ICUYAHOGA sl HH Asbestos Survey Report Prepared F Cuyahoga County Land Reutilization Corporation 323 W. Lal ide Ave., Suite 160 Cleveland, OH 44113 Phone: 216-368-5658 Fax: 216-698-8972 Project Location: Parcel Number: 3881 W 25th St, Cleveland, OH 44109 009-01-006 Building Description: 5 Story, Former YMCA, Year Built: Approximate SF: Date Assigned: Prepared By: Title: Company Name: Address: Phone, Fax: 1955 48,104 SF. May 22, 2015 by Rosemary Woodruff Kenneth Tyson Executive Director CLB Services, LLC 323 W. Lakeside Ave Suite 180, Cleveland, OH 44113 216-213-0876 Ktyson@clbservices.comcit SERVICES ASBESTOS SURVEY Date: Parcel Number: Project Location: Prepared For: Surveyed By: Table of Contents June 25, 2015 009-01-006 3881 W 25" St Cuyahoga County Land Reutilization Corporation CLB SERVICES 323 W. LAKESIDE AVE. SUITE 180 Cleveland, OH 44113 CONTENT. PAGES Executive Summary 2 Survey Findings* 3 Surfacing Materials Sampled Appendix A Photographs ‘Appendix B. Drawings, Lab Results ‘Appendix C Chain of Custody ‘Appendix D Qualifications ‘Appendix E *RACM Detected: Clean out Needed: 1[PageCc it SERVICES ASBESTOS SURVEY EXECUTIVE SUMMARY Cuyahoga County Land Reutilization Corp has retained CLB Services to conduct a Pre-Demolition Asbestos Survey for the vacant commercial structure located at 3881 W 25" St, Cleveland OH 44109. The purpose of the Pre-Demolition Asbestos Survey was to identify any asbestos containing material (ACM) currently present in the structure. As defined in 40 CFR Part 763.83, ACM means any material or product which contains more than one (1) percent asbestos, The report will determine which ACM requires removal before renovation, demolition or occupancy. The report also identifies "Homogenous Areas”, (HA), which are materials that are uniform in texture, color, date of application, use or system, and appear identical in every other respect. All determinations will be in accordance with the NESHAP 40 CFR Part 61, Subpart M, federal regulations regarding the National Emissions Standards for Asbestos. CURRENT CONDITIONS: The assessor's observed the following at this structure: large sections of ceiling tile and most of the original flooring material have been removed. Although the building has been vacant for some time, | presume this activity occurred during a previous abatement by Alpha-Omega Chemical Co. (see Appendix F - EPA Notification). The notification references pipe insulation having been abated, however there isa significant amount that remains. METHODOLOGY: The samples were taken by the hand “Grab” method, containerized, labeled, and recorded on a “Chain of Custody’ log, Which was submitted along with samples to L&S Lab Consulting, Inc. PO Box 202354, Shaker Hts. OH 44120 a qualified and experienced AIHA laboratory. The samples were analyzed by Polar Light Microscopy (PLM). The accredited test method was EPA/600/M-4-82/020. Procedures described in EPA/600/R-93/1116 have been incorporated where applicable. Sample testing was halted at the “First Positive” for any particular Homogenous Area. ASSUMPTIONS: Certain items are “Assumed” ACM because of two reasons. First, it may be impractical to obtain samples of the same, such as roofing material, and secondly, the material is considered Non-friable. These materials are "Category | Non- friable”, like asphalt shingle roofing and floor tile. If any of these materials are in poor condition, and would likely become friable during the demolition process, then they would be categorized as Friable, and be required to be removed prior to demolition. In any case the demolition contractor must use appropriate “Wet Methods” while taking down the structure. If additional suspect ACM is found during demolition, the contractor should immediately STOP, and call the qualified individual designated by the CCLRC. CONDITION TABLE General Damage AHERA Damage Criteria No Damage Good No Damage {ASTM allows small amount) : Up to 10% overall damage Fair Damage Up to 25% localized damage ‘Over 10% overall damage Poor Significant Damage Over 25% localized damage American Society for Testing and Materials (ASTM) 21PageCLB ‘ASBESTOS SURVEY SERVICES PN 009-01-006 (3881 W 25" ST, Cleveland, OH 46109) June 25", 2015 SURVEY FINDINGS ‘The Following is alist of actual ACM/RACM at the assessed premises. Friable/ sample Material % Non Lumber |H..