August 18, Dr. Robert Leisman Mecklenburg Foot and Ankle 2115 East 7 th Street, Suite 107 Charlotte, NC Indoor Air Quality Assessment

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1 August 18, 2014 Dr. Robert Leisman Mecklenburg Foot and Ankle 2115 East 7 th Street, Suite 107 Charlotte, NC RE: Indoor Air Quality Assessment 2115 East 7 th Street, Suite 107 Charlotte, NC EI Project ID: IHCH Dear Dr. Leisman: The EI Group, Inc. (EI) is pleased to present this report for the Indoor Air Quality (IAQ) assessment performed at Mecklenburg Foot and Ankle located at 2115 East 7 th Street in Charlotte, North Carolina. EI was requested to assess potential indoor air quality concerns throughout the facility. Interviews with site personnel, a visual inspection, collection of sampling data through direct reading instruments, and air sampling were utilized to perform this assessment. The data, along with guidance from nationally recognized literature produced by the Environmental Protection Agency (EPA), the American Industrial Hygiene Association (AIHA), and the American Conference of Governmental Industrial Hygienists (ACGIH) among others, was used to formulate the conclusions and recommendations outlined in this report. Project Information The scope of this study was limited to the conditions observed during the course of the site visit. Every effort has been made to provide as complete and comprehensive an evaluation as professionally practical. However, inherent constraints of time, observation, and scope of work must be recognized. Observations, findings, results and conclusions are limited accordingly to those apparent on the date of the site visit. It should not be construed that actions taken as a result of this study will achieve complete compliance with every regulatory standard nor prevent every possible accident or loss. Neither should it be considered that any recommendations noted are the only possible actions to be taken. The owner should assess and analyze each recommendation in relation to resources, objectives and activities. EI was requested to assess indoor air quality parameters, ambient fungal spore concentrations as well as conduct a visual assessment of the Mecklenburg Foot and Ankle facility. Mr. Lars Aamoth, with EI, visited the site to perform the study.

2 Site Information Site personnel reported musty odor in the back of the facility near room #10. Personnel reported frequent water leaks from the roof during rain showers in the area. Stained ceiling tiles were noted throughout the facility. Water damage was noted from a leak in the roof above Room 10. This area was actively leaking during the survey. Water damaged carpet and drywall were also noted in this area and adjacent areas. Moisture measurements ranging from 12 to 40% (Delmhorst scale 2), where readings exceeding 18% are considered saturated Indoor Air Quality Measurements Carbon dioxide (CO 2 ), temperature, and relative humidity were measured using a Fluke 975 Indoor Air Quality Meter to evaluate general indoor air quality parameters and conditions that may promote amplification of microorganisms. The American Society of Heating, Refrigeration, and Air- Conditioning Engineers (ASHRAE) recommend specific temperature and relative humidity (RH) ranges to achieve thermal acceptability ("Comfort Zone"). ASHRAE recommends an indoor relative humidity range between 30-65% and a temperature range between 68 F 74.5 F. ASHRAE 62.1:2013 recommends indoor CO 2 levels should not exceed 700 ppm above outdoor ambient levels. Based on the CO 2 levels collected at the time of the assessment, indoor CO 2 levels should not exceed 1,263 ppm. Approximately cubic feet per minute (cfm) of outside air per person is generally recommended in office type environments. Supply of outside air into buildings is generally recommended to lower indoor-generated pollutants and to reduce carbon dioxide levels. The temperature, relative humidity, and CO 2 measurements collected during this assessment are as follows: Sample Location Temperature CO2 CO Relative Humidity ( F) (ppm) (ppm) (%) Outside Left Outside Right Waiting Room Exam Room , Surgery Room , Break Room , Sampling Methodology Fungal Spore Sampling Air sampling was conducted utilizing Air-O-Cell spore-trap sampling media. All air samples were collected utilizing a high-volume sampling pump, calibrated to 15 liters per minute (LPM) with a sampling time of 5 minutes, giving a total sample volume of 75 liters. Following collection, each sample was given a unique tracking number, placed under chain of custody, and delivered to EMSL in Charlotte, North Carolina for optical microscopy analysis. This method was utilized in order to establish a baseline

3 of analytical data, using standard methods to detect total counts of both viable and non-viable airborne fungal spores. Findings Air Sampling Sampling for airborne fungal spores was conducted in Mecklenburg Foot and Ankle to determine airborne fungal counts, the genera present, and the relative levels of each genus. Two air samples were also collected from outdoors as reference samples. Two surface samples were also collected to compare as a source for airborne fungal spore concentrations. Analytical results for air samples are represented in counts, or spores per cubic meter of air. The concentration indoors is compared to that concentration observed outside. The comparison of indoor versus outdoor samples is based on the concentration of those genera observed, as well as the general rank-order. Outside spore levels were found to range from 15,570 to 15,880 spores/m 3. The indoor concentration was found to range from 1,720to 2,030 spores/m 3. Amplification of Aspergillus/Penicillium fungal spores was noted in exam room 10 and the break room. Visible fungal growth was detected behind the vinyl wallpaper in exam room 10 and above the ceiling tiles on the light fixture in exam room 4. A summary of air sample analysis can be found in Table 1 below and a summary of tape lift samples can be found in Table 2 below. Room/Area Description Table 1. Summary of Results of Microscopic Analysis of Air Samples August 7, 2014 Sample Number Spore Density or Concentration Results Predominant Genus AIR-O-CELL CASSETTE AIR SAMPLES Ascospores (1,300) Aspergillus/Penicillium (910) Outside Left ,880 spores/m³ Basidiospores (11,200) Cladosporium (1,600) Paecilomyces (560) Outside Right ,570 spores/m³ Ascospores (1,300) Aspergillus/Penicillium (100) Basidiospores (9,540) Cladosporium (3,800) Cercospora (300) Exam Room ,870 spores/m³ Aspergillus/Penicillium (1,200) Basidiospores (520) Cladosporium (90) Surgery Room ,720 spores/m³ Ascospores (200) Aspergillus/Penicillium (300) Basidiospores (1,100) Cladosporium (90)

4 Room/Area Description Sample Number Spore Density or Concentration Break Room ,030 spores/m³ Results Predominant Genus Ascospores (90) Aspergillus/Penicillium (1,300) Basidiospores (400) Cladosporium (200) Table 2. Summary of Results of Microscopic Analysis of Surface Samples August 7, 2014 Room/Area Description Sample Number Spore Density or Concentration Results Predominant Genus Room 4 above ceiling T1 TAPE LIFT SAMPLES Low Rare Low Rare Rare Rare Rare Alternaria Bipolaris Cladosporium Curvularia Epicoccum Myxomycetes Pithomyces Room 10 behind wallpaper T2 High Aspergillus/Penicillium Rare: 1 to 10, Low: 11 to 100, Medium: 101-1,000, High: >1,000 Conclusions and Recommendations Indoor air quality parameters measured at the time of the assessment were found to be within the ASHRAE recommended guidelines with the exception of the temperature in the waiting room which was 78.8 F at the time of the assessment. All other parameters were within recommended ranges. Fungal growth was identified behind the vinyl wallpaper in exam room 10 and on the light fixture in exam room 4. Water was actively leaking from the roof into exam room 10 at the time of the assessment. All water leaks should be fixed prior to remediation of the fungal impacted materials. Amplification of Aspergillus/Penicillium spores was noted in exam room 10 and the break room. 1. EI recommends that a professional roofing contractor is hired to address the roof leaks in Suite 107. Vinyl wallpaper should be removed from exam room 10 and adjacent areas. Fungal impacted sheetrock/interior insulation should be removed a minimum of 24 inches beyond signs of moisture impaction or fungal growth. A minimum of 2 inches of the wall system should be maintained below the drop in ceiling system. The ceiling system can remain in place, however stained or water damaged ceiling tiles should be replaced. Remove material up to non-impacted material (to the closest wall stud/equipment). HEPA vacuum, wet wipe with a biocide disinfectant solution, and clean all affected building components within the isolation area. All

5 remediation activities will be performed in accordance with the Institute of Inspection, Cleaning and Restoration, IICRC S520, Standard and Reference Guide for Professional Mold Remediation, December In addition EI recommends that all carpeting be professionally steam cleaned to remove any musty odor or fungal spores. EI recommends utilizing the following guidelines for containment procedures for removal of contaminated materials: 2. Containment requirements will follow procedures designed for Full Containment as outlined in the Environmental Protection Agency s (EPA) Mold Remediation in Schools and Commercial Buildings. 3. HEPA vacuum and damp wipe with plain water and remove all furnishings and contents from the remediated areas. Items that cannot be removed shall be covered and sealed with two layers of 6- mil fire-retardant polyethylene sheeting Ensure that all removed and covered items are thoroughly dry. 4. One (1) layer of 6-mil polyethylene sheeting shall be used to create a barrier between the mold remediation area and other parts of the building. 5. A decontamination chamber or airlock should be constructed for entry into and exit from the remediation area with an adjacent clean room. The entryways to the airlock from the outside and from the airlock to the main containment area should consist of a slit entry with covering flaps on the outside surface of each slit entry. The chamber should be large enough to hold a waste container and allow a person to put on the remove PPE. All contaminated PPE, except respirators, should be placed in a sealed bag while in this chamber. Respirators should be worn until the remediation workers are outside the decontamination chamber. PPE must be worn throughout the final stages of HEPA vacuuming and damp wiping of the contained area. PPE must also be worn during HEPA vacuum filter changes or cleaning of the HEPA vacuum. 6. All openings such as HVAC (heating ventilation and air conditioning) air supply and return vents, doorways, and plumbing and electrical penetrations within the containment areas must be sealed with critical barriers consisting of two (1) layer of 6-mil polyethylene sheeting to minimize the migration of contaminants to other parts of the building. 7. The containment area must be maintained under negative pressure relative to the surrounding areas throughout the entire project until written passed clearance is issued by the Mold Assessment Consultant (MAC), utilizing HEPA negative air machines exhausted to the outside / exterior of the building if feasible. Negative pressure shall be documented with the use of a recording manometer. Fungi and fungal spores are omnipresent in the environment and concentrations are subject to variation. Indoor/outdoor levels identified during the assessment may not be indicative of conditions later. Additionally, remediation of identified fungal material in a structure is not sufficient to ensure that amplification will not re-occur if moisture intrusion sources are not correctly identified and corrected. Qualifications and Limitations This report summarizes our evaluation of the conditions observed at the Mecklenburg Foot and Ankle at 2115 East 7 th Street, Suite 107 in Charlotte, North Carolina. Our findings are based upon our

6 observations and sampling results obtained at the facility at the time of our visit. The report, results, and subsequent recommendations reported herein are also limited to the information available at the time it was prepared and investigated. Conditions may have been in effect prior to the sampling events that have changed over time and which cannot be predicated within the scope of this limited investigation. Any conditions discovered which deviate from the data contained in this report should be presented to us for our evaluation. The sampling and laboratory protocols used in this investigation are in accordance with standard industrial hygiene protocols for indoor air quality assessments and sampling protocol for environmental fungi. EI is pleased to be of service to Mecklenburg Foot and Ankle on this project. Should you have any questions regarding the information presented herein, please do not hesitate to contact us at Sincerely, The EI GROUP, INC. Lars Aamoth Manager, Charlotte Operations Encl. Laboratory Analysis Report EMSL Site Photographs

