BUILDING A. BUILDING IDENTIFICATION residential 1. Address 2. City 3. State 4. Zip 5. Type of Building 6. Building Size 7. Year Built/Remodel 8. Building Inspector 9. Business Affiliation 10. Address 11. City 12. State 13. Zip 14. Telephone 15. Accreditation 16 Signature 447 SW 5 th Street Pendleton Oregon 97801 Wood '"720 sq. feet 1960's Steven M. Paulsen Paulsen Environmental Consulting, Inc. 2019 Graham Boulevard Vale Oregon 97918-5355 541 473-2243 AI 18024/IMR-15-2065A
BUILDING INSPECTIONS A. BUILDING 1. Date of inspection: 2. Purpose: 3. Scope: 447 SW 5 th Street November 17,2015 To determine the presence of ACBM Asbestos building inspections prior to demolition For Professional use, not an abatement specification B. HOMOGENEOUS AREA (SURFACING MATERIALS) NO ASBESTOS CONTAINING SURFACING MATERIALS LOCATED C. HOMOGENEOUS AREA (THERMAL SYSTEM INSULATION) NO ASBESTOS CONTAINING THERMAL SYSTEM INSULA TlON LOCATED
O. HOMOGENEOUS AREA (MISCELLANEOUS MATERIAL) 1. 2. 3. 4. 5. 6. 7. Location Identification Scheme Photographs Identity of Material Quantity of Material Sampling Scheme Abatement method Kitchen? flooring Attached this page asbestos sheet flooring (top layer) ::::150sq. ft. Random full scale licensed abatement contractor E. BULK SAMPLING 1. 2. 3. 4. Sample 10 Data Sheets Sketches/Sample Loc. Laboratory Information Sample Analysis/Method Attached this Section. Attached this Section. Attached this Section. Polarized Light Microscopy Dispersion Staining Technique.
HOMOGENEOUS AREAS/BULK SAMPLE SUMMARY Area Approx. Sq. Sample ID'sl Asbestos? Description or Un. Ft. # of Samples YeslNo sheet vinyl flooring 150 sq. 1/1 no sheet vinyl flooring 150 sq. 1a/1 YES backing sheet vinyl flooring 600 sq. 2/1 no sheet vinyl flooring 600 sq. 2a/1 no mastic tan sheet vinyl 12 sq 311 no flooring yellow mastic 12 sq. 3a/1 no sheetrock 300 sq. 4,5,6/3 no roof coating 720 sq. 7/1 no
2033 HERIT,A,GE PARK DR, OKLAHOMA CITY, OK 73120 1.800,822.1650 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 257081 Client: Paulsen Environmental Consulting Account Number: B041 2019 Graham Blvd. Vale, OR 97918 Date Received: 1111912015 Received By: Jeff Mlekush Date Analyzed: 1112012015 Project: City of Pendleton Analyzed By: Dee Ammerman Project Location: 447 SW 5th Pendleton, OR Methodology: EP N600/R-93/116 Project Number: N/A QuanTEM Client Color / Non-Asbestos Non Fibrous Sample ID Sample ID Composition Description Asbestos (%) Fiber (%) 001 Layered Multi-Color Asbestos Not Present Cellulose 10 CaC03 Sheet Vinyl Synthetic 15 Vinyl OOla Layered White Asbestos Present Cellulose 30 Binder Sheet Vinyl Backing Chrysotile 60 002 2 Layered Brown Asbestos Not Present Cellulose 25 CaC03 Sheet Vinyl Vinyl 002a Layered Brown Asbestos Not Present NA Glue Mastic 003 3 Layered Tan Asbestos Not Present Cellulose 15 CaC03 Sheet Vinyl Vinyl 003a Layered Yellow Asbestos Not Present NA Glue Mastic 004 4 Homogeneous White Asbestos Not Present Cellulose 15 Gypsum Sheetrock Glass Fiber 2 Paint Unless otherwise noted, upon receipt the condition of the sample was acceptable for analysis. QuanTEM is a NVLAP accredited PLM laboratory (Lab Code: 101959-0), This report relates only to the specific items tested, NVLAP accreditation applies only to analysis performed utilizing EPAl6001M4-82-020 and EPAl600/R-93/116 methods, This report may not be used to claim product endorsement by NVLAP or any agency of the US Government. This report may not be reproduced except in full, without the written approval of the laboratory, Page 1 of 2
