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: 14-016-2990-2375SCHOOL NAME: Nobel SchoolADDRESS OF SCHOOL: 4127 W. Hirsch StreetCITY: Chicago, IL, 60651

DATE LAST THREE YEAR REINSPECTION WAS COMPLETED 3/20/2013If 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: 5/23/2016 ENROLLMENT 893

IDPH INSPECTOR LICENSE NUMBER: 100-02950

IDPH LICENSED INSPECTOR NAME (Please Print): Keith Clough

IDPH MP LICENSE NUMBER: 100-04019

IDPH LICENSED MANAGEMENT PLANNER NAME (Please Print): Arturo Saenz

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

5/23/2016

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

Nobel School

4127 W. Hirsch StreetChicago, IL, 60651

Unit: 24691Building ID: 5110

IDPH ID Number: 14-016-2990-2375

REPORT DATE:Monday, May 23, 2016

Prepared for:Chicago Public Schools

125 S. Clark StreetChicago, IL 60603

Prepared by:GSG Consultants, Inc.

855 W. Adams St., Ste. 200

Phone (312) 733-6262

Fax (312) 733-5612

DO NOT REMOVE FROM SCHOOLREQUIRED BY FEDERAL LAW

March 16, 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:

GSG Consultants, Inc., Managing Environmental Consultant (MEC), conducted the Three-Year Reinspections and performed management plan updates for the Chicago Public Schools (CPS) facilities in Region 1,2,6 Elementary Schools. Please update your records with the following information.

School District: 299 Unit: 24691 Region: 02 IDPH ID: 14-016-2990-2375

School: Nobel School Building ID: 5110

Address: 4127 W. Hirsch Street

Chicago, IL, 60651

Building Contact: Dissette, William Contact Phone: 773-848-4508

Current Building Owners: Chicago Public Schools

Review Date: 05/03/2016

Inspector: Keith Clough Inspector IDPH License: 100-02950Management Planner: Arturo Saenz Management Planner IDPH License: 100-04019

If you have any questions or comments, please contact us at (312) 733-6262

Sincerely,GSG Consultants, Inc.

Arturo Saenz100-04019

Environmental Notification to Occupants

To: Faculty, Staff and ParentsFrom: Chicago Public SchoolsDate: March 16, 2016

RE: Nobel School, Unit 24691 4127 W. Hirsch Street Chicago, IL, 60651

Dear Faculty, Staff and Parents,

This letter is to notify you that the 2016 asbestos three year re-inspection has been completed at NobelSchool , 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 Nobel 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: Nobel School Unit: 24691 Region: 02Address: 4127 W. Hirsch Street Chicago, IL, 60651IDPH ID: 14-016-2990-2375 Building ID: 5110Contact: Dissette, William Phone: 773-848-4508

2. Description of Facility

Original Construction: 1910 Additional Construction: Total Square Footage: 75800 No of Floors: 4Current Occupancy: 893

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: GSG Consultants, Inc.Contact: Arturo SaenzAddress 855 W. Adams St., Ste. 200Phone: (312) 733-6262 Fax: (312) 733-5612

5. Inspector

Inspector Name: Keith Clough

Signature: Inspector IDPH license # 100-02950 Date: 3/16/2016

6. Management Planner

Management Planner Name: Arturo Saenz

Signature: Management Planner IDPH license # 100-04019 Date: 05/03/2016

7. Review Date: 05/03/2016

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: 5/23/2016

Name: Robert Christlieb

Unit : 24691 Nobel School Building: 5110

Unit: 24691 Nobel School Building: 5110

II. EXECUTIVE SUMMARY

GSG Consultants, Inc. was retained by the Chicago Public Schools (CPS) to perform a three-year asbestos reinspection of the Nobel 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 previous 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 5110:

D MJP E/F/V on Fiberglass Pipe Insulation


B. The following new homogenous areas have been identified for Building 5110:


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:

01 Hard Coat Plaster09 9"x9" Beige Floor Tile Mastic10 12"x12" Tan Floor Tile11 12"x12" Tan Floor Tile Mastic12 Red & Brown Linoleum13 Red & Brown Linoleum Mastic17 12"x12" Pink & Tan Floor Tile18 12"x12" Pink & Tan Floor Tile Mastic19 12"x12" Gray Floor Tile21 12"x12" White Floor Tile23 12"x12" White Ceiling Tile24 12"x12" Blue Floor Tile25 12"x12" Blue Floor Tile Mastic26 Ceramic Tile Grout27 Ceramic Tile Adhesive28 12"x12" White Floor Tile29 12"x12" White Floor Tile Mastic

The following areas were deemed to be inaccessible:

11 12"x12" Tan Floor Tile Mastic12 Red & Brown Linoleum13 Red & Brown Linoleum Mastic25 12"x12" Blue Floor Tile Mastic27 Ceramic Tile Adhesive29 12"x12" White Floor Tile 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 Keith Clough, IDPH License # 100-02950. The Management Plan was updated by Arturo Saenz, IDPH License # 100-04019. 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 Nobel School Building 5110 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 Nobel School Unit 24691 Building ID 5110 Address 4127 W. Hirsch Street Region 02

ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONSInspector's Reinspection Findings Table 1

Managing Environmental Consultant (MEC) GSG Consultants, Inc.

855 W. Adams St., Ste. 200 Phone: (312) 733-6262 Fax: (312) 733-5612

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 Hard Coat Plaster 110,000 SF Throughout ASSUMED SURFACE Y NONE 0 No ACBM with the potential for damage

LOW

03 12"x12" Tan, Brown & White Floor Tile (Abated 12/18/04)

Serving Areas, Kitchen & Room 003 (Under Carpet)

ABATED MISC

06 12"x12" Tan, Brown & White Floor Tile Mastic (Abated 12/18/04)


ABATED MISC No

08 9"x9" Beige Floor Tile 1,450 SF Engineer's Office and Room 210 (Under HA #17)

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

MODERATE

09 9"x9" Beige Floor Tile Mastic 1,450 SF Engineer's Office and Room 210 (Under HA #17)

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

LOW

10 12"x12" Tan Floor Tile 2,000 SF Auditorium Balcony ASSUMED MISC N NONE 0 No ACBM with the potential for damage

MODERATE

11 12"x12" Tan Floor Tile Mastic 2,000 SF Auditorium Balcony ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

12 Red & Brown Linoleum 300 SF Gymnasium Supply Closet


LOW

13 Red & Brown Linoleum Mastic 300 SF Gymnasium Supply Closet


LOW

14 9"x9" Beige & Brown Floor Tile 1,200 SF 2nd FloorTeacher's Toilet, 3rd Floor Men's Toilet, North & South Stairwells


MODERATE

15 9"x9" Beige & Brown Floor Tile Mastic 1,200 SF 2nd FloorTeacher's Toilet, 3rd Floor Men's Toilet, North & South Stairwells


LOW

16 Black Carpet Mastic (Not Observed) Room 004 MISC No17 12"x12" Pink & Tan Floor Tile 3,200 SF Rooms 201, 210,

305 & 309ASSUMED MISC N NONE 0 No ACBM with the

potential for damageMODERATE

18 12"x12" Pink & Tan Floor Tile Mastic 3,200 SF Rooms 201, 210, 305 & 309


LOW

19 12"x12" Gray Floor Tile 350 SF Room 001 (Kindergarten - Art Room)


MODERATE

20 12"x12" Gray Floor Tile Mastic 350 SF Room 001 (Kindergarten - Art Room)


LOW

21 12"x12" White Floor Tile 350 SF Room 001 (Kindergarten - Art Room)


MODERATE







Material Units


Material Category

Friable Damage Type

Damage Quantity



22 12"x12" White Floor Tile Mastic 350 SF Room 001 (Kindergarten - Art Room)


LOW

23 12"x12" White Ceiling Tile 1,800 SF Rooms 301-303, 308-310, Top of North & South Middle Stairs

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

MODERATE

24 12"x12" Blue Floor Tile 1,100 SF Rooms 002 and 003 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

MODERATE

25 12"x12" Blue Floor Tile Mastic 1,100 SF Rooms 002 and 003 ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

