illinois department of public health ahera...

ILLINOIS DEPARTMENT OF PUBLIC HEALTHAHERA THREE YEAR REINSPECTIONASBESTOS ABATEMENT PROGRAM

SCHOOL INFORMATION FORM

SECTION I

NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299SCHOOL ID NUMBER: 14-016-2990-2700SCHOOL NAME: Clark SchoolADDRESS OF SCHOOL: 1045 S. MonitorCITY: Chicago, IL, 60644

DATE LAST THREE YEAR REINSPECTION WAS COMPLETED 4/11/2013If 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: 4/8/2016 ENROLLMENT 251

IDPH INSPECTOR LICENSE NUMBER: 100-06065

IDPH LICENSED INSPECTOR NAME (Please Print): Bruce Alroth

IDPH MP LICENSE NUMBER: 100-03613

IDPH LICENSED MANAGEMENT PLANNER NAME (Please Print): Daniel Juneau

DESIGNATED PERSON (Please Print): Robert Christlieb PHONE: (773) 553-3197

4/8/2016

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-482-1026 Revised 10.03

THREE–YEAR REINSPECTION

CHICAGO SCHOOL DIST 299

Clark School

1045 S. MonitorChicago, IL, 60644

Unit: 22191Building ID: 2230

IDPH ID Number: 14-016-2990-2700

REPORT DATE:Friday, April 08, 2016

Prepared for:Chicago Public Schools

125 S. Clark StreetChicago, IL 60603

Prepared by:Carnow, Conibear and Associates

600 West Van Buren St., Ste 500

Phone (312) 762-2900

Fax (312) 782-5145

DO NOT REMOVE FROM SCHOOLREQUIRED BY FEDERAL LAW

February 25, 2016

Mr. R. Kent CookAsbestos ProgramIllinois Department of Public Health525 West Jefferson StreetSpringfield, Illinois 62761

Re: Chicago Public Schools - 2016 Three-Year Reinspections

Dear Mr. Cook:

Carnow, Conibear and Associates, Managing Environmental Consultant (MEC), conducted the Three-Year Reinspections and performed management plan updates for the Chicago Public Schools (CPS) facilities in Region 3,4,5 Elementary Schools. Please update your records with the following information.

School District: 299 Unit: 22191 Region: 03 IDPH ID: 14-016-2990-2700

School: Clark School Building ID: 2230

Address: 1045 S. Monitor

Chicago, IL, 60644

Building Contact: Douglas, Donald Contact Phone: 312-318-1319

Current Building Owners: Chicago Public Schools

Review Date: 04/08/2016

Inspector: Bruce Alroth Inspector IDPH License: 100-06065Management Planner: Daniel Juneau Management Planner IDPH License: 100-03613

If you have any questions or comments, please contact us at (312) 762-2900

Sincerely,Carnow, Conibear and Associates

Daniel Juneau100-03613

Environmental Notification to Occupants

To: Faculty, Staff and ParentsFrom: Chicago Public SchoolsDate: February 25, 2016

RE: Clark School, Unit 22191 1045 S. Monitor Chicago, IL, 60644

Dear Faculty, Staff and Parents,

This letter is to notify you that the 2016 asbestos three year re-inspection has been completed at Clark 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 Clark 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 carefullymonitor 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 Robert Christlieb, the designated Local Education Authority's Designated Person at (773) 553-3197 .

Table of Contents

I. School and Inspection Information

II. Executive Summary

III. Methodology

IV. Abatement History

V. Reassessments and Recommendations

VI. Conclusions

Table I: Inspector's Reinspection Findings

Table II: Management Planner's Review

APPENDICES:

Appendix A: Assessment Sheets, Drawings and Photos

Appendix B: Inspector and Management Planner Licenses

Appendix C: Laboratory Accreditations

Appendix D: Laboratory Results

Appendix E: Chain of Custody Forms

SCHOOL AND INSPECTION INFORMATION

1. School Information

School: Clark School Unit: 22191 Region: 03Address: 1045 S. Monitor Chicago, IL, 60644IDPH ID: 14-016-2990-2700 Building ID: 2230Contact: Douglas, Donald Phone: 312-318-1319

2. Description of Facility

Original Construction: 1927 Additional Construction: 1996Total Square Footage: 10900 No of Floors: 1Current Occupancy: 251

3. LEA Designated Person

Contact: Robert Christlieb Phone: (773) 553-3197Address: 125 South Clark Street, 17th Floor Chicago, IL 60603

4. Managing Environmental Consultant

MEC: Carnow, Conibear and AssociatesContact: Dan JuneauAddress 600 West Van Buren St., Ste 500Phone: (312) 762-2900 Fax: (312) 782-5145

