HomeMy WebLinkAbout15-102359 • Demolition
City of Federal Way
Community&Econ.Dev.Services Permit #: 15-102359-00-DE
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)
Ph:(253)835-2607 Fax:(253)835-2609 p q 835-3050
Project Name: STARIKOV
Project Address: 36228 6TH AVE SW Parcel Number: 302104 9049
Project Description: Demolition of single family residence.
Owner Applicant Contractor
PAVEL STARIKOV PAVEL STARIKOV OWNER IS CONTRACTOR
34425 16TH AVE S 34425 16TH AVE S
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
Demolition Valuation 3000
PERMIT EXPIRES Wednesday, May 17, 2017
Permit Issued on Monday, May 18, 2015
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: . ` d✓�� lv Date: e95"--/- ---207.5
• THIS CARD IS TO MAIN ON-SITE
CITY OF
Federal WayConstruction In ection Record
INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 15-102359-00-DE Address: 36228 6TH AVE SW
Project: PAVEL STARIKOV FEDERAL WAY, WA 98023-7215
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as
possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
❑ Final-Building(4050)
Approved
By Date
❑ Rough Electrical111 Final Electrical Right of Way
Approved Approved11] Approved
By Date By Date By Date
RECEIVE
MAY 18 2MIT N
CITY pp PER PPLI T CA IO
Federal Way CITY OF FEDERAL WAY 05"✓
CDS '3
PERMIT NUMBER /5 _ ` ? _ /CCC!!!)
/ 0 fJ� ✓V TARGET DATE
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#/
$ 3 k Z / U Li - y ?
•
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING D MECHANICAL L &MOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT 5—�-C.�, /C—
PROJECT
CPROJECT DESCRIPTION 71-9��
Detailed description of work to
be included on this permit only
NAME 163 :44-16-(
Q PRIMARY PHONE
PROPERTY OWNER / .4¢f/c(/ .2457"J)' 3 7'y
MAILING ADDRESS E-MAIL
C1 3 6i
5«f /
1 "
, CITYSTATE _ ZIP 4
NAME PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT _c - -- e{J -'f p C91/Z;
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
PROJECT FINANCING NAME IJ
�� OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses,and attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE:
/ D/11--V6-
�� _ / DATE
PRINT NAME: / / -V6- V 7*/Z, p-✓
Bulletin#100—January I,2013 Page 1 of 3 k:\Handouts\Permit Application
•
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application
5/17/2015 , Confirmation Page
s !
pscleanair.org
Puget Sounr Agency
Single-Family Notification Confirmation
RECEIVED
Fee Information: (Fees Last Revised 7/1/2011)
I----
After payment, Asbestos Demolition! MAY 18 2015
Project Categories when can I start Fee Fee
my project?
i_ OF FEDERAL WAY
Single-Family Residence Project CITY CDS
Asbestos removal only Today $25 j
Demolition (with or without Demolition - In 10 Daysi
asbestos removal) Asbestos Removal -Today $0 $65
Project other than Single-Family Residence j
w<ith48< 10 linear feet and/friableor
asbestos Demolition In 10 Days I$0 $65
square feet
Q >= 10 - 259 linear feet and/or Asbestos Removal -Today 1$65
p >= 48 - 159 square feet of asbestos Demolition - In 1.0 Days ($65
11
260160 4- 999
999 linearsquare feetfeetand/or
LIn_
10._Days $210 $65
of asbestos� ..._. _.
>= 1,000 linear feet and/or l
In 10 Days 1$640 J$85
>= 5,000 square feet of asbestos
hIf your project is an Emergency, an additional fee may apply.
Emergency Demolition or IToday applicable fees + $40
Emergency Asbestos Removal* 111111
L*Single-family residences_are exempt from the emergency fee.
Please review the following information you have submitted. If a change is needed, select the Modify
Notification Information button.
Notification Fee: Asbestos
Demolition $65.00
Emergency
Total $65.00
Owner's Name Starikov Pavel Phone (253) 347-3704
Project Street Address 36228 6th Ave SW
City Federal Way Zip 98023
Contact Person Pavel A Starikov Phone (253) 347-3704
Mailing Address 34425 16th Ave SW
Federal Way, WA 98023
This project includes asbestos removal.