26 Ceramic Tile Grout 600 SF Washrooms ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

27 Ceramic Tile Adhesive 600 SF Washrooms ASSUMED MISC N NONE 0 No ACBM with the potential for damage

LOW

28 12"x12" White Floor Tile 70 SF Second Floor Teacher's Lounge


MODERATE

29 12"x12" White Floor Tile Mastic 70 SF Second Floor Teacher's Lounge


LOW

D MJP E/F/V on Fiberglass Pipe Insulation 116 LF 1st, 2nd , 3rd Fl Boys & Girls Toilets, Eng. & 1st Fl Teach Toilet, Rm003, N & S Bsmt Playrooms

CHR TSI Y NONE 0 Yes ACBM with the potential for damage

MODERATE

E Cardboard Pipe Insulation 1,135 LF N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet Next Teach Toilet, Boiler Room

CHR TSI Y DIST 20 No Damaged or significantly damaged friable thermal system insulating ACBM

MODERATE

F Aircell Pipe Insulation 55 LF Boiler Room South Corridor, 2nd Fl Boys Toilet, Boiler Room

CHR TSI Y NONE 0 No ACBM with the potential for damage

MODERATE

G MJP E/F/V on Aircell Pipe Insulation 10 LF Boiler Room South Corridor, 2nd Fl Boys Toilet, Boiler Room

CHR TSI Y NONE 0 No ACBM with the potential for damage

MODERATE

H MJP E/F/V on Cardboard Pipe Insulation 108 LF N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet Next

CHR TSI Y LOC 10 No Damaged or significantly damaged friable thermal system insulating ACBM

MODERATE







Material Units


Material Category

Friable Damage Type

Damage Quantity



Teach Toilet, Boiler Room






Reinspection Date 3/16/2016

Inspector Name Keith Clough

100-02950 5/15/2017Inspector's IDPH License Number / Expiration Date

Inspector's Comments

HA Number: Inspector Comments:010306080910111213141516171819202122232425262728






HA Number: Inspector Comments:29DEFGH

Table II

Management Planner's Review

Chicago Public SchoolsSchool Nobel School Unit 24691 Building ID 5110

Address 4127 W. Hirsch Street Chicago, IL, 60651 Region 02

ASBESTOS REINSPECTION FINDINGS AND RECOMMENDATIONS

Management Planner's Review Table II



Phone: (312) 733-6262 Fax: (312) 733-5612

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 Hard Coat Plaster 110,000 SF Throughout Assumed SURFACE Yes 0 SF 6 ACBM with the potential for damage Follow O&M Plan03 12"x12" Tan, Brown & White Floor Tile (Abated

12/18/04)Serving Areas, Kitchen & Room 003 (Under Carpet)

Abated MISC

06 12"x12" Tan, Brown & White Floor Tile Mastic (Abated 12/18/04)


Abated MISC

08 9"x9" Beige Floor Tile 1,450 SF Engineer's Office and Room 210 (Under HA #17)

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

09 9"x9" Beige Floor Tile Mastic 1,450 SF Engineer's Office and Room 210 (Under HA #17)

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

10 12"x12" Tan Floor Tile 2,000 SF Auditorium Balcony Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan11 12"x12" Tan Floor Tile Mastic 2,000 SF Auditorium Balcony Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan12 Red & Brown Linoleum 300 SF Gymnasium Supply Closet Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan13 Red & Brown Linoleum Mastic 300 SF Gymnasium Supply Closet Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan14 9"x9" Beige & Brown Floor Tile 1,200 SF 2nd FloorTeacher's Toilet, 3rd Floor

Men's Toilet, North & South StairwellsChrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan

15 9"x9" Beige & Brown Floor Tile Mastic 1,200 SF 2nd FloorTeacher's Toilet, 3rd Floor Men's Toilet, North & South Stairwells

