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19-101172City of Federal way Community Development Dept 33325 8th Ave S Federal Way, WA 98003 Ph: (253) 835-2607 Fax: (253) 835-2609 Project Name: JACKSONS #636 Project Address: 1520 S 348TH ST Demolition Permit #:19-101172-00-DE Inspection Request Line: (253) 835-3050 Parcel Number: 889700 0115 Project Description: Demolition of existing fuel canopy, car wash, convenience store and auto building. Owner Applicant Contractor JACK DAVISPACWEST ENERGY LLC DARYN GILSTRAPSAYBR SAYBR CONTRACTORS INC 3450 COMMERCIAL PKWY CT CONTRACTORS INC SAYBRCI033L7 (6/27/20) MERIDIAN ID 83642 3852 S 66TH ST 3852 S 66TH ST TACOMA WA 98409 TACOMA WA 98409 Additional Permit Information PERMIT EXPIRES Monday, 9 September, 2019 Permit Issued on Wednesday, March 13, 2019 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the us 'II accordance with the laws, rules and regulations of the State of Wa in on and the City of Federal Way. Owner or agent: Date: I .� CITY OF Federal Way THIS CARD IS TO REMAIN ON -SITE Construction Inspection Record INSPECTION REQUESTS: (253) 835-3050 PERMIT #: 19101172 00 Address: 1520 S 348TH ST Project: JACK DAVIS FEDERAL WAY WA 98003-6844 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. ❑ SWM Precon Site Mtg (4400) 0 Initial Erosion Control (4365) ❑ Interim Erosion Control (4370) Approved To be done PRIOR to breaking ground Approved By Date By Date By Date ❑ Final Erosion Control (4375) ❑ Final - Building (4050) Approved Approved By Date By Date Rough Electrical Final Electrical ❑ Right of Way Approved Approved Approved By Date By Date By Date CiTY OF 'V Federal Way RECEIVED MAR 13 2019 C41YOF FEDEPALWAY C,OMMONrfy [)EVELOPMENT PERMIT NUMBER PERMIT APPLICATION PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + nermitcen erCie:cilyaffederszlw_��+ TARGET DATE SITE ADDRESS SUITE/UNIT M 1520 S 348th Street, Federal Way, WA 98003 (& 34713 S 16th Ave S - old address, Performance Auto) PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL / $ CE 8897000115 85,000.00 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ® DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT Jacksons 636 PROJECT DESCRIPTION Demo existing fuel canopy, car wash building, convenience store building, auto buildin . Detailed description of work to be included on this permit only NAME PRIMARY PHONE PacWest Energy LLC - Jack Davis (208)888-6061 PROPERTY OWNER MAILING ADDRESS 3450 E Commercial Court EMAIL jack.davis@jacksons.com CITY STATE ZIP Meridian ID 83642 NAME Saybr Contractors, Inc. PHONE (253)531-2144 MAILING ADDRESS 3852 S 66th Street E-MAIL dgilstrap@saybr.com CONTRACTOR CITY STATE ZIP FAX Tacoma WA 98409 WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M CC SaybrC1033L7 6 / 27 20 20-19-100566-00-BL NAME Daryn Gilstrap - Saybr Contractors PRIMARY PHONE (253) 531-2144 ext 120 APPLICANT MAILING ADDRESS 3852 S 66th Street dgilstrap@saybr.com CITY Tacoma STATE wA "I 98409 FAX NAME PRIMARY PHONE PROJECT CONTACT Darvn Gilstra - Saybr Contractors (253)531-2144 ext 120 MAILING ADDRESS 3852 S 66th Street E-MAIL dgilstrap@saybr.com (The individual to receive and respond to all correspondence CITY STATE ZIP FAX concerning this application) Tacoma WA 98409 PROJECT FINANCING NAME ® OWNER -FINANCED When ualue is $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 authorised agent of the property owner. I certify that to the best of any knowledge, the information submitted in support of this permit application Is true and correct. I certl(fy 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 cue 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. Jack DavitN"It:I019.03a10Y1015:09-06'00' SIGNATURE: DATE PRINT NAME: Jack Davis Bulletin #100 — January 29, 2016 Page 1 of 2 Uflandouts\Permit Application V/A MECHANICAL PERMIT Indicate how MgaXot each !ypo AIR HANDLING UNITS AIR CONDITIONER BOILERS COMPRESSORS DUCTING v/A N/A N/A d/A to be installed or rel FANS FIREPLACE INSERTS FURNACES GAS LOG SETS GAS PIPING VALUE OF MECHANICAL WORK this PwWt. Do not include existing rxtu.res to remain. GAS