If the address on this form is different than the address of the building, submit a written explanation.

Transcription

1 ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: SCHOOL NAME: Courtenay School ADDRESS OF SCHOOL: 1726 W Berteau Avenue CITY: Chicago, IL, DATE LAST THREE YEAR REINSPECTION WAS COMPLETED 3/11/2010 If the address on this form is different than the address of the building, submit a written explanation. SECTION II (Please type or print) PLEASE COMPLETE THE FOLLOWING FOR YOUR THREE YEAR REINSPECTION: DATE REINSPECTION COMPLETED: 4/19/2013 ENROLLMENT 634 IDPH INSPECTOR LICENSE NUMBER: IDPH LICENSED INSPECTOR NAME (Please Print): IDPH MP LICENSE NUMBER: Roberto Rivera IDPH LICENSED MANAGEMENT PLANNER NAME (Please Print): Jigar Shah DESIGNATED PERSON (Please Print): Ms. Lynn Crivello PHONE: (773) /19/2013 Signature of Designated Person Date SECTION III PLEASE COMPLETE THE FOLLOWING INFORMATION FOR ANY CHANGES WITHIN THE SCHOOL DISTRICT. School building has been sold. Date of Sale: School has been closed. Date closed: School building has been demolished. Date: School building is asbestos free since last reinspection: Please explain in writing why the school building is now asbestos free and include the supporting documentation. If a new school building has been added to the district, submit either and exclusionary statement or a management plan and inspection report. Include the complete name, address and city of school building. Explain in writing if the address of the building is different than the address on this form: IL Revised 10.03

2 THREE YEAR REINSPECTION CHICAGO SCHOOL DIST 299 Courtenay School 1726 W Berteau Avenue Chicago, IL, Unit: Building ID: 7910 IDPH ID Number: REPORT DATE: Friday, April 19, 2013 Prepared for: Chicago Public Schools 125 S. Clark Street Chicago, IL Prepared by: 855 W. Adams St., Ste. 200 Phone (312) Fax (312) DO NOT REMOVE FROM SCHOOL REQUIRED BY FEDERAL LAW

3 March 1, 2013 Mr. R. Kent Cook Asbestos Program Illinois Department of Public Health 525 West Jefferson Street Springfield, Illinois Re: Chicago Public Schools Three-Year Reinspections Dear Mr. Cook:, Managing Environmental Consultant (MEC), conducted the Three-Year Reinspections and performed management plan updates for the Chicago Public Schools (CPS) facilities in Region 1,2,6 Elementary Schools. Please update your records with the following information. School District: 299 Unit: Region: 01 IDPH ID: School: Courtenay School Building ID: 7910 Address: 1726 W Berteau Avenue Chicago, IL, Building Contact: Contact Phone: Current Building Owners: Chicago Public Schools Review Date: 4/19/2013 Inspector: Roberto Rivera Inspector IDPH License: Management Planner: Jigar Shah Management Planner IDPH License: If you have any questions or comments, please contact us at (312) Sincerely, Jigar Shah

4 Environmental Notification to Occupants To: Faculty, Staff and Parents From: Chicago Public Schools Date: March 01, 2013 RE: Courtenay School, Unit W Berteau Avenue Chicago, IL, Dear Faculty, Staff and Parents, This letter is to notify you that the 2013 asbestos three year re-inspection has been completed at Courtenay School, following the Federal Asbestos Hazard Emergency Response Act (AHERA), 40 CFR Part 763, Subpart E and is available for your review at the main office of the school. Although asbestos-containing materials have been identified at Courtenay School, there is no reason to believe that any threat to the health of students or staff exists at this time. CPS will continue to carefully monitor the condition of asbestos-containing materials and if conditions warrant, all appropriate steps will be taken to maintain the health and safety of all building occupants. If you have any questions regarding this matter or require additional information, please feel free to contact Ms. Lynn Crivello, the designated Local Education Authority's Designated Person at (773)