Project Size linear feet / 2000 square feet
Project Start Date 05/12/15 Completion Date 07/12/15
Asbestos will be removed by the home owner
This project includes a demolition.
Demolition Start Date 05/22/15 Completion Date 07/12/15
Demolition will be completed by the home owner
I certify that:
(1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile.
(2) The information I have provided is to the best of my knowledge accurate and complete.
(3) I understand the fee for this Notification is nonrefundable.
After clicking the "Submit Payment" button, do not double-click the "I Authorize this transaction"
button on the following pages. This may result in duplicate charges.
file:///C:/Users/Pavel/Documents/Confirmation%20Page.html 1/2
• DEPARTMSOF COMMUNITY DEVELOPMENT SERVICES
33325 8th Avenue South
,_,,,4k,
Federal Way,WA 98003-6325
CITY OF '''' 253-835-2607;Fax 253-835-2609
Federal Way www.cityoffederahvay.com
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning
Division to see if the proposal exceeds thresholds that trigger an environmental review.An environmental review and
submittal of an environmental checklist may be required, which will extend the time period before a demolition permit can
be issued.
❑ Prior to submitting a demolition permit,the following items (as applicable)must be signed by the respective
agency(see attached Demolition Permit Contact List).
NOTE TO APPLICANT: Utilities shall be disconnected and services performed, if applicable,prior to issuance of the demolition permit.All applicable
items below are to be signed and dated by the respective agency representatives.
1.ASBE OS ABATEM T 6. ELECTRICITY
(Cop ,f..proval form :n. it- os survey from Puget Sound Clean Air (Electrici to be but off�,nd meter removed)
Age . . .ed) 6 6-1 a e (/,r (1
Ill -4 (Puget Sound Energy)
(Ci"�'.f Federal Way Buildilfficial)
2. GAS SUPPLY 7. FUEL STORAGE TANKS
(Gas to be stiff, t�emoved and final bill paid) (Above or below grade fuel tanks, have been pumped or removed
under Fire ep Anent permit prior to any dismantle/excavation)
(Puget Sound Energy)
(South King Fire and Rescue)
3. SEPTIC SYSTEM 8.WATER- Public Source (Check applicable box)
(Tank to be removed or tank o be drained and filled) Meter to be removed and final utility bill paid
deter o remai nd be protected
. a (-. G ``- r ytotr
(King County Environmenwl Services) (Water Supplier)
******OR******
4.SANITARY SEWER (Check applicable box) 9.WATER- Private Well (Check applicable box)
❑Sewer line capped at property line o Private well filled and capped
❑Existing7we Ip to remain and be used by proposed new structure o Private wel to,be used for other purposes
N (Lakehaven Utility District) / (King County Environmental Services)
5.GARB GE
(All ho oldfjarAge disposed off and final bill paid)
/ (Waste Management/Other Company)
i
❑ Completed Construction Permit Application form
❑ Provide the following fees: 1.Demolition Permit Fee Based on valuation.See table on pg 4 of the construction permit application.
2.Automation Fee $6.00
3.WA State Surcharge $4.50
Bulletin#122—January 1,2011 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
DEPARTMENT OF COMINITY DEVELOPMENT SERVICES
33325 8`h Avenue South
CITY OF Federal Way,WA 98003-6325
Federal Way 253-835-2607;Fax 253-835-2609
www.ci troffederalway.com
DEMOLITION PERMIT CONTACT LIST
This list of agencies may assist you in expediting the demolition permit process.Refer to the demolition permit
requirements for signature blocks.All applicable signatures are required prior to permit approval.