PIPE OUTLETS OTHER (Describe) HOODS (Commercial( HOT WATER TANKS (Gas) REFRIGERATION SYST WOODSTOVES PLUMBING PERMIT VA LUE OF PLUMBING WORK Indicate how many of each type of fixture to be installed or relocated as part of this projecL Do not include existing Ixtures to remain., BATHTUBS (or Tub/shower Combo) LAVS Gland Sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS (Kitchen/Utility) WATER HEATERS (Eleetriq HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS Yes Lakehaven Lakehaven 665,000.00 NG/PREVIOUS USE LOT SIZE (Iu Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? E'v"L hicle Service Station 45,699 sf ❑ Yes x No ❑ Yes N 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 �s»............... __.... ......... GARAGE ❑ CARPORT ❑ .... _.... __. ,r _..,,._ ,,._,,,.._.... »,....�.. �..,. ,...__..... OTHER (describe) »....................,,. ,,_._„... ......::W.,::..._-_..� . ............. Area Totals IN EXISTG PROPOSED TOTAL "NEW HOMES ONLY" ESTIMATED SELLING PRICE FWOFBET)ROOMS COMMERCIAL — NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy s P Grou P() Construction a # of Stories Additional Information NEW BUILDING ADDITION COMMERCIAL — REMODEUTENANT IMPROVEMENTS AREA DESCRIPTION Area is $ uare Feet Occupancy Grou P PIsl Construction Type # of Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin #100 - January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application 41k OF Federal Way COMMUNITY DEVELOPMENT DEPARTMENT 33325 8'h Avenue South Federal Way, WA 98003 253-835-2607; Fox 253-835-2609 DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure on a subject property. Demolition of separate structures may require separate permits. ❑ Address of Demolition: 1520 S. 348th St. Federal Way, WA ❑ Prior to submitting a demolition permit, the following Items must be signed by the respective agency or their approvals attached. Items not applicable to your project should be marked N/A. ❑ A completed Constructlon PermltAppllcatlon form Is also required. 1. ASBESTOS ABATEMENT (Provide copy of Notice oflntentfrom Puget Sound Clean Air Agency & ELECTRICITY and r py inspection repor rtby AHERA-certifled Inspector) �� C0 �p (Puget Sound Eriergy/Tacoma Power) City of FederAl ul ding -Official) 2. FUEL STORAGE TANKS ot Under grade tank(s) Is/are present o Above grade tank(s) are present o Tank(s) has been pumped or removed under South King Fire & Rescue permit prior to any dismantling or excavation 1 (South King Fire and Rescue) lr e.f.-N o v 1� , 3. SEPTIC SYSTEM DECOMISSIONING N/A (King County Environmental Services) 6. NATURAL GAS Cg & e. (Puget Energy) ATER - Public Source - MEllfies n) 1�7?ff1� 4- �r T- �f�3 3204wCs Dam O. 3 8 La n Utility DIs ict 8. WATER - Private Well N/A (King County Environmental Setvlces) ER -7f5CQnn1K'NO7I�r/� T7 01vurTWN `C�6�K�Wl4.SANITARYSEd B3rG��nfG1l 7j-0 AIM t o ;r__ -3111 /Z �? a ehave Utility District ❑ Please Note: Erosion control measures must be in place during the demolition and through completion of the site clean-up. r (A Icant) Bulletin #122—Marclr 16,2017 Page 1 of 1 kMandoulsWemolitionPermitRequirements .1-1— 1. I P A V VUU I lQ11ZP0 d1U11 pscIeanair.org Puget Sound Clean Air Agency Notification Case #: 201900970 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $275.00 Credit Card Transaction # AROFFD586A4A Transaction Date 03/04/19 Owner's Name PacWest Energy LLC dba 3acksons Food Stores Phone (208) 888-6061 Project Street Address 1520 S 348th - Convenience Store Building City Federal Way Zip 98003 Contact Person Richard Wright Phone (208) 955-6282 Mailing Address 3450 E Commercial Court Meridian, ID 83642 This project Includes asbestos removal. Project Size linear feet / 2000 square feet Project Start Date 03/18/19 Completion Date 03/29/19 Asbestos will be removed by a licensed asbestos abatement contractor Contractor Pacific Northwest Environmental LLC Contractor Job # 1906 Contact Todd Ray Phone (503) 891-9462 Mailing Address 952 Industry Drive Tukwila, WA 98188 This project includes a demolition. Demolition Start Date 03/18/19 Completion Date 03/29/19 Demolition