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Report NewYork state Departmenlof llealth AHllRAAudit/Inspectlion

District CitYSchool MountVernon SuPerintendent JudithJohnsonn NY 10553 MountVernon' Avenue, 165NorthColumbus 5,7017 December
School ) Inspected:Ceeil H. ParkerElementary

'.

OBJ The Dist EI


BA( The com The

IVE if the *at !? determine Act (AHERA) inspection Response HazafiEmergency ive of this Asbestos objective' this

pist,[lis ii;;fiiffi; cityschoor non


5,2012. on Decembet School ND INFOR]VIATION

il1":"idffirl"i"*.a

' H' Parker allCecil conducted was inspection awalk-through and

*$']1iii::^.]:::i:t'ih aHnRn wrtn

ProtectlonAgency (EPA)' The tment receiveda complaint from the united states Ernvironmental

cal l rece'yd"lLlt phone ithan w gi nated ori Y::l'"l*ll:: l#" T::l'L?:lli#*' off lbeen toseal used had that door """;t;;; rbiir"e ilH,f!}}fiffiffi;;ffi;;,fiil "ff"r;cioset rntaininsmaterialipaclassroomcloset.Uponinspection,itwasdetermiTl,tllllT5i*5tsj offto taped were closets rhe ctosets. i" the oJ*ie' &'!|ifi:?iiffi'dffi;ffiffi;;ffiil;'
andmoldissues. dueto moisture vernoncity schoolDistrictvia U's' mail on to thelVlount wasprovided r of AHERA inspection (see (NYsDoH) inspectors of Health er 5,20l2New YorkstaieD:partmen! on Decemb 13,2012. porrions school Parker

H. the cecil o.f ;ffi#:,ffiffiilffiil;;;;;".oJ*,,ui**. AHERA of the findings thepreliminary heldto review
ponferJnce was d anda closing

aud De1

asperAHERAregulations' thatmustbeaddressed theaudi'inspection during :ieswereidentified notethatall below'Please outlined are alongwith othJrobservations/recommendalions ficiencies exist' may otherdeficiencies therefore werenot inspected, tuilOingloJations Y OF FINDINGSAND RECOMMENDATION$ andthereis a lackof surveillance' managed pooily. (ACM)arebeing Materials Containing Asbestos *uitiiil" anaaOdrellaccordingly'n;riofic.s-11i:t]lT::.t: is to identifydamaged nse of surveitlance in
materialsthat exist Thereare damaged every6 monthsand this hasnoi beenf,erform"d,in"r, 2005' (2010) was not re-inspection The lasttriennial ;taing, which shouldbe a priority foi response. -emenf asbestosmanagement

Plan' Management areneedidto theAsbestos updates Significant

making Becauseof this, the Uuiiding inlentoriei of ACM ar:eunreliable

are for thosespecific albove mentioned and recornmendlations observations ote that deficiencies, ft: tllat ris strongly recommended visited;however, 1Et,l"]3 i"-':^::ilreviewedand locations in rll LEA records improvements unA qnd observations recommendations uru tlium to matri

york stateDepartment Ne!ry of HmrthArl*RAAudit/*spoetion CTOSING CON},ERENCE SIGN.INSIIEET

Report

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NYSDOH Corning Tower, Room 1325 Empire Stirte Plaza Albany, NY L2737

Mount Vernon Ci{g SchoolDistrict

Avenue NorthColumbus 165 10553 NY MountVernon

Dateof IruPectiion: Name of lndividual to Whom Notice is Given: Superintendent Judith Johtlson

ffi F

: L EA Representative "86-*"iendent/ llistrict Schooi IVIountVernon City


165 North ColumbusAveuue Mount Vernon NY 10553

The fol thereto

list of potentialdeviationsfrom the

ffi

ffi

promulgated d regulations

Pen;on: Designated

-- 7/ge"/ Notincation:

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4-a

q}/"fr/

/'+'o*'17

-------r l,,:::", \ :-*' -fo'r*


Re-inspection: Bulk Sampling:

*/:4
req.utr4/../.-"

':- /ft',."'l'/A
art tj '; r-7'tt f

,&fr

periodicsuweilianqe: -.noa< Plan: Management


Actions: Response

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;trrei//roal

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- 4 v-/ Maintenance: and operations - {ort( warninglabeki: /q//i


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TheSummaryofob,"*usear.asofconcernattheear1iestpossibletime.Itisnot
Conlrol Act andregulations of the Toxic Substances intendedto bL a complerelist of p;bntial deviatiois fiom the requirements

apparent' readily those and/or concern of imme{iate conclitions a list of those but rather thereto,

hltlr: irvu'iv.epa.gov'rrestouu-4/alrera lintr to nHfRA guidancetools are locatedat the fQllowingEPA websiLte: 'l Name/Title of LEA Representative:
Kevin Malone, Section Chief

zr^b"Ll, wylwne 5o\^,.-

Ne, r York StrteDe


I

of llealth AttERAAudit/.Inspection Rlrporr

FOR DOCUMENTS
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ERA-Acronyms

DP -AHERA Designated person

il;i;;;" +!Py Asbestos-containiig H*il fi;;;; f fl*o-lsbesros r"orrrri.rTyeiil"i +|[A- American plan Managemenr lyl - Asbestos NySDoL puit'so rzN-ycnn llso u

