illinois department of public health ahera three...

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: 14-016-2990-564XSCHOOL NAME: UNO - Octavio Paz PrimaryADDRESS OF SCHOOL: 2651 W. 23rd StCITY: Chicago, IL, 60608

DATE LAST THREE YEAR REINSPECTION WAS COMPLETED 3/4/2013If 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: 5/4/2016 ENROLLMENT 382

IDPH INSPECTOR LICENSE NUMBER: 100-00249

IDPH LICENSED INSPECTOR NAME (Please Print): John Feely

IDPH MP LICENSE NUMBER: 100-09870

IDPH LICENSED MANAGEMENT PLANNER NAME (Please Print): Todd Huffer

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

5/4/2016

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

UNO - Octavio Paz Primary

2651 W. 23rd StChicago, IL, 60608

Unit: 66131Building ID: 5810-23rd

IDPH ID Number: 14-016-2990-564X

REPORT DATE:Wednesday, May 04, 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

April 12, 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: 66131 Region: 02 IDPH ID: 14-016-2990-564X

School: UNO - Octavio Paz Primary Building ID: 5810-23rd

Address: 2651 W. 23rd St

Chicago, IL, 60608

Building Contact: Contact Phone:

Current Building Owners: Chicago Public Schools

Review Date: 05/04/2016

Inspector: John Feely Inspector IDPH License: 100-00249Management Planner: Todd Huffer Management Planner IDPH License: 100-09870

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

Sincerely,Carnow, Conibear and Associates

Todd Huffer100-09870

Environmental Notification to Occupants

To: Faculty, Staff and ParentsFrom: Chicago Public SchoolsDate: April 12, 2016

RE: UNO - Octavio Paz Primary, Unit 66131 2651 W. 23rd St Chicago, IL, 60608

Dear Faculty, Staff and Parents,

This letter is to notify you that the 2016 asbestos three year re-inspection has been completed at UNO - Octavio Paz Primary , following the Federal Asbestos Hazard Emergency Response Act (AHERA), 40CFR 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 UNO - Octavio Paz Primary, there is noreason to believe that any threat to the health of students or staff exists at this time. CPS will continue to carefully monitor 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: UNO - Octavio Paz Primary Unit: 66131 Region: 02Address: 2651 W. 23rd St Chicago, IL, 60608IDPH ID: 14-016-2990-564X Building ID: 5810-23rdContact: Phone:

2. Description of Facility

Original Construction: Additional Construction: Total Square Footage: No of Floors: Current Occupancy: 382

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: John Feely

Signature: Inspector IDPH license # 100-00249 Date: 4/12/2016

6. Management Planner

Management Planner Name: Todd Huffer

Signature: Management Planner IDPH license # 100-09870 Date: 05/04/2016

7. Review Date: 05/04/2016

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: 5/4/2016

Name: Robert Christlieb

Unit : 66131 UNO - Octavio Paz Primary Building: 5810-23rd

Unit: 66131 UNO - Octavio Paz Primary Building: 5810-23rd

II. EXECUTIVE SUMMARY

Carnow, Conibear and Associates was retained by the Chicago Public Schools (CPS) to perform a three-year asbestos reinspection of the UNO - Octavio Paz Primary. 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 theprevious three-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 5810-23rd:

01 MJP on Corrugated Pipe Covering

02 Corrugated Pipe Covering

09 Wrapped Pipe Covering


B. The following new homogenous areas have been identified for Building 5810-23rd:


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:

05 Linoleum10 Fire Door Insulation100 Plaster101 Window Caulk102 Door Caulk103 Green Terrazzo104 12" X 12" Black VFT105 12" X 12" Black VFT Mastic106 Boiler Insulator107 Boiler Gasket11 12"x12" Blue w/Dk Blue & White Streaks Floor

