Chicago Public Schools 6 Month Asbestos Surveillance Fall
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1 Chicago Public Schools 6 Month Surveillance Fall School: Mary E Courtenay Elementary Language Arts Center Oracle Unit: Building ID: 6061 Address: 4425 N Magnolia Avenue Region: 01 Mail Room: 32 Surveyor: Nesse, Mr. Cameron X CHECK HERE IF NO CHANGE TO ASBESTOS Survey Date: 10/11/2017 Address: cnesse@cps.edu A copy of the 2016/2017 notice to parents and staff regarding the asbestos management plan notifications was distributed via: Each child's backpack Notice printed in school's newsletter Notice printed in school's calendar X Other Posted on wall HA No Description Location Change in Assessment 01 2'x4' Dot Pattern Ceiling Tile SF Throughout Miscellaneous Yes None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 1
2 HA No Description Location Change in Assessment 02 Vinyl Baseboard 5000 SF Throughout Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 03 12"x12" Yellow w/ Brown Streaks VFT(abated) Room 103, & North Vestibule Miscellaneous YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 2
3 HA No Description Location Change in Assessment 04 12"x12" Yellow w/ Brown Streaks VFT Mastic (abated) 40 SF Room 103, & North Vestibule Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 05 MJP E/F/V on Fiberglass Pipe Insulation 950 LF Bathrooms Behind Metal Walls, Main Office Closet TSI Yes Loc 1 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 3
4 HA No Description Location Change in Assessment 06 Vinyl Baseboard Mastic 5000 SF Throughout Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 07 12"x12" Brown VFT 300 SF Lunchroom/Kitchen Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 4
5 HA No Description Location Change in Assessment 08 12"x12" Brown VFT Mastic 300 SF Lunchroom/Kitchen Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 09 12"x12" off Yellow VFT 250 SF Room 104 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 10 12"x12" off Yellow VFT Mastic 250 SF Room 104 Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 11 12"x12" Rust VFT 200 SF Room 104 Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 6
7 HA No Description Location Change in Assessment 12 12"x12" Rust VFT Mastic 200 SF Room 104 Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 13 12"X12"Light Gray w/colored Specks 2000 SF Rms 103, 102, 101; Family Rm, North and West Vestibule Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 7
8 HA No Description Location Change in Assessment 13A 12"X12"Light Gray w/colored Specks Mastic 2000 SF Rms 103, 102, 101; Family Rm, North and West Vestbule Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 14 Carpet Mastic 1500 SF Main Office, Family Rm (101) hallways Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 8
9 HA No Description Location Change in Assessment 15 12"x12" gray w/ blue and white specks 1400 SF Room 101 & 102 Miscellaneous No None 0 YES X NO HA No Description Location Change in Assessment 15A 12"x12" gray w/ blue and white specks 1400 SF Room 101 &102 Miscellaneous No None 0 YES X NO = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 9
10 ALL LEA Responsibilities, for this school, will be met. Robert Christlieb = Can be crumbled, pulverized, or reduced to powder by hand pressure. Page 10
11 NOTICE TO PARENTS AND STAFF REGARDING THE ASBESTOS MANAGEMENT PLAN NOTIFICATION School: Date: 10/6/2017 Mary E Courtenay Elementary Language Arts Center 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. 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 X Other. Posted on wall 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 11
Chicago Public Schools 6 Month Asbestos Surveillance Fall
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Chicago Public Schools 6 Month Asbestos Surveillance Fall
Chicago Public Schools 6 Month Surveillance 2015 - Fall School: UNO Charter School - SPC Daniel Zizumbo Campus Oracle Unit: 66395 Building ID: 3344 Address: 4248 W 47th St. Region: 04 Mail Room: 44 Surveyor:
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If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-3743
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2603
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-0042
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2160
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2093
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2825
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2236
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2311
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2385
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-1220
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-0037
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: CHICAGO SCHOOL DIST 299 SCHOOL ID NUMBER: 14-016-2990-2429
If the address on this form is different than the address of the building, submit a written explanation.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: SCHOOL ID NUMBER: ADDRESS OF SCHOOL: CITY: CHICAGO
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DATE SENT: RESPONSE NEEDED: YES NO SUBJECT: Risk Assessment(s)
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An adjacent sauna must be well insulated and located to leave a gap of at least 10 cm (4 ) for air to circulate between the sauna and the steam room.
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EXTERIOR o Exterior body paint touch up complete o Fascia and eves termite damage repaired o Fascia and eves paint touch up complete o Fence gates open and close properly without sticking or rubbing o