+9y

- Asbestos-Containing Marerial Act

iation
regulations al Program

yt'ironmeitaf f.aUo*toiy 3,,OO,-, -_u.s. Environmen,"t il;;;",t IIA FS .* Funptional Space

Luuo.J,J., program ccreditation ilYl*k - New N_YsDoH 'Health v*t "n,u", sr"ir"n purr*ili, yorkState n*O**r", liIlDOL - - New Labor york New " state rJd;;; ryYlED
inistration . +vourrrsu rrsoeslos_Uontaining Asbestos_ContaininE :i:l"r - rresumed M ial " Phase Contrasr tvticroscof;l9lrl polarized Light

Institut"e foiOccuparic SafetyandH.ealth lY]gsg National

Ed ucari onAgency !.E.1t^.. !".a1 -

I]?PA: HA - HomogeneousArea

Highparricutate Efficiency Air

*t'i:"ir, v:r

g:Ij - occuparionar sur"iyuiJiiJattir -

9*y

- Operarions and Maint"nun."

TSI - ThermalSystem Insulation VAT - Vinyl Asbestos Tile (Floor Tile)

Micros;$i llM TEM- Transmission Electron Vttior.opy

New rrbrk State

Report t of HestthAHERAAUdit/Inspection

Did theLEA comeinto

information
Note: Sign-in

(whomay workers short-term with in tlhe school) ith asbestos ofACBM? thelocations

f* Yes 17 No

f N/A

Did theLEA management thenotification?

teaghers. and |ir Yes f- No f N/A in writing pargnts. of the of theavailabilitv is provided Thenotification coPY of yearlyinrtheschool adated asrequired? Isthere calendar.

763.ea(a)(t)
trainingon the minimum asbestos awareness fqllowing topics: Information
effectso locations which they work, and location of usesand forms, health ing asbestos ACBM in eachschoolbuilding in the DP name ition of damage,

|7 Yes f- No

f N/A

Was thistraining

of hire? within69 d.ays

f* ves |7 No r* N/A a planfor Mustdevelop of training within60 days hire. f* Yes [- No 17N/A bY O&M is not conducted school employees.

it;

763.e2(a)(2) of ACBM in thedisturbance aativities that wil result where training, the of additional received applicable? Note:NYSDOL andcertification -t63.94(c)
Do the trai

licensing 55O&M (minimum) ired


for custodittland maintenance f* Yes [;i No ing information?
f N/A

the staffinclude
Datetraining Locationof train Numberof hours

Pprson's name a job title?


pleted? to show also recomm,ended

Training;recordsshould includecoursetimesand showthat a minimumof 2 hours is dedicatedto asbestos training. awarenss

Note:Course with compliance

.e2(aXl)

New York State

t of HealthAllERAAudit/Inspection Rerport

#24

theinspector ?63.88(aX2) 763.85(a)(a)ff) atrdinclude a


763.88(b)

material l* Yes l- No F N/A of friable assesEmentg


date and accreditati-6n?

#25

Did theinspector theACBM and t for classiffing written to beAIOMin theschool ACB assumed srirspected
blrildinginto one f the following categories?

I* Yes f* No |7 N/A

(l)

(:2) (3) (4) (6) (7\

or si Damaged friable Qamaged


Significantly

TSIACM. damaged
friable surfacingACM.

(s)

or si Qamaged ACBMwith ACBMwith Any remaining


Note: See

ACM. misc. friable darnaged icantly ial for damage. damage. ial for significant bleor suspectedlACBM. (763.90) for requirements Actions

'/63.93(eX2)

dbes befirre J2114/87, conducted For each include: tlle management 'llhe dateof the ton.

(i) (ii)

[* Yes [* No P N/A

A blueprint, schoolbuilding approximate or lpmogeneous forACII spmpled bulk where epllection. A copyofthe
and a analyses,

of each or writtendescription |7 NiA locationand f* Yes [- No identifies clearlyeach ofanY or linearfootage


materialwas mpling areawh,ere and,ifpossible,the exactlocations and the datesof were collectecl, |7 N/A

of dates samPles, yses of anybulk. rePorts ofany otherlaboratory

f- Yes l* No

pertaining to the #29


(iv) actionsor preventive of ly response A description taken rneasures the if possible, including exposure, reduceasbestos ofall contractors and addresses l- Yes l- No F N/A

of thework,and dat,es start completion involved, duringand uPon analyzed of anyai rBsults work. of completion to bemade requrired of A description before was identified qnder materialthat 763.88, $
14. I December quspected ACB
and signature, S

f- Yes [* No

la N/A

, as friableACBM or friable assumed to be A,CM,and the name

of accreditation, and if applicable,

accreditation the assessments.

making of eachaccncdited Person

NewYork State

Rtrport AIIERA Audit/Inspeetion of ,Health

#37 763.85(bXr)

of all friableand Did theLEA conructa reinspecliotl school ACBM in each nonfiiableknownor assumed useasa own,or otlrerwise thattheylease, building p : least once everv three vears? building, school

l* Yes [- No 17N/A

#38

by anaccredited lF Yes [* No T N1A 763.85(bX2) Wereall reinspeconsconducted i;nthemanagement here signatures andare 763.e3(eX3Xi) inspector plan?
Signedbut not dated.