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

16 Black Carpet Mastic (Not Observed) Room 004 MISC 17 12"x12" Pink & Tan Floor Tile 3,200 SF Rooms 201, 210, 305 & 309 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan18 12"x12" Pink & Tan Floor Tile Mastic 3,200 SF Rooms 201, 210, 305 & 309 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan19 12"x12" Gray Floor Tile 350 SF Room 001 (Kindergarten - Art Room) Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan20 12"x12" Gray Floor Tile Mastic 350 SF Room 001 (Kindergarten - Art Room) Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan21 12"x12" White Floor Tile 350 SF Room 001 (Kindergarten - Art Room) Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan22 12"x12" White Floor Tile Mastic 350 SF Room 001 (Kindergarten - Art Room) Chrysotile MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan23 12"x12" White Ceiling Tile 1,800 SF Rooms 301-303, 308-310, Top of North

& South Middle StairsAssumed MISC Yes 0 SF 6 ACBM with the potential for damage Follow O&M Plan

24 12"x12" Blue Floor Tile 1,100 SF Rooms 002 and 003 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan25 12"x12" Blue Floor Tile Mastic 1,100 SF Rooms 002 and 003 Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan26 Ceramic Tile Grout 600 SF Washrooms Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan27 Ceramic Tile Adhesive 600 SF Washrooms Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan28 12"x12" White Floor Tile 70 SF Second Floor Teacher's Lounge Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M Plan29 12"x12" White Floor Tile Mastic 70 SF Second Floor Teacher's Lounge Assumed MISC No 0 SF 6 ACBM with the potential for damage Follow O&M PlanD MJP E/F/V on Fiberglass Pipe Insulation 116 LF 1st, 2nd , 3rd Fl Boys & Girls Toilets,

Eng. & 1st Fl Teach Toilet, Rm 003, N & S Bsmt Playrooms

Chrysotile TSI Yes 0 LF 6 ACBM with the potential for damage Follow O&M Plan







Phone: (312) 733-6262 Fax: (312) 733-5612

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

E Cardboard Pipe Insulation 1,135 LF N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet Next Teach Toilet, Boiler Room

Chrysotile TSI Yes 20 LF 1 Damaged or significantly damaged friable thermal system insulating ACBM

Repair

F Aircell Pipe Insulation 55 LF Boiler Room South Corridor, 2nd Fl Boys Toilet, Boiler Room


G MJP E/F/V on Aircell Pipe Insulation 10 LF Boiler Room South Corridor, 2nd Fl Boys Toilet, Boiler Room


H MJP E/F/V on Cardboard Pipe Insulation 108 LF N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet Next Teach Toilet, Boiler Room

Chrysotile TSI Yes 10 LF 1 Damaged or significantly damaged friable thermal system insulating ACBM

Repair







Phone: (312) 733-6262 Fax: (312) 733-5612

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

Review Date 5/3/2016

Manager Planner Name Arturo Saenz100-04019 1/19/2017Manager IDPH License No/Expiration

HA Number Management Comments010306080910111213141516171819202122232425262728







Phone: (312) 733-6262 Fax: (312) 733-5612

Management Planner's Comments Summarized at the End of the ReportHA Number Management Comments29DEFGH

Chicago Public Schools

GSG Consultants, Inc.

2016 AHERA REINSPECTION

Inspector Assessment Form (REASSESSMENT) LEA NAME: Chicago Public Schools UNIT NUMBER: 24691 BUIDLING ID: 5110

CITY/STATE: Chicago, Illinois AHERA INSPECTOR: Keith Clough

SCHOOL NAME: Nobel School INSPECTION DATE: 3/16/2016

ADDRESS: 4127 W. Hirsch Street IDPH LICENSE NO: 100-02950

INFORMATION FROM PREVIOUS INSPECTION

HOMOGENEOUS AREA: 01

MATERIAL DESCRIPTION: Hard Coat Plaster

HISTORICAL AHERA DAMAGE CATEGORY 6

HISTORICAL DAMAGE REASON:

HISTORICAL RESPONSE ACTION: Follow O&M Plan

ASBESTOS TYPE: Assumed 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 6. ACBM with the potential for damage

DAMAGE REASON:

DISTURBANCE POTENTIAL: LOW

MATERIAL LOCATION: Throughout

MATERIAL QUANTITY: 110000 MATERIAL UNITS: SF

DAMAGE QUANTITY: DAMAGE UNITS: SF

COMMENTS:

Inspector's Signature: Date: 03/16/2016




Management Planner Review FormLEA NAME: Chicago Public Schools UNIT NUMBER: 24691 BUIDLING ID: 5110