5. Inspector

Inspector Name: Bruce Alroth

Signature: Inspector IDPH license # 100-06065 Date: 2/25/2016

6. Management Planner

Management Planner Name: Daniel Juneau

Signature: Management Planner IDPH license # 100-03613 Date: 04/08/2016

7. Review Date: 04/08/2016

8. 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: 4/8/2016

Name: Robert Christlieb

Unit : 22191 Clark School Building: 2230

Unit: 22191 Clark School Building: 2230

II. EXECUTIVE SUMMARY

Carnow, Conibear and Associates was retained by the Chicago Public Schools (CPS) to perform a three-year asbestos reinspection of the Clark School. This inspection was conducted in accordance with the United States Environmental Protection Agency (USEPA) Asbestos Hazard Emergency Response Act (AHERA) part 763.92 (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 previousthree-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 763.85 and 763.88. 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 2230:

A Cementitious Pipe Joint Insulation

43 Hard Joints on Fiberglass Pipe Insulation

45 Mag Block Pipe Insulation

46 Mag Block Insulation Joints

47 Duct Insulation


B. The following new homogenous areas have been identified for Building 2230:


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/orcontained in areas that were inaccessible for sampling and have been classified as Assumed:

10 12x12 floor tile associated mastic12 12x12 white w/blue brown gray streaks FT14 12x12 green VFT w/beige, dk green streaks16 Canvas17 12x12 yellow w/dark yellow & white specks FT19 12x12 Dark green w/white and green specks FT2 Exterior Window Glazing - Not AHERA21 12x12 pink FT w/white streaks23 12x12 light green FT w/dark green specks3 Exterior Brick- Non AHERA31 12x12 light yellow FT w/white specks4 exterior brick associated mortar Non AHERA45 Mag Block Pipe Insulation46 Mag Block Insulation Joints47 Duct Insulation48 Vibration Collar49 Un-recognizable Floor Materials5 Exterior Door Caulk - Non AHERA50 Un-recognizable Floor Material Mastic51 Yellow Linoleum51M Yellow Linoleum Mastic52 12" x 12" Brown w/ White & Brown VFT52M 12" x 12" Brown w/ White & Brown VFT Mastic7 Roofing Material - Non AHERA8 9x9 VFT -8A 9x9 VFT Mastic

The following areas were deemed to be inaccessible:

A Cementitious Pipe Joint Insulation10 12x12 floor tile associated mastic51M Yellow Linoleum Mastic52M 12" x 12" Brown w/ White & Brown VFT Mastic

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 Bruce Alroth, IDPH License # 100-06065. The Management Plan was updated by Daniel Juneau, IDPH License # 100-03613. Inspector and


Management Planner Licenses are included in Appendix B.


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 thesematerials 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 anyHA(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 appropriateresponse 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 forinclusion into the management plan.

IV. ABATEMENT HISTORYThe information collected from the existing management plan and inspection report(s) and from interviews with the schoolofficial revealed that the following asbestos abatement was conducted at the school since the previous Three year Reinspection.

Abatement Dates:

V. REASSESSMENTS AND RECOMMENDATIONSThe reassessments and recommendations are summarized in Tables I and II on the following pages. Detailed Hazard AssessmentSheets and Drawings and Photos (if applicable) are included in Appendix A.

VI. CONCLUSIONSThe Clark School Building 2230 Three-Year reinspection has been completed and response actions have been recommended forboth friable and non-friable materials. A timely execution of the response actions recommended will enable the LEA and theDesignated 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 hasbeen identified. Also, periodic surveillance documentation and any summary reports from any response actions that are executedat the school should be used to update the Management Plan.

Table IInspector's Reinspection Findings

Chicago Public Schools School Clark School Unit 22191 Building ID 2230 Address 1045 S. Monitor Region 03

ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONSInspector's Reinspection Findings Table 1

Managing Environmental Consultant (MEC) Carnow, Conibear and Associates

600 West Van Buren St., Ste 500 Phone: (312) 762-2900 Fax: (312) 782-5145

Inspector's Comments are Summarized at the End of the Report

HA No Material Description Material Quantity

Material Units

Material Location Asbestos Type

Material Category

Friable Damage Type

Damage Quantity

Damage Units Change in Assessment Category

Damage Category Damage Reason Disturbance Potential

A Cementitious Pipe Joint Insulation 200 LF Maintenance Room, Room 4, Above Ceilings

AMO TSI Y NONE 0 Yes Any remaining friable ACBM or friable suspect ACBM

LOW

1 Exterior Window Caulk - Non AHERA Exterior Window CHR MISC10 12x12 floor tile associated mastic 4,500 SF throughout ASSUMED MISC N NONE 0 No ACBM with the

potential for damageLOW

12 12x12 white w/blue brown gray streaks FT 2,880 SF Old Building, hall, office, 204 and 206

ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

13 12x12 white w/blue brown gray streaks FTmastic

Old Building, hall, office, 204 and 206

NO_ACBM MISC

14 12x12 green VFT w/beige, dk green streaks 480 SF Old Building Hall ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