763.8s(bX3)

rei Foreach e4chperson

areaof a scltoolbuilding,did g a reinspection:

did not conduct The Ins;oector for re-inspection a thorourgh the 2010 triennial.

#39 (i) #40 (ii)

the under andreassesso reinspeci, Visually $ 763'88, ACBM? at;sumed or frfiable known all of condition

l* Yes F No f N1A

niraterial thatwaspreviously Visuallyinspect [- Yes F No T N/A to andtouchthematerial nonfrifible ACBM considered thelast since frriable it hasbecome whethdr determine or rein$pection? inspection has f* Yes f- No P- N/A with materialthat areas Identiffanyhomfgeneous or thelastinsperction friablesihce bpcome reinspection? (763,86 l* Yes [* No |7 NiA fur analysis andsubmit lectbulksamples Cof newly of area homogeneous for e[ch 763.8?) and to beACBM? assumed t$atis already friablematerial of thenewly under Assess, $ 7Ol.gt,thecondition l7 N/A arecollected, l* Yes [- No samples where iit areas material friable to thatareassumed in area,s andnewlyfriabl! materials ACBM? be of friable under Reassess, thecondition $ 763.88, identified? ACBM previously or assumld known l* Yes l* No P N/A

# 4 1 (iii) #42 (iv)

#43

(v)

#44

(vi)

NewYork StateDepa

Audi#InspectionR:eport t ofiHealth,AlflERA

R,eport NewYork StateDepartmentof HealthAIIERAAUdit/Inspection

#98

763.e4(g)

under activitY Foreach time thrt rnajorasbestos f- Yes [- No |7 N/A provide the JLEA did the 763.91{e) wasS rformed, person of each signature, md acmeditation name, dates performing thestartandcompletion thea rtivity, activity where,such of theactivity,th I locations the a descrptionandifACElM is removed, occurred, siteofthe ordisposal name andlocaticr ofstorage ACM?
notification requrired Note: NESHAPf procedures aftera Did theLEA usethedescribed of 3 (fallingor dislodging ;eepisode minorfiberrelea sq.ftllf or less)?

#99

763.er(fx|)

l- Yes f* No

17NiA

procedures disturbance Note:NYSDOL ncidental # 1 0 0 763.el(f)(2)


after a majot [- Yes l- No Did the LEA usethe describedprccedures of more fibqr release epir rde (falling or dislodging than 3 sq. ft/lf)? samplingand NYSDOL Note: AHERA cl ]arance procedures incidentaldistut:,ance F N/A

# l 0 r 763.94(h)

of each planinclud,e a record Doesthe manag(ment l- Yes l- No F N/A information: epit de with thefolkrwing fiber release
Date and locatio rofthe episode? Methodof repair) actiontaken? Preventivemeas re or response thework? Nameof eachpt sonperformin$

of the location anrd IfACBMis remved,thename anddisp salsiteof theACM? storage sl+";ltj:ifi#ffiffi&.s #102 763.95(a) 763.84(e) immediatelY label:i ch waryrine Did the LEA atta ACBM located f riable and nonfrizrble to any adjacent Inance areas? in routinemaintt l* Yes F No f NiA
on ACBM(Picture directly in is missing 4). Laloeling (picture 8). some areas
Some labels have been Placed

# t 0 3 763.e5(b)

pl;;;[dt;qh],ec-in ni. air"n"rr

ly visible readi

until theACBM thatis locationsand rernainposted labeledis remov

l* Yes f- No tr N/A

#104 763.95(c)

Doesthe warnin l labelread,in print whieh is readily visible in larges ze or bright colorr? CAUTION:ASI ESTOS.HAZATI.DOUS. DO NOT DISTI RB WITHOUT PROPER TRAININC AN ) EQUIPMENT.

F Yer; l- No T N/A

or NotAssessed N/A = Not Applicable

NewYorkState

Report of HealthAIIERA AudiUlnspection

#82

(by an collected 763.eo(ix2xi) Wereaggressive clearance air samples persor *ctions? accredited r)afterresponse

[- Yes [- No

|a N/A

#83

for PCM laboratory 763.e0(ixzxii) Did theLEA usem accredited (AIHA) or TEM NVLAP)air clearance sampling after a r sponse action? analysis

f- Yes [- No

l7 N/A

#84

763.e0(ix3)
763.eO(ix4) 763.e0(ix5)

lf., act rnsgreater thanll60sq;ft./260 Forresponse by TEM? werelJ air saml escollected andanalyled

l* Yes l- No

|7 N/A

#85 #86

collected?f- Yes l* No FoTTEM analys ; was| 199litersor greater

ta NiA

to 160sq. Forresponse act rnsless thanor equal [* Yes l* No tu NiA j air $amples andanalyzed were collected ft.12601f.0 by PCM(Nlosl 7400)? Notefor NYSU L Part 56:was>2 LPMand>1200 literscollected? afterthe next for 3 y'ears Did theLEA retiin records all where rach area homogeneouts for reinspection rernoved? ACBM hasbeen
Did rhe LEA ma rtain recordsfor eachBrplrentive and resl onseaction taken for friable and nea.su-re ACBI I and friable and nonfriable suspected nonfriable ACBM assumed io be ACM including: l* Yes f- No |7 N/A or action, of tlhemeasure A detailedwritte r description includingmetho s used,the location wherethe for selectingthe or actio r was taken,reasons measure datesof the or actio r, start and complletion measure involved, of all r;ontractors work, namesant addresses and and if applicabletheir Stateof ac,oreditation, the and ifACIlM is removed, accreditationnur rbers. site of the or disposal nameand locitir n of storage ACM. collectingany The nameand si inature of any person the comPletion at air samplerequi :d to be collected the by $ 763.90(i), ie actionsspecified of certain resp"or of date where ampleswere colllected, locations of the laboratorY collection,the n; me and address the results analyzingthesa rples,the dateof analysis, and the narne t remethodof anallysis, of the analysis, and a analysis, performing fhe of the erson signature that th r laboratorymeetsthe aPPlicable statement of 763.e0(ix2xii), requirements
t-.Yes l-- No |a N/A

#87

763.94(a)

l* Yes [* lto

17N/A

763.e4(b)

#88

(l)

#89

(2\

NewYork StateDepartmeirt of HealthAllERA.Audit/InspectionBleport

763.e3(e)(e) Doesthemanage thefollowing mentplaninclude


recommendationr

#qs'
#66 #67 #68

A planfor reins! oction u;nder 763.85? required


A plan fbr (including

l* Yesr I* No Fr N/A f- Yesi [- No li' N/A

agtivities ionUand maintenance 763.91? cleaning) under requirerd

763.92?f* Yes l- No F N/A A planfor ppfiod ic suwejll4ircq required under 's plannef A description of thernaJragement l* Yesr [* No |7 N/A recommendation under for additional cle4ning 763.91(c)(2), as1 rartof anoperatirlns andmaintenance program, andtheresponse of the l,EA to thatrecommenda :ion?

#69

763.93(eXl I)

of Doesthe manage mentplaninclud,e anevalu4tion actionso resourc.es neededto carry out response operationsand maintenance. and reinspections, periodicsurveillr nce and trainingll

[* Yesr f* No

17N/A

#70

763.e3(g(2)

a Did theLEA mai ntainin itsadministrativegffipe f" Yesr F No l* Nle plan for each complete, update d copy of a management Not updated/completeschoolunder its irdministrative or direction? control
Did each complete, that school,and office a f* Yesr Ii' No f N/A ntain in its admiqistrAtive plan for copy of the marnagement Not updated/complete. without cost or ke the plan available

#71 763.e3(eX3)

restriction as

ffi

ffi
#72 #73 763.90(a)

in a time.ly acl;ions Did the LEA coriductresponse manne{consisteftwith assessmenits? Weretheseresp{nseactionssufficient to protect humanhealthandthe environment?

ffi

f* Yes f* No l* Yes [* No

|7 N/A |7 N/A

#7i ?63.r06t--

*-

| ) damage{ or.significantlydam4ged For(Category areaor TSl, did the LEA at leastreoairthedamaged all TSI and andmaintain material remove thedamriged andgndamaged in ari intac!state its covering condition?

f* Yes Fl No f N/A area storage TSI in custodial (pictures 4 and5)andin the neartheelevator basement (picture 7).

New York Sta$e

Report of HealthATIERAAudit/Inspection

#s3

bulk sufficient Did theLEA takeandhaveanalyzed to not assumed fromea$h area, samples homogeneous beasbestos?

[* Yes I- No l7 N/A

(aXl) (aX2) (aX3)

- upto 1000 sq.ft. 3 samples minimum - 100l-5000 sq.ft. 5 samples minimum >5000 sq.ft. 7 samples minimum TSI minimum 3 samples < 6 sq.ft. or lf. minimqm of patches I sample (2 rnin.) for fittings In a manner sufficient to determin,e (friable) M isc-el laneouS (2 min.) sufficient ln a manner to determino
(2 min.) ln a manner sufficientto determine

(bxl)

(bx3)
(c)
(d)

(bx2)

thefollowing include 763.87(d) andhas samples bulk the on ttJre analysis of 763.93(eX3Xiv) information in theplan to theDPfor inc;lusion it been submiued within30 days of theanalysis: collected l- Yes l- No F N/A samples of theanflysis of anybulk. Copies that laboratory of any N{meandaddress andanalyzed, laboratory any that bulk safnples, A statement analyzed accreditation used meets thealplicablelaboratory p0 of any Dates requirements of CFR$ 763.87(a),
perforniedand the nameand signatureof the analyses personperformifigeachanalysis

763.e2(b)(t)

in each periodic surveillangq DidtheLEA corfduct asa uses building thatit l$ases, owns, or otherwise to is assumed or ACIIM building contains school ihat onc.e everysix monjhs? ACBM dt lg3st contain Did theperson
visually management

[* Yer; |7 No f N/A since anY Therehaven'tbeen 2005andmanyarmissing priorto thatyear. l* Yes F No T N/A

763.e2(b)(2) 763.94(d)

periodic surveillance
that are iidentifiedin the asACBM, recordthe datqof the

surveillance, !i
conditionof the

in the andanyqhangqs to the andsutrmit a record


plan? in the management

DPfor i

lg!1rE:III F":rry.d"d

New York StateDepartme4tof Health AllERAAudit/Inrpection Report

SUMMARYOF OBSERVATIONS

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Report A1il0RAAndit/Inspetion Yorh$tateDepr"t**f of 1lealth Nery


OPENING CONFERENCE SIGN-IN SHEET

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NewYork $tateDepadmentof HealthAfitERAAudit/Inspection Report

requirements of theAHERAregulations areproperly implemented? 763.84(g)(2) on thehealth effects ofasbestos, detection, identification, andassessment ofACM, options for controllingACBM, asbestos managemenf programs andregulations conceming asbestosi in orderto properly perform his/her duties?

Has a psrsgn.been desisnated to ensure that

F Yes f* No f NiA John Zambelli isthe designatr:d person.


P Yes l- No f N/A Mr.Zambelli hashadO&M training. Werecommend Designated Person training.

Has. thedeS! gnaled person.received adequate ning trai

763.e3(e)@)

Does thernanagement plancontain thename, address, l- Yes [* No ta N/A andtelephone person number of the Desigmated and thecourse namen anddates andhours of training taken? Does theman4gement plancontain a trueandqgrrect state{nenl, by the individual clesignated peison, ^sjgneU whichcertifies rhanhegeneral LEA responsiUitities have been metor will bemet? Note:Statement should besigned by c.urrent Dp
[* Yes |7 No T N/A The "Consultantand LEA Information and Sign:off' providedin the 2010 rriennial doesnot comply with the expectations provided by the EPAfor an AHERA True and Coffect Slatement.

Doesthe managemgnt plan havea glrssripjionolstepg fo:

763.e3(e)( l0)

Inform workersand buildinq occupar[g.or their legal guardrans, aboutinqpections, reinsperctions, response actions, andpost,response actionactivities, inciuding periodicreinspections andsurveillance activitiesthai are plannedor in progress?

The2010re-inspection report discusses notification, buta desmiption of steps is not included. lrleed to develop anddefine procedures steps/ for notifications. f-- Yes Fi No f* N/A

763.e3(g(a)

Notift in writing,at leasr oncea year;parent. teacher. management planfor review?


f* Yes l" No f N/A

763.84(c)

Have gplkpfs 4nd building occqpants, oG.i. f"gul l* Yes f- No guardians, beeninbrmed at leasi onei:eachschool ysalabout inspections, response actions,and post_ response actionactivities, includingprariodi c reinspection and surveillance activitiesthat are planned or in progress?

l"- N/A

NewYork stateDepartment of HealthAllERAAudit/InepectionReport

# r 4 763.85(aX |)

DidtheLEA inspbct each school building.that they lease, own,or othprwise useasa school building before October 12,1988 to identify all locations of friable andnonfriable ACBM?
School building means: suitablr,. { l) Any structure tbr use asa classroom. including aschool fbcilitysuch asa laboratory library, school eating lacility,or fhcilityused lor thepreparation of'food.lflAny.gymnasium or otherfbcilitywhichis specially designed firr alhl,.tic or recrealional adtivities I'oranacadernig coum in physical (3) Any other cdu:ation. tacilityused t'ortheinstnfction or housing ofstudents or lor the administration of educatibnal or progrlms. (4) Ar,ly rnaintenance, storage, or utility lircility, leTar.qh including.any hallway, esscntial to rheoperatioiofany hiility d*cribed in thisdellnition of "schoot buitding"under poragnrphsi I ), (2):or (J). (5) Any.ponico or covered exterior (6) Anyexterior halluayor ualkr.ray. portion ofa mechanical rystem used to condition interior space.

f- Yes [- tVo 17NiA

763.85(a)(2)

12,1988, did theUEAinspect priorto these buildings useasa school building? If emergerncy use of an uninspected building wasnecessitatr;d, wasthe building inspected within30 days?

For buildings leasgd or acquiredon or after October

f* Yes f* No

Fr N/A

763.8s(aX3) tVas each inspectiqn conducted by anaccredited f- Yes l* No |7 NiA 763.e3(eX3Xi) inspector andis thgre a signature in themanagement
plan? #t7 763.85(a)(a)(i) Did the LEA visuallyinspect all arersto idgntiqv all_
locations of suspect materials, both I'riable and nonfriable,in eachschbolbuilding?

l- Yes l* No |7 N/A

# r 8 763.8s(aXaXiv) For eachhomogengous areathat is n,otassumed


to beACM, did the LEA collectandsubmitfor analysis bulk sampfes?

[- Yes [- No F N/A

763.8s(aXaXvi) Hasthe followine i;rforFatiqn,about the inspection


beenrecorded andgubmitted to the Dp for inclusionin the management pl4n within 30 daysof the inspection?

#t9 #20 #21 #22

(A) (B)

Datedinspectionreportsignedby acr:redited inspector. Inventoryof the exqct locationsof the homogeneous areaswheresampleB werecollectedand datesthat samples werecolleoted.

f- Yes [* No f- Yes f- No

ls N/A l? N/A

(c)
(D)

Description of the rnanner usedto determine sampling f- Yes [-'No locations. List of whether the homogeneous areimidentifiedare surfacing material, thermalsysteminsulation, or miscellaneous material. Assessments madeof friablematerialis. f* Yes l* No

|7 N1A

|i' N/A

#23 (E)

f- Yes l* No

|7 N/A

Newlbrk State Depart mqntof HealthA|IERAAudi#InspqetionReport


763.e3(e)(3)
Foreach gluttl.2l conducted the !4187 ; does management plarlinclude: Thedate of theinspection or reinspection andthenamef* Yes [No Ia NiA andstgnature, State of accreditatiori and,if applicable, theaccreditation number of each acuedited inspector performing thre inspection or relnspection. Ablueprint,.diagram, or wiittendescription of each schoolbuilding rhatidentifies clearly iach loc4tion and l- Yes l- No |7 N/A approximate square or linearfootatrp of homogeneous areas wheremateriial wassamplcd lbr ACM, t6eexact location where each bulksample wascollecied, dateof homogpneous areils where friable suspected :*k:tjgn, ACBM is assumed to beACM,andwhere nonfriable suspectedACBM is assumed to beA,cM.

#31 (i)

#33 (iii)

A description of themanner used to determine f- Yes l* No |7 N/A sampling locations, andthename andsignature of each accredited inspectqr collecti ples,-the ng sam State of accreditation, andif ippticuUle, tri, or her accreditation number.
A c:py of the analyses of any bulk sramples collected and analyzed, the nameand address ofany laboratory that analyzedbulk samples, a statement f- Yes [- No 17 N/A

#34

(iv)

tT,-,F meeis theappl icalble requirements lt9".ratory of 763.87(a) thed4te of analyiis, and thenarne and signature of theperpon performing theanalysis.
#35
(v)

A descriptionof assessments, requirdto be made l* Yes f* No under 763.88, of all ACBM and susprected ACBM to be ACI\,f,and the name,iignature, 11ume! Stateof accreditation, and if applicab,li, accreditation numberof eachaccredited pursonmaking the assessments.

lir N/A

#36 763.9e(a[7)
f_ Yes |7 No T N/A An exclusionary statement exists for a2002 abatement project. However,there does not appearto an exclusionarv statement for the parker Elementary additionthat wascompleted in ZOO7.

3:1i"

may be missing as

NewYork $fateDepartmpnt of-trearth ATTERAAudit/Inspcfion Report


763.85(b)(3)(vii) Hasthefollowinginformation about reinspections beenThisinformation is for the recorded andsubmitted to ttle Dp for inclusion in the 2010 triennial onlv. management plqnwithin30 daysof thereinspections:

#45 l(A)

Dateof reinspection, name/signature/ accreditation of lnspector.al{uny changes in thecondition of known or |7 Yes l* No T N/A assumed ACBM? Exactlocation where samples werecollected, a man1e1 used ro determ inesamp Ii ng lXrf::r::f^1h1 rocatlons andthename/signature/ accreditation of inspector who collected simples?

f* Yes f- No F N/a

of friablematerial, 763.88(aX2) dateof theassesspnent namelsignafure/ accreditation inspector?

Any assessments or reassessments

of FYes I No f N/A

763.e3(e)(3) (i)

For each reinspec[ion conducted utte,lZil+tfr, Go rnemanagement planinclude:


The d,a1e of the inspectionor reinspection and name/stgnature/ aacreditation of ealh inspector?

This information is for the 2010 triennial only. F Yes l- No f N/A

A blueprint,.diaqram, or written description of each l* Yes |7 No f NiA scnoot Durtding thatidentifies clearlly to the information each location and According approxtmate squarp or linearfootage in rhe2010 of homogeneousprovided areas. wherematerial theZO04 wassampled im nCU, tfreexact trienniaf, reinspection wfereeach wasconducted butk,u*pt" *uu,of fr.i"d, dateof 9:lll." without buitding drawings/ homogqneous areas whercfriablesuspectedoragrams. :oj[:tjgn, ACBM is assumed spaces to beACM, *nO*frrrc nlnfriable should Functional beused to identiru suspected ACBM ipassumed to bel CM. locations asroomnumbers A des.cription of themanner used to determine locations,_ andname/signalrure/ accreditation f- Yes f- No |7 N/A :lTpl,.ng or me tnspector collecting samples? A copy,of theanalyses of anybulksarmples, thename andaddress f* Yes l- No F N/A of anylaboratory, a statemCnt ,1"j l meets the appl icablerequ iremenrs T:_ t$ratory of g 763.s7(a), rhedate of anaiysis, andtf,J # signature of theperson perform i ng'th".r"ili,"r*, f
Adescriptionof assessments under7ti3.gg, of all f* Yes [* No suspecred ACBM assumed to beACM, and l:-:lyl ilg rne.name/slgnature/ accreditationof eachinspector making assessments? |a N/A
can change.

M*t*

h*"**un'

o, *oun r\Hf,RAAudi,rlnspection Report

763.e3(d)

ElleYe lpp an, *r;ffi ffi ^oj^ttf,! r,besta$ ur t ouffiffi y,* j::l r,^", H** own, orotherwise use as schoor [iliilirepi
Leemaintain ana.qpdate ''rr rr*8,*rr 3tl^* to Keep it current

F Yeb I- No r N/A

icsurieil rini,i i;ro.d;, Tl il*i:*, period rernspection, and response activiti es aJl*q"i*or

with ongorng operations and

pt* l* Yes |7 No f N/A


Significant updates are needed to themanagement ptan.Theinventorv presented in theplanis

Inaccurate.

Y:^*:gasemenr manags:ment nlanner?


763.e3(e)(t)

pt;;e;er,op,Ju, * *r.Jir"a

l7 Yes I- No

f N/A

Does rhe management ,t" r*rfl31,"rt,,J:;tir, F Yes f* No f N/A "f Manoicenffi'etherthe schoot bu ird ing 6a5ffiffi & ^;:ffi :lfr ,;ililT|Hil, and non-friabte suspeced ACBM assumed to be l3lf
.--..-.noesthe 1ugesemcItebn;;tai;hs resommendatio-ru made toltreliGjlilication agency f- Yes f- No |7 N/A regard ingresponse actions, ggid;'ihs under Ze;:.

763.e3(e)(s)

name, signature, State oru".r"Jituu._ person making the recommenoutionr, "iX.t, his unJjiroo,ari,., or heraccreditation number 2

::::lT"igactions? response
#63 763.93(e)(6)

Did a^Ir::raleT,ent olaqner rfire resutts of each {e.vie-w Inspectton,.reinspection, andissfimunt in o.O*,to f* Yes f". No l;| NIA in witing

tothe LEA utr*;;;iu,"

,esnrin+i^- ^c ____ ..plan

Doesthe*unus"r.nt ;;;;;- contain -;;; a $etailed

l- Yes f* No

17 N/A

3: i:g:11,1* and response action?


#64

taken-r"r"^," ;; *:::::^rrrtr't5urss res ponse acr io n". o,*,t;;fr T:f#::'ffj :-.:'?, u, * and compretirs ;il;;;dffi

and action will be

meas ure
f- Yes P No f N/A Floorplans do notindicate wnere ACBMcanbefound. j..l.J,lno:tdbeupdared using runctional
spaces/homogeneous areas.

763.e3(e{8)

en tp rdil; i;;]ffi ?::, *: ::asem

New York stateDepartment of HearthcTHERAAudit/Inspecfion Report

#7s f763.e0(c)

n,Eiiffiffi uut, o, ll^-t fof*^.'n'up'u repatr the damaged material?

ff;'!::[Te.ilffiffi:t,o,n" Iufr

{* Yed f- No |7 N/A

f* Yes P No

f N/A

notnecessary to protect human treaittr andthl envtronment AND remove thematerial in the functional spae or, depending ,prrn*t rtt enclosure or encapsulation wouldbesufucient ", human Kindergarten to p.oi..t closet mayneed health andtheenvironment, response enclosie or rnruprutut"f actionpending 5) ,friabte. surfacingACfrA, fSf eCfr4, f9r.lCategory misc. ACM that has poi",ii,,j "i roiouiuee, ti"fl: oio at leastimplemenr an opemtions and llre.L.EA matntenance (O&M) program?
results of sampling (pictures I and2)

Ceiling plaster in the boiler room ( picture 3) and water damage to plasterarounda window in the west stairwell (picture6)

I- Yes f* No ta N/A

program, insriture;rreventive lTll.r:l anO.SM measures appropriate toeliminate ihereasonable


nxettnood tnattheACM or its coveringwill become

6) friabte. surfr;i"slGM, TSIACM,; f91(cate_eory friabte misc. ACMthar has ooi.n?iui fo,,ie;nrun, damase, didtheLEA:

f- Yes l-- No

|7 N/A

lqnincllur nNn remove.the materialas soonas possibleif appropriate

damaged; dererioratea, oritelur-Nui.o cannor beiffectivety

envrronment.

