ll ( ) ° 6mAe,
l d �u .(Ar-
066 S alr
lr m• ws
Jr- t F 00� ► Ulf .e' LAX0,
6 D uAlit'rWad ,n r
*Unless alheruise stated please nnnlyic each group to first(1")positive result.
Comments: # 222092243 .
CHAIN CU "
I Odic y XD n de 'Time Received By Dale 'Time Method of Submittal
1 f n i /. c7=
I I
111 ( et.,
Environmental Consulting A Management Services •.Ilealth h Safety Training • Laboratory Services
S SPECTRVA P.O.Box 1024
SchenecfadY,N912301
P (518)346-6374(Phone)
a Environmental fissociates. Inc. (518)346-4062(Fax)
'EXCP.EDINC ODR CLIENTS EXPECT/1TIONS OF EXCELLENCE' Wlvrv.4spectrum.com
BULI{ SAMPLING CHAIN OF CUSTODY (tP-3I1I14)
PROJECT INFORNIA'rION
rra�ca na 'rrcm- Analysis Requested Turnaround
Uatn Sanq,led: Uwldinb: l.ocauon:
X PLM—ELAP 198.1 'I'I:M—ELAP 198.4 ❑ RUSH ❑ 24 hour
Page a ol. tr,vestigamr.Jd PI_M—ELAP 198.6 ❑ ❑ 72 I-lour G R
SAMPLE IDENTIFICATION
Samplee7ID 11: Group M: Material Sample Location Condition
( 8 1C 11G Wc, rn, IQ tF PG�Ct1Li
x/' c i t A k en i o—� Feet Tr e �
II it
11121 lb 51ny, s•n - it e- 10
:2A to j1 m, 10
11 lti A-\ -rctf Na4k rpeoc c'
41Atl
(is 'em, ll
I 19, 11 f IOC SC h Facade,
l cs L
11
,> I v,
1S z>,j 5 kl n s Zed - &. e-,kd
11 - F eo
*Unlcis otherwise stated please analyze each group to first(1")positive result.
an,n,cnls: # 2 2 2 0 9 2 2 4 3
CIIAIN - 1 TODY
IAl I' qui ed By )It Time Recc' d By Dale Time Method of Submittal
t I ) n - ' is,-�D
l l
m Q •p• rGC'
Environmental Consulting A.Management Services • llealth&Safety Training • Laboratory Services
SPECTRV
P.O.P V12301
S � Schenectady, 2301
8 A Environmental flssociates. Inc. (518)346-6374(Phone)
(518)346-4062(Pax)
'Excecai,vc Opa Celexrs ExpeeTrrrlaxs of Exeeetence'
unm4spectrum.com
BULK SAMPLING CHAIN OF CUSTODY (IP-9,1,14)
PROJECT INFORMATION
Prnl«I u:
da —() Analysis Requested 'Turnaround
llwc Snm�c ^ Iluilding:� f�`Jr�` l.ocalion: )f E14
oC H�7C IY_J 11. ` VI C V(Q +PLM—TiLAP 198.1 t'I'I:M—ELAP 198.4 ❑ ItUS11 ❑ 24 Flour
1'agc tl 01. 'gnat"' Invcstigator.•�
C'C4 i PLM-GLAI'1>8.6 ❑ ❑ 72 Hour
SAMPLE ID►MI'H'ICATION
Sample 11)4. Group 9: ' Material Sample Location Condition
F -I nQ rn
*Unless olhenvi.se stated please analyze each group to first(1")positive result.
I....ou"',
# 22209 2243
CHAIN JSTODY
I uis d 13y Datl Tinle Rcc ' ed By Date "Time Method of Submittal
l l
Environmental Consulting A.Management Services • Health&Safety Training • Laboratory Services
LICENSING AND CERTIFICATION
P.0.Box 1024
Schenectady,W 12301
SPECTRVAI (518)346-6374(Phone)
FWAgnmental Issociates, Inc. (518)346-4062(Far)
'EXCEEDING OUR CLIENTs EXPEMITIONS of EXCELLENCE' wmm4spectrum.com
State of New York— Department of Labor
Asbestos Certification
STATE OFNEW YORK=DEPARTMENT QFLABOR
ASBESTOS CERTIFICATE L _ ' _-j
JASON R TEAGLE
CLASS(EXPIRES)
C ATEC(01/23) D INSP(01/23)
H PM (01/23) 1 PD (01/23) -
CER1d 00-07903
OM V# 366627.3•i
MUST BE CARRIED ON ASBESTOS PROJECTS
� uum�inamm�nnn J
State of New York— Department of Labor
Codes Certification
A Asbestos Handler
B Restricted Handler -.Allied Trades
C Air Sam ling Technician
D Inspector
E Management Planner
F Operations and Maintenance
G Supervisor
H Project Monitor
I Project Designer
Environmental Consulting&Management Services • Health &Safety Training • Laboratory Services
New-York State •Department of.Labor"_ .