2033 HERIT!-\GE P"''\K DR, OKLAHOMA CITY, OK 73120 1.800.822.1650 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 257081 Account Number: B041 Date Received: 1111912015 Received By: Jeff Mlekush Date Analyzed: 1112012015 Analyzed By: Dee Ammerman Methodology: EPN6001R-93/116 Project: Project Location: Project Number: Client: City of Pendleton 447 SW 5th Pendleton, OR N/A Paulsen Environmental Consulting 2019 Graham Blvd. Vale, OR 97918 QuanTEM SampleID Client SampleID Composition Color I Description Asbestos (%) Non-Asbestos Fiber (%) Non Fibrous 005 5 Homogeneous White Asbestos Not Present Cellulose 15 Gypsum Sheetrock Glass Fiber 2 Paint 006 6 Homogeneous White Asbestos Not Present Cellulose 15 Gypsum Sheetrock Glass Fiber 2 Paint 007 7 Homogeneous Silver Asbestos Not Present Cellulose 3 CaC03 Roofing Paint Binder U, 4~ 1112012015 Dee Ammerman, Analyst Date of Report Unless otherwise noted, upon receipt the condition of the sample was acceptable for analysis. QuanTEM is a NVLAP accredited PLM laboratory (Lab Code: 101959-0). This report relates only to the specific items tested. NVLAP accreditation applies only to analysis performed utilizing EPAl6001M4-82-020 and EPAl6001R-93/116 methods. This report may not be used to claim product endorsement by NVLAP or any agency of the US Government. This report may not be reproduced except in full, without the written approval of the laboratory. Page 2 of 2
Page of L Other Alr- NIOSH 7402 Bulk- Quantitative [weight%l- Air-ISO 10312 Dust- Presence / Absence Drinking Water- EPA 100_2 Dust- Quantitative Chatfield Ifibers/sq.crnl- ASTM 05755 2 3 4 5 6 7 8 9 o -._---------- [1 --------------------._---_. -.,. '.._...... =4--- -.."-.~.. -.. ----..,_._, _......,-- ----_ -,'-. _...... ".
BUILDING A. BUILDING IDENTIFICATION residential 1. Address 2. City 3. State 4. Zip 5. Type of Building 6. Building Size 7. Year Built/Remodel 8. Building Inspector 9. Business Affiliation 10. Address 11. City 12. State 13. Zip 14. Telephone 15. Accreditation 16 Signature 451 SW 5 th Street Pendleton Oregon 97801 Wood z 720 sq. feet 1960's Steven M. Paulsen Paulsen Environmental Consulting, Inc. 2019 Graham Boulevard Vale Oregon 97918-5355 541 473-2243 AI 18024/IMR-15-2065A
A. BUILDING 1. Date of inspection: 2. Purpose: 3. Scope: BUILDING INSPECTIONS 451 SW 5 th Street November 17, 2015 To determine the presence of ACBM Asbestos building inspections prior to demolition For Professional use, not an abatement specification B. HOMOGENEOUS AREA (SURFACING MATERIALS) NO ASBESTOS CONTAINING SURFACING MATERIALS LOCATED C. HOMOGENEOUS AREA (THERMAL SYSTEM INSULATION) NO ASBESTOS CONTAINING THERMAL SYSTEM INSULA TlON LOCATED
D. HOMOGENEOUS AREA (MISCELLANEOUS MATERIAL) 1. 2. 3. 4. 5. 6. 7. Location Identification Scheme Photographs Identity of Material Quantity of Material Sampling Scheme Abatement method Roof coating Attached first page asbestos silver roof seal ",720 sq. ft. Random trained abatement worker E. BULK SAMPLING 1. 2. 3. 4. Sample 10 Data Sheets Sketches/Sample Loc. Laboratory Information Sample Analysis/Method Attached this Section. Attached this Section. Attached this Section. Polarized Light Microscopy Dispersion Staining Technique.