Tile12 12"x12" Blue w/Dark Blue & White Streaks FT

Mastic13 9"x9" Tan w/ Dark Streaks Floor Tile14 9"x9" Tan w/Dark Streaks Floor Tile Mastic15 9"x9" Maroon w/Dark Streaks Floor Tile16 9"x9" Maroon w/Dark Streaks Floor Tile Mastic17 12"x12" White w/Multi-Colored Streaks FT18 12"x12" White w/Multi-Colored Streaks FT Mastic19 9"x9" Red Floor Tile20 9"x9" Red Floor Tile Mastic21 9"x9" Black Floor Tile22 9"x9" Black Floor Tile Mastic25 2" Black Mop Board26 2" Black Mop Board Adhesive27 Grey Carpet Mastic

The following areas were deemed to be inaccessible:

04 Vinyl Floor Tile Mastic10 Fire Door Insulation105 12" X 12" Black VFT Mastic23 12"x12" Off-White w/Brn,Wht,& Gry Strks Floor

Tile

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 John Feely, IDPH License # 100-00249. The Management Plan was updated by Todd Huffer, IDPH License # 100-09870. 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 UNO - Octavio Paz Primary Building 5810-23rd Three-Year reinspection has been completed and response actions havebeen recommended for both friable and non-friable materials. A timely execution of the response actions recommended willenable the LEA and the Designated 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 UNO - Octavio Paz Primary Unit 66131 Building ID 5810-23rd Address 2651 W. 23rd St Region 02

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

01 MJP on Corrugated Pipe Covering 270 LF Tunnel CHR TSI Y DIST 230 Yes Damaged or significantly damaged friable thermal system insulating ACBM

3 HIGH

02 Corrugated Pipe Covering 1,400 LF Tunnel CHR TSI Y DIST 1,190 Yes Damaged or significantly damaged friable thermal system insulating ACBM

3 HIGH

03 9"x9" Floor Tile 100 SF All Floors of Building

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

LOW

04 Vinyl Floor Tile Mastic 1,000 SF All Floors of Building

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

LOW

05 Linoleum 8,100 SF All Floors of Building

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

LOW

06 MJP on Corrugated Pipe Covering 40 LF Boiler Room #1 Boiler Storage and Tunnels

CHR TSI Y DIST 34 No Damaged or significantly damaged friable thermal system insulating ACBM

3 HIGH

07 MJP on Wrapped Pipe Covering 6 LF Boiler Room #1Boiler Storage and Tunnels


3 HIGH

08 Corrugated Pipe Covering 300 LF Boiler Room #1Boiler Storage and Tunnels


3 HIGH

09 Wrapped Pipe Covering 70 LF Boiler Room #1Boiler Storage and Tunnels

CHR TSI Y DIST 59 Yes Damaged or significantly damaged friable thermal system insulating ACBM

2 HIGH

10 Fire Door Insulation 28 SF Basement ASSUMED TSI Y NONE 0 No Any remaining friable ACBM or friable suspect ACBM

LOW

100 Plaster 300,000 SF Throughout ASSUMED SURFACE Y NONE 0 No Any remaining friable ACBM or friable suspect ACBM

LOW

101 Window Caulk 3,000 LF Throughout ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

102 Door Caulk 3,000 LF Throughout ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

103 Green Terrazzo 2,500 SF RR's ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

104 12" X 12" Black VFT 200 SF Elevator and Basement


LOW







Material Units


Material Category

Friable Damage Type

Damage Quantity



105 12" X 12" Black VFT Mastic 200 SF Elevator and Basement


LOW

106 Boiler Insulator 200 SF Both Boilers ASSUMED TSI Y NONE 0 No Any remaining friable ACBM or friable suspect ACBM

LOW

107 Boiler Gasket 10 SF Both Boilers ASSUMED MISC N NONE 0 No Any remaining friable ACBM or friable suspect ACBM

LOW

11 12"x12" Blue w/Dk Blue & White Streaks Floor Tile

916 SF Room 104- Principle's Office, Main Office, Teacher's Lounge


LOW

12 12"x12" Blue w/Dark Blue & White Streaks FT Mastic

916 SF Room 104-Principle's Office, Main Office, Teacher's Lounge


LOW

13 9"x9" Tan w/ Dark Streaks Floor Tile 620 SF Room 101 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