5 Table of Contents I. School and Inspection Information II. III. IV. Executive Summary Methodology Abatement History V. Reassessments and Recommendations VI. Conclusions Table I: Inspector's Reinspection Findings Table II: Management Planner's Review APPENDICES: Appendix A: Appendix B: Appendix C: Appendix D: Appendix E: Assessment Sheets, Drawings and Photos Inspector and Management Planner Licenses Laboratory Accreditations Laboratory Results Chain of Custody Forms

6 SCHOOL AND INSPECTION INFORMATION 1. School Information School: Courtenay School Unit: Region: 01 Address: 1726 W Berteau Avenue Chicago, IL, IDPH ID: Building ID: 7910 Contact: Phone: 2. Description of Facility Original Construction: Additional Construction: Total Square Footage: No of Floors: 1 Current Occupancy: LEA Designated Person Contact: Ms. Lynn Crivello Phone: (773) Address: 125 South Clark Street, 17th Floor Chicago, IL Managing Environmental Consultant MEC: Contact: Arturo Saenz Address 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) Inspector Inspector Name: Roberto Rivera Signature: Inspector IDPH license # Date: 3/1/ Management Planner Management Planner Name: Jigar Shah Signature: Management Planner IDPH license # Date: 4/19/ Review Date: 4/19/ LEA Designated Person's Acknowledgement The reinspection report and recommendations have been received by me and appropriate action will be taken by the School District. Signature: Date: 4/19/2013 Name: Ms. Lynn Crivello Unit : Courtenay School Building: 7910

7 II. EXECUTIVE SUMMARY was retained by the Chicago Public Schools (CPS) to perform a threeyear asbestos reinspection of the Courtenay School. This inspection was conducted in accordance with the United States Environmental Protection Agency (USEPA) Asbestos Hazard Emergency Response Act (AHERA) part (b), and the ongoing Operations and Maintenance Program (O&M) originally designed in the School's Asbestos Management Plan. The purpose of this three-year reinspection is to record any condition changes in the asbestos-containing building material (ACBM) in the school since the previous three-year reinspection and the six-month periodic surveillance, to identify, assess, and include any Homogeneous Areas (HA) not identified in the Management Plan, and to recommend an appropriate response action to manage asbestos. The inspector conducted a three-year reinspection of this facility under Illinois Department of Public Health (IDPH) school reinspection requirements and AHERA, sections and The main building and each addition to the main building, if constructed at different dates, were inspected separately. Laboratory accreditations are included in Appendix C, laboratory results are included in Appendix D, and chain of custody forms are included in Appendix E. Note: During previous inspections, some of the HA(s) were identified together as 9" x 9" floor tile (FT), mastics assoc. with 9" x 9" FT, 12" x 12" FT, mastics assoc. with 12" x 12" FT, pipe insulation, etc. Some of these HA(s) have been re-identified by areas that are uniform in color, texture, construction date, application date, and general appearance. The inspector has determined the following: A. The following HAs have changed assessment categories for Building 7910: Unit: Courtenay School Building: 7910

8 B. The following new homogenous areas have been identified for Building 7910: 13 12" X 12" off-white with light gray streaks VFT 13A 12" X 12" off-white with light gray streaks, mastic 14 12" X 12" beige with white streaks VFT 14A 12" X 12" beige with white streaks, mastic Unit: Courtenay School Building: 7910

9 C. This reinspection covered only physically accessible and visible areas and materials that were identified in the LEA's management plan. The following materials were concealed and/or contained in areas that were inaccessible for sampling and have been classified as Assumed: 10 12"x12" Green w/ Specks VFT 11 12"x12" Green w/ Specks VFT Mastic 12 Terrazo 13 12" X 12" off-white with light gray streaks VFT 13A 12" X 12" off-white with light gray streaks, mastic 14 12" X 12" beige with white streaks VFT 14A 12" X 12" beige with white streaks, mastic The following areas were deemed to be inaccessible: 02 Spray Applied Acoustical Plaster A Aircell Pipe Insulation C MJP on Aircell Pipe Insulation Materials were also listed as "assumed" if they were in good condition and sampling was not conducted to avoid damage. This reinspection was conducted by Roberto Rivera, IDPH License # The Management Plan was updated by Jigar Shah, IDPH License # Inspector and Management Planner Licenses are included in Appendix B. Unit: Courtenay School Building: 7910

