3 PR Insp FBOP WOPM Planned Event NYM 10373 FM01 WO Description: Asbestos Abatement Monthly Report Asset /I: Asset/Group Desc: Site Code: Building Code: Location: Make: Assigned to: FM01 • FM01 Skill: 400 - Administrative FPS Number: Serial NoNIn: Model: Date Created: 7/7/2019 If applicable, ensure all safety precautions are followed, to include, but not limited to "LOCKOUT/TAGOUT AND CONFINED SPACE ENTRY" PM Instructions and Material: 21312 FIN I VI m Schedule: 33899 Pros ly NAP Instructions 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? Location: r i l 4 cr Des ipcon: 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" q A 4 Quantity abated (anent reel. square feet etc): AJIA HS If yes, report asbestos he being abated as pan of an ESPC7 NAi requested requestedin 5. General description of asbestos abated (i.e_ pipe ins Iron. loot lb. etc.) N A 6 Is t REQUIRED SPECFIC DOCUMENTATION: nio 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 ISS