substantial endangerment to humai t

areaandres*ict"d;ilf#,:Sf il:jfl1li,llfllT:,'h,
"Jrt *,f,""'

irnir"lr"nt lfLl"rll.^:^:ll-s unless other.response *" o.i"r,ii."i'i" p-"" c,o, "",ion" humanhealthand theenr

#79

763.90(e)

Were response actions,(otfr". I},*ESOIG ien.d by persons acmedited to design (projectDeiigner;and conduct response actions ?
Weremaintenance activities(otherrhanSSSD)

f- Yes f- No |a N/A

#80

763.9l(e)

763.eO(ix t)

persons acc red itedto a"s f- Yes l- No 17 N/A iln orion." :::ls:93. actions (project Designer) una if'p.oon. a_ccredited "onoui,'t?o to cond uct-response action s? At theconclusion of anyac_tion to removern.uprufu*, f* Yes f- No |7 N/A or enclose ACBM or material assumed to L" eCgM, wasthere a visgalinspectiuof each tin.tionur,pu.e where such action wa, conducted to d,ttermine whether theactionlrasbeen properly ,o*piet.,j'iirr"j'..t
Monitor)?

NewYork StateDepartment of HealthAHERAAudit/Inspction Report

763.91(a)

Did the LEA develop andimplement anoperations and maintenance (O&M) planwhenever anyfiiableACBM is present or assurned to bepresent in a buildingthat the LEA leases, owns, or otherwise uses asa school building?

l* Yes F No f N/A
Someof the information provided in the O&M program is incorrect. This shouldbe updatedto reflect currentpractices,procedures, and regulations.

(b) 763.er

Did theLEAcomply with either theOSHAAsbesros [* Yes l* No 17N/A Construction Standard (29CFR 1926.110l) or the Asbestos Worker Protection Rule(40CFR763.120)? [- Yes l- No |7 NiA

763.91(cXl) Did theLEAconduct aninitialcleaning priorto the


initiation of a response action?

763.e1(c)(2)

Did the management plannermake lvritten recommendations as to whetheraddiitional cleaningis neededo and ifso, the methods and firequency ofsuch cleaning?

l- Yes l- No |7 NiA

763.e4(e)

Foreach timethatcleaning under 76;3.91(c) was [- Yes [* No 17N/A performed, did theLEA record the name of each person performing thecleaning, therdate of such cleaning, thelocations cleaned, andthemethods used to perform such cleaning?
Did the LEA follow described procedures for all O&M I- Yes l- No |7 N/A activities? Note: NYSDOL part 56 requirements

763.9t(d)

763.94(f)

#97

763.90(g\ 763.9t(e)

accredited to conduct response actions (O&M, Handleletc.)?

For eachtime that operations and maintenance I* Yes [- No F N/A activitiesunder763.91(d) wereperfo,rmed, did the LEA recordthe nameof eachpersonperforming the acfivity, the start and completiondaters of the activity, the locations wheresuchactivity occurred, a description of the activity includingprreventive measures used,and ifACBM is removed, the nameand locationof storage or disposal site of theACM? Wereresponse actionsor maintenance activities f* Yes [- No |7 N/A conducted by persons

NewYork State.Department of HealthAlHERAAudit/J[nspection Report - CecllH. Parker Elernentarg INSPECTIONPICTURES $chosl- December 5r,Z$12

NewYork StateDepartment of HcalthAllERAAndit/Inspection NOTICE OF INSPECTION

Report

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Kavln Matona

Ssctlon Chtot

AHERA Audit/InsPer:tiqnRecords Thefollowingrecords(ifavailable)shouldbeaccessibtrreduringtheAHERAAudit/Inspection: \ \ \ \

List of SchoolBuildings Datesbuildings/schoolsoccupied Datesof originalconstruction Datesof additions/renovations Diagrams/Floor Plans

\\

and staffby district andbuilding Number of students plan developed reportandthe management plans- Initial inspection original rnspection/Management for eachschoolbuilding' at leasteverysix reports'conducted records- Periodicsurve:illance 6 month periodic surveillance months,in buildings that containACBM' 3year(triennial)re-inspections_Re-inspectionreporl;sfrominspectionsconductedeverythreeyears $ planner' by a certified inspector/management availability of management notificationsregar:ding Annual reporting/notifications copies of annual actions' Plansand any resPonse and custodialstaff 2- hour --Documentati'sn of maintenance Stafftraining records/listof personnel activitiesthat hc,urtrainin! for staffwho conduct training and any ,ooiri"r"ii+ awareness asbestos will result in disturbance' activities asbestos to oversee person_ The nameof the inclividualthat hasbeendesignated Designated and Jnsurecompliancewith AHERA requirements'

a 1,

thatthegeneral certifies tlhat person - Statement by thedesignated signed Trueandconect statement metor will be met' been t.tpo"tiuilitiesof theLEAhave by thedistrict' work completed - Documentation of anyabatement records abatement Asbestos

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