10 III. METHODOLOGY Tasks performed on-site included the following: 1. Review current management plan, identify HA(s) and extract appropriate information. 2. Examine and verify abatement records. 3. Touch and visually and physically reinspect and reassess the condition of all friable known or assumed ACBM. 4. Touch and visually and physically reinspect all non-friable known or assumed ACBM to determine whether these materials have become friable since the last inspection or periodic surveillance. 5. Identify any condition changes that may affect Hazard Ranking of known ACBM or Assumed ACBM, as well as any HA(s) that have become friable since the last reinspection. 6. Collect bulk samples from each newly discovered friable HA or previously assumed and submit for laboratory analysis. 7. Tabulate reinspection findings and submit for management planner review and recommendations with appropriate response actions based on the AHERA Damage Category of the ACBM. 8. Submit reinspection findings and management planner recommendations to the LEA within thirty (30) days for inclusion into the management plan. IV. ABATEMENT HISTORY The information collected from the existing management plan and inspection report(s) and from interviews with the school official revealed that the following asbestos abatement was conducted at the school since the previous Three year Reinspection. Abatement Dates: V. REASSESSMENTS AND RECOMMENDATIONS The reassessments and recommendations are summarized in Tables I and II on the following pages. Detailed Hazard Assessment Sheets and Drawings and Photos (if applicable) are included in Appendix A. VI. CONCLUSIONS The Courtenay School Building 7910 Three-Year reinspection has been completed and response actions have been recommended for both friable and non-friable materials. A timely execution of the response actions recommended will enable the LEA and the Designated Person(s) to effectively manage the existing ACBM. This three-year reinspection report should be inspected in the current Management plan at the CPS Central Office, and one (1) copy should be kept at the school for use when planning any renovation and/or demolition activities in areas where ACBM has been identified. Also, periodic surveillance documentation and any summary reports from any response actions that are executed at the school should be used to update the Management Plan. Unit: Courtenay School Building: 7910

11 Table I Inspector's Reinspection Findings

12 School Courtenay School Unit Building ID 7910 Address 1726 W Berteau Avenue Region 01 ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS Inspector's Reinspection Findings Table 1 Managing Environmental Consultant (MEC) 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) Inspector's Comments are Summarized at the End of the Report HA No Material Description Material Quantity Material Units Material Location 02 Spray Applied Acoustical Plaster 3,700 SF 1st, 2nd, & 3rd Floor Corridors Above Hard Plasters 04 9"x9" Tan w/ White & Brown Speckles 16,260 SF Throughout (See VFT Hatching Maps); 05 9" x 9" Green w/ White Speckles VFT 3,754 SF Throughout (See Hatching Maps) 06 9"x9" Tan w/ White & Brown Speckles 16,860 SF Throughout (See VFT Mastic Hatching Maps) 07 9"x9" Green w/ White Speckles VFT 3,754 SF Throughout (See Mastic Hatching Maps) Asbestos Type Material Category Friable Damage Type Damage Quantity Damage Units Change in Assessment Category CHR MISC Y NONE 0 No ACBM with the potential for damage CHR MISC N NONE 0 No ACBM with the potential for damage CHR MISC N NONE 0 No ACBM with the potential for damage CHR MISC N NONE 0 No ACBM with the potential for damage CHR MISC N NONE 0 No ACBM with the potential for damage 08 9"x9" Gray w/ White Speckles VFT 352 SF Rooms 301 and 201 CHR MISC N NONE 0 No ACBM with the potential for damage 09 9"x9" Gray w/ White Speckles VFT Mastic 352 SF Room 301 and 201 CHR MISC N NONE 0 No ACBM with the potential for damage 10 12"x12" Green w/ Specks VFT 300 SF MDF Room 210 ASSUMED MISC N NONE 0 No ACBM with the potential for damage 11 12"x12" Green w/ Specks VFT Mastic 300 SF MDF Room 210 ASSUMED MISC N NONE 0 No ACBM with the potential for damage 12 Terrazo 3,500 SF Stairwells, Food ASSUMED MISC N NONE 0 No ACBM with the Prep (Kitchen) Area; potential for damage Boys and Girls Toilets on 1st, 2nd, and 3rd Floors, Vestibules 13 12" X 12" off-white with light gray streaks VFT 13A 12" X 12" off-white with light gray streaks, mastic 2,500 SF Room 111, elevator, main office, and main- office toilet 2,500 SF Room 111, elevator, main office, and main- office toilet 14 12" X 12" beige with white streaks VFT 2,000 SF First, second, and third floor corridors by elevator, Room 108, storage by Room A 12" X 12" beige with white streaks, mastic 2,000 SF First, second, and third floor corridors by elevator, Room 108, storage by Room 108 A Aircell Pipe Insulation 200 LF 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & ASSUMED MISC N NONE 0 No ACBM with the potential for damage ASSUMED MISC N NONE 0 No ACBM with the potential for damage ASSUMED MISC N NONE 0 No ACBM with the potential for damage ASSUMED MISC N NONE 0 No ACBM with the potential for damage CHR TSI Y NONE 0 No ACBM with the potential for damage Damage Category Damage Reason Disturbance Potential LOW MODERATE MODERATE LOW LOW MODERATE LOW LOW LOW MODERATE MODERATE LOW LOW LOW LOW