CITY/STATE: Chicago, Illinois MANAGEMENT PLANNER: Arturo Saenz

SCHOOL NAME: Nobel School REVIEW DATE: 5/3/2016



MATERIAL DESCRIPTION: Hard Coat Plaster

MATERIAL LOCATION: Throughout


DAMAGE QUANTITY: 0 DAMAGE UNITS: SF

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: 05/03/2016










MATERIAL DESCRIPTION: 12"x12" Tan, Brown & White Floor Tile (Abated 12/18/04)

HISTORICAL AHERA DAMAGE CATEGORY


HISTORICAL RESPONSE ACTION:

ASBESTOS TYPE: Abated FRIABLE:



The current AHERA DAMAGE CATEGORY is determined to be .

DAMAGE REASON:

DISTURBANCE POTENTIAL:

MATERIAL LOCATION: Serving Areas, Kitchen & Room 003 (Under Carpet)

MATERIAL QUANTITY: MATERIAL UNITS:

DAMAGE QUANTITY: DAMAGE UNITS:

COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Tan, Brown & White Floor Tile (Abated 12/18/04)






Comments:











MATERIAL DESCRIPTION: 12"x12" Tan, Brown & White Floor Tile Mastic (Abated 12/18/04)



HISTORICAL RESPONSE ACTION:

ASBESTOS TYPE: Abated FRIABLE:




DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Tan, Brown & White Floor Tile Mastic (Abated 12/18/04)






Comments:











MATERIAL DESCRIPTION: 9"x9" Beige Floor Tile

HISTORICAL AHERA DAMAGE CATEGORY 6 ACBM with the potential for damage



ASBESTOS TYPE: Chrysotile FRIABLE: No




DAMAGE REASON:

DISTURBANCE POTENTIAL: MODERATE

MATERIAL LOCATION: Engineer's Office and Room 210 (Under HA #17)



COMMENTS:










MATERIAL DESCRIPTION: 9"x9" Beige Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Beige Floor Tile Mastic




ASBESTOS TYPE: Assumed FRIABLE: No




DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 9"x9" Beige Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Tan Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Auditorium Balcony



COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Tan Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Tan Floor Tile Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Tan Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Red & Brown Linoleum








DAMAGE REASON:


MATERIAL LOCATION: Gymnasium Supply Closet



COMMENTS:










MATERIAL DESCRIPTION: Red & Brown Linoleum






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Red & Brown Linoleum Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: Red & Brown Linoleum Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Beige & Brown Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: 2nd FloorTeacher's Toilet, 3rd Floor Men's Toilet, North & South Stairwells



COMMENTS:










MATERIAL DESCRIPTION: 9"x9" Beige & Brown Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 9"x9" Beige & Brown Floor Tile Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 9"x9" Beige & Brown Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Black Carpet Mastic (Not Observed)




ASBESTOS TYPE: FRIABLE:




DAMAGE REASON:


MATERIAL LOCATION: Room 004



COMMENTS:










MATERIAL DESCRIPTION: Black Carpet Mastic (Not Observed)

MATERIAL LOCATION: Room 004





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Pink & Tan Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Rooms 201, 210, 305 & 309



COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Pink & Tan Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Pink & Tan Floor Tile Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Pink & Tan Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Gray Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Room 001 (Kindergarten - Art Room)



COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Gray Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Gray Floor Tile Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Gray Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" White Floor Tile








DAMAGE REASON:





COMMENTS:
















Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" White Floor Tile Mastic








DAMAGE REASON:





COMMENTS:
















Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" White Ceiling Tile

HISTORICAL AHERA DAMAGE CATEGORY 6 ACBM with potential for significant damage



ASBESTOS TYPE: Assumed FRIABLE: Yes




DAMAGE REASON:


MATERIAL LOCATION: Rooms 301-303, 308-310, Top of North & South Middle Stairs



COMMENTS:










MATERIAL DESCRIPTION: 12"x12" White Ceiling Tile

MATERIAL LOCATION: Rooms 301-303, 308-310, Top of North & South Middle Stairs





Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Blue Floor Tile








DAMAGE REASON:


MATERIAL LOCATION: Rooms 002 and 003



COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Blue Floor Tile






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: 12"x12" Blue Floor Tile Mastic








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: 12"x12" Blue Floor Tile Mastic






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Ceramic Tile Grout








DAMAGE REASON:


MATERIAL LOCATION: Washrooms



COMMENTS:










MATERIAL DESCRIPTION: Ceramic Tile Grout






Follow O&M Plan

Comments:











MATERIAL DESCRIPTION: Ceramic Tile Adhesive








DAMAGE REASON:





COMMENTS:










MATERIAL DESCRIPTION: Ceramic Tile Adhesive






Follow O&M Plan

Comments:



















DAMAGE REASON:


MATERIAL LOCATION: Second Floor Teacher's Lounge



COMMENTS:
















Follow O&M Plan

Comments:



















DAMAGE REASON:





COMMENTS:
















Follow O&M Plan

Comments:










HOMOGENEOUS AREA: D

MATERIAL DESCRIPTION: MJP E/F/V on Fiberglass Pipe Insulation

HISTORICAL AHERA DAMAGE CATEGORY 6 Any remaining friable ACBM or friable suspect ACBM



ASBESTOS TYPE: Chrysotile FRIABLE: Yes




DAMAGE REASON:


MATERIAL LOCATION: 1st, 2nd , 3rd Fl Boys & Girls Toilets, Eng. & 1st Fl Teach Toilet, Rm 003, N & S Bsmt Playrooms

MATERIAL QUANTITY: 116 MATERIAL UNITS: LF

DAMAGE QUANTITY: DAMAGE UNITS: LF

COMMENTS:









HOMOGENEOUS AREA: D

MATERIAL DESCRIPTION: MJP E/F/V on Fiberglass Pipe Insulation

MATERIAL LOCATION: 1st, 2nd , 3rd Fl Boys & Girls Toilets, Eng. & 1st Fl Teach Toilet, Rm 003, N & S Bsmt Playrooms


DAMAGE QUANTITY: 0 DAMAGE UNITS: LF



Follow O&M Plan

Comments:










HOMOGENEOUS AREA: E

MATERIAL DESCRIPTION: Cardboard Pipe Insulation

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


HISTORICAL RESPONSE ACTION: Repair




The current AHERA DAMAGE CATEGORY is determined to be 1. Damaged or significantly damaged friable thermal system insulating ACBM

DAMAGE REASON:


MATERIAL LOCATION: N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet NextTeach Toilet, Boiler Room



COMMENTS:









HOMOGENEOUS AREA: E

MATERIAL DESCRIPTION: Cardboard Pipe Insulation

MATERIAL LOCATION: N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet Next Teach Toilet, Boiler Room





Repair

Comments:










HOMOGENEOUS AREA: F

MATERIAL DESCRIPTION: Aircell Pipe Insulation








DAMAGE REASON:


MATERIAL LOCATION: Boiler Room South Corridor, 2nd Fl Boys Toilet, Boiler Room



COMMENTS:









HOMOGENEOUS AREA: F

MATERIAL DESCRIPTION: Aircell Pipe Insulation






Repair

Comments:










HOMOGENEOUS AREA: G

MATERIAL DESCRIPTION: MJP E/F/V on Aircell Pipe Insulation








DAMAGE REASON:





COMMENTS:









HOMOGENEOUS AREA: G

MATERIAL DESCRIPTION: MJP E/F/V on Aircell Pipe Insulation






Repair

Comments:










HOMOGENEOUS AREA: H

MATERIAL DESCRIPTION: MJP E/F/V on Cardboard Pipe Insulation







The current AHERA DAMAGE CATEGORY is determined to be 1. Damaged or significantly damaged friable thermal system insulating ACBM

DAMAGE REASON:


MATERIAL LOCATION: N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet NextTeach Toilet, Boiler Room



COMMENTS:









HOMOGENEOUS AREA: H

MATERIAL DESCRIPTION: MJP E/F/V on Cardboard Pipe Insulation

MATERIAL LOCATION: N & S Playrooms, Boiler Room S Corridor, 1st Fl Teachers Toilet, Janitors Closet Next Teach Toilet, Boiler Room





Repair

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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