| Material Description Locations Quantity | Asbestos | RACM | Condition | _Friable Pool, Trophy Case Shed1 & Exterior | Approx. N/A N/A | Transite Paneling ‘Awning/Overhang | 3,300SF_| N/A__| PACM | Fair Friable ‘Approx. N/A N/A | Pipe Wrap Throughout 1,000LF | N/A _| PACM | Fair Friable | ‘Approx. 8 N/A N/A | Pipe Wrap and Debris Mix__| Throughout ov N/A _| PACM | Fair Friable ] ‘Cementitous siding and shingles or transite panels. Y Total Floor Garage _| Basement | First | Second | Third | Windows Windows with Glazing Per Floor N/A 3[PageCLB ASBESTOS SURVEY SERVICES PPN# 009-01-006 (3881 W 25" ST, Cleveland, OH 44109) June 25", 2015 Limitations ‘Sampling, by definition, has some degree of error. Although the inspector established homogeneous sampling areas based on his or her training and experience, and although the inspector collected sufficient samples from each homogeneous area to conclude that a suspect material was not ACM, it is possible that a visually similar, but untested, ‘material may contain asbestos. ‘Sampling and Analysis Subject to the limitations discussed above, CLB Services conducted a Pre-Demolition Asbestos Survey of accessible areas inside the structure. Mr. Kenneth Tyson surveyed and sampled the structure on June 3, 2015. Mr. Tyson is certified by the ODH as an Asbestos Hazard Evaluation Specialist (AHES #ES35791). The inspector's qualifications are included in Appendix E. Photographs of the structure are included in Appendix B. CLB Services established homogeneous areas for sampling of suspect friable ACM and Category Ii non-friable ACM that may become friable during demolition. Sampling of each homogeneous area consisted of the collection of random samples based on the quantity of suspect material in each area. The condition and friability of sampled material was also noted. All samples were properly bagged, labeled, and shipped to the laboratory under standard chain of custody. ‘Awritten description that identifies each sample location is included in the Bulk Asbestos Sampling Form, which is attached to the chain of custody. CLB Services collected a total of 39 samples of suspect ACM, which were analyzed as 50 layers. Point count methods were conducted on friable materials as necessary. Category |, non-friable ACM, such as asphalt roofing products and resilient flooring, when not sampled, are presumed ACM (PACM), All samples were submitted to L&S Lab Consulting, inc. a qualified and experienced independent laboratory, for analysis by Polarized Light Microscopy (PLM). The laboratory's qualifications are included in Appendix E. 4|PageCLB. ASBESTOS SURVEY SERVICES PPN# 009-013-006 (3881 W 25* ST, Cleveland, OH 44109) June 25", 2015 Conclusions and Recommendations Bases on the inspector’s observations, along with the sampling and laboratory analysis conducted for this survey, CLB Services presents this summary: The following material, due to the asbestos content, should be removed prior to demolition of the structure: ‘© Approx. 3,300 SF of Transite Paneling located in Pool, Trophy Case, Shedi & Exterior Awning/Overhang, ‘© Approx. 1,000 LF of Pipe Wrap located throughout (Basement, Ground, First Floor, Second Floor (rooms & underneath gym floor), Third Floor (Storage Closet) * Approx. 8 CY of Pipe Wrap and Debris Mix located throughout The following materials identified at the Property are presumed to contain asbestos and were found to be in fair condition, but do not have to be removed from the structure prior to demolition, as long as they do not become friable ‘+ Approx. 3,100 SF of Blue Vinyl Commercial Tile located in Lobby2 & Trophy Case Area Roofing Material, found to be in Poor condition, is friable and tested Non-Detect for asbestos: ‘+ Approx. 350 SF of Asphalt Roll Roofing (Gray) located Lower level Roof adjacent to Shed structure and Shed 2 & Shed 2 ‘© Approx. 