Form Aqm-Asb-001 - Asbestos Inspection Form Page 2
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1
2SUMMARY OF ABESTOS SURVEY/INSPECTION
1
Material/Product Surveyed
Sampled? –
ACM
Condition of
No
Abatement
2
Yes/No
Present
ACM/
ACM
Required?
3
(%)
Suspected ACM
Present
– Yes/No
ROOFING & SIDING
Yes
No
Yes No
o Roof felt shingles
Yes
No
Yes No
o Roofing shingles
Yes
No
Yes No
o Roofing Tiles
Yes
No
Yes No
o Siding shingles
Yes
No
Yes No
o Clapboards
Yes
No
Yes No
o Other
WALLS & CEILINGS
Yes
No
Yes No
o Ceiling Tiles
Yes
No
Yes No
o Ceiling Tile Mastic
Yes
No
Yes No
o Sprayed/Troweled coating
Yes
No
Yes No
o Asbestos-cement sheet
Yes
No
Yes No
o Paneling, Tile, Baseboard Mastic
Yes
No
Yes No
o Spackle/Joint compounds
Yes
No
Yes No
o Textured paints
Yes
No
Yes No
o Millboard, rollboard
Yes
No
Yes No
o Vinyl wallpaper
Yes
No
Yes No
o Insulation board
Yes
No
Yes No
o Other
FLOORS
Yes
No
Yes No
o Vinyl-asbestos tile
Yes
No
Yes No
o Asphalt-asbestos tile
Yes
No
Yes No
o Resilient sheet flooring
Yes
No
Yes No
o Mastic adhesives
Yes
No
Yes No
o Other
PIPES & BOILERS
Yes
No
Yes No
o Cement pipe and fittings
Yes
No
Yes No
o Block insulation
Yes
No
Yes No
o Preformed pipe wrap
Yes
No
Yes No
o Corrugated asbestos paper
Yes
No
Yes No
o Paper tape
Yes
No
Yes No
o Putty (mudding)
Yes
No
Yes No
o Other
OTHER PRODUCTS
Yes
No
Yes No
o Window Glazing Putty
Yes
No
Yes No
o Building Caulk
Yes
No
Yes No
o Gaskets/Packing
Yes
No
Yes No
o Clothing/Cloth/Blankets
Yes
No
Yes No
o Cement/mortar
Yes
No
Yes No
o Metal-clad firebrick
Yes
No
Yes No
o Gunnite/fire-proofing spray
Yes
No
Yes No
o Hot-tops (ingot mold covers and
inserts)
Yes
No
Yes No
o Other
1
This list is not an exclusive list of potential materials containing asbestos and the inspector should use it only as a minimal reference
of potential asbestos containing materials present.
2
No sampling is required if the inspector suspects that the materials are ACM and treats them as ACM. For a suspect material to be
classified as non-ACM, a minimum number of samples must be collected and analyzed as required by AHERA/ASHARA regulations.
3
All materials identified as having an asbestos content greater than 1% are considered to be regulated asbestos containing materials
(RACM).
NOTE: If this structure is to be demolished by intentional burning by a Delaware Fire Company. This form must be provided to the
Fire Company in order for DNREC-AQM to process the Fire Fighting Instruction by intentional burning application.
AQM-ASB-001
Rev. 3
Dec 2006
Page 2 of 2
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