7 Appendix A Laboratory Report

8 OrderID: Page 1 Of 1

9 EMSL Analytical, Inc. 376 Crompton Street Charlotte, NC Phone/Fax: (704) / (704) / charlottelab@emsl.com Order ID: Customer ID: Customer PO: Project ID: ENVI44 Attn: Proj: Lars Aamoth The EI Group, Inc. 201 McCullough Drive Suite 150 Charlotte, NC Merck Foot IAQ Phone: (704) Fax: (704) Collected: 08/07/2014 Received: 08/08/2014 Analyzed: 08/08/2014 Test Report: Air-O-Cell( ) Analysis of Fungal Spores & Particulates by Optical Microscopy (Methods EMSL 05-TP-003, ASTM D7391) Lab Sample Number: Client Sample ID: Volume (L): Sample Location: O/S Left O/S Right Exam Room Surgery # Break Room Spore Types Count/m³ Count/m³ Count/m³ Count/m³ Count/m³ Alternaria - 40* 10* - - Ascospores * Aspergillus/Penicillium Basidiospores Bipolaris Chaetomium Cladosporium Curvularia Epicoccum Fusarium Ganoderma Myxomycetes Pithomyces 10* Rust Scopulariopsis Stachybotrys Torula 40 10* Unidentifiable Spores - 10* Cercospora Nigrospora 10* Paecilomyces Zygophiala Total Fungi Hyphal Fragment Insect Fragment Pollen Analyt. Sensitivity 600x Analyt. Sensitivity 300x 13* 13* 13* 13* 13* Skin Fragments (1-4) Fibrous Particulate (1-4) Background (1-5) Myxomycetes++ = Myxomycetes/Periconia/Smut Bipolaris++ = Bipolaris/Drechslera/Exserohilum No discernable field blank was submitted with this group of samples. Lee Plumley, Laboratory Manager or Other Approved Signatory High levels of background particulate can obscure spores and other particulates leading to underestimation. Background levels of 5 indicate an overloading of background particulates, prohibiting accurate detection and quantification. Present = Spores detected on overloaded samples. Results are not blank corrected unless otherwise noted. The detection limit is equal to one fungal spore, structure, pollen, fiber particle or insect fragment. "*" Denotes particles found at 300X. "-" Denotes not detected. Due to method stopping rules, raw counts in excess of 100 are extrapolated based on the percentage analyzed. EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported above and may not be reproduced, except in full, without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. Samples received in good condition unless otherwise noted. Samples analyzed by EMSL Analytical, Inc. Charlotte, NC AIHA-LAP, LLC - EMLAP Initial report from: 08/11/ :10:01 For Information on the fungi listed in this report please visit the Resources section at Test Report SPVER Printed: 8/11/ :10:01AM Page 1 of 1

10 Attn: Proj: Merck Foot IAQ EMSL Analytical, Inc. 376 Crompton Street Charlotte, NC Phone/Fax: (704) / (704) / charlottelab@emsl.com Lars Aamoth The EI Group, Inc. 201 McCullough Drive Suite 150 Charlotte, NC Order ID: Customer ID: Customer PO: Project ID: Phone: (704) Fax: (704) Collected: 08/07/2014 Received: 08/08/2014 Analyzed: 08/09/ ENVI44 Test Report: Microscopic Examination of Fungal Spores, Fungal Structures, Hyphae, and Other Particulates from Tape Samples (EMSL Method: M041) Lab Sample Number: Client Sample ID: Sample Location: T1 Exam Room #4 Above CT on Light T2 Exam Room #10 Behind Wallpaper Dummy Dummy Dummy Dummy Dummy Dummy Spore Types Category Category Agrocybe/Coprinus Alternaria Low Ascospores Aspergillus/Penicillium - High Basidiospores Bipolaris++ Rare Chaetomium Cladosporium Low Curvularia Rare Epicoccum Rare Fusarium Ganoderma Myxomycetes++ Rare Paecilomyces Rust Scopulariopsis Stachybotrys Torula Ulocladium Unidentifiable Spores Zygomycetes Pithomyces Rare Fibrous Particulate Medium Rare Hyphal Fragment - Low Insect Fragment Pollen Rare Category: Count/per area analyzed Rare: 1 to 10 Low: 11 to 100 Medium: 101 to 1000 High: >1000 Bipolaris++ = Bipolaris/Dreschlera/Exserohilum Myxomycetes++ = Myxomycetes/Periconia/Smut * = Sample contains fruiting structures and/or hyphae associated with the spores. Lee Plumley, Laboratory Manager No discernable field blank was submitted with this group of samples. or Other Approved Signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported above and may not be reproduced, except in full, without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation of the data contained in this report is the responsibility of the client. "-" denotes not detected. Samples received in good condition unless otherwise noted. Samples analyzed by EMSL Analytical, Inc. Charlotte, NC Initial report from: 08/11/ :10:01 For Information on the fungi listed in this report please visit the Resources section at Test Report DEVER Printed: 8/11/ :10:01AM Page 1 of 1

11 Appendix B Site Photographs

12 Water damage outside of exam room 10. Water damage above exam room 10 ceiling.

13 Fungal growth behind wallpaper in exam room 10. Water leak from roof above exam room 10 ceiling.

14 Fungal growth on light fixture above ceiling in exam room 4.