will be completed by a demolition contractor Demo Contractor TITAN Earthwork LLC Contact Courtney Soyring Mailing Address 1585 Valentine Ave SE Pacific, WA 98047 Contractor Job # 1906 Phone (253)985-1185 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Nratificatiori View History If you have questions, contact us at asbestos@pscleanalr.org or 206.689.4058. L2gOut https://secure.pscleanair.org/Asbestos/Approved.aspx 1/1 pscIeanair.org Puget Sound Clean Air Agency Notification Case #: 201901028 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AKOF611311354A91 Transaction Date 03/07/19 Owner's Name PacWest Energy LLC dba Jacksons Food Stores Phone (208) 888-6061 Project Street Address 1520 S 348th - Fuel Canopy City Federal Way Zip 98003 Contact Person Richard Wright Phone (208) 955-6282 Mailing Address 3450 E Commercial Court Meridian, ID 83642 This project includes a demolition. Demolition Start Date 03/18/19 Completion Date 03/29/19 Demolition will be completed by a demolition contractor Demo Contractor TITAN Earthwork LLC Contact Courtney Soyring Mailing Address 1585 Valentine Ave SE Pacific, WA 98047 Contractor Job # 1906 Phone (253)985-1185 (1) I certify that the information I have provided Is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification If: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. Log Out https://secure.pscleanair.org/Asbestos/Approved.aspx 1!1 ..,-.1-1. r+NPivvdu iianaauiwn pscIeanair.org Puget Sound Clean Air Agency Notification Case #: 201900968 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AI0F7F8E2898 Transaction Date 03/04/19 Owner's Name PacWest Energy LLC dba Jacksons Food Stores Phone (208) 888-6061 Project Street Address 1520 S 348th - Performance Auto Building City Federal Way Zip 98003 Contact Person Richard Wright Phone (208) 955-6282 Mailing Address 3450 E Commercial Court Meridian, ID 83642 This project Includes a demolition. Demolition Start Date 03/18/19 Completion Date 03/29/19 Demolition will be completed by a demolition contractor Demo Contractor TITAN Earthwork LLC Contact Courtney Soyring Mailing Address 1585 Valentine Ave SE Pacific, WA 98047 Contractor Job # 1906 Phone (253)985-1185 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. Log Out https://secure.pscleanair.org/Asbestos/Approved.aspx /� .x-.rwia r%NNiweeu iraiiau%;uvu pscleanair.org Puget Sound Clean Air Agency Notification Case #: 201900969 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AROFFD5863C6 Transaction Date 03/04/19 Owner's Name PacWest Energy LLC dba Jacksons Food Stores Phone (208) 888-6061 Project Street Address 1520 S 348th - Car Wash Bullding City Federal Way Zip 98003 Contact Person Richard Wright Phone (208) 955-6282 Mailing Address 3450 E Commercial Court Meridian, ID 83642 This project Includes asbestos removal. Project Size 1 linear feet / 1 square feet Project Start Date 03/18/19 Completion Date 03/29/19 Asbestos will be removed by a licensed asbestos abatement contractor Contractor Pacific Northwest Environmental LLC Contractor Job # 1906 Contact Todd Ray Phone (503) 891-9462 Mailing Address 952 Industry Drive Tukwila, WA 98188 This project Includes a demolition. Demolition Start Date 03/18/19 Completion Date 03/29/19 Demolition will be completed by a demolition contractor Demo Contractor TITAN Earthwork LLC Contractor Job # 1906 Contact Courtney Soyring Phone (253) 985-1185 Mailing Address 1585 Valentine Ave SE Pacific, WA 98047 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History If you have questions, contact us at asbestos@pscleanaIr.org or 206.689.4058, Log out https://secure.pscleanair.org/Asbestos/Approved.aspx /1 A-T Csbesto-Test, Inc. 1429 Ave. D. #187, Snohomish, WA 98290 425-489-4040 www.asheslolest.com; info&asheslolesl.com ASBESTOS SURVEY Perform ance Auto Brlildiil Located Dilectl l Behind Jacksons Shell Station 0)1520 348`^' S , Federal Way, King O nty, lYashinyon 98003 Page 1 of 6 May 10,2018 PAT21803 Jackson Food Stores 3450 E. Commercial Ct., Meridian, ID 83642 208-954-2084 Attn.: Joe Hempel i oe.li empcl(a),,i acksons.coin On May 2, 2018, Asbesto-Test