13 School Courtenay School Unit Building ID 7910 Address 1726 W Berteau Avenue Region 01 ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS Inspector's Reinspection Findings Table 1 Managing Environmental Consultant (MEC) 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) Inspector's Comments are Summarized at the End of the Report HA No Material Description Material Quantity Material Units Material Location Girl's Toilet (Throughout inaccessable) B MJP E/F/V on Fiberglass Pipe Insulation 50 LF 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet; Boiler Rm; Kitchen Storage to Material Location C MJP on Aircell Pipe Insulation 20 LF 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet (Throughout inaccessable) Asbestos Type Material Category Friable Damage Type Damage Quantity Damage Units Change in Assessment Category CHR TSI Y NONE 0 No ACBM with the potential for damage CHR TSI Y NONE 0 No ACBM with the potential for damage Damage Category Damage Reason Disturbance Potential LOW LOW

14 School Courtenay School Unit Building ID 7910 Address 1726 W Berteau Avenue Region 01 ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS Inspector's Reinspection Findings Table 1 Managing Environmental Consultant (MEC) 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) Inspector's Comments are Summarized at the End of the Report Reinspection Date 3/1/2013 Inspector Name Roberto Rivera /15/2013 Inspector's IDPH License Number / Expiration Date Inspector's Comments HA Number: Inspector Comments: According to the Engineer, this floor tile was placed over the 9 X 9 flooring. 13A 14 14A A B C