15 12x12 green VFT w/beige, dk green streaksmastic

Old Building Hall NO_ACBM MISC

16 Canvas Old Bldg, Main Office

ASSUMED MISC

17 12x12 yellow w/dark yellow & white specks FT

7,320 SF Annex-Throughout 1st floor and 2nd floor hall and classrooms


LOW

18 12x12 yellow w/dk yellow & white specks FT mastic

Annex-throughout 1st flr and 2nd flr hall and class rms

NO_ACBM MISC

19 12x12 Dark green w/white and green specks FT

7,320 SF Annex-throughout 1st, 2nd flr hall and class rooms


LOW

2 Exterior Window Glazing - Not AHERA Exterior Window Walls

ASSUMED MISC

20 12x12 dk green w/white and green specks FT mastic

Annex-throughout 1st, 2nd flr hall and class rooms

NO_ACBM MISC

21 12x12 pink FT w/white streaks 1,880 SF Annex-throughout 2nd flr class rooms


LOW

22 12x12 pink FT w/white streaks mastic Annex-throughout 2nd flr class rooms

NO_ACBM MISC

23 12x12 light green FT w/dark green specks 7,076 SF Annex-throughout 1st, 2nd floor


LOW

24 12x12 light green FT w/dark green specks mastic

Annex-throughout 1st, 2nd floor

NO_ACBM MISC

25 4" green base board Annex- throughout classroom and hall

NO_ACBM MISC

26 4" green base board mastic Annex- throughout classroom and hall

NO_ACBM MISC

27 2x4 white wormy pinhole CT Annex- 305, 303, NO_ACBM MISC







Material Units


Material Category

Friable Damage Type

Damage Quantity



30128 2x2 white wormy pinhole CT Annex-1st and 2nd

floor hallNO_ACBM MISC

29 2'x2' Pink Linoleum Annex-stairway NO_ACBM MISC3 Exterior Brick- Non AHERA Exterior Walls ASSUMED MISC30 2x2 Pink Linoleum Mastic Annex-stairway NO_ACBM MISC31 12x12 light yellow FT w/white specks 1,125 SF Annex-1st floor

class roomsASSUMED MISC N NONE 0 No ACBM with the

potential for damageLOW

32 12x12 light yellow FloorTile w/white specks mastic

Annex-1st floor class rooms

NO_ACBM MISC

33 Vibration Caulk Annex-2nd floor mech. Room

NO_ACBM MISC

34 Gray Linoleum annex-gym NO_ACBM MISC35 gray linoleum mastic Annex-gym NO_ACBM MISC36 Sink Undercoat Annex-classrooms NO_ACBM SURFACE37 Red/green carpet mastic Annex-Library and

Main OfficeABATED MISC

38 4" Gray Base Board Annex-gym NO_ACBM MISC39 4" Gray Base Board Mastic Annex-gym NO_ACBM MISC4 exterior brick associated mortar Non

AHERAexterior walls ASSUMED MISC

40 Drywall Throughout Building

NO_ACBM MISC

41 Drywall Compound Throughout Building

NO_ACBM MISC

42 Spray-On Throughout Building

NO_ACBM SURFACE

43 Hard Joints on Fiberglass Pipe Insulation 71 LF Basement, Crawl Space and storage room

CHR TSI Y NONE 0 Yes Any remaining friable ACBM or friable suspect ACBM

LOW

44 Lab Table Tops Annex-306 NO_ACBM MISC45 Mag Block Pipe Insulation 170 LF Crawl Space 1 ASSUMED TSI Y NONE 0 Yes Any remaining friable

ACBM or friable suspect ACBM

LOW

46 Mag Block Insulation Joints 20 LF Crawl Space 1 ASSUMED TSI Y NONE 0 Yes Any remaining friable ACBM or friable suspect ACBM

LOW

47 Duct Insulation 800 SF Crawl Space 1, 2, 3, 4

ASSUMED TSI Y NONE 0 Yes Any remaining friable ACBM or friable suspect ACBM

LOW

48 Vibration Collar 5 LF Mechanical Room ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

49 Un-recognizable Floor Materials Slop Sink in Old ASSUMED MISC







Material Units


Material Category

Friable Damage Type

Damage Quantity



Building5 Exterior Door Caulk - Non AHERA Exterior Walls ASSUMED MISC50 Un-recognizable Floor Material Mastic Slop sink in Old

buildingASSUMED MISC None Low

51 Yellow Linoleum 35 SF Basement Boiler Room Bathroom


LOW

51M Yellow Linoleum Mastic 35 SF Basement Boiler Room Bathroom


LOW

52 12" x 12" Brown w/ White & Brown VFT 600 SF Main Office ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

52M 12" x 12" Brown w/ White & Brown VFT Mastic

600 SF Main Office ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

6 Incinerator Mortar Boiler Room NO_ACBM MISC7 Roofing Material - Non AHERA Roof ASSUMED MISC8 9x9 VFT - Throughout school ASSUMED MISC Low8A 9x9 VFT Mastic Throughout School -

Old BuildingASSUMED MISC Low

9 12x12 floor tile throughout- This material has been separated into HA's 12, 13, 14, 15

MISC None Low






Reinspection Date 2/25/2016

Inspector Name Bruce Alroth

100-06065 5/15/2017Inspector's IDPH License Number / Expiration Date

Inspector's Comments

HA Number: Inspector Comments: A1101213141516 Not observed 2016171819220212223242526272829330






