EFTA00142422.pdf

3 PR Insp FBOP WOPM 10373 Planned Event FM01 NYM WO Description: Asbestos Abatement Monthly Report Date Created: 7/7/2019 Asset /I: Assigned to: FM01 • FM01 Asset/Group Desc: Skill: 400 - Administrative Site Code: FPS Number: Building Code: Serial NoNIn: Location: Make: Model: If applicable, ensure all safety precautions are followed, to include, but not limited to "LOCKOUT/TAGOUT AND CONFINED SPACE ENTRY" PM Instructions and Material: Schedule: 33899 21312 FIN Pros ly NAP Instructions I VI m 32300 Yes Asbestos Abasement Report . Monthly The rolowing PE is to report ALL costs, quantifies. and types of asbestos abatement to ensure proper reporting to DOJ. Review the steps below and submit the 'Reputed Specific Documentation: ak>ng wth a copy of this PE as the cover pep. in a .Pdf fie to the Regional Facktos Administrator by lho 1st of each month. The .pdf file must be labeled in the Needing format- Serena. Month. and Year. For example. LEW0316. For rettorting PutheSes, each abatement event (single purchase) must be listed individually In a gdf Me. It multiple abatement events lake places. the reporting month, produce a 'cover sheet' for each subsequent event to indicate the info motion as required below. Complete as requested, per each event Is asbestos abatement In progress? nio Location: ril 4 Descripcon: N in 1. Abatement paid from SEE or)88F Funds" Al /4 a. If BIF Project Number _Ar/ _p/(p' 2. Was the asbestos skininedin a precious asbestis sunny? NIA 3. Is the asbestos Pleas or non-fnable" qA 4 Quantity abated (anent reel. square feet etc): AJIA 5. General description of asbestos abated (i.e_ pipe ins Iron. loot lb. etc.) N A 6 Is the asbestos being abated as pan of an ESPC7 NAi requested HS If yes, report requestedin REQUIRED SPECFIC DOCUMENTATION: ider lbw .pdl file roust include the following. Place a Check mart in the space ;Minded indicating the proper documentation is deluded: 7. at Order or ISSF Monthly Report. . Copy of the active cc completed minor work order or WO>$10k. Include a beef description of the asbestos abatement in the Description filet b. Copy of the EUIF Monthly Report. Include e brief description of the asbestos abatement in the Completion Comments rod Ensure the check box 'Asbestos Abatement is required a has been completecr on the Complete Tab is checked. gy the asbestos abatement is procured on a Government Issued Purchase Card: N e. Copy of completed signed Credit Card Purchase Form. AND b. Copy of signed and dated Purchase Card Statement from JP Meagan Chase matching purchase, AND A c. Copy et Invoice signed by the facilities manager certifying services have been received. 9. the asbestos abatement is procured on a Purchase Order or Contract a. Copy of completed and signed Purchase Order or Contract. AND b. Copy of Invoice or Pay Application signed by facilities manager certifying services have been received. AND yids_c. Copy of Payment Voucher Validation Report mese documents can Ise obtained Iron. the Business Office and must contain appropriate signatures. W. If the asbestos is abated during the course of on ESPC project, the ESCO (Environmental Services Contractor) shall dowdy a loner to the Facility Manager certifying that any specific asbestos abatement as identified on an appbcazon Ice payment or itemized schedule of values has been performed at the lime of completion of that item of work This knee shad include IM cost of the abatement. The ESCO shall repent this information for every Instance of asbestos abatement during the course of an ESPC project. The Facility manager that send a signed copy of this letter to the Regionsl FaCkieS Administrator indicating concurrence with the dollar amount and notification of completion of abatement Note: 'MI abatement will be reported in the month in is 'demi.ied,atinied. if supporting documentation is not available la submission to complete the event ding the meal reporting month then the event wit be reported on each month untill all required documentation has been finalized and submitted. 'The Asbestos Monthly Report and all required documentation to complete each event is to be maimaired on de in the Facility Managers office. Documents may be month nod electroncaly. if no abatement was conducted, submit a copy 01 the completed PE stating no abatement was conducted dosing the month. Updated Aug 3t. 2017 EFTA00142422 3 PR Insp FBOP WOPM 10373 Planned Event FM01 NYM Ensure all equipment has a WI label affixed that is in clear view and legible. Ensure all MWI Information is correct. LIST BELOW COMMENTS AND ALL MATERIAL USED. Act. Staff Hours: CI 2.0 No 6.60Aterent 4 '1LS Akett, • Material Cost: 0 Date Completed: 1 13I ri Staff Sionature Staff Code 2 EFTA00142423