14 9"x9" Tan w/Dark Streaks Floor Tile Mastic

620 SF Room 101 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

15 9"x9" Maroon w/Dark Streaks Floor Tile 30 SF Room 101 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

16 9"x9" Maroon w/Dark Streaks Floor Tile Mastic

30 SF Room 101 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

17 12"x12" White w/Multi-Colored Streaks FT 12,125 SF Kindergarten, Rooms 105,106, 103, 207, 208, 209, 210, 211, 213, 213 closet, 212, 215, 216, 218


LOW

18 12"x12" White w/Multi-Colored Streaks FTMastic

12,125 SF Kindergarten, Rooms 105, 106, 103, 207m 208, 209,211, 210, 213, 213 closet, 212, 214, 215, 216, 217


LOW

19 9"x9" Red Floor Tile 1,950 SF 1st & 2nd Floor Hallways


LOW

20 9"x9" Red Floor Tile Mastic 1,950 SF 1st & 2nd Floor Hallways


LOW

21 9"x9" Black Floor Tile 1,950 SF 1st & 2nd Floor Hallways


LOW

22 9"x9" Black Floor Tile Mastic 1,950 SF 1st & 2nd Floor Hallways


LOW







Material Units


Material Category

Friable Damage Type

Damage Quantity



23 12"x12" Off-White w/Brn,Wht,& Gry StrksFloor Tile

4,050 SF Gym and Stage CHR MISC N NONE 0 No ACBM with the potential for damage

LOW

24 12"x12" Off-White w/Brn,Wht,& Gry StrksFT Mastic

4,050 SF Gym and Stage CHR MISC N NONE 0 No ACBM with the potential for damage

LOW

25 2" Black Mop Board 270 LF Gym Stage ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

26 2" Black Mop Board Adhesive 270 LF Gym Stage ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

27 Grey Carpet Mastic 750 SF Room 102 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW






Reinspection Date 4/12/2016

Inspector Name John Feely

100-00249 5/15/2016Inspector's IDPH License Number / Expiration Date

Inspector's Comments

HA Number: Inspector Comments:01020304050607080910100101102103104 105106107111213141516






HA Number: Inspector Comments:1718192021222324252627

Table II

Management Planner's Review

Chicago Public Schools

SchoolUNO - Octavio Paz Primary Unit 66131 Building ID 5810-23rd

Address 2651 W. 23rd St Chicago, IL, 60608 Region 02

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

01 MJP on Corrugated Pipe Covering 270 LF Tunnel Chrysotile TSI Yes 230 LF 1 Damaged or significantly damaged friable thermal system insulating ACBM

Remove

02 Corrugated Pipe Covering 1,400 LF Tunnel Chrysotile TSI Yes 1,190 LF 1 Damaged or significantly damaged friable thermal system insulating ACBM

Remove

03 9"x9" Floor Tile 100 SF All Floors of Building Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan04 Vinyl Floor Tile Mastic 1,000 SF All Floors of Building Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan05 Linoleum 8,100 SF All Floors of Building Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan06 MJP on Corrugated Pipe Covering 40 LF Boiler Room #1 Boiler Storage and

TunnelsChrysotile TSI Yes 34 LF 1 Damaged or significantly damaged

friable thermal system insulating ACBMRemove

07 MJP on Wrapped Pipe Covering 6 LF Boiler Room #1Boiler Storage and Tunnels

Chrysotile TSI Yes 5 LF 1 Damaged or significantly damaged friable thermal system insulating ACBM