15 Table II Management Planner's Review

16 School Courtenay School Unit Building ID 7910 Address 1726 W Berteau Avenue Chicago, IL, Region 01 ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS Management Planner's Review Table II Managing Environmental Consultant (MEC) 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) Management Planner's Comments Summarized at the End of the Report HA Material Description Material Material Material Location Asbestos Material Friable Damage Damage Damage Category Response Num Quantity Units Type Category Quantity Units 02 Spray Applied Acoustical Plaster 3,700 SF 1st, 2nd, & 3rd Floor Corridors Above Chrysotile MISC Yes 0 SF 6 ACBM with the potential for damage Operations and Maintenance Hard Plasters 04 9"x9" Tan w/ White & Brown Speckles VFT 16,260 SF Throughout (See Hatching Maps); Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 05 9" x 9" Green w/ White Speckles VFT 3,754 SF Throughout (See Hatching Maps) Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 06 9"x9" Tan w/ White & Brown Speckles VFT Mastic 16,860 SF Throughout (See Hatching Maps) Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 07 9"x9" Green w/ White Speckles VFT Mastic 3,754 SF Throughout (See Hatching Maps) Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 08 9"x9" Gray w/ White Speckles VFT 352 SF Rooms 301 and 201 Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 09 9"x9" Gray w/ White Speckles VFT Mastic 352 SF Room 301 and 201 Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 10 12"x12" Green w/ Specks VFT 300 SF MDF Room 210 Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 11 12"x12" Green w/ Specks VFT Mastic 300 SF MDF Room 210 Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance 12 Terrazo 3,500 SF Stairwells, Food Prep (Kitchen) Area; Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance Boys and Girls Toilets on 1st, 2nd, and 3rd Floors, Vestibules 13 12" X 12" off-white with light gray streaks VFT 2,500 SF Room 111, elevator, main office, and Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance main- office toilet 13A 12" X 12" off-white with light gray streaks, mastic 2,500 SF Room 111, elevator, main office, and Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance main- office toilet 14 12" X 12" beige with white streaks VFT 2,000 SF First, second, and third floor corridors Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance by elevator, Room 108, storage by Room A 12" X 12" beige with white streaks, mastic 2,000 SF First, second, and third floor corridors Assumed MISC No 0 SF 6 ACBM with the potential for damage Operations and Maintenance by elevator, Room 108, storage by Room 108 A Aircell Pipe Insulation 200 LF 1st, 2nd, 3rd Floor Corridors Above Chrysotile TSI Yes 0 LF 6 ACBM with the potential for damage Operations and Maintenance Plaster, Boy's & Girl's Toilet (Throughout inaccessable) B MJP E/F/V on Fiberglass Pipe Insulation 50 LF 1st, 2nd, 3rd Floor Corridors Above Chrysotile TSI Yes 0 LF 6 ACBM with the potential for damage Operations and Maintenance Plaster, Boy's & Girl's Toilet; Boiler Rm; Kitchen Storage to Material Location C MJP on Aircell Pipe Insulation 20 LF 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet (Throughout inaccessable) Chrysotile TSI Yes 0 LF 6 ACBM with the potential for damage Operations and Maintenance

17 School Courtenay School Unit Building ID 7910 Address 1726 W Berteau Avenue Chicago, IL, Region 01 ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS Management Planner's Review Table II Managing Environmental Consultant (MEC) 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) Management Planner's Comments Summarized at the End of the Report Review Date 4/19/2013 Manager Planner Name Jigar Shah /15/2013 Manager IDPH License No/Expiration HA Number Management Comments

18 School Courtenay School Unit Building ID 7910 Address 1726 W Berteau Avenue Chicago, IL, Region 01 ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS Management Planner's Review Table II Managing Environmental Consultant (MEC) 855 W. Adams St., Ste. 200 Phone: (312) Fax: (312) HA Number A 14 14A A B C Management Comments Management Planner's Comments Summarized at the End of the Report

19 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 02 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY Spray Applied Acoustical Plaster 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: Yes RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: LOW 1st, 2nd, & 3rd Floor Corridors Above Hard Plasters MATERIAL QUANTITY: 3700 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

20 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 02 MATERIAL DESCRIPTION: MATERIAL LOCATION: Spray Applied Acoustical Plaster 1st, 2nd, & 3rd Floor Corridors Above Hard Plasters MATERIAL QUANTITY: 3700 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

21 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 04 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: 9"x9" Tan w/ White & Brown Speckles VFT 6 ACBM with the potential for damage Physical Damage Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: MODERATE Throughout (See Hatching Maps); MATERIAL QUANTITY: MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

22 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 04 MATERIAL DESCRIPTION: MATERIAL LOCATION: 9"x9" Tan w/ White & Brown Speckles VFT Throughout (See Hatching Maps); MATERIAL QUANTITY: MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

23 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 05 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY 9" x 9" Green w/ White Speckles VFT 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: MODERATE Throughout (See Hatching Maps) MATERIAL QUANTITY: 3754 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

24 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 05 MATERIAL DESCRIPTION: MATERIAL LOCATION: 9" x 9" Green w/ White Speckles VFT Throughout (See Hatching Maps) MATERIAL QUANTITY: 3754 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

