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Asbestos Survey Form <br />Job Name: Old Bethel ES <br />Job Number: 7110 7253 <br />Area: D Buildi <br />Sample <br />No. <br />1 <br />Homogeneous Material Description <br />12 "x12" Grey and White Streaked Floor tile <br />Sample Location <br />Dining Room <br />Floor <br />1 <br />Condition <br />D <br />Quantity <br />2,500 <br />Friable/ <br />Non - Friable <br />Non- Friable <br />2 <br />12 "°x12" Grey and White Streaked Floor tile <br />Dining Room <br />1 <br />3 <br />12 "x12" G rey and White Streaked Floor the <br />Dining Room <br />1 <br />4 <br />12 "x12" Grey and White Streaked Floor tile <br />Dining Room <br />1 <br />5 <br />12"x12" Grey and White Streaked Floor tile <br />Dining-Room <br />1 <br />6 <br />Interior Window Frame Caulking <br />Throughout <br />1 <br />SD <br />24 window frames <br />Non- Friable <br />7 <br />Interior Window Frame Caulking <br />Throughout <br />1 <br />8 <br />Interior Window Frame Caulking <br />Throughout <br />1 <br />9 <br />Exterior Window Glazing <br />Throughout <br />1 <br />SD <br />* same as #6 -8 <br />Friable <br />10 <br />Exterior Window Glazing <br />Throughout <br />1 <br />11 <br />Exterior Window Glazing <br />Throughout <br />1 <br />12 <br />Piaster Skim Coat Ceilings <br />Kitchen Area <br />1 <br />SD <br />1,250 ft <br />Friable <br />13 <br />Piaster Skim Coat Ceilings <br />Kitchen Area <br />1 <br />14 <br />Plaster Skim Coat Ceilings <br />Kitchen Area <br />1 <br />15 <br />Plaster Skim Coat Ceilings <br />Kitchen Area <br />1 <br />16 <br />Piaster Skim Coat Ceilings <br />Kitchen Area <br />1 <br />17 <br />Exterior Window /Door Frame Caulking <br />Throughout <br />1 <br />SD <br />6 door frames <br />Non - Friable <br />18 <br />1 Exterior W /Door Frame Caulking <br />Throughout <br />1 <br />19 <br />Exterior Window /Door Frame Caulking <br />Throughout <br />1 <br />20 <br />Insulation in Doors <br />All Doors <br />1 <br />G <br />5 doors <br />Friable <br />21 <br />Insulation in Doors <br />All Doors <br />1 <br />22 <br />Insulation in Doors <br />All Doors <br />1 <br />23 <br />4" Black Cove Base <br />Throughout <br />1 <br />D <br />500 ft <br />Non- Friable <br />24 <br />4" Black Cove Base <br />Throughout <br />1 <br />25 <br />4" Black Cove Base <br />IThroughout <br />1 <br />D <br />v <br />0 <br />3 <br />m <br />c <br />3 <br />s <br />m <br />J <br />I l erracan <br />Inspector: Chris Kell <br />License: 12487 <br />Date: 1212/2010 <br />G = Good <br />D = Damaged <br />SD = Significantly Damaged <br />G -6 <br />Pag @'�fti of 1 <br />