1. Asbestos Removal: Puget Sound Clean Air Agency
110 Union Street, Suite 500
Seattle,WA 98101-2038
206-343-8800—OR—800-552-3565
www.pscleanair.org
2. Electricity: Puget Sound Energy Tacoma Public Utilities
Attn: Construction Coordinator Customer Service
22828 68th Avenue South,Suite#102 —OR— 747 Market Street
Kent,WA 98032 Tacoma,WA 98402
888-225-5773 253-383-9600 or 253-383-2471
3. Gas: Puget Sound Energy
805 156t Avenue NE
Bellevue,WA 98004
888-225-5773
4. Telephone: Qwest Communications
801-962-2475 (phone)/801-237-6491 (fax)
5. Water: Lakehaven Utility District Tacoma Public Utilities
Technical Service Division Customer Service
31623 First Avenue South —OR— 747 Market Street
Federal Way,WA 98003 Tacoma,WA 98402
253-941-2288 253-383-9600 or 253-383-2471
6. Garbage: Waste Management
655 Second NW
Auburn,WA 98071
253-833-3333 (residential)—OR—253-939-9792(commercial)
7. Sewer: Lakehaven Utility District
Technical Services Division
31623 First Avenue South
Federal Way,WA 98003
253-941-2288
8. Septic: King County Environmental Services
14350 SE Eastgate Way
Bellevue,WA 98007
206-296-4932
9. Fire Department: South King Fire&Rescue
33325 8th Avenue South
Federal Way,WA 98003
253-946-7248
Bulletin#109—January I,2011 Page 1 of 1 k:\Handouts\Demolition Permit Contact List
0 •
Haw7955 46th Ave S.
Seattle, WA 98118
Hawk Phone: 206-755-3371
'ronmental Fax: 206-538-0039
eruices, Inc.
info@hawkenvironmental.com
www hawkenvironmental.com
License # HAWKEES876KW
Client: Pavel Starikov
Inspector: Ben Tressel
,,,.:
Date of Inspection: 4/29/15
Inspection Type:Asbestos Testing(pre demolition)
I
,.,,e10-,,1:„fri-
RECEIVED
Inspection Site Address: 36228 6th Ave SW Federal Way.WA 98023 MAY 18 2015
Email: pashastarikov@yahoo.com CITY OF FEDERAL WAY
Phone: 253-347-3704 CDS
Hawk Environmental Services, Inc. Page 1
•
Background information:
The client is planning to demolish the home,and requested a full good-faith asbestos site survey
on suspected asbestos containing materials.
Property description:
The property is a 720 square foot single family home,originally constructed in 1932.
Summary-
Based on the results of the sampling performed on the subject property and the description of
demolition work that is to be performed, special asbestos abatement and disposal procedures will be
needed for the ceiling tiles in the kitchen,the mortar around the living room chimney inlet, and all
drywall surfaces.
As quoted from WISHA Regional Directive 23.30 :
"Scope and Application
This WISHA Regional Directive(WRD)provides guidance to WISHA enforcement and
consultation staff whenever they must address issues concerning employee exposure to
hazards involving asbestos-containing joint compound in wallboard systems. This document
does not address materials sprayed or applied with a trowel across the full surface of the wall
(such surfacing materials are covered under the Class I work provisions of the asbestos
standard, found in WAC 296-62-07712).
This WRD supersedes all previous guidance on this subject, both formal and informal."
WISHA Regional Directive 23.30 does not exclude the wall assembly demolition from being an
asbestos abatement project when asbestos is detected in the texture. The wall assemblies cannot be
compounded to lower the overall asbestos percentage. Asbestos abatement procedures will be
required.
Lab Analysis
All samples included in this report were analyzed by Aerobiology Laboratory Associates,
Incorporated in Denver Colorado(NVLAP Certification number 200860-0). The samples were analyzed
using Polarized Light Microscopy/Dispersion Staining(PLM),Method for the Determination of Asbestos
in Bulk Building Materials,EPA-600/R-93/116 July 1993.
Please see the included .pdf document for additional information in regards to analysis and layers
included in each sample.