HOMOGENEOUS AREAS/BULK SAMPLE SUMMARY Area Approx. Sq. Sample ID'sl Asbestos? Description or Lin. Ft. # of Samples Yes/No sheet vinyl flooring 10 sq. A1/1 no sheet vinyl flooring 10 sq. A1a/1 no gray mastic sheet vinyl flooring 300 sq. A1b/1 no sheet vinyl flooring 150 sq. A2/1 no sheet vinyl flooring 150 sq A2a/1 no white mastic sheet vinyl flooring 400 sq. A3/1 no sheet vinyl flooring 400 sq. A3a/1 no yellow mastic roof seam sealer 50 sq. A4/1 no silver roof seal 720 sq. A5/1 YES
2033 HERITAGE PARK DR, OKLAHOM!\ CITY, OK 73120.800.822.1650 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 257075 Account Number: B041 Date Received: 1111912015 Received By: Jeff Mlekush Date Analyzed: 1112012015 Analyzed By: Gayle Ooten Methodology: EPAl6001R-931116 Project: Project Location: Project Number: Client: 451 SW 5th Street Pendleton, OR N/A Paulsen Environmental Consulting 2019 Graham Blvd. Vale, OR 97918 QuanTEM Sample ID Client SampleID Composition Color I Description Asbestos (%) Non-Asbestos Fiber (%) Non Fibrous 001 Al Layered Beige Sheet Vinyl Asbestos Not Present Cellulose 25 Vinyl OOla Layered Gray Asbestos Not Present Cellulose 5 Glue Mastic OOlb Layered White Sheet Vinyl Asbestos Not Present Cellulose 30 Vinyl 002 A2 Layered White Sheet Vinyl Asbestos Not Present Cellulose 25 Vinyl 002a Layered White Asbestos Not Present NA Glue Mastic 003 A3 Layered WhitelTan Sheet Vinyl Asbestos Not Present Cellulose 25 Vinyl 003a Layered Yellow Mastic Asbestos Not Present NA Glue Unless otherwise noted, upon receipt the condition of the sample was acceptable for analysis. QuanTEM is a NVLAP accredited PLM laboratory (Lab Code: 101959-0). This report relates only to the specific items tested. NVLAP accreditation applies only to analysis performed utilizing EPN600/M4-82-020 and EPN600/R-93/l16 methods. This report may not be used to claim product endorsement by NVLAP or any agency of the US Government. This report may not be reproduced except in full, without the written approval of the laboratory. Page 1 of 2
M 2033 HERITAGE PARK DR, OKL!\HOMA CITY, OK 73120 1.800.822.1650 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 257075 Account Number: B041 Date Received: 1111912015 Received By: Jeff Mlekush Date Analyzed: 11120/2015 Analyzed By: Gayle Ooten Methodology: EPN600/R-93/116 Project: Project Location: Project Number: Client: 451 SW 5th Street Pendleton, OR NIA Paulsen Environmental Consulting 2019 Graham Blvd. Vale, OR 97918 QuanTEM SarnpleID Client SampleID Composition Color I Description Asbestos (%) Non-Asbestos Fiber (0/0) Non Fibrous 004 A4 Homogeneous Black/Gray Asbestos Not Present NA Tar Roofing Plastic Binder 005 AS Homogeneous Silver Asbestos Present NA Paint Roofing Chrysotile 8 Binder t)fly 1112012015 Gayle Ooten, Analyst Date of Report Unless otherwise noted, upon receipt the condition of the sample was acceptable for analysis. QuanTEM is a NVLAP accredited PLM laboratory (Lab Code: 101959-0). This report relates only to the specific items tested. NVLAP accreditation applies only to analysis performed utilizing EPAl600/M4-82-020 and EPAl6001R-931116 methods. This report may not be used to claim product endorsement by NVLAP or any agency of the US Government. This report may not be reproduced except in full, without the written approval of the laboratory. Page 2 of 2
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