Form E (ASB-7) "Asbestos Management Plan - Room/Functional Space Boiler Room Response Actions" - New Jersey

What Is Form E (ASB-7)?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2013;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form E (ASB-7) by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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New Jersey Department of Health
E
Consumer, Environmental and Occupational Health Service
Environmental and Occupational Health Assessment Program
FOR STATE USE ONLY
P. O. Box 369, Trenton, NJ 08625-0369
ASBESTOS MANAGEMENT PLAN - ROOM/FUNCTIONAL SPACE
BOILER ROOM RESPONSE ACTIONS
Building Assessed
Room/Functional Space
SECTION I: TYPE OF ASBESTOS-CONTAINING MATERIAL (CHECK ONLY ONE TYPE PER SHEET)
THERMAL
SURFACING
MISCELLANEOUS
Check One:
Check One:
Check One:
Check One:
VAT
Pipe Insulation
Air Cell
Ceiling
Sprayed On
Transite
Elbows/Joints
Cementitious
Wall
Trowelled On
Other:
Boiler
Solid Lag
Other:
Other:
Duct
Asbestos Block
__________
Breeching
Other:
__________
__________
Hot Water Tank
__________
Other:
__________
Accessibility
Homogeneous ID No.
Check One
Material
Total Sq./LF
Material
(See Instructions)
Sample Taken
Friable
Localized
1
2
3
Material Assumed
Non-Friable
Distributed
Damage Assessment
Damaged or
Significantly Damaged
ACBM With Potential for Damage
Thermal System Insulation
ACBM With Potential for Significant Damage
Damaged Friable Surfacing ACM
Any Remaining Friable ACBM
Significantly Damaged Friable Surfacing ACM
or Friable Suspected ACBM
Damaged or
Significantly Damaged Friable Miscellaneous ACM
Response
Action(s)
Date of Response
Square/Linear Feet
Comments
SECTION II: TYPE OF ASBESTOS-CONTAINING MATERIAL (CHECK ONLY ONE TYPE PER SHEET)
THERMAL
SURFACING
MISCELLANEOUS
Check One:
Check One:
Check One:
Check One:
VAT
Pipe Insulation
Air Cell
Ceiling
Sprayed On
Transite
Elbows/Joints
Cementitious
Wall
Trowelled On
Other:
Boiler
Solid Lag
Other:
Other:
Duct
Asbestos Block
__________
Breeching
Other:
__________
__________
Hot Water Tank
__________
Other:
__________
Accessibility
Homogeneous ID No.
Check One
Material
Total Sq./LF
Material
(See Instructions)
Sample Taken
Friable
Localized
1
2
3
Material Assumed
Non-Friable
Distributed
Damage Assessment
Damaged or
Significantly Damaged
ACBM With Potential for Damage
Thermal System Insulation
ACBM With Potential for Significant Damage
Damaged Friable Surfacing ACM
Any Remaining Friable ACBM
Significantly Damaged Friable Surfacing ACM
or Friable Suspected ACBM
Damaged or
Significantly Damaged Friable Miscellaneous ACM
Response
Action(s)
Date of Response
Square/Linear Feet
Comments
ASB-7
MAR 13
New Jersey Department of Health
E
Consumer, Environmental and Occupational Health Service
Environmental and Occupational Health Assessment Program
FOR STATE USE ONLY
P. O. Box 369, Trenton, NJ 08625-0369
ASBESTOS MANAGEMENT PLAN - ROOM/FUNCTIONAL SPACE
BOILER ROOM RESPONSE ACTIONS
Building Assessed
Room/Functional Space
SECTION I: TYPE OF ASBESTOS-CONTAINING MATERIAL (CHECK ONLY ONE TYPE PER SHEET)
THERMAL
SURFACING
MISCELLANEOUS
Check One:
Check One:
Check One:
Check One:
VAT
Pipe Insulation
Air Cell
Ceiling
Sprayed On
Transite
Elbows/Joints
Cementitious
Wall
Trowelled On
Other:
Boiler
Solid Lag
Other:
Other:
Duct
Asbestos Block
__________
Breeching
Other:
__________
__________
Hot Water Tank
__________
Other:
__________
Accessibility
Homogeneous ID No.
Check One
Material
Total Sq./LF
Material
(See Instructions)
Sample Taken
Friable
Localized
1
2
3
Material Assumed
Non-Friable
Distributed
Damage Assessment
Damaged or
Significantly Damaged
ACBM With Potential for Damage
Thermal System Insulation
ACBM With Potential for Significant Damage
Damaged Friable Surfacing ACM
Any Remaining Friable ACBM
Significantly Damaged Friable Surfacing ACM
or Friable Suspected ACBM
Damaged or
Significantly Damaged Friable Miscellaneous ACM
Response
Action(s)
Date of Response
Square/Linear Feet
Comments
SECTION II: TYPE OF ASBESTOS-CONTAINING MATERIAL (CHECK ONLY ONE TYPE PER SHEET)
THERMAL
SURFACING
MISCELLANEOUS
Check One:
Check One:
Check One:
Check One:
VAT
Pipe Insulation
Air Cell
Ceiling
Sprayed On
Transite
Elbows/Joints
Cementitious
Wall
Trowelled On
Other:
Boiler
Solid Lag
Other:
Other:
Duct
Asbestos Block
__________
Breeching
Other:
__________
__________
Hot Water Tank
__________
Other:
__________
Accessibility
Homogeneous ID No.
Check One
Material
Total Sq./LF
Material
(See Instructions)
Sample Taken
Friable
Localized
1
2
3
Material Assumed
Non-Friable
Distributed
Damage Assessment
Damaged or
Significantly Damaged
ACBM With Potential for Damage
Thermal System Insulation
ACBM With Potential for Significant Damage
Damaged Friable Surfacing ACM
Any Remaining Friable ACBM
Significantly Damaged Friable Surfacing ACM
or Friable Suspected ACBM
Damaged or
Significantly Damaged Friable Miscellaneous ACM
Response
Action(s)
Date of Response
Square/Linear Feet
Comments
ASB-7
MAR 13