Hawk Environmental Services,Inc. Page 2
ASBESTOS TESTING:
Homogeneous Sampling Area:SP-01
4
Description of Material:Drywall assembly
Color:White � �
Pattern:Smooth
w ,..:'
Condition: Good � � • � �+
Category: Surfacing
Friability:Friable
Location: Walls and ceilings except the living room ceiling and bedroom 2
walls(including enclosed porch)
Quantity: Approximately 1680 square feet
Number of samples taken: 5
Sample ID numbers: SP-01-01,SP-O1-02,SP-01-03,SP-01-04,SP-01-05
Result: 2%Chrysotile asbestos was detected in the texture of samples SP-01-01,02,03 and 05.See.pdffor more details.
1 b �r + �, ";r :
Homogeneous Sampling Area:SP-02
Description of Material:Drywall assembly
Color:White
Pattern:Pearlite
Condition: Good
Category: Surfacing
Friability:Friable
Location: Living room ceiling,bedroom 2 walls
Quantity: Approximately 400 square feet
Number of samples taken: 3
Sample ID numbers: SP-02-01,SP-02-02,SP-02-03
Result:2%Chrysotile asbestos was detected in the texture of samples SP-02-01,02 and 03.See.pdffor more details.
Hawk Environmental Services, Inc. Page 3
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,Homogeneous Sampling Area:SP-03
Description of Material:Sheet vinyl
Color:White
Pattern:Decorative grid
Condition: Good
Category: Miscellaneous
Location: Kitchen and bathroom floors
Quantity: Approximately 225 square feet
Number of samples taken: 3
Sample ID numbers: SP-03
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Homogeneous Sampling Area:SP-04
Description of Material:Ceiling tile '''
Color:White
Pattern:Dimple
Condition: Good
Category: Miscellaneous
Friability:Friable
Location: Kitchen ceiling
Quantity: Approximately 145 square feet
Number of samples taken: 1
Sample ID numbers: SP-04
Result: 2%Amosite asbestos was detected in the ceiling tile.See.pdf for more details.
Homogeneous Sampling Area:SP-05
Description of Material:Counter,back-splash
Color:Yellow
Pattern:None
Condition: Good
Category: Miscellaneous
Location: Kitchen
Quantity: Approximately 15 square feet
Number of samples taken: 1
Sample ID numbers: SP-05
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Hawk Environmental Services,Inc. Page 4
S 0
Homogeneous Sampling Area:SP-06 a V 4 "'
Description of Material:Window glazing
Color:Gray
1.6
Pattern:None
Condition: Good
! i iso E,r,r 11f 3i11; ; I
••Cate on Miscellaneous "'
,
Location: Kitchen window
Quantity: Approximately 25 linear feet
Number of samples taken: 1
Sample ID numbers: SP-06
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Homogeneous Sampling Area:SP-07
Description of Material:Roofing , ^^;,,,,'
Color:Gray
Pattern:None °
Condition: Good
Category: Miscellaneous -- •Art n
1
Location: Roof
Quantity: Approximately 900 square feet
Number of samples taken: 1
Sample ID numbers: SP-07
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Homogeneous Sampling Area:SP-08 ;# ;.
Description of Material:Vinyl composition tile
Color:Brown : ,,p
Pattern:None ''
Condition: Good
•
Category: Miscellaneous
Location: Hallway,bedroom below carpet
Quantity: Approximately 100 square feet
Number of samples taken: 1
Sample ID numbers: SP-08
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Hawk Environmental Services,Inc. Page 5
S
- Homogeneous Sampling Area:SP-09 :f
Description of Material:Mortar ,
Color:White
Pattern:None
Condition: Good
s
Category: Miscellaneous
Friability:Friable
Location: Living room chimney inlet
Quantity: Approximately 1 linear foot
Number of samples taken: 1
Sample ID numbers: SP-09
Result:3%Chrysotile asbestos was detected in the plaster around the inlet See.pdf for more details.
Homogeneous Sampling Area:SP-10 � >,
a
Description of Material:Mortar ` h
Color:Gray -
R
Pattern:None
Condition: Good
Category: Miscellaneous ' ''`
Location: Chimney
Quantity: Unknown
Number of samples taken: 1
Sample ID numbers: SP-10
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
$omogeneous SamplingArea:SP-11 c";
Description of Material:Paneling,adhesive '7'A•li
Color:Cream
Pattern:None
Condition: Good
Category: Miscellaneous , —
Location: Bathroom walls
Quantity: Approximately 252 square feet
Number of samples taken: 1
Sample ID numbers: SP-11
Result:No asbestos was detected in the sample analyzed.See.pdf for more details.
Hawk Environmental Services, Inc. Page 6
S •
• Homogeneous Sampling Area:SP-12
Description of Material:Building paper '
dF
Color:Black �qi a
Pattern:None 1; '
Condition: Good
Category: Miscellaneous =.
Location:Below siding
Quantity: Approximately 950 square feet
Number of samples taken: 1
Sample ID numbers: SP-12
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Homogeneous Sampling Area:SP-13 : ;-
Description of Material:Insulated wire
Color: Silver
.e
Pattern:None w
Condition: Good ,
Category: Miscellaneous
Location: Throughout
Quantity: Unknown
Number of samples taken: 1
Sample ID numbers: SP-13
Result: No asbestos was detected in the sample analyzed.See.pdf for more details.
Materials not inspected or sampled:
All appliances are to be disposed of whole. Wood windows, sinks,fixtures and the fuse panel will be
removed intact and recycled. The detached garage is not covered in this document.
Hawk Environmental Services, Inc. Page 7
• •
Sampling Methodology:
Asbestos is a generic name given to a number of naturally occurring hydrated mineral silicates that
possess a unique crystalline structure, are incombustible in air, and are separable into fibers. Asbestos
includes asbestiform varieties of chrysotile(serpentine); crocidolite(riebeckite); amosite (cummingtonite-
grunerite); anthophyllite;tremolite,and actinolite. Inhalation of asbestos fibers has been linked to
diseases such as asbestosis, lung cancer,and mesothelioma.
All asbestos sampling performed by Hawk Environmental Services is carried out pursuant to 40 CFR
763.86 as required by both AHERA and ASHARA. All samples will be collected by an AHERA
accredited asbestos building inspector and analyzed by polarized light microscopy by a laboratory
accredited by the National Bureau of Standards(NBS). All asbestos samples are taken under wet-
removal method to limit the likelihood of airborne particles being released.
Notes and terms:
Homogeneous Sampling Area-An areas of suspected asbestos containing building materials which appears similar
throughout in color,texture,and date of material application.
Thermal System Insulation-Material applied to pipes,fittings,boilers,breechings,tanks,ducts,or other interior
structural components to prevent heat loss or gain,or water condensation,or for other purposes.
Surfacing Material-Material that is sprayed-on,troweled-on,of otherwise applied to surfaces,such as acoustical
plaster on ceilings and fireproofing materials on structural members,or other materials on surfaces for acoustical,
fireproofing,or other purposes.
Miscellaneous Material-Interior building material on structural components,structural members or fixtures,such as
floor and ceiling tiles,and does not include thermal system insulation or surfacing materials.
Hawk Environmental Services,Inc. Page 8
• •
Sampling Locations:
li
porch
'Ape 1-01 Sp 02-01 S p-1 2
Livmo rrD,I•fl
SP-02.C.
bedroom 1 j
,1 01 rt: S -09
Sp 0
s 2-03
Sp-10
'p-01-04
St).01-0:
bedroom 2
Sp.°
..1 •'`. S -1 1
Sp-01-05
Sp-04
k lichen
Sp-03
Sp-05
Sp-07 Sp-06
Hawk Environmental Services,Inc. Page 9
S •
Detailed layer data:
:4-:— -,,
„.„..S:ruple Icienithcanon
-iption of S 'L1,,.,ample
ayer gesaeOUS v ACbe:7o:Dernec Asbestos Percentage
Lab Sample Number (TIC) .ei::eLr?ge
15008331-1A Tau T extol e w White Paint,2 1 N
. 4,e C HRY _
SP-01-(1
:50083.-7.1-1B ':,7.-.1-e Tr,n-)r.,-w:,.1 N 95': ND
15008331-2A Tan Textui e IA W hire Paint I's-: 2.„
C HRI. 2
SP-01-02
15008331-213 White.Tan Drywall N2 ND
15008331-3A Tan Textus e n White Paint N • ,
C HRN- 2
...:,?- :- 3
15008331-3B '.1.-..-Are Trii Dr--,v,:: l-C
150083314A White Tan Drywall w.White Pam N ll,:=,
15008331-5A White Texture n White Paint N 2'- C HRS 2
SP-0 i-(
'.I.-..-.1-. Tn..Dr.-A .1 N ND
SP-02-01 133l-oA Tau Texture w White Paw 2; N CHRY 2
'.,2-•:l 15008331-6B ':'.1:17,. Mu Dr.-v.7.: N ND
4110S,,1-- \I lure Mica...low Textui e n IA hire Paint N 2• ' C HR1* 2
SP-02-02
15008.331-"B '.,-.-.r.i.T..:1 Drywall ..:...,: ND
1501)S3.31-SA NVIntr Micaiiou-Textur e NI'Green Paint N 2'. (l HRY '
-
15008331-8B White/Tan Drywall ND
15008331-9A White Masuc , ,:
- ND
15008331-98 Gray Cementitious Material N _ _
2,
I 50083'31-9C 'Kline Sheet Vinvi w White Fibrous B3Clarig N 96°: --,
.
150083;1-IA 1.11-ate Fibrous Insulation N ...,... 7...,.,
l•P-04
15008331-10B White Ceiling Tile w/Gray Paint N .35'o A
Hawk Environmental Services,Inc. Page 10
• •
• Sampleldenn5canon .�u _ - _
L•a
Ph+_uai Decnipaon of SampleLa•.zs eertvus .-::oe-,:.:�=_�z:re� ---
C hem =a:Samp:e Number - (Yr, Percentage
-54 15008331-10C WhitelTanDrywali 10°° ND
15008331-1:-. Yellow Mastic N = ND
15008331-115 Bronn Fibrous Material w-Yellow Pam: 1°° ND
15008331-11C Mrte Tan Drywall - N7).
15008331-12 White Resinous Material - I J''
15008331-13 Black Tar Paper ND
Black Shingle w White Black Rock .D
SP 15008331-1313 Fragments
:5008331-13C Black Shingle w!R'hrte Red Fleck Fragment- N ND
15008331-14A Brown Mastic ND
15008331-1413 Black Fibrous Material t a` ND
F-:i 15008331-14C Brown Tile '
15008331-18 White Plaster N lt'i"o C HRS-
15008331-16A White Compound ,: - N D
Gray Granular Plaster
15008331-1-A Black Mastic
F-: 15008331-1713 Brown Fibrous Material N
15008331-17C Browu White Fiberboard `: ND
SP-12 15008331-18 Black Tar Papet
SP-13 15008331-19 Black Wire Wrap
Hawk Environmental Services, Inc. Page 11
. •
Accreditation
Certificate of Completion
This is to certify that
Ben Tressel
has satisfactorily completed
4 hours of refresher training as an
AHERA Building Inspector
in compliance with TSCA Title II AHERA 40 CFR Part 763
U S. EPA Region 10 Accreditation #792
Course Date: 10/10/2014 Certji 14-1736
v
RGARefresher required by: 10/10/2015
3317 3rd Ave. S, Suite D
Seattle, WA 98134. 888.281.8858
`, I R 0 N M E N T www.rgatrarning.com
4 hours of refresher training as an
AHERA Buildirfg Inspector
Ben Tressel
Cert. 14-1730
Course Date. 10/10/2014
RcIicsher required by 10/10/2015
Instructor: Bruce Rogstad Training Manager: Andrea Lijegren
RGA Training: 206.269.6313
ACAPPF RGA Laboratory: 206.956.3775
j I RGA Consulting: 206.2696302
ARGA3317 3rd r\ve S. Suite D Seattle, WA 98134
NVIRCINNIF NTA 1 888 281.8858•www rgatraining_com
Hawk Environmental Services, Inc. Page 12
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