25 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 06 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: 9"x9" Tan w/ White & Brown Speckles VFT Mastic 6 ACBM with the potential for damage Physical Damage Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: LOW Throughout (See Hatching Maps) MATERIAL QUANTITY: MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

26 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 06 MATERIAL DESCRIPTION: MATERIAL LOCATION: 9"x9" Tan w/ White & Brown Speckles VFT Mastic Throughout (See Hatching Maps) MATERIAL QUANTITY: MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

27 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 07 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY 9"x9" Green w/ White Speckles VFT Mastic 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: LOW Throughout (See Hatching Maps) MATERIAL QUANTITY: 3754 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

28 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 07 MATERIAL DESCRIPTION: MATERIAL LOCATION: 9"x9" Green w/ White Speckles VFT Mastic Throughout (See Hatching Maps) MATERIAL QUANTITY: 3754 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

29 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 08 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY 9"x9" Gray w/ White Speckles VFT 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MODERATE MATERIAL LOCATION: Rooms 301 and 201 MATERIAL QUANTITY: 352 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

30 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 08 MATERIAL DESCRIPTION: 9"x9" Gray w/ White Speckles VFT MATERIAL LOCATION: Rooms 301 and 201 MATERIAL QUANTITY: 352 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

31 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 09 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY 9"x9" Gray w/ White Speckles VFT Mastic 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: LOW MATERIAL LOCATION: Room 301 and 201 MATERIAL QUANTITY: 352 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

32 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 09 MATERIAL DESCRIPTION: 9"x9" Gray w/ White Speckles VFT Mastic MATERIAL LOCATION: Room 301 and 201 MATERIAL QUANTITY: 352 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

33 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 10 MATERIAL DESCRIPTION: 12"x12" Green w/ Specks VFT HISTORICAL AHERA DAMAGE CATEGORY 6 HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: ASBESTOS TYPE: Assumed FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: LOW MATERIAL LOCATION: MDF Room 210 MATERIAL QUANTITY: 300 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

34 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 10 MATERIAL DESCRIPTION: 12"x12" Green w/ Specks VFT MATERIAL LOCATION: MDF Room 210 MATERIAL QUANTITY: 300 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Comments: Management Planner's Signature: Date: 04/19/2013

35 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 11 MATERIAL DESCRIPTION: 12"x12" Green w/ Specks VFT Mastic HISTORICAL AHERA DAMAGE CATEGORY 6 HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: ASBESTOS TYPE: Assumed FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: LOW MATERIAL LOCATION: MDF Room 210 MATERIAL QUANTITY: 300 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

36 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 11 MATERIAL DESCRIPTION: 12"x12" Green w/ Specks VFT Mastic MATERIAL LOCATION: MDF Room 210 MATERIAL QUANTITY: 300 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Comments: Management Planner's Signature: Date: 04/19/2013

37 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: 12 MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY Terrazo 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Assumed FRIABLE: No RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: MODERATE Stairwells, Food Prep (Kitchen) Area; Boys and Girls Toilets on 1st, 2nd, and 3rd Floors, Vestibules MATERIAL QUANTITY: 3500 MATERIAL UNITS: SF DAMAGE QUANTITY: DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

38 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 12 MATERIAL DESCRIPTION: MATERIAL LOCATION: Terrazo Stairwells, Food Prep (Kitchen) Area; Boys and Girls Toilets on 1st, 2nd, and 3rd Floors, Vestibules MATERIAL QUANTITY: 3500 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

39 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY A Aircell Pipe Insulation 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: Yes RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: LOW 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet (Throughout inaccessable) MATERIAL QUANTITY: 200 MATERIAL UNITS: LF DAMAGE QUANTITY: DAMAGE UNITS: LF COMMENTS: Inspector's Signature: Date: 03/01/2013

40 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: MATERIAL DESCRIPTION: MATERIAL LOCATION: A Aircell Pipe Insulation 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet (Throughout inaccessable) MATERIAL QUANTITY: 200 MATERIAL UNITS: LF DAMAGE QUANTITY: 0 DAMAGE UNITS: LF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