personnel conducted an Asbestos survey (per U.S.E.P.A./A.H.E.R.A. guidelines as designated and specified by Puget Sound Air Agency and Washington State) of the Performance Auto budding located directly hellind Jackson Shelf Station a) 1520 34e S Federal Way, Kiniz County, Washington 98003. This survey purpose is to identify asbestos containing materials prior to demolition. Note: Samples of suspect Asbestos Containing Materials were taken and analyzed for the presence of asbestos. THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN. If there is any additional suspect ACM located prior to or during demolition (such as, but not limited to, those materials listed on the last page of this report), that was not discovered in this survey, the material(s) must be Presumed Asbestos Containing Material unless tested otherwise by laboratory analysis. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The structure is one story on a concrete slab. The siding is CMU block. The block siding materials were sampled. The roofing membrane over torch down. The roofing materials were sampled. The roofing sealant materials were also sampled from around the metal edges. INTERIOR CONSTRUCTION, FINISHES, AN FLOORINGS: The interior construction is drywall, CMU block, and wood. The drywall/taping materials were sampled. The vinyl and tile flooring materials and mastics were sampled. The misc. mastic materials were sampled. The acoustic ceiling panels were sampled. INSULATION: The insulation was sampled. continue to page 2 `.EPA r Page 2 of 6 PAT2180503 May 10, 2018 Asbesto-Test, Inc. 425-489-4040 Performance Auto Bi►ildin� Located Direct!y Behind Jackso>:s She!! Station n 1520 348fh S. Federal Way, King County. Washington 98003 ELECTRICAL SYSTEM: Any suspect electrical wiring insulation or any suspect TSI (Thermal System Insulation).1bund in, around or behind any located fuse or breaker boxes should be considered to be ACM (Asbestos Containing Material), unless determined otherwise by laboratory analysis. HEATING AND VENTILATION SYSTEM: The HVAC (heating/ventilation/air- conditioning unit) is rooftop. There was no visible suspect ACM located associated with the unit or ducting. Note: It was not possible to dismantle the HVAC unit and ducting to locate and/or evaluate any additional suspect ACM which may be concealed, inside the unit, or associated in hidden areas. It is our opinion any further handling of the furnace system should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect materials are located prior to and/or during any demolition or renovation, any and all additional related suspect materials should be considered to be ACM (Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. Any TSI that may be present inside or outside the HVAC and/or ducting system including but not limited to all gaskets, joint compounds, sealants, and/or insulations, are PACM unless tested otherwise by laboratory analysis. MISC.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None. # of structures included in survey: one Requested by: Joe Hempel aeayv Nra—,5e315 -® } Mn gm This cenl0esthat n Christopher L Patterson has sahsfactodly completed 4 hours of refresher training as an AHERA Building Inspector to comply wkh the training requirements of TSCA Title II, 40 CFR 763 (AHERA) _ EPA ProAder# 1065 oweMey s. ]ete Epi— h 1 y— Cen Nun'. 167364 Christopher Patterson VP Operations/Analyst- Asbesto-Test, Inc. Inspector, Certified A.H.E.R.A. Accred. #167284 EXP. May 9, 2019 continue to page 3 CED Adlftk t IM@8 1429Ave. D. #187, Snohomish, WA 98290 425-489-4040; f 775-665-0420 Page 3 of 6 PAT2180503 May 10, 2018 Asbesto-Test, Inc. 425-489-4040 Performance Auto Building Located Directly Behind Jacksons Shell Station a71520 3481h S Federal Way, Kin Countp, Washin tore 98003 ANALYSIS ID ASBESTOSHTYPEJJ UANTITY OTHER MATERIAL NOTE: ANY ADDITIONAL COLORS OR KINDS OF VINYL FLOORING AND/OR TILE WITH ANY RELATING MASTICS/BACKINGS THAT WERE NOT DISCOVERED IN THIS SURVEY AND MAY LATER BE LOCATED IN THIS STRUCTURE ARE ALSO PRESUMED TO CONTAIN ASBESTOS UNLESS TESTED OTHERWISