Negative Exposure Assessment

For use in AT&T buildings in authorized States only

For use only by authorized contractors and AT&T employees

This form may not be altered except as authorized by AT&T

REVISED May 9, 2013 VALID UNTIL May 9, 2014

A. Description of current job

1. The procedure used for installation of equipment on asbestos-containing resilient floor coverings includes drilling holes in the coverings, using shaving cream to control debris and fiber release. This NEA is applicable to both vinyl floor tile and sheet vinyl/rolled goods such as linoleum with asbestos backing material.

2. Type and amount of material - Work will be performed on 9" x 9" and/or 12" x 12" resilient floor tile and/or sheet/rolled vinyl floor covering such as linoleum , installed on a concrete floor, and on the associated adhesive mastic.

3. Type and percent asbestos - The floor covering is presumed to contain asbestos and no samples have been taken for analysis.

4. Engineering controls - No engineering controls are required.

5. Worker's training and experience - Workers have completed a 2-hour Awareness Training course, plus training in use of the drilling procedure. This training included "hands-on" exercises using non-asbestos floor coverings similar to the asbestos-containing material on which the work will be performed.

6. Class of work - Class III work - Maintenance and repair on resilient floor covering.

B. Initial Exposure Assessment (IEA) - Resilient Floor Tile Drilling

1. Initial Exposure Assessment (IEA) was completed on October 23, 1996

a. Name of person performing IEA: Andrew F. Oberta, MPH, CIH, The Environmental Consultancy, Austin, TX, a licensed asbestos consultant (TDH License No. 10-5430).

b. Was a project design completed for this project? Yes. Test procedures and air sampling procedures were prepared, and a drawing of the test facility was provided.

c. Were engineering controls implemented as designed? Yes.

d. Results of an 8-hr TWA: No 8-hr TWA exposures were calculated. The sample results in Table 1a are for the actual duration of sampling, which ranged from 20 to 230 minutes (average = 62). 8-hr TWA exposures would be less than the values in Table 1, all of which are below the PEL of 0.1 fibers/cc.

e. Results of a 30-minute STEL: All of the EL samples are below the excursion limit of 1.0 fibers/cc.

f. How were these samples analyzed? Phase Contrast Microscopy using NIOSH Method 7400.

g. Are the results less than the PEL and the EL? Yes. Also, the 95% UCL is below the PEL and EL.

h. Were the samples taken representative of all operations which will take place during the work? Yes, provided that the workers receive training in using the procedure, that they use similar equipment and materials, and that work is limited to resilient floor tile.

Table 1a. Summary of Personal Samples for hole drilling on floor tile

Collected October 10, 17 and 23, 1996

PEL samples / EL samples
No. of tests / 3 / 3
No. of samples / 8 / 16
Range, fibers/cc / 0.0053 – 0.0114 / 0.0237 - 0.098
Average, fibers/cc / 0.008 / 0.033
95% UCL, fibers/cc / 0.012 / 0.062

Drilling NEA Form – Page 1 of 3

Drilling NEA Form - Holes up to 1-inch in diameter

Page 2 of 3 Make sure you have the correct form !!!!!

Form Expires May 9, 2014

2. Annual Updates have been conducted for drilling holes in floor tile. The most recent is summarized below.

a. Name of person performing update: Ken Garza, Gobbell Hays Partners, Inc.

b. Was a project design completed for this project? A test plan and air sampling strategy were prepared.

c. Were engineering controls implemented as designed? No engineering controls were necessary, based on the Initial Exposure Assessment and previous updates.

d. Results of an 8-hr TWA: No 8-hr TWA exposures were calculated. The sample result below is for the actual duration of sampling, 90 minutes. 8-hr TWA exposures would be less than this value.

e. Results of the EL: All of the EL sample results are less than the excursion limit of 1.0 f/cc.

f. How were these samples analyzed? Phase Contrast Microscopy using OSHA ID 160.

g. Are the results less than the PEL and the EL? Yes. Also, the 95% UCL is less than the PEL and EL.

See Table 2a below.

C. Initial Exposure Assessment (IEA) - Resilient Sheet Vinyl Flooring Drilling (Linoleum)

1. Initial Exposure Assessment (IEA) was completed on September 11 and 12, 2003

a. Name of person performing IEA: Peter D. Cappel, Senior Industrial Hygienist, Gobbell Hays Partners, Inc.

b. Was a project design completed for this project? Yes. Test procedures and air sampling procedures were prepared.

c. Were engineering controls implemented as designed? Yes.

d. Results of an 8-hr TWA: See Table 1b. All air samples collected were below the OSHA Permissible Exposure Limit of 0.1 fibers/cc.

e. Results of a 30-minute EL: See Table 1b. All EL air samples collected were below the OSHA Excursion Limit of 1.0 fibers/cc.

f. How were these samples analyzed? Phase Contrast Microscopy

g. Are the results less than the PEL and the EL? Yes. In addition, the 95% UCL is below the PEL and EL.

h. Were the samples taken representative of all operations which will take place during the work? Yes,

provided that the workers receive training in using the procedure, that they use similar equipment and

materials, and that work is limited to resilient sheet vinyl flooring.

Table 1b. Summary of Personal Samples for hole drilling on sheet vinyl flooring

Collected September 11 and 12, 2003

PEL samples EL samples

No. of samples 3 9

Range, fibers/cc 0.016 0.044

Average, fibers/cc 0.017 0.047

95% UCL, fibers/cc 0.023 0.099

2. Annual Updates have been conducted for drilling holes in sheet vinyl flooring. The most recent is summarized below.

a. Name of person performing update: Ken Garza, Gobbell Hays Partners, Inc.

b. Was a project design completed for this project? A test plan and air sampling strategy were prepared.

c. Were engineering controls implemented as designed? No engineering controls were necessary, based on the Initial Exposure Assessment.

d. Results of an 8-hr TWA: No 8-hr TWA exposures were calculated. The sample result below is for the actual duration of sampling, 90 minutes. 8-hr TWA exposures would be less than this value.

e. Results of the EL: All of the EL sample results are less than the excursion limit of 1.0 f/cc.

f. How were these samples analyzed? Phase Contrast Microscopy using OSHA ID 160.

g. Are the results less than the PEL and the EL? Yes. Also, the 95% UCL is less than the PEL and EL.

See Table 2b below.

DRILLING NEA Form - Holes up to 1-inch in diameter

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Form Expires May 9, 2014

Table 2a. Summary of Personal Samples for hole drilling on floor tile

Collected May 9, 2013*

PEL samples EL samples

No. of samples 1 3

Range, fibers/cc 0.014 <0.045

Average, fibers/cc 0.007 0.023

95% UCL, fibers/cc 0.010 0.034

Table 2b. Summary of Personal Samples for hole drilling on sheet vinyl flooring

Collected May 9, 2013*

PEL samples EL samples

No. of samples 1 3

Range, fibers/cc 0.015 0.044

Average, fibers/cc 0.0075 0.022

95% UCL, fibers/cc 0.011 0.033

*Employer is responsible for obtaining current (within 12 months) air sampling data

This project was completed on (check one): Floor Tile Sheet Vinyl Flooring

Project/Job Information Con./Project/TEO/Job #

1. Description of work: Floor covering drilling Date(s) Work Performed:

This work will be performed at______

CLLI City State

by employees of______

Company that you work for

D. Certification of Negative Exposure Assessment

Based on the information herein, worker exposures during the current job described above are not expected to exceed the Permissible Exposure Limits, based on comparison of the current job to the Initial Exposure Assessment and annual updates described in Section B.

Name:______Signature:______Date:______

PRINT name of competent person

Last 4 digits of SS#______Phone Number:

Installer______[PRINT name] ID (Last 4 digits of SS#)______

E-Mail or Fax or Mail Last Page NEA Management Center

of completed NEA form to: c/o TITAN Engineering

Fax: 512-250-2940

Phone: 512-250-2600

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