; Division of Safety and Health.1
1 License and Certificate Unit
1 State Campus,Buildinb 12' >
r-- Albany,NY 12240
4
-ASBESTOS HANDLING LICENSE
Spectrum-Environmental Associates;Inc: .;` ------FILE NUMBER: 99-0129.,
LICENSE NUMBER: 29081 "
P:,O. Box.1024 _";'a `:*'`''= j: LICENSE CLASS: RESTRICTED,
DATE OF ISSUE: 02/02/2022
Sdhen_ectady,.NY 12301 EXPIRATION DATE: 02/28/2023
,t':J
10
• i" � j a` y!/ i,�•={`:�'," - ,, '�� ;lit •��
Duly-Authorized Representative`=William 'Wasysmann:_ -
ti f
` / 1 `j I ;r•; ' : � '� 'i`ftr-~r�',''''.[•'';a,•'ir 1,y t,•Y"[1j^' ,'-{ i i - - •, ,
This license has been issued in accordance:with applicable provisons;ofArfi'c1e3,0,'of the Labor Law of New York State and of
the New York State Codes,Rules'and'Regulations'(12 NYCRR Part`56)" It ig-subject to suspension or revocation for a(1)
serious"violation of state,federal or local laws wtli 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 nained:above and''this license or a'=phofocopy must_be_p omineritly displayed'at the
asbestos project worksite.`This license verifies that/all persons-employed by-the lick see on an-asbestos,project in New York
State have been'issued an Asbestos Certificate;appropriate for Ihe,type-of work"they perform,by the New York.State
Department of Labor. - —
- y• fir- t�
Amy Phillips,Director
SH 432(8/12) For the Commissioner of Labor
_-NEW YORK STATE DEPARTMENT OF HEALTH
WADSWORTH CENTER -
Expires 12 01 AM April 01,2023-
_ Issued April 01, 2022
r
-:: - CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued in accordance with and pursuant to section 502 Public Health Law of New York State
MR. PAUL J MUCHA NY Lab Id No: 11480 -
=.=- AMERICA SCIENCE TEAM NEW YORK, INC
117€AST 30TH ST
NEW YORK, NY 1-0016
is hereby APPROVED as an Environmental Laboratory for the,category
ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE =
All approved-subcategories andlor analytes are listed below: _
°-Miscellaneous - - - -
Asbestos-in Fnabfe-Matedal Item 198.1 of Manual
EPA 600/M4/82/020
Asbestos in Non-Friable Material-PLM Item 198.6 of Manual(NOB by PLM)-
Asbestos in Nan-Friable Material-TEM Item 198.4 of Manual
Serial No.: 64683
Property of the New York State Department o1 Health. Certificates are valid only at tha address
- shaWn,must be conspicuously posted,and are printed-96 secure paper. Continued accreditation depends
n successful ongoing.particlpation in the Program. Consumers are urged to call(518)485-557'0 to-
%erify the laboratorys acened t-atfon status.
SOILS ANALYSIS — TEST PIT AND PERCOLATION T ST DATA
SOIL TEST PITS WERE PERFORMED BY THE ENVIRONMENTAL DESIGN
PARTNERSHIP ON AUGUST 22, 2022 THE RESULTS IVERE AS FOLLOWS:
T",
O — B" ORGANIC MATERIAL LOAMY SAND TOPSOIL
B•• — 48" LICHTBROWSN FINE LOAMY SAND:. FIRMER. WITH. DEPTH
NO SIGNS OF SEASONAL HIGH GROUNDWATER :OR. BEDROCK
TP Z
0" — 70• ORGANIC MA TERUL/LOAMY SAND TOPSOIL
f0" 48' LICHT BROWN FINE LOAMY SAID,FIRMER WITH DEPTH
NO SIGNS OF SEASONAL HIGH GROUNDWATER OR BEDROCK
THE FOLLOWING INFILTRATION TESTS WERE PERFORMED BY THE
ENVIRONMENTAL OESICN PARTNERSHIP ON AUGUST 22, 2022--
ITRI
STABILIZATION RATE :OF 96 INCHES PER HOUR
AZ-
STTABILIZATION RATE OF 80 INCHES PER HOUR
MAP R F R N :
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