Chicago Public Schools 6 Month Asbestos Surveillance Fall
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1 Chicago Public Schools 6 Month Surveillance Fall School: Carter G Woodson South Oracle Unit: Building ID: 7820 Address: 4444 S. Evans Region: 04 Mail Room: 41 Surveyor: Johnson, Mr. Michael Dewayne X CHECK HERE IF NO CHANGE TO ASBESTOS Survey Date: 10/13/2015 Address: mdjohnson2@cps.edu A copy of the 2013/2014 notice to parents and staff regarding the asbestos management plan notifications was distributed via: Each child's backpack X Notice printed in school's newsletter Notice printed in school's calendar Other HA No Description Location Change in Assessment 1 Acoustical Ceiling Plaster SF Fall: Other on all 3 floors Third Floor - Removed From 1st and 2nd Floors Surface No None 0 X YES NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 1
2 HA No Description Location Change in Assessment 2 Hard Coat Plaster SF Throughout Facility Surface No None 0 YES X NO HA No Description Location Change in Assessment 3 Spray On Surfacing SF Throughout Facility Surface No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 2
3 HA No Description Location Change in Assessment 4 12" x 12" Ceiling Tile 750 SF Room 325 Miscellaneous Yes None 0 X YES NO Fall: Abated acoustical ceiling HA No Description Location Change in Assessment 5 2' x 4' Lay In Ceiling Panels 7400 SF Rooms 116, 117, 125, 126, 216, 217, 227, 316, 317, lunchroom Miscellaneous Yes None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 3
4 HA No Description Location Change in Assessment 6 9" x 9" Floor Tiles These Tiles Have Been Abated YES X NO HA No Description Location Change in Assessment 7 12" x 12" Floor Tile These tiles have been abated YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 4
5 HA No Description Location Change in Assessment 8 Overspray 50 SF 1st,2nd and 3rd Floor Above Drop Ceiling TSI Yes None 0 YES X NO HA No Description Location Change in Assessment 10 Cinderblock 1100 SF Throughout Facility Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 5
6 HA No Description Location Change in Assessment 11 Cinderblock Mortar 1100 SF Throughout Facility Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 12 Exterior Brick - Not AHERA Exterior of Building Miscellaneous YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 6
7 HA No Description Location Change in Assessment 13 Exterior Brick Mortar - Not AHERA Exterior of Building Miscellaneous YES X NO HA No Description Location Change in Assessment 14 Roof - Not AHERA Roof Miscellaneous YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 7
8 HA No Description Location Change in Assessment 15 Interior Window Glaze LF Throughout Facility Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 16 Exterior Window Caulk - Not AHERA) Exterior of Building Miscellaneous YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 8
9 HA No Description Location Change in Assessment 17 12" x 12" Beige Floor Tile w/brown Streaks SF Throughout Facility Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 18 12" x 12" Beige Floor Tile w/brown Streaks Mastic SF Throughout Facility Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 9
10 HA No Description Location Change in Assessment 19 12" x 12" Ceiling Tile Mastic 750 SF Room 325 Miscellaneous No None 0 X YES NO Fall: Abated acoustical ceiling HA No Description Location Change in Assessment 20 Green Carpet Mastic 800 SF Room 121, 126 Miscellaneous No None 0 X YES NO Fall: Abated 12 x 12 brown tile = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 10
11 HA No Description Location Change in Assessment 21 12" x 12" Purple Floor Tile 2400 SF Room 122, 227, Corr. Miscellaneous No None 0 X YES NO Fall: Abated 12 x 12 brown tile HA No Description Location Change in Assessment 22 12" x 12" Purple Floor Tile Mastic 2400 SF Room 122, 227, Corr. Miscellaneous No None 0 X YES NO Fall: Abated 12 x 12 brown tile = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 11
12 HA No Description Location Change in Assessment 23 4" Brown Baseboard 90 LF Room 122 Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 24 4" Brown Baseboard Mastic 90 LF Room 122 Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 12
13 HA No Description Location Change in Assessment 25 Black Sink Undercoat 9 SF Room 122, 123, 116 Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 26 9x9 brown floor tile 2300 SF Fall: Abated 12 x 12 tile classrooms under old counters Miscellaneous No None X YES NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 13
14 HA No Description Location Change in Assessment 27 Mastic associated with 9x9 brown tile 2300 SF classrooms under old counters Miscellaneous No Unknown 0 X YES NO Fall: Abated 12 x 12 tile HA No Description Location Change in Assessment 28 leveling compund SF throughout Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 14
15 HA No Description Location Change in Assessment 29 Window glaze on doors 317, 123, 1st floor bathroom Surface YES X NO HA No Description Location Change in Assessment 30 Brown linoleum 1600 SF Rooms 216,217,316,317 Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 15
16 HA No Description Location Change in Assessment 31 Brown Linoleum Mastic 1600 SF Rooms 216,217,316,317 Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 32 Fire Doors 10 EA Boiler Room/Mechanical Room Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 16
17 HA No Description Location Change in Assessment 33 Terrazo Flooring 2000 SF Stairwells Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 34 Transite Table Tops 160 SF Rms. 216, 316 Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 17
18 HA No Description Location Change in Assessment B Hard Joint Compound on Fiberglass Pipe Insulation 48 LF Throughout Facility TSI Yes YES X NO HA No Description Location Change in Assessment E Mag Block Pipe Insulation 92 LF Boiler Room and Crawlspace TSI Yes None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 18
19 ALL LEA Responsibilities, for this school, will be met. Lynn A.Crivello = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 19
20 NOTICE TO PARENTS AND STAFF REGARDING THE ASBESTOS MANAGEMENT PLAN NOTIFICATION School: Date: 10/13/2015 Carter G Woodson South This is to notify you in accordance with Illinois and Federal Regulations, that a copy of the Management Plan is available at each school during school hours by appointment. Requests to review the Management Plan must be made at least 24 hours in advance. Also please be advised that CPS conducts asbestos inspections of all Schools every three years. The last inspection was completed in surveillances are conducted every six months. CHECK ONE A copy of this notice was sent home in each child's backpack. X A copy of this notice was printed in the school's newsletter and sent home with each child A copy of this notice was printed in the school's calendar and sent home with each child Other. A COPY OF THIS NOTICE MUST BE PLACED IN THE SCHOOL'S ASBESTOS MANAGEMENT PLAN. = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 20
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