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Asbestos Survey Form <br />Job Name: Old Bethel ES <br />Job Number: 71107253 <br />Area: E Buildin <br />Sample <br />No. <br />Homogeneous Material Description <br />Sample Location <br />Floor <br />Condition <br />Quantity <br />Friable/ <br />Non - Friable <br />32 <br />12 "x12" Beige with Brown Streak Floor the <br />Art Room Patch <br />1 <br />33 <br />12 "x12" Beige with Brown Streak Floor the <br />Art Room Patch <br />1 <br />34 <br />9 "x9" Black Floor the Beneath Carpeting <br />Classroom One <br />1 <br />G <br />300 ft <br />Non- Friable <br />35 <br />9"x9" Black Floor the Beneath Carpeting <br />Classroom One <br />1 <br />36 <br />9 "x9" Black Floor the Beneath Carpeting <br />Classroom One <br />1 <br />37 1 1 <br />2"x12" Ceilinu Tile <br />Throu hout <br />1 <br />❑ <br />1000 ft <br />Friable <br />38 <br />12 °x12° Ceiling Tile <br />Throughout <br />1 <br />39 <br />12 "x12 " C&IIng Tile <br />Throughout <br />1 <br />40 <br />Roof Membrane <br />Roof <br />R <br />G <br />8,900 ft <br />Non - Friable <br />41 <br />lRoof Membrane <br />Roof <br />R <br />42 <br />IRoof Membrane <br />Roof <br />R <br />D <br />v <br />0 <br />3 <br />m <br />c <br />3 <br />s <br />m <br />i ierracon <br />Inspector: William Reid <br />License: 11977 <br />Date: 121312010 <br />ltg ■+0. <br />D = Damaged <br />SD = Significantly Damaged G -6 <br />Pag2g4M of 2 <br />