HA Number: Inspector Comments:313233343536373839440414243444546474849 Not observed 2016550 Not observed 20165151M5252M678 Not observed 2016






HA Number: Inspector Comments:8A Not observed 20169

Table II

Management Planner's Review

Chicago Public SchoolsSchool Clark School Unit 22191 Building ID 2230

Address 1045 S. Monitor Chicago, IL, 60644 Region 03

ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS

Management Planner's Review Table II



Phone: (312) 762-2900 Fax: (312) 782-5145

Management Planner's Comments Summarized at the End of the ReportHA Num

Material Description Material Quantity

Material Units

Material Location AsbestosType

Material Category

Friable Damage Quantity

Damage Units

Damage Category Response

A Cementitious Pipe Joint Insulation 200 LF Maintenance Room, Room 4, Above Ceilings

Amosite TSI Yes 0 LF 7 Any remaining friable ACBM or friable suspect ACBM

Follow O&M Plan

1 Exterior Window Caulk - Non AHERA Exterior Window Chrysotile MISC 10 12x12 floor tile associated mastic 4,500 SF throughout Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan12 12x12 white w/blue brown gray streaks FT 2,880 SF Old Building, hall, office, 204 and 206 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan13 12x12 white w/blue brown gray streaks FT mastic Old Building, hall, office, 204 and 206 No ACBM MISC 14 12x12 green VFT w/beige, dk green streaks 480 SF Old Building Hall Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan15 12x12 green VFT w/beige, dk green streaks mastic Old Building Hall No ACBM MISC 16 Canvas Old Bldg, Main Office Assumed MISC 17 12x12 yellow w/dark yellow & white specks FT 7,320 SF Annex-Throughout 1st floor and 2nd

floor hall and classroomsAssumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan

18 12x12 yellow w/dk yellow & white specks FT mastic Annex-throughout 1st flr and 2nd flr halland class rms

No ACBM MISC

19 12x12 Dark green w/white and green specks FT 7,320 SF Annex-throughout 1st, 2nd flr hall and class rooms

Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan

2 Exterior Window Glazing - Not AHERA Exterior Window Walls Assumed MISC 20 12x12 dk green w/white and green specks FT

masticAnnex-throughout 1st, 2nd flr hall and class rooms

No ACBM MISC

21 12x12 pink FT w/white streaks 1,880 SF Annex-throughout 2nd flr class rooms Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan22 12x12 pink FT w/white streaks mastic Annex-throughout 2nd flr class rooms No ACBM MISC 23 12x12 light green FT w/dark green specks 7,076 SF Annex-throughout 1st, 2nd floor Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan24 12x12 light green FT w/dark green specks mastic Annex-throughout 1st, 2nd floor No ACBM MISC 25 4" green base board Annex- throughout classroom and hall No ACBM MISC 26 4" green base board mastic Annex- throughout classroom and hall No ACBM MISC 27 2x4 white wormy pinhole CT Annex- 305, 303, 301 No ACBM MISC 28 2x2 white wormy pinhole CT Annex-1st and 2nd floor hall No ACBM MISC 29 2'x2' Pink Linoleum Annex-stairway No ACBM MISC 3 Exterior Brick- Non AHERA Exterior Walls Assumed MISC 30 2x2 Pink Linoleum Mastic Annex-stairway No ACBM MISC 31 12x12 light yellow FT w/white specks 1,125 SF Annex-1st floor class rooms Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan32 12x12 light yellow FloorTile w/white specks mastic Annex-1st floor class rooms No ACBM MISC 33 Vibration Caulk Annex-2nd floor mech. Room No ACBM MISC 34 Gray Linoleum annex-gym No ACBM MISC 35 gray linoleum mastic Annex-gym No ACBM MISC 36 Sink Undercoat Annex-classrooms No ACBM SURFACE







Phone: (312) 762-2900 Fax: (312) 782-5145

Management Planner's Comments Summarized at the End of the ReportHA Num

Material Description Material Quantity

Material Units

Material Location AsbestosType

Material Category

Friable Damage Quantity

Damage Units

Damage Category Response

37 Red/green carpet mastic Annex-Library and Main Office Abated MISC 38 4" Gray Base Board Annex-gym No ACBM MISC 39 4" Gray Base Board Mastic Annex-gym No ACBM MISC 4 exterior brick associated mortar Non AHERA exterior walls Assumed MISC 40 Drywall Throughout Building No ACBM MISC 41 Drywall Compound Throughout Building No ACBM MISC 42 Spray-On Throughout Building No ACBM SURFACE 43 Hard Joints on Fiberglass Pipe Insulation 71 LF Basement, Crawl Space and storage

roomChrysotile TSI Yes 0 LF 7 Any remaining friable ACBM or friable

suspect ACBMFollow O&M Plan

44 Lab Table Tops Annex-306 No ACBM MISC 45 Mag Block Pipe Insulation 170 LF Crawl Space 1 Assumed TSI Yes 0 LF 7 Any remaining friable ACBM or friable

suspect ACBMFollow O&M Plan

46 Mag Block Insulation Joints 20 LF Crawl Space 1 Assumed TSI Yes 0 LF 7 Any remaining friable ACBM or friable suspect ACBM