12,000 SF of Felt Paper Tar Mix Roofing (Black) located on Main Structure Roof When less than 50 square feet or 50 linear feet of ACM are encountered, removal is not typically required by the Ohio Department of Health (ODH) per the definition of an Asbestos Hazard Abatement Activity included in the OAC 3701-34- 01. However, if the Cleveland Department of Public Health, Division of Air Quality (DQ) considers this an urban. renewal project where friable ACM and/or non-friable ACM will be rendered friable through demolition activities, the AQ requires notification and removal of the ACM regardless of the amount reported. Every demolition project requires Ohio EPA notification regardless of the type or amount of asbestos present. Ohio EPA notifications must be submitted at least 10 working days prior to planned abatement or demolition. Demolition projects involving amounts of friable asbestos greater than 50 linear feet or 50 square feet also require Ohio Department of Health (ODH) notification at least 10 working days prior to planned abatement, Clean Out Condition © N/A Closing The undersigned Asbestos Hazard Evaluation Specialist has authored this report: Name of Certifying Inspector: Kenneth Tyson License Number: AHES #6535791 aaa Cha 5|PageCLB ASBESTOS SURVEY SERVICES PN 009-01-006 (3881 W 25" ST, Cleveland, OH 44109) June 25%, 2015 APPENDIX A SURFACING MATERIALS 6|PageC ibe ASBESTOS SURVEY SERVICES PPN# 009-01-006 (3882 W 25" ST, Cleveland, OH 44109) SURFACING MATERIALS June 25", 2015 HA. Material Description Quantity: Condition Texture - Stucco Approx. 250 SF Fair 4_| Plaster System — (PS) Approx. 4500 SF Fair 1_| Plaster (P) Approx. 20,000 SF | _ Fair 7|Pagecipe ‘ASBESTOS SURVEY SERVICES PPN# 009-01-006 (3881 W 25" ST, Cleveland, OH 44109) APPENDIX B PHOTOGRAPHS June 25", 2015(ax) amv 0 MoV —9 O70 (com) g 5uzei9 mopiin JO math ~ 5 O04 (vom Buizeg mopuann jo MoI, ~ F 104 hs OMI SUGDC JO NAIA ~¢e10Ue ones od yo mon ~7 ua 15452 M LOBE 10 aN — | OUR(a) 2569 Adon, — Buyouey oysuer, yo MoMA - OF O10Ue (aida Buypoo jo mara ~6 o10Ue (019) 914 Sune9 Jo main ~@ o10U4 (10) V O41 Suen Jo mary — @ o10U ($a) worst sIsejg J0 waIA J 10UdBveweno 20ve03 Jo mo oF Cloud Buewano s0van3 0 maIA S| O104e (vain) Buewiong sovep3 ~ Buyouey oySUEHL EL o1OUd zaseg hydous so.ein 21 Cua 4 0380 fydou4 Jo moIA ~ Lof0ud(tin) wooas Anan 40 men 22 o10¥ewoRea - yeus Jo1Eneg 19 MON 92 CL owe - 980d J0}eN913 0-mOIN Gz O1OUE 04 - Bee srensr3 jo maIA Fe O10Ud 2004 J018n@13 J0 math EZ cou(6u) S1yood roy Jo a1 € C10Ud any wouaregy 21 snoMaLG Jo MEIN LZ C10Ueun Kus Z1XZL Oma 10 meIA HE COU (al arsed 0 mo EF o10¥eCLB ASBESTOS SURVEY SERVICES PPN# 003-01-006 (3881 W 25* ST, Cleveland, OH 44109) June 25%, 2015 APPENDIX C FLOOR PLAN AND LAB RESULTS 9[Page\eY = alae we : Cee exe | / — Wn H | Agge7 te mune Zz E : Zl _ 2 ema lll teal ‘ - : Shea ; PET 9 BRNO | AaRYS IMWID | enc 7anvd Lied 2dHe ? : Ganbrelis, atveisdas) 1222 ssa De 300 -10-boO FTIDYVeTTT ZS HOM HAL) -Uo -ao adend Ivoas Wail £-39M t-99M () |-a5m(N) slo & date,€ll co) aan ad Hid — HH Ce) 7 2 vl in ; oS a IAL jeeeliwn373 aia \-Sd NY ,2 hago aulsoeat 1 UHHH JAX 00)Se) a eee eeee tee geeeecr eet EE | | aati ee C2 | (“) IT LL a inow3sv4 INFISASTD ‘41s sz M /[88€ 200 - |o- 600TOES tema ventana HPO T ha pruofing estiowy rani hg yoseuddy 9 pamnyene 1 PA sha vax oa0g ends endutoe ve pagonpues ste OU Wu @ ‘fe epowaen suman swied 290K versoupuosc aydeosesow yoneis swer=o nun ntoscasowe u6r7 orteniod Ls ena Ue} PIUPUMEIENT adeorasoit SUDPI Poayiod ‘anbjuNoaL 109A Sr1-b6:6/009 VE - OF0.C8 HOOT YEE ‘POWTER 3, syoyey Sunujoques soysaqsn sof uoRjurex> 2ydoose.0j o8La7 TonER fg per2eI0P PON “oq oF PUnof az9m PUD “pettus fo apoxgeu 009 var arta Ba peshroun sssm sjpieyou Buypring p30 snoauebourey n¥ ——swoyemouen Mmurums erTee no ‘pemvesrig 900706008 19104 ors ‘av spiaso7 “8 ECE rocosst9 areunax 10st Sewage ea rese cms a7 rey uN LEONE sroe'es weaarioay ava ‘NomvooTs99rous unar qodoy epsfippuy s1ng soxsogsy 14517 POTMOLOd o> yyoulidymsuoganaursT ELEL'96¢ (912) # ANOHd FI1LAO roosoee var /ectses saH¥ 3s1B0101qo9)H /9814098 0493 “ON ‘DNIL'INSNOO EVTS 7TOES sma vonmdase, POT FPO T sa prsoking =Ishouy Tana TCE te mete vennnet a dus woprmuumng opdarsouow rome cuoppDeyeMoND adooseione BVT Domed AIH SNCMD :Uo}.PeURUNAIEMT odooseoar 1957 Poe *MbpN2— TBOPALEUY 911663009 Yaa ~ 0Z0-ZRPN/009 VAT POON HAL m8 oooms soy ce rxeeee rt 4 sowne woop ree ROMER umee BoM 4 veneer = mupeeeCmARE na sewer Fame ‘ amuner matey pe mE tems Yat wot pescenea eonengny OX minteer tae 4 aoepa HEU 1 evomese a ares ‘ee 5.008 posenneg wotengey ox ewe topo 4 couse soon mee + evomese satares ‘ment 00 poroeneg ereoany ox. resem Bem 4 somone HOOT me + womese tiemsavon | sondioena | sopeoor av sat sedéysnosqacconss | eedéuamorquusomos | sedcasowomys — | wonduoeg adm smciey | 30 rand | stems ‘aden coon | seme enter 0 ‘Pumwer19 ‘900-10'600 9 199204 ogre say opiexoT “mt CCE Tocoget9 agama 40K hese mem Tsao ‘e298 81D ICT 2gaMON LoarowE sr0r'e'9 saaArsR SLE ‘NoMLYD0T soaroua NIT uodoy stouy sane sossoqey 14677 PozHOIed T0060z# VHIV /eerse# SAHV ‘gsi6o}0xq0s0191 /2s1do2S0.0 1H woo joMbiizNSUODOAUTST ZLEL'96b (91) # ANOHd FIO ORT by O1HO “SLH MINVHS #S8T0Z XO 'O'd ‘ONT ‘ONILINSNOO SVT SPTTOES toma wonedves eT SURF a prasfing sirowy ee sopaqey $01 OW #901 far paceuddly op pomaya2y TOE TORT ha eon vmwa erduos ends wo porarpoo SEMOUY "Jo spon 3une9 3uied 220K worse 2xdoose.01 yonsiA Zuo DoHfMOMO, sdoseo.oyn 3407 Pomme ALzT EndhlfhO 2uoysnUasENAE ‘odeovanan 1487 pom ‘onbpwnoay TORAEUY 918-061/000-¥da * OCOTSHR/OOS-VE :DOUIR 221, pos nema we maeené pen ak SNM HACOU IY + eseese snore et ’ seorme9 45 tu onemyaeay 2000 ve + eecane scores 5 poonecsorecey on fasintayeeneo pn aN atuR/fup SRO TY + vases er mt nr 00k pcewea wveegry 9 saGetseweé pomp esoms oom asso me © sues sens ner 00F pewewea senesgey ou sedetsovmd pesmamaoooms coma aa s0eu rae, © mene ssyeet pte soot peeneasowegey ox sadelunend posmmnomms ome ou 0 2 exvese syn > sre n= 001 papneavortecey ox ssiacsoieé pamiy some sou we 2 eaves andézesguecon | sndkienaiammoss | sdkrsoweceyss | woniuoneg adm emaieny | 20 ores “asa coon | ices e8tey Ho ‘peoyener9 (900-10°600 # 0204 ogre ay 9pIsexDT “m EzE "ag ince toms Tse ‘s20m25 TD /Nomyo01 soaroxe amar uoday sisfippuy ying sozseqsy 34677 POz ORO woo yRoUABansUegosAUEsT ZLEL'966 (92) # INOHd TO1EIO Oz $b OIHO “SLH UTHVHS T0060z# VHIV /eeIse# SaHV PSEZOZ KOH ‘O'd eiBororgosoin /as1doos0so1H ‘ONT ‘DNIL'TNSNOD A¥T STBoers ema wonndog TORT ea possafueg nahiouy sonsoery s0r DMD 5291 Zita ponent ry ponnang 1590 ORT a wan va 1s s2dume ue przanpuoo sishiouY "fe spexnoTe 30709 Wed ON opsmugurony oydooee.o ronsya ‘uonouinon adaseo.oyn 807 DOMNDIOG ALIS ERUALO EuoRDRUTUNASUT Sdosonopn 9UBT DamHDIog zomBnuNERL 027A. Srrc63W/009vaa - 020 Z#9A/009 VAT POW HAL setae SOP pevsereasonengey ok seem asm 9 FERTOO . ou eager k TONE seoasona 08 2 ‘eormtes N08 pmseiea seneegry ox svyatean mopous Jasin emo we reowouy 8 eae semasonu soe Seerres 208 pmssiea sovegey ox sassy opens Yao ammeg we momar 9 aot sores 86 ‘ omen sp s00u et seo sepa ns worm m6 Premed scweaey on 9 4 wn nassou ny 8 wise sou oven emi wa yan npr se ssc 8 poisneasewoqw ox /atsncetanrgm ameter seat 000 PRE + seesee wx eed pt se snes a svga/seap ro PHNOND + reese wavox | aepduoeea | wopnoor oy vor aethavecseneaon sy | sedKa energie 05 ass, seen coon | tne etter Ho ‘Punpesio 900°10'500 4 189.0 ogre ‘av 9pysexoT "a BCC “3s wage teat aRe "sso BD ‘NoWyo0T Louroxe NIT podoy sishyouy y1ng sossogsy 2461 P2zHOLOd woo HOU Ba;NeUONOLIAUTST EL0L'96¢ (912) # BNOHA TO1LEO OTI b> OHO “SLH UTAVHS 10060z# VHIV /eeIse# SHHV wSet0e XOM 'O'd 38160010401! /28;d0980491 1 “ONT ‘DNLLINSNOO EVT S PTSTORES 21a wonerdwes aT SPORT a pousofina hoy (ha ponoucidy 99 panoysoy TES A ar wens 9d enews sydurvs uo prrompuco sishiouy oysounuongy oydeososoys ronera iuenooy io) doce 0so10 OPT DomOIOd ALE MAD UORDRUEHNIV, doosesoun 2Y0HT DerDIod ‘ombuao2L 1A MY 911-2639/009VIi ~ OZ0T#SH/009 VET ‘POUAN FAL ea ies ee — — memeniney ow EEE Se ett Se “ee —— = odoy sisfiyouy xing sowsoasy 24BPT P9zHO10d woo} oWABaNSUODONAVTST ELEL'96¢ (912) # INOHA BIIIO OzI¥> OIHO “SLH MaVHS Too60c# VHIV /eetse¥ SaHV ¥SeZ0e KOM ‘O'd 351Bojo.qos01y" /3s;doos0s01H ‘ONT ‘ONLLTASNOO V7 STTOES ia veredweg “aor SPORT 8a posing eehrouy a poseudy 29 pomesye TOTO sha wax viog apd erduses we peaonpuco speyouy sroMezo Binuypyu0o sorseqs0 sof uoyImujurDx® 2ydose019;4 oa194s TONE ha Por2e9P eveU ‘64 03 punof aise prio s18hpo uo fo spouse ooo-vaswId Mq Poxhoun s19m syo}mOU Burpring Derm enesveGouoy YY _-wosryoued Rrousung, exT¢e 0 ‘pumsecig 00-10-6000 12040 o9re ev opine as coe ‘as ise seu Test sens wD wotLrooT Loarona war dodow siefouy sing sonsoasy 146r1 pezsojog woo ypou6PansuooenAUTST ZLEL'96+ (OTZ) # INOHd FILLIO O2T +> OO “SL NEVES Toosoes viv /eersee saHV #8820 KOT 'O'd sibororqosow As}doososoiny “ONI ‘ONILINSNOD ETS 7S109 iowa wonaidiues JOTITT Cp 0 rte mn CCRT PHT ii pousifing fio HO BBA ie wee ming adams seiduos vo paronpues eiehjouy ‘Bo spenem sume jue :20N orsoupuorg 2}de0%0s21 tones suopvoyawend sdeoseon IUD pomsoIod dist eduig suopmvownastT edeosauown 3MB¥1 Dex}Og ‘mbjuYDAs TOOAMOU, STT-26:w/009-V49 - OF0-TeHNt/009 Vid ‘DOVION 191 a sun Hot my 1 vases send su soo Doboneg orengty oi 2 a fun san pene 1 ouee a“ fe ed mie 1 suave as fun Heog wt ' reese a fon oenoouwr ease fa i a TTT ‘rum “appre oor ‘ater ds art 2 on sup peascou pee cane TESTS ERT sunb yore i008 Dronteg wetengey ox ns an fe0) exo ou wr reese rarsacox | wondisesg | eeneer any tar scx snowmawonn | wséAsenoraazomos | anddisomemy | condnonea mien apseny | TeaoenN | Senda maaee omer | ates e1t¢% Ho ‘pwoye0a19 900°F0'600 ¢ 120 sre say spIe=07 ‘a Cee Tovosst9 araaman boar ‘aS wise 29m eee ssomues a7 ‘rer aaMON LoaroNe s10t'r'9 ‘amaraoma avo ‘sNomvo0T soarome wari vodey sisfipouy sing soysoqsy 34617 pezuojog Toosove vHIV/eetses saHV asBrjorgoioy sidoososoyy, Moo OUD Ns UuodoNaUAST ELEL‘96¢ (912) # INOHd FOLIO Ot +e O1HO “SLH YANVHS b9et0t XOM 'O'd ‘ONT ‘ONILTASNOD AVT STBTOEDT 0g wopoyerwes lin eae Panouddy op pomoyasy TT BOAT a pawsefing pahyouy TORT TORT a uss eg ards sarduoe uo poronpues siehiouy ‘Fo epousenr T0009 700d 20 woppupuong o\deosesoi ony cwonvoyauond ooeosoye 3Y8VT PezDIOd Site SMdUMO "ua; adoosesoin 1BYT pomDod ‘anbpnj20g oon MOUY 911 £6-W/009ViS - C0 EEYRIODD-VEE “DOWN 191 rms smn smenen or vest as wendy 4 perme sentaiccum grease rence sen armor wor reve ses eadev paren sonny vmwcese Promarmeex ——aeonenetemmg =a ammonia Peenegsowmee ox esjonemsdereng =a emma penon = auaee | agvasee| cenduowa | vonwor | ww | sat us | meceemonacemo | satcswomeeys | sontimea aitemansvey | SReoan| “agiert | sepmen | mw | aa Topo9sto ‘waannN 1x0dae rer acvaMAN Loaroue st0e'r'9 sazarzoa guava 900-10'500 #9204 WS Mise 2m eee ‘NolyDOT 4oaroKe E1t¢+ Ho ‘Pungo osty sey opieonoT ‘a cee somo8 aD, ana Hodoy sishpuy ying soiseqsy 348'7 poruojog T0060 viv /eersee saHY asiBoorgoioy /sdoososonyy woo THAW ADs InsueyonaUEST CLEL°96¢ (912) # INOHd FI1LIO O€I +P OHO “S.LH NAYES #SeTOe XO ‘O'd ‘ONT ‘ONILTASNOD EVT S 7STOTT 9 20a wonytwes ROT SpaeAT se powsesiog eehrouy sevesaey or uo eon WARY LEA te wosnudty re pansy —veeR Wm sg uayn v0 meng 3 sroHeiva Burizrion eoyerqee sof worsoujuoze oosoizyu 021298 ney Ra Pesoeep sueU ‘94 0} punef alam pare “tio fo moun Ooa-vesnTa Ma Peshyou e1em s!>}erou Bujning vere monvofowey HY ‘ojeno¥eD Ribunange Tb 0 ‘Pusat 200:10-5008 120004 sre sey 9phtomeT “moo Teoroers nwzmenn wyosse ese sm Tese M28 eT rer cwsenay taro. stoc‘or'9 aaarsoa atve ‘ouvsoT s9aroe uaxarm Hodow sishrouy ying soysogsy 34611 poz wood woo" Pubda nsuodos}augST BLE2'96+ (OTe) # INOHE FOLIO Otte o1o “SiH uaHVHS Too6oze vin /eetser sanv esezor Kom O'd ssibolorqoinn Asidoososoy ‘ONT ‘ONILTASNOD BVT 8% 7TPS sina wop2yetues, TF SORT tg pousofing seshrouy seiseasy %01 woNg sen WATT CYL te vecatty wy panneny $$WoaRT THROU iq wanna wove dung saichuoe ue pesonpwon syahhouy Fo spowange mune aed 0K Lonpspumeg 2ydeososou4 tonsIA swopvo4amn sdeovosoin 10M Postimjog asta mchuh woygopuoninceny dooce 2uOHT Derumog ‘anbpuyony, toonhouy SIT 86009 VET - FOS DN/O0D-VEE “DONOR 2091 06 sores or romeg owsegey ox on ges wetey 4 Anyoorm, —soogpmesn og — eee ees Peeliee eee eae ae soe TEE fee ee eee eee ae moe eee sens | oem wz [ays eee aeeestt aad anne Sato men mye wan =i ee