41 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY B MJP E/F/V on Fiberglass Pipe Insulation 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: Yes RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: LOW 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet; Boiler Rm; Kitchen Storage to Material Location MATERIAL QUANTITY: 50 MATERIAL UNITS: LF DAMAGE QUANTITY: DAMAGE UNITS: LF COMMENTS: Inspector's Signature: Date: 03/01/2013

42 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: MATERIAL DESCRIPTION: MATERIAL LOCATION: B MJP E/F/V on Fiberglass Pipe Insulation 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet; Boiler Rm; Kitchen Storage to Material Location MATERIAL QUANTITY: 50 MATERIAL UNITS: LF DAMAGE QUANTITY: 0 DAMAGE UNITS: LF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

43 2013 AHERA REINSPECTION Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM PREVIOUS INSPECTION HOMOGENEOUS AREA: MATERIAL DESCRIPTION: HISTORICAL AHERA DAMAGE CATEGORY C MJP on Aircell Pipe Insulation 6 ACBM with the potential for damage HISTORICAL DAMAGE REASON: HISTORICAL RESPONSE ACTION: Operations and Maintenance ASBESTOS TYPE: Chrysotile FRIABLE: Yes RESULTS OF REINSPECTION AND REASSESSMENT This homogeneous area was reinspected and reassessed in accordance with Section and of AHERA and it's condition HAS NOT CHANGED when compared to the conditions of the last AHERA reinspection. The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage DAMAGE REASON: DISTURBANCE POTENTIAL: MATERIAL LOCATION: LOW 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet (Throughout inaccessable) MATERIAL QUANTITY: 20 MATERIAL UNITS: LF DAMAGE QUANTITY: DAMAGE UNITS: LF COMMENTS: Inspector's Signature: Date: 03/01/2013

44 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: MATERIAL DESCRIPTION: MATERIAL LOCATION: C MJP on Aircell Pipe Insulation 1st, 2nd, 3rd Floor Corridors Above Plaster, Boy's & Girl's Toilet (Throughout inaccessable) MATERIAL QUANTITY: 20 MATERIAL UNITS: LF DAMAGE QUANTITY: 0 DAMAGE UNITS: LF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: Operations and Maintenance Comments: Management Planner's Signature: Date: 04/19/2013

45 2013 AHERA REINSPECTION Inspector Assessment Form (New Homogeneous Area) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 13 INFORMATION FROM CURRENT INSPECTION MATERIAL DESCRIPTION: MATERIAL LOCATION: 12" X 12" off-white with light gray streaks VFT Room 111, elevator, main office, and main- office toilet MATERIAL QUANTITY: 2500 MATERIAL UNITS: SF MATERIAL CATEGORY: MISC FRIABLE: No ASBESTOS TYPE: Assumed DISTURBANCE POTENTIAL: MODERATE CONDITION: AHERA DAMAGE CATEGORY: 6 ACBM with the potential for damage ACCESSIBILITY: Within Reach DAMAGE REASON: DAMAGE REASON: DAMAGE REASON: DAMAGE QUANTITY: 0 DAMAGE UNITS: SF COMMENTS: According to the Engineer, this floor tile was placed over the 9 X 9 flooring. Inspector's Signature: Date: 03/01/2013

46 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 13 MATERIAL DESCRIPTION: MATERIAL LOCATION: 12" X 12" off-white with light gray streaks VFT Room 111, elevator, main office, and main- office toilet MATERIAL QUANTITY: 2500 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: COMMENTS: Management Planner's Signature: Date: 04/19/2013

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48 2013 AHERA REINSPECTION Inspector Assessment Form (New Homogeneous Area) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM CURRENT INSPECTION HOMOGENEOUS AREA: MATERIAL DESCRIPTION: MATERIAL LOCATION: 13A 12" X 12" off-white with light gray streaks, mastic Room 111, elevator, main office, and main- office toilet MATERIAL QUANTITY: 2500 MATERIAL UNITS: SF MATERIAL CATEGORY: MISC FRIABLE: No ASBESTOS TYPE: Assumed DISTURBANCE POTENTIAL: LOW CONDITION: AHERA DAMAGE CATEGORY: 6 ACBM with the potential for damage ACCESSIBILITY: Barely Reachable DAMAGE REASON: DAMAGE REASON: DAMAGE REASON: DAMAGE QUANTITY: 0 DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