Follow O&M Plan

47 Duct Insulation 800 SF Crawl Space 1, 2, 3, 4 Assumed TSI Yes 0 SF 7 Any remaining friable ACBM or friable suspect ACBM

Follow O&M Plan

48 Vibration Collar 5 LF Mechanical Room Assumed MISC No 0 LF 6 ACBM with the potential for damage Follow O&M Plan49 Un-recognizable Floor Materials Slop Sink in Old Building Assumed MISC 5 Exterior Door Caulk - Non AHERA Exterior Walls Assumed MISC 50 Un-recognizable Floor Material Mastic Slop sink in Old building Assumed MISC 51 Yellow Linoleum 35 SF Basement Boiler Room Bathroom Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan51M Yellow Linoleum Mastic 35 SF Basement Boiler Room Bathroom Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan52 12" x 12" Brown w/ White & Brown VFT 600 SF Main Office Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan52M 12" x 12" Brown w/ White & Brown VFT Mastic 600 SF Main Office Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan6 Incinerator Mortar Boiler Room No ACBM MISC 7 Roofing Material - Non AHERA Roof Assumed MISC 8 9x9 VFT - Throughout school Assumed MISC 8A 9x9 VFT Mastic Throughout School - Old Building Assumed MISC 9 12x12 floor tile throughout- This material has been

separated into HA's 12, 13, 14, 15MISC







Phone: (312) 762-2900 Fax: (312) 782-5145

Management Planner's Comments Summarized at the End of the Report

Review Date 4/8/2016

Manager Planner Name Daniel Juneau100-03613 5/15/2016Manager IDPH License No/Expiration

HA Number Management Comments A1101213141516 If identified, implement O&M171819







Phone: (312) 762-2900 Fax: (312) 782-5145

Management Planner's Comments Summarized at the End of the ReportHA Number Management Comments220212223242526272829330313233343536373839440414243







Phone: (312) 762-2900 Fax: (312) 782-5145

Management Planner's Comments Summarized at the End of the ReportHA Number Management Comments444546474849 If identified, implement O&M5 If identified, implement O&M50 If identified, implement O&M5151M5252M678 If identified, implement O&M8A If identified, implement O&M9

Chicago Public Schools

Carnow, Conibear and Associates

2016 AHERA REINSPECTION

Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: 22191 BUIDLING ID: 2230

CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Bruce Alroth

SCHOOL NAME: Clark School INSPECTION DATE: 2/25/2016

ADDRESS: 1045 S. Monitor IDPH LICENSE NO: 100-06065

INFORMATION FROM PREVIOUS INSPECTION

HOMOGENEOUS AREA: A

MATERIAL DESCRIPTION: Cementitious Pipe Joint Insulation

HISTORICAL AHERA DAMAGE CATEGORY 7 ACBM with the potential for damage

HISTORICAL DAMAGE REASON:

HISTORICAL RESPONSE ACTION: Follow O&M Plan

ASBESTOS TYPE: Amosite FRIABLE: Yes

RESULTS OF REINSPECTION AND REASSESSMENT

This homogeneous area was reinspected and reassessed in accordance with Section 763.85 and 763.88 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 7. Any remaining friable ACBM or friable suspect ACBM

DAMAGE REASON:

DISTURBANCE POTENTIAL: LOW

MATERIAL LOCATION: Maintenance Room, Room 4, Above Ceilings

MATERIAL QUANTITY: 200 MATERIAL UNITS: LF

DAMAGE QUANTITY: DAMAGE UNITS: LF

COMMENTS:

Inspector's Signature: Date: 02/25/2016




Management Planner Review FormLEA NAME: Chicago Public Schools UNIT NUMBER: 22191 BUIDLING ID: 2230

CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Daniel Juneau

SCHOOL NAME: Clark School REVIEW DATE: 4/8/2016


HOMOGENEOUS AREA: A

MATERIAL DESCRIPTION: Cementitious Pipe Joint Insulation

MATERIAL LOCATION: Maintenance Room, Room 4, Above Ceilings


DAMAGE QUANTITY: 0 DAMAGE UNITS: LF

In accordance with Sections 763.88 and 763.90 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 763.88 and 763.90 with the following recommendations.

The RESPONSE ACTION recommendation is:

Follow O&M Plan

Comments:

Management Planner's Signature: Date: 04/08/2016









HOMOGENEOUS AREA: 1

MATERIAL DESCRIPTION: Exterior Window Caulk - Non AHERA

HISTORICAL AHERA DAMAGE CATEGORY


HISTORICAL RESPONSE ACTION:

ASBESTOS TYPE: Chrysotile FRIABLE:



The current AHERA DAMAGE CATEGORY is determined to be .

DAMAGE REASON:

DISTURBANCE POTENTIAL:

MATERIAL LOCATION: Exterior Window

MATERIAL QUANTITY: MATERIAL UNITS:

DAMAGE QUANTITY: DAMAGE UNITS:

COMMENTS:









HOMOGENEOUS AREA: 1

MATERIAL DESCRIPTION: Exterior Window Caulk - Non AHERA

MATERIAL LOCATION: Exterior Window





Comments:










HOMOGENEOUS AREA: 10

MATERIAL DESCRIPTION: 12x12 floor tile associated mastic




ASBESTOS TYPE: Assumed FRIABLE: No



The current AHERA DAMAGE CATEGORY is determined to be 6. ACBM with the potential for damage

DAMAGE REASON:


MATERIAL LOCATION: throughout

MATERIAL QUANTITY: 4500 MATERIAL UNITS: SF

DAMAGE QUANTITY: DAMAGE UNITS: SF

COMMENTS:










MATERIAL DESCRIPTION: 12x12 floor tile associated mastic

MATERIAL LOCATION: throughout


DAMAGE QUANTITY: 0 DAMAGE UNITS: SF



Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 white w/blue brown gray streaks FT








DAMAGE REASON:


MATERIAL LOCATION: Old Building, hall, office, 204 and 206



COMMENTS:










MATERIAL DESCRIPTION: 12x12 white w/blue brown gray streaks FT






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 white w/blue brown gray streaks FT mastic




ASBESTOS TYPE: No ACBM FRIABLE:




DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12x12 white w/blue brown gray streaks FT mastic






Comments:











MATERIAL DESCRIPTION: 12x12 green VFT w/beige, dk green streaks








DAMAGE REASON:


MATERIAL LOCATION: Old Building Hall



COMMENTS:










MATERIAL DESCRIPTION: 12x12 green VFT w/beige, dk green streaks






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 green VFT w/beige, dk green streaks mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12x12 green VFT w/beige, dk green streaks mastic






Comments:











MATERIAL DESCRIPTION: Canvas




ASBESTOS TYPE: Assumed FRIABLE:




DAMAGE REASON:


MATERIAL LOCATION: Old Bldg, Main Office



COMMENTS: Not observed 2016










MATERIAL DESCRIPTION: Canvas

MATERIAL LOCATION: Old Bldg, Main Office





Comments:

If identified, implement O&M











MATERIAL DESCRIPTION: 12x12 yellow w/dark yellow & white specks FT








DAMAGE REASON:


MATERIAL LOCATION: Annex-Throughout 1st floor and 2nd floor hall and classrooms



COMMENTS:










MATERIAL DESCRIPTION: 12x12 yellow w/dark yellow & white specks FT

MATERIAL LOCATION: Annex-Throughout 1st floor and 2nd floor hall and classrooms





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 yellow w/dk yellow & white specks FT mastic








DAMAGE REASON:


MATERIAL LOCATION: Annex-throughout 1st flr and 2nd flr hall and class rms



COMMENTS:










MATERIAL DESCRIPTION: 12x12 yellow w/dk yellow & white specks FT mastic

MATERIAL LOCATION: Annex-throughout 1st flr and 2nd flr hall and class rms





Comments:











MATERIAL DESCRIPTION: 12x12 Dark green w/white and green specks FT








DAMAGE REASON:


MATERIAL LOCATION: Annex-throughout 1st, 2nd flr hall and class rooms



COMMENTS:










MATERIAL DESCRIPTION: 12x12 Dark green w/white and green specks FT






Follow O&M Plan

Comments:










HOMOGENEOUS AREA: 2

MATERIAL DESCRIPTION: Exterior Window Glazing - Not AHERA








DAMAGE REASON:


MATERIAL LOCATION: Exterior Window Walls



COMMENTS:









HOMOGENEOUS AREA: 2

MATERIAL DESCRIPTION: Exterior Window Glazing - Not AHERA

MATERIAL LOCATION: Exterior Window Walls





Comments:











MATERIAL DESCRIPTION: 12x12 dk green w/white and green specks FT mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12x12 dk green w/white and green specks FT mastic






Comments:











MATERIAL DESCRIPTION: 12x12 pink FT w/white streaks








DAMAGE REASON:


MATERIAL LOCATION: Annex-throughout 2nd flr class rooms



COMMENTS:










MATERIAL DESCRIPTION: 12x12 pink FT w/white streaks






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 pink FT w/white streaks mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12x12 pink FT w/white streaks mastic






Comments:











MATERIAL DESCRIPTION: 12x12 light green FT w/dark green specks








DAMAGE REASON:


MATERIAL LOCATION: Annex-throughout 1st, 2nd floor



COMMENTS:










MATERIAL DESCRIPTION: 12x12 light green FT w/dark green specks






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 light green FT w/dark green specks mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12x12 light green FT w/dark green specks mastic






Comments:











MATERIAL DESCRIPTION: 4" green base board








DAMAGE REASON:


MATERIAL LOCATION: Annex- throughout classroom and hall



COMMENTS:










MATERIAL DESCRIPTION: 4" green base board






Comments:











MATERIAL DESCRIPTION: 4" green base board mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 4" green base board mastic






Comments:











MATERIAL DESCRIPTION: 2x4 white wormy pinhole CT








DAMAGE REASON:


MATERIAL LOCATION: Annex- 305, 303, 301



COMMENTS:











MATERIAL LOCATION: Annex- 305, 303, 301





Comments:



















DAMAGE REASON:


MATERIAL LOCATION: Annex-1st and 2nd floor hall



COMMENTS:











MATERIAL LOCATION: Annex-1st and 2nd floor hall





Comments:











MATERIAL DESCRIPTION: 2'x2' Pink Linoleum








DAMAGE REASON:


MATERIAL LOCATION: Annex-stairway



COMMENTS:










MATERIAL DESCRIPTION: 2'x2' Pink Linoleum






Comments:










HOMOGENEOUS AREA: 3

MATERIAL DESCRIPTION: Exterior Brick- Non AHERA








DAMAGE REASON:


MATERIAL LOCATION: Exterior Walls



COMMENTS:









HOMOGENEOUS AREA: 3

MATERIAL DESCRIPTION: Exterior Brick- Non AHERA






Comments:











MATERIAL DESCRIPTION: 2x2 Pink Linoleum Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 2x2 Pink Linoleum Mastic






Comments:











MATERIAL DESCRIPTION: 12x12 light yellow FT w/white specks








DAMAGE REASON:


MATERIAL LOCATION: Annex-1st floor class rooms



COMMENTS:










MATERIAL DESCRIPTION: 12x12 light yellow FT w/white specks






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12x12 light yellow FloorTile w/white specks mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12x12 light yellow FloorTile w/white specks mastic






Comments:











MATERIAL DESCRIPTION: Vibration Caulk








DAMAGE REASON:


MATERIAL LOCATION: Annex-2nd floor mech. Room



COMMENTS:










MATERIAL DESCRIPTION: Vibration Caulk

MATERIAL LOCATION: Annex-2nd floor mech. Room





Comments:











MATERIAL DESCRIPTION: Gray Linoleum








DAMAGE REASON:


MATERIAL LOCATION: annex-gym



COMMENTS:










MATERIAL DESCRIPTION: Gray Linoleum

MATERIAL LOCATION: annex-gym





Comments:











MATERIAL DESCRIPTION: gray linoleum mastic








DAMAGE REASON:


MATERIAL LOCATION: Annex-gym



COMMENTS:










MATERIAL DESCRIPTION: gray linoleum mastic






Comments:











MATERIAL DESCRIPTION: Sink Undercoat








DAMAGE REASON:


MATERIAL LOCATION: Annex-classrooms



COMMENTS:










MATERIAL DESCRIPTION: Sink Undercoat

MATERIAL LOCATION: Annex-classrooms





Comments:











MATERIAL DESCRIPTION: Red/green carpet mastic




ASBESTOS TYPE: Abated FRIABLE:




DAMAGE REASON:


MATERIAL LOCATION: Annex-Library and Main Office



COMMENTS:










MATERIAL DESCRIPTION: Red/green carpet mastic

MATERIAL LOCATION: Annex-Library and Main Office





Comments:











MATERIAL DESCRIPTION: 4" Gray Base Board








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 4" Gray Base Board






Comments:











MATERIAL DESCRIPTION: 4" Gray Base Board Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 4" Gray Base Board Mastic






Comments:










HOMOGENEOUS AREA: 4

MATERIAL DESCRIPTION: exterior brick associated mortar Non AHERA








DAMAGE REASON:


MATERIAL LOCATION: exterior walls



COMMENTS:









HOMOGENEOUS AREA: 4

MATERIAL DESCRIPTION: exterior brick associated mortar Non AHERA

MATERIAL LOCATION: exterior walls





Comments:











MATERIAL DESCRIPTION: Drywall








DAMAGE REASON:


MATERIAL LOCATION: Throughout Building



COMMENTS:










MATERIAL DESCRIPTION: Drywall






Comments:











MATERIAL DESCRIPTION: Drywall Compound








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: Drywall Compound






Comments:











MATERIAL DESCRIPTION: Spray-On








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: Spray-On






Comments:











MATERIAL DESCRIPTION: Hard Joints on Fiberglass Pipe Insulation




ASBESTOS TYPE: Chrysotile FRIABLE: Yes




DAMAGE REASON:


MATERIAL LOCATION: Basement, Crawl Space and storage room



COMMENTS:










MATERIAL DESCRIPTION: Hard Joints on Fiberglass Pipe Insulation

MATERIAL LOCATION: Basement, Crawl Space and storage room





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Lab Table Tops








DAMAGE REASON:


MATERIAL LOCATION: Annex-306



COMMENTS:










MATERIAL DESCRIPTION: Lab Table Tops

MATERIAL LOCATION: Annex-306





Comments:











MATERIAL DESCRIPTION: Mag Block Pipe Insulation

HISTORICAL AHERA DAMAGE CATEGORY 7 Any remaining friable ACBM or friable suspect ACBM



ASBESTOS TYPE: Assumed FRIABLE: Yes




DAMAGE REASON:


MATERIAL LOCATION: Crawl Space 1



COMMENTS:










MATERIAL DESCRIPTION: Mag Block Pipe Insulation






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Mag Block Insulation Joints








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: Mag Block Insulation Joints






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Duct Insulation


HISTORICAL DAMAGE REASON: WaterPhysical DamageDelamination

HISTORICAL RESPONSE ACTION: Repair





DAMAGE REASON:


MATERIAL LOCATION: Crawl Space 1, 2, 3, 4



COMMENTS:










MATERIAL DESCRIPTION: Duct Insulation

MATERIAL LOCATION: Crawl Space 1, 2, 3, 4





Repair

Comments:











MATERIAL DESCRIPTION: Vibration Collar








DAMAGE REASON:


MATERIAL LOCATION: Mechanical Room



COMMENTS:










MATERIAL DESCRIPTION: Vibration Collar

MATERIAL LOCATION: Mechanical Room





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Un-recognizable Floor Materials








DAMAGE REASON:


MATERIAL LOCATION: Slop Sink in Old Building













MATERIAL DESCRIPTION: Un-recognizable Floor Materials

MATERIAL LOCATION: Slop Sink in Old Building





Comments:











HOMOGENEOUS AREA: 5

MATERIAL DESCRIPTION: Exterior Door Caulk - Non AHERA








DAMAGE REASON:





COMMENTS:









HOMOGENEOUS AREA: 5

MATERIAL DESCRIPTION: Exterior Door Caulk - Non AHERA






Comments:












MATERIAL DESCRIPTION: Un-recognizable Floor Material Mastic








DAMAGE REASON:

DISTURBANCE POTENTIAL: Low

MATERIAL LOCATION: Slop sink in Old building













MATERIAL DESCRIPTION: Un-recognizable Floor Material Mastic

MATERIAL LOCATION: Slop sink in Old building





Comments:












MATERIAL DESCRIPTION: Yellow Linoleum








DAMAGE REASON:


MATERIAL LOCATION: Basement Boiler Room Bathroom



COMMENTS:










MATERIAL DESCRIPTION: Yellow Linoleum






Follow O&M Plan

Comments:










HOMOGENEOUS AREA: 51M

MATERIAL DESCRIPTION: Yellow Linoleum Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: Yellow Linoleum Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12" x 12" Brown w/ White & Brown VFT








DAMAGE REASON:


MATERIAL LOCATION: Main Office



COMMENTS:










MATERIAL DESCRIPTION: 12" x 12" Brown w/ White & Brown VFT






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12" x 12" Brown w/ White & Brown VFT Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12" x 12" Brown w/ White & Brown VFT Mastic






Follow O&M Plan

Comments:










HOMOGENEOUS AREA: 6

MATERIAL DESCRIPTION: Incinerator Mortar








DAMAGE REASON:


MATERIAL LOCATION: Boiler Room



COMMENTS:









HOMOGENEOUS AREA: 6

MATERIAL DESCRIPTION: Incinerator Mortar

MATERIAL LOCATION: Boiler Room





Comments:










HOMOGENEOUS AREA: 7

MATERIAL DESCRIPTION: Roofing Material - Non AHERA








DAMAGE REASON:


MATERIAL LOCATION: Roof



COMMENTS:









HOMOGENEOUS AREA: 7

MATERIAL DESCRIPTION: Roofing Material - Non AHERA

MATERIAL LOCATION: Roof





Comments:










HOMOGENEOUS AREA: 8

MATERIAL DESCRIPTION: 9x9 VFT -








DAMAGE REASON:


MATERIAL LOCATION: Throughout school












HOMOGENEOUS AREA: 8

MATERIAL DESCRIPTION: 9x9 VFT -

MATERIAL LOCATION: Throughout school





Comments:











HOMOGENEOUS AREA: 8A

MATERIAL DESCRIPTION: 9x9 VFT Mastic








DAMAGE REASON:


MATERIAL LOCATION: Throughout School - Old Building












HOMOGENEOUS AREA: 8A

MATERIAL DESCRIPTION: 9x9 VFT Mastic

MATERIAL LOCATION: Throughout School - Old Building





Comments:











HOMOGENEOUS AREA: 9

MATERIAL DESCRIPTION: 12x12 floor tile




ASBESTOS TYPE: FRIABLE:




DAMAGE REASON:


MATERIAL LOCATION: throughout- This material has been separated into HA's 12, 13, 14, 15



COMMENTS:









HOMOGENEOUS AREA: 9

MATERIAL DESCRIPTION: 12x12 floor tile

MATERIAL LOCATION: throughout- This material has been separated into HA's 12, 13, 14, 15





Comments:


APPENDIX B

Inspector and Management Planner Licenses

APPENDIX C

Laboratory Accreditations

APPENDIX D

Laboratory Results

APPENDIX E

Chain of Custody Forms

Three-Year Reinspection Key to Terms

CODE KEYMATERIAL

ACBM Asbestos Containing Building MaterialsMATERIAL CATEGORY

MISC Miscellaneous

SURF Surfacing

TSI Thermal System InsulationMATERIAL UNITS

LF Linear Feet

SF Square Feet

CF Cubic FeetDAMAGE TYPE

Loc Localized

Dist Distributed

illinois department of public health ahera...

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