AHERA 3 e ~ Reluspectiow Repuns — 2010 — jVISHAKA WY) AND INST ied than i provided on this form, please copy appropriate page and report aditional data. Subsequent additonal pages must be appropriately number ‘Where itis determined necessary to collect samples of previ accordance with 40 CFR Part 763.86 und 763.87. Require assumed or newly identified Asbestos Containing Materia ‘mation not provided on this form must be prepared In a alysis must be completed ia cluded in the management plan. ‘The LEA’s designated person should coordinate the completion ofthis form with appropriate sections completed by an accredited building inspector and management planner. IDENTIFICATION INFORMATION Public School ‘District Number Uheeren Tyne: Yes ats ea fn Public Steal ‘Building Name: aaa Te Cyuinncrentas see "Name of Designated Person = School, Employer, Consultant) Dale Wieme. | Sins of IM Limon heer print name, racing BUDA “Musser Environmental Consulting, Inc Steven J Musser {Aga We avenue, Clarke NSE ‘Name of Management Planner (Please prin name, including wiv Wai | Company Name: Steven Musser Muster Environmental Consuing, inc Anitin Tague ne ERO Aram TN MN SEE —— — — VERIFICATION OF DATA the LEA Designated Person, rrrmy signature, agree that” ‘contained in) Signature ~ Designated Person: Vive this repr facta and complet the best of my Knowledge % Slur AT MN Aseredited Building Inspector ia Wat, & /) of ° ra ee oe eee ——" Fe Seems e | Aion Bi PMhocrser Sofie¢ Table 1-Room Inventory Lynd Public Schoo! CaSO | Mam Deas | wa aiing ble mastic 7” Cena tle mastic TFT and maste dork gray wi mn rg se dark gray 1923 T. and mate cream wi crarcoal seats H 961-5 T and ashe ylow Waray creamy and ust oaks “ Hare ebow sag [ 8 FT mast (ot 208)Certificate No: 5LM01051004IR Expiration Date: January 5, 2011 This is to certify that Steven J. Musser has attended and successfully completed an ASBESTOS INSPECTOR REFRESHER TRAINING COURSE permitted by the State of Minnesota under Minnesota Rules 4620.3702 to 4620.3722 and meets the requirements of Section 206 of Title II of the Toxic Substances Control Act (TSCA) conducted by Lake States Environmental, Ltd. White Bear Lake, MN on January 5, 2010 Examination Date: January 5, 2010 Lake States Environmental, Lid P.O. Box 645, Rice Lake, WI 54868 (800) 254-9811Expiration Date: January 5, 2011 This is to certify that Steven J. Musser has attended and successfully completed an ASBESTOS MANAGEMENT PLANNER REFRESHER TRAINING COURSE permitted by e the State of Minnesota under Minnesota Rules 4620.3702 to 4620,3722 and meets the requirements of Section 206 of Title IT of the Toxic Substances Control Act (TSCA) conducted by Lake States Environmental, Ltd. White Bear Lake, MN on January 5, 2010 Examination Date: January 5, 2010 Lake States Environmental, Lid l] P.O. Box 645, Rice Lake, WI 54868 (800) 254-9811ae ay PSEESTOS | MWSPECTOR Dovey ty. i) Soe Fesikanire Expieest 9100802041 8 eos Mogae hehe Aye lai mi et ORAS ETEN, to nce toome 01282010 ore assesTos MANAGEMENT CANNER. so ARTES ym,