pe Hodey sishrouy ying sozsaqsy UBT pezpojog ape eae 2LEL'96¢ (9TZ) # INOHd FOIdAO OZI > OHO “SLH NZNVHS 1006024 VHIV /eerse# saHy bSetor xog ‘Od 381601 01q0.101) (38302801019 ‘ONT ‘ONILTASNOD EVT § 7svg wopayduieg WoT SPRATT a powsafing hous ha posoudy2@ poomany Teh WRTIOT Ma von wba ora endure ue prinpwoo syofiouy S11-cewoos via ~ OCOETsOOD Ved "POeR aE “ermueyou Bujureques s0}s0qs0 40f wopsoujurmxe 2}doaso12}u 021098 TOMO fq s0}88qRD B1HOFALID KGE-MOE 94 6 PLNe[ 210m PUD ‘siehrou fo spounew 009-vaarHTd M4 prehouD a10m spDUszoU a7}eWo.R eneeUEBOWOY TTY: wo}enjoMed Ramunwnss 900-10°800 # 2104 cere ev apna¥o7 18 coe Treeosto axaamnx Lyosz "Se wage 28 Toe cmos 7 ‘EreT mwannw 1oarowd sroe ero awarsory ava \worevoot toarowa swvarr> uodex ssfiypuy ying sopsaqsy 34877 paztio}od woo jyowuAPa nsuogos mEEST 2LEL°96% (9TZ) # INOHd FI1IO OSI +b O1HO “SLH UTHVHS T0060%e viv /ectsee san #86202 Koa ‘Od seyBoromasone fsidoososonn “ONT ‘ONILINSNOD AVTS 7aT PTT a prusofiog showy sorseqey or uowa #801 Ta TOPPA te ponosday 19 pomsjony $e TR fg ways, 109 orcas open 98 omens 40 sentir se moyen une 6019 « swroma reo ponaun © cores enjos opm 88 ower Ot nonaine ne mye oyun 429 ‘ syroms (col pumas © roma sepun se storms 40 anos se oye yess sep a fyeuers oo Aydoes peneso canes opera 908 stern 0 sunonaine oe oqo yams e19 4 sniroms oem knees poner ronun ane pera 908 srerae8 40 smensins oe uoyo enemas, fun coyeums — toysmosonees rerun aee spe 08 nere9 Wor sanoseane we pion yeas 4019 ‘ cyan, Syme sown rat ase sxqrzason | vonéyowsa | vonesoy = sar sods emowaueton 4 | sadérmmaicasmo% | tedéyrowseey y, — | vonduoteg done eitieay | omens | etdewe oes coon | aides tag ‘900°0'600 4 190104 sre ay apisooT “a bee Trezosro aeamnn cwosre "1S 1056 3m T2RE somes TD Erer azamnN osrowa sror'ee 9 asarsoay ava wor¥907 soarows wart uodox s1shtouy sng sorsogsy 1467 paztiojog wos }oUbADznsuegonAUEST ELEL'96% (91%) # NOHd FILL OfT bt OIHO “SLH YaAVHS PSETOL XO 'O'd ‘ONT ‘ONIL'NSNOO EV7 ST Toosove viv /estse+ saHV asiBororqoorpt /Asidoososonycet ASBESTOS SURVEY SERVICES PPN# 009-01-006 (3881 W 25" ST, Cleveland, OH 44109) June 25%, 2015, APPENDIX D CHAIN OF CUSTODY 10| PageMicroscopist/IMicrobiologist AHES #35133 / AIHA#209001 | L & § LAB CONSULTING, INC. P.O. BOX 202354 SHAKER BTS., OHIO 44120 OFFICE PHONE # (216) 496.7272 FAX PHONE ¢ (216) 373.1495 _ E-Mail LSEnviroConsult@gmail.com thain of Custod (Cert Name: Mc : as Chest nasres: ' Tiling Adress (ofaitterend Prone Number: Gewlomd oe cus — (-6 73: Poe "p04 6(.006 Fax Nomber rect Name ZB4) _w.260r Seiten ga Clbsecs at Conia x Via: Em: FAX__Verbat “Total # Samples Submitted: | Total # Samples to be Analyzed: ‘Majerfol Matri Ain Bul) Water Poche reese indicat appropriate turn around time Ha Asbestos ease call shed for availabilty ofall rh andlor afer hours samples TEM TA Time PLM ™ eT ‘Optical TAQ. TAT al Seer] Phar] PEM: NIOSH 7200 | Now TAT EPA Level Il hour Shoor | apebutkiwab 2aays Dainking Water 16 ho iéhour | Cycles-deasenes 3 dass Wipe 2a hoor | AHERA [Airo-ellcasenes | Says Microsc Daays 7s) | Anderson cures Specify NIOSH 7402 | 34ys | Point Count Bulldswah caliores Mold or Chatfcks Bolk [Sais | iNesHars) Sdays | Baceeri eulures bectera Les tips nds Te ‘Mairi Paint Chips Soil Air Wipes Wastewater TA Time: ‘B hour i day 2 days 3 days 3 days Sample information: ‘Sample Number: | __ Sample Locati ‘Sample Date/Time: | Sample Volume (1): Custody Information: Defers rscivescet SERVICES Total samples #__Z*f CLB Services Bulk Asbestos Sampling Form Project Name: 36) W 25 Project Number:_/ S12 ant pair /3)15 inspector: MATTBOBEL ‘Sample ID | HAR | Building Floor Room Location Description | _F/NF 3e8-woa-t| | 2 ZB He SW Exreriqen F fi Z } Nw } { 4 |v NW I ag -wos-|| 2 \ Zz | Gym ww INTERIOR 2 | 1 \ 3 | va v a pen x -1| 3 i He c Stucco z i | 4 — 3 ] Vv Vv ye t zZ Sc 8 | 3 = WW Vv see-ps-1| * | He 4 ww Gray fvobre Ni 2 I Z He Ew 3 a Ht Ew ) | 4 Ground | Cel Nw S ee He Ew 3a -CM] S 4 Eun a Hores| FE z i 1 [cet | 388 -C18-1| G cee ZK zZ 4 [338 -Cre-)| 7 i Cre Tei zi a 28-CD|_ & + 2 laym THick a et z Gym Vv wv reo ke vate:_6/ 3/15 time:_Co 3 Samy received, LCL YI Wa wre LBS te 23204L& 8 LAB CONSULTING, INC. Microecopist /Micrabiologist P.O, BOX 202354 ABES 035133 / AIHAZ09001 SHAKER BT@., OHIO 44120 OFFICE PHOME 6 (216) 496.7272 FAX PHONE 6 (216) 373.1498 E-lail Qa oe semegs [| ——————————, =. a Sieesbe Fe yaa ae 374 — Pot — Of- 5a, enn a sages CLizemigzoeanome Tape eS ‘Report Results: 2 Comact,_ KEN SON Via: Email FAX, Verbal Tea Fle Ses | Taare SRG Te Mate Ma IL 4 Air/Bak Wace : wt Postive Please indicate appropriate urn around time. Ca ee a mes Tag Tae en pag sto oreo) ‘tow | Atoger Paar Fre tra toe Stowe Shout | petaunens = je i fl Mew |Gmcreename [a0 ve ier |e fae [aeecteeme ieee Set a > saceme ieee MOSH fro Se lecow tabi [are Seimei [RR | Poet roe (eres eae Ie ecancilpmamenetite Matrix Paint Chips Soil Air ‘Wipes ‘Wastewater TA Time Sour fay ga ee ay Sample Information, Sample Number: Sample Date/Time: | Sample Volome @): Custody information opis Fon Sap iid Sunples reeves SRP mare Sipaioe ba Tae seers eteaenee fiont Total samples ai CLB Services Bulk Asbestos Sampling Form S Project Name: = l Ww 2 Project Number: I3(e coe pate: G/4/15 inspector, MAM BOREL Sample 1D Ha# | Building Floor Room Location Description | _F/NF [sea-e-1| \ | test \ cre 7 SW @eay | NE 2 Zz esc ¢ 2 ( " ee Be t H coLumN Ss H kW. 6 Ground | Cie Wow ET. 4 H c I 333 -cre | 2 GRovN)| UR $ Buick Tile Zz i Z 388-es-}| 3 7 ' Exiseor | & yaep ROU RoOF FE Zs 7 zi = : Relinquished:, =— Date: 1s” Time: Poe Received: FP UV / vb) date f¢//-5— Soho Z1L & § LAB CONSULTING, INC. Microscopist/Microbiologist P.O. BOX 202354 AES #35133 / ATHA€209001 SHAKER HTS., OHIO 44120 OFFICE PHONE # (216) 496.7272 FAX PHONE ¢ (216) 373.1495 _ E-Mail LSEnviroConsult a Chain of Custody pull a : Sate “Eogaaaama ee Report Rest: conser Kennet. Tyson WietEinsil Fax ves Total Samples Submited: Total ¥ Samples o he Awa Moigig Matrie ee Ty Poesdive resins eproprine um even tne, sep Aste ee cal had for eval of al hand er hoar sample rt mee ci Ta ge amos Te Fore ante stow [Ga e005) ‘voor [Agen Parte | 3 EPA Level IT Shou oo Shour tepeloulk/swab 2 days ritisg Wome | Soe ieee |ieitomms feat Wipe | 26hoor | ANERA 2shour | Airo-celleasetes 54a Mowe | 2une ‘Andenen cates Tey MOSH 2 ine fcc Cy |taecen ae Ca a [3sms__[eesnnts sein _[Busercurues™ | cr Paint Chips Soil Air Wipes | Wastewater Thou iy Tdaye Sdays_[ Saye Sample Information: E ha z Sample Number: | Sample Location: Sample Date/Time: | Sample Volume (Ly: sovernannins LUE) Boy Gop bid. Samper raced Spa BATTCLE SERVICES at Total Somples #. YY CLB Services Bulk Asbestos Sampling Form rok Name: zs LW. 2 ProjectNumber: / 3/2 opeeaye Date: CHOMLS specter penne TGsex Sample | aw | Building | Floor Room Location Description | _F/NF we-Rena| [3651 1 vya N/b. Gtocsl Floor | PalleR nel F Zz i t i { | 3x5-Rebr| 2 | | i Fac heRrs|_| 2 Y ou v v receivea:_ LEM Miva vate L205 me, € FYL& § LAB CONSULTING, INC. Microscopist/Microbiologist P.O. BOX 202354 AHES #35133 / ATHA#209001 SHAKER HTS., OHIO 44120 OFFICE PHONE # (216) 496.7272 FAX PHONE ¢ (216) 373.1495 _ E-Mail LSEnviroConsult Chain of Custody (Ghent Nae: Senices eee sees] (Cent Address: . ‘Biling Adare freien) | Phone Number: Wz SGe Pom es Fas Number: Proje Name 2x81 -wW25 Send Repoasto Tra Clipse Dee Coan Pest Number: a2 et Report Results Contac, Kenn Gon ‘Via: Email FAX Verba ‘Total # Samples Sybmitted: ‘Total # Samples to be Analyzes “Mategial Matrix: C Aug bulk) Water 17 Poc.ive Pisese indicate appropriate turn around time isis il hs orci ose ers sc Tem fre FLAT Tatee | Optical TAQ] a Out 1a anh ee Kime [Altres arias —[attor fect oe the | eee Ee poses | ete tee reece aa oe co ee Mie |(cecieees dau oe Saye’ hnisersinees —[Saehy Motion ee a | pum coee tae erat eee (eases petremmerecns |Our ‘Soil ‘Ain | __ Wipes Wastewater co Tay Saas Sie Suu e Information EF COC: Sample Number: | __ Sample Location: ‘Sample Date/Time: | Sample Volume (L): Custody InformatioCLB SERVICES Total samples #__(@ CLB Services Bulk Asbestos Sampling Form ProjectName: 2H 25h Project number. [3] ae vwe:_ (2205 inspeewr: Ke nn esevr ‘Sample iO | HA# | Building Floor Room Location Deseription | _F/NF | 2s Bad) | (| Nip. Nike [Exterior Oxclaup| tune | 2 | 2e6-7RB| Z. Gram! NIA | Traply Case 4 | zecethe-(| 2 Grasud| feat | oiling VTY a WZ Date: @ (2205 Time:, Relinguished: AL ft receiv Lf A time: 5 300Cc wa ASBESTOS SURVEY SERVICES PPN# 009-01-006 (3881 W 25" ST, Cleveland, OH 44109) June 25%, 2015 APPENDIX E INSPECTOR’S QUALIFICATIONS & LABORATORY QUALIFICATIONS 11| Page% Lp8ss ISL ST aig voneuuesy, sano Jo ae HO “puepras[g $1/9/S St/9/$ O06V9-XX-XXX uosk], YUU ynsao 01 st SL aqwoynjaD Joysarjay Joyodsuy Surpying soisoqsy sevuojjeusajzuy sazinsag Burusessd 898-999-9981 jdur 1488s) = ISL ST ‘pea PUMRoWTOSIEE ISL wonwoe7] 9sin07) avg vonwurunessy dv neSeuyyy Surrey HO ‘puryaaa|y $1/9/S 91/9/8 pk 00V9 XX XXX uosd]T, auUay Sqque9 01 st st aqeoynqa_ FIYSIIFOY JOUUL[ quoWNSvuLy solsogqsy Jeuoveusaju] SsaoiAiag buries[L & S LAB CONSULTING, INC. Microscopist/Microbiologist | P.O. BOX 202384 AHES #35133 / AIHA¥209001 SHAKER HTS., OHIO 44120 OFFICE PHONE # (216) 496.7272 FAX PHONE # (216) 373.1495 _ E-Mail LSEnviroConsult@gmail.com L & S$ Consultants has over 35 years experience in microscopic analysis, microbiological and chemical testing of water, food products, dairy products, cosmetics and many other products for consumer use. The following ts a listing of our laboratory credentials and equipment which involves EPA test methods for % asbestos in bulk samples and PCM NIOSH test methods for total fibers on personals and final air clearance after asbestos removal activities. On site environmental surveys in commercial buildings and homes for the presence of asbestos containing building materials prior to renovations or demolition per EPA and NESHAP rules and regulations. Laboratory Credentials American Industrial Hygiene Association since 1989 to present AIHA Bulk Program Laboratory I.D. #209001 Certified Asbestos Hazard Evaluation Specialist on staff (ODH) Microscopist - Microbiologist Engineer on staff Equipment MJI Olympus Stereo Microscope Bausch & Lomb Phase Contrast Microscope Olympus BH? Polarized Microscope American Optical Phase Contrast Microscope Calibrator- Primary Standard for Air Pumps High Volume Air Sampling Pumps Low Volume Air Sampling Pumps - For Personal Monitoring PCM- Polarized Light Microscopy on bulk samples for % asbestos EPA interim test methods (600/R-93/116) (600/M2-82-020) PCM- Phase Contrast Microscopy for total fibers- NIOSH 7400 methodsCc Lb ASBESTOS SURVEY SERVICES PPN# 009-01-006 (3881 W 25" ST, Cleveland, OH 44109) June 25%, 2015 APPENDIX F EPA NOTIFICATION FOR PREVIOUS ABATEMENT 12|PageA-296-09 Do Mor We w Tes See Para Da Ha CREW Ohio Department of Health Prior Notification of Asbestos Hazard Abatement Project Read caceully all the instructions and questions prio to completing the notification form. | Notiizatons including check shal be typed and sent to the Ohio Deparment ol Heath, Att: Revenve Processing, PO Box 15278, Columbus, Ohio <8215 2 Checks sha be made payable to Treasure, State of Ohi, fr the amount of sixty fv dors (65.00 3 Any eased asbestos hazard abatement contractor who perlorms any asbestos hazard abatoment projects within the State of Ono shal submit pier rtifeations tothe Drector at ees en business days before begining eock planned esbestox hazard astement project as vequied by Choptey 3701 94 ofthe Oho Adminsivowe Code oun, 4 Type of rottcation Corina! — revision number_/_rewsedinets) number 2 PF Clemergency C1] blanket CDleanceliation 5 Tipe of astement volving at lose 50 roa foe! oF $0 squre feet RECEIVED Wemova repair Cleneapsutetion Clenciosure [renovation [Rar Vacloommat Core. — “Bl yer 2s st “Claclaad — seanpaPPun ig Polar He GL Ce) ZC G33 € TObS “Tena Cg. Wem! Cb. Ser Lan “o£ Me Plecelarrel Of PY yes” rove lu Jackson re) 475-7704 ered thoy Meath 575 Jos Feno UCA St hist 257 ST [ Chelend (ee ement fbn tliag [" Goecacms rw CJawterg — Clmecrwict Clot (loti Tile q blache seseses eno tom — ome OD oir eaves AC toneernganeos —_ [EYAFD Dvoersg Comer en Clathiod < Eangeaces same ICO Pisca ma 5 [iz |r0 3 lanwnen 5/22.| 200% set 22/2008 72e fa ae a 7 ar cto [ Sr ar est