49 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: MATERIAL DESCRIPTION: MATERIAL LOCATION: 13A 12" X 12" off-white with light gray streaks, mastic Room 111, elevator, main office, and main- office toilet MATERIAL QUANTITY: 2500 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: COMMENTS: Management Planner's Signature: Date: 04/19/2013

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51 2013 AHERA REINSPECTION Inspector Assessment Form (New Homogeneous Area) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 14 INFORMATION FROM CURRENT INSPECTION MATERIAL DESCRIPTION: 12" X 12" beige with white streaks VFT MATERIAL LOCATION: First, second, and third floor corridors by elevator, Room 108, storage by Room 108 MATERIAL QUANTITY: 2000 MATERIAL UNITS: SF MATERIAL CATEGORY: MISC FRIABLE: No ASBESTOS TYPE: Assumed DISTURBANCE POTENTIAL: LOW CONDITION: AHERA DAMAGE CATEGORY: 6 ACBM with the potential for damage ACCESSIBILITY: Within Reach DAMAGE REASON: DAMAGE REASON: DAMAGE REASON: DAMAGE QUANTITY: 0 DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

52 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: 14 MATERIAL DESCRIPTION: 12" X 12" beige with white streaks VFT MATERIAL LOCATION: First, second, and third floor corridors by elevator, Room 108, storage by Room 108 MATERIAL QUANTITY: 2000 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: COMMENTS: Management Planner's Signature: Date: 04/19/2013

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56 2013 AHERA REINSPECTION Inspector Assessment Form (New Homogeneous Area) LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Roberto Rivera SCHOOL NAME: Courtenay School INSPECTION DATE: 3/1/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: INFORMATION FROM CURRENT INSPECTION HOMOGENEOUS AREA: MATERIAL DESCRIPTION: 14A 12" X 12" beige with white streaks, mastic MATERIAL LOCATION: First, second, and third floor corridors by elevator, Room 108, storage by Room 108 MATERIAL QUANTITY: 2000 MATERIAL UNITS: SF MATERIAL CATEGORY: MISC FRIABLE: No ASBESTOS TYPE: Assumed DISTURBANCE POTENTIAL: LOW CONDITION: AHERA DAMAGE CATEGORY: 6 ACBM with the potential for damage ACCESSIBILITY: Barely Reachable DAMAGE REASON: DAMAGE REASON: DAMAGE REASON: DAMAGE QUANTITY: 0 DAMAGE UNITS: SF COMMENTS: Inspector's Signature: Date: 03/01/2013

57 2013 AHERA REINSPECTION Management Planner Review Form LEA NAME: Chicago Public Schools UNIT NUMBER: BUIDLING ID: 7910 CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Jigar Shah SCHOOL NAME: Courtenay School REVIEW DATE: 4/19/2013 ADDRESS: 1726 W Berteau Avenue IDPH LICENSE NO: HOMOGENEOUS AREA: MATERIAL DESCRIPTION: 14A 12" X 12" beige with white streaks, mastic MATERIAL LOCATION: First, second, and third floor corridors by elevator, Room 108, storage by Room 108 MATERIAL QUANTITY: 2000 MATERIAL UNITS: SF DAMAGE QUANTITY: 0 DAMAGE UNITS: SF In accordance with Sections and of the Asbestos Hazard Emergency Response Act (AHERA) the LEA must select a management planner to review the results of the inspection and assessment and recommend appropriate response actions. The original inspection of the above identified homogeneous area has been reviewed in accordance with Sections and with the following recommendations. The RESPONSE ACTION recommendation is: COMMENTS: Management Planner's Signature: Date: 04/19/2013

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61 2013 AHERA REINSPECTION

62 APPENDIX B Inspector and Management Planner Licenses

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