Remove

08 Corrugated Pipe Covering 300 LF Boiler Room #1Boiler Storage and Tunnels


Remove

09 Wrapped Pipe Covering 70 LF Boiler Room #1Boiler Storage and Tunnels


Remove

10 Fire Door Insulation 28 SF Basement Assumed TSI Yes 0 SF 7 Any remaining friable ACBM or friable suspect ACBM

Follow O&M Plan

100 Plaster 300,000 SF Throughout Assumed SURFACE Yes 0 SF 7 Any remaining friable ACBM or friable suspect ACBM

Follow O&M Plan

101 Window Caulk 3,000 LF Throughout Assumed MISC No 0 LF 6 ACBM with the potential for damage Follow O&M Plan102 Door Caulk 3,000 LF Throughout Assumed MISC No 0 LF 6 ACBM with the potential for damage Follow O&M Plan103 Green Terrazzo 2,500 SF RR's Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan104 12" X 12" Black VFT 200 SF Elevator and Basement Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan105 12" X 12" Black VFT Mastic 200 SF Elevator and Basement Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan106 Boiler Insulator 200 SF Both Boilers Assumed TSI Yes 0 SF 7 Any remaining friable ACBM or friable

suspect ACBMFollow O&M Plan

107 Boiler Gasket 10 SF Both Boilers Assumed MISC No 0 SF 7 Any remaining friable ACBM or friable suspect ACBM

Follow O&M Plan

11 12"x12" Blue w/Dk Blue & White Streaks Floor Tile 916 SF Room 104- Principle's Office, Main Office, Teacher's Lounge

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

12 12"x12" Blue w/Dark Blue & White Streaks FT Mastic

916 SF Room 104-Principle's Office, Main Office, Teacher's Lounge


13 9"x9" Tan w/ Dark Streaks Floor Tile 620 SF Room 101 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan14 9"x9" Tan w/Dark Streaks Floor Tile Mastic 620 SF Room 101 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan15 9"x9" Maroon w/Dark Streaks Floor Tile 30 SF Room 101 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan








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

16 9"x9" Maroon w/Dark Streaks Floor Tile Mastic 30 SF Room 101 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan17 12"x12" White w/Multi-Colored Streaks FT 12,125 SF Kindergarten, Rooms 105,106, 103,

207, 208, 209, 210, 211, 213, 213 closet, 212, 215, 216, 218


18 12"x12" White w/Multi-Colored Streaks FT Mastic 12,125 SF Kindergarten, Rooms 105, 106, 103, 207m 208, 209, 211, 210, 213, 213 closet, 212, 214, 215, 216, 217


19 9"x9" Red Floor Tile 1,950 SF 1st & 2nd Floor Hallways Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan20 9"x9" Red Floor Tile Mastic 1,950 SF 1st & 2nd Floor Hallways Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan21 9"x9" Black Floor Tile 1,950 SF 1st & 2nd Floor Hallways Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan22 9"x9" Black Floor Tile Mastic 1,950 SF 1st & 2nd Floor Hallways Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan23 12"x12" Off-White w/Brn,Wht,& Gry Strks Floor Tile 4,050 SF Gym and Stage Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan24 12"x12" Off-White w/Brn,Wht,& Gry Strks FT Mastic 4,050 SF Gym and Stage Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan25 2" Black Mop Board 270 LF Gym Stage Assumed MISC No 0 LF 6 ACBM with the potential for damage Follow O&M Plan26 2" Black Mop Board Adhesive 270 LF Gym Stage Assumed MISC No 0 LF 6 ACBM with the potential for damage Follow O&M Plan27 Grey Carpet Mastic 750 SF Room 102 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan








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

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

Review Date 5/4/2016

Manager Planner Name Todd Huffer100-09870 5/15/2016Manager IDPH License No/Expiration

HA Number Management Comments01 remove/repair damaged material. Follow O&M procedures after response action02 remove/repair damaged material. Follow O&M procedures after response action03040506 Remove/Repair materials. Follow O&M procedures following response action07 remove/repair damaged material. Follow O&M procedures after response action08 remove/repair damaged material. Follow O&M procedures after response action09 remove/repair damaged material. Follow O&M procedures after response action10100101102103104 10510610711








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

Management Planner's Comments Summarized at the End of the ReportHA Number Management Comments12131415161718192021222324252627


Carnow, Conibear and Associates

2016 AHERA REINSPECTION

Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: 66131 BUIDLING ID: 5810-23rd

CITY/STATE: Chicago, Illinois AHERA INSPECTOR: John Feely

SCHOOL NAME: UNO - Octavio Paz Primary INSPECTION DATE: 4/12/2016

ADDRESS: 2651 W. 23rd St IDPH LICENSE NO: 100-00249

INFORMATION FROM PREVIOUS INSPECTION

HOMOGENEOUS AREA: 01

MATERIAL DESCRIPTION: MJP on Corrugated Pipe Covering

HISTORICAL AHERA DAMAGE CATEGORY 1 Damaged or significantly damaged friable thermal system insulating ACBM

HISTORICAL DAMAGE REASON: Deterioration

HISTORICAL RESPONSE ACTION: Follow O&M Plan

ASBESTOS TYPE: Chrysotile 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 1. Damaged or significantly damaged friable thermal system insulating ACBM

DAMAGE REASON: DeteriorationPhysical Damage

DISTURBANCE POTENTIAL: HIGH

MATERIAL LOCATION: Tunnel

MATERIAL QUANTITY: 270 MATERIAL UNITS: LF

DAMAGE QUANTITY: DAMAGE UNITS: LF

COMMENTS:

Inspector's Signature: Date: 04/12/2016




Management Planner Review FormLEA NAME: Chicago Public Schools UNIT NUMBER: 66131 BUIDLING ID: 5810-23rd

CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Todd Huffer

SCHOOL NAME: UNO - Octavio Paz Primary

REVIEW DATE: 5/4/2016






DAMAGE QUANTITY: 230 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:

remove/repair damaged material. Follow O&M procedures after response action

Management Planner's Signature: Date: 05/04/2016










MATERIAL DESCRIPTION: Corrugated Pipe Covering













COMMENTS:

















Follow O&M Plan

Comments:












MATERIAL DESCRIPTION: 9"x9" Floor Tile

HISTORICAL AHERA DAMAGE CATEGORY 6 ACBM with the potential for damage

HISTORICAL DAMAGE REASON:


ASBESTOS TYPE: Chrysotile FRIABLE: No



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

DAMAGE REASON:

DISTURBANCE POTENTIAL: LOW

MATERIAL LOCATION: All Floors of Building

MATERIAL QUANTITY: 100 MATERIAL UNITS: SF

DAMAGE QUANTITY: DAMAGE UNITS: SF

COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Floor Tile



DAMAGE QUANTITY: 0 DAMAGE UNITS: SF



Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Vinyl Floor Tile Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: Vinyl Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Linoleum




ASBESTOS TYPE: Assumed FRIABLE: No




DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: Linoleum






Follow O&M Plan

Comments:



















DAMAGE REASON: Deterioration


MATERIAL LOCATION: Boiler Room #1 Boiler Storage and Tunnels



COMMENTS:












MATERIAL LOCATION: Boiler Room #1 Boiler Storage and Tunnels





Follow O&M Plan

Comments:

Remove/Repair materials. Follow O&M procedures following response action











MATERIAL DESCRIPTION: MJP on Wrapped Pipe Covering










MATERIAL LOCATION: Boiler Room #1Boiler Storage and Tunnels



COMMENTS:











MATERIAL DESCRIPTION: MJP on Wrapped Pipe Covering






Follow O&M Plan

Comments:

























COMMENTS:

















Follow O&M Plan

Comments:












MATERIAL DESCRIPTION: Wrapped Pipe Covering


HISTORICAL DAMAGE REASON: Delamination






DAMAGE REASON: Delamination





COMMENTS:











MATERIAL DESCRIPTION: Wrapped Pipe Covering






Follow O&M Plan

Comments:












MATERIAL DESCRIPTION: Fire Door Insulation

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



ASBESTOS TYPE: Assumed FRIABLE: Yes



The current AHERA DAMAGE CATEGORY is determined to be 7. Any remaining friable ACBM or friable suspect ACBM

DAMAGE REASON:


MATERIAL LOCATION: Basement



COMMENTS:











MATERIAL DESCRIPTION: Fire Door Insulation

MATERIAL LOCATION: Basement





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Plaster








DAMAGE REASON:


MATERIAL LOCATION: Throughout



COMMENTS:











MATERIAL DESCRIPTION: Plaster






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Window Caulk








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: Window Caulk






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Door Caulk








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: Door Caulk






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Green Terrazzo








DAMAGE REASON:


MATERIAL LOCATION: RR's



COMMENTS:











MATERIAL DESCRIPTION: Green Terrazzo

MATERIAL LOCATION: RR's





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12" X 12" Black VFT








DAMAGE REASON:


MATERIAL LOCATION: Elevator and Basement



COMMENTS:











MATERIAL DESCRIPTION: 12" X 12" Black VFT






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12" X 12" Black VFT Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 12" X 12" Black VFT Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Boiler Insulator








DAMAGE REASON:


MATERIAL LOCATION: Both Boilers



COMMENTS:











MATERIAL DESCRIPTION: Boiler Insulator






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Boiler Gasket








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: Boiler Gasket






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Blue w/Dk Blue & White Streaks Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Room 104- Principle's Office, Main Office, Teacher's Lounge



COMMENTS:











MATERIAL DESCRIPTION: 12"x12" Blue w/Dk Blue & White Streaks Floor Tile

MATERIAL LOCATION: Room 104- Principle's Office, Main Office, Teacher's Lounge





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Blue w/Dark Blue & White Streaks FT Mastic








DAMAGE REASON:


MATERIAL LOCATION: Room 104-Principle's Office, Main Office, Teacher's Lounge



COMMENTS:











MATERIAL DESCRIPTION: 12"x12" Blue w/Dark Blue & White Streaks FT Mastic

MATERIAL LOCATION: Room 104-Principle's Office, Main Office, Teacher's Lounge





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Tan w/ Dark Streaks Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Room 101



COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Tan w/ Dark Streaks Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Tan w/Dark Streaks Floor Tile Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Tan w/Dark Streaks Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Maroon w/Dark Streaks Floor Tile








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Maroon w/Dark Streaks Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Maroon w/Dark Streaks Floor Tile Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Maroon w/Dark Streaks Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" White w/Multi-Colored Streaks FT








DAMAGE REASON:


MATERIAL LOCATION: Kindergarten, Rooms 105,106, 103, 207, 208, 209, 210, 211, 213, 213 closet, 212, 215, 216, 218



COMMENTS:











MATERIAL DESCRIPTION: 12"x12" White w/Multi-Colored Streaks FT

MATERIAL LOCATION: Kindergarten, Rooms 105,106, 103, 207, 208, 209, 210, 211, 213, 213 closet, 212, 215, 216, 218





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" White w/Multi-Colored Streaks FT Mastic








DAMAGE REASON:


MATERIAL LOCATION: Kindergarten, Rooms 105, 106, 103, 207m 208, 209, 211, 210, 213, 213 closet, 212, 214, 215, 216, 217



COMMENTS:











MATERIAL DESCRIPTION: 12"x12" White w/Multi-Colored Streaks FT Mastic

MATERIAL LOCATION: Kindergarten, Rooms 105, 106, 103, 207m 208, 209, 211, 210, 213, 213 closet, 212, 214, 215, 216, 217





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Red Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: 1st & 2nd Floor Hallways



COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Red Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Red Floor Tile Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Red Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Black Floor Tile








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Black Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Black Floor Tile Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 9"x9" Black Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Off-White w/Brn,Wht,& Gry Strks Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Gym and Stage



COMMENTS:











MATERIAL DESCRIPTION: 12"x12" Off-White w/Brn,Wht,& Gry Strks Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Off-White w/Brn,Wht,& Gry Strks FT Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 12"x12" Off-White w/Brn,Wht,& Gry Strks FT Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 2" Black Mop Board








DAMAGE REASON:


MATERIAL LOCATION: Gym Stage



COMMENTS:











MATERIAL DESCRIPTION: 2" Black Mop Board






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 2" Black Mop Board Adhesive








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: 2" Black Mop Board Adhesive






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Grey Carpet Mastic








DAMAGE REASON:





COMMENTS:











MATERIAL DESCRIPTION: Grey Carpet Mastic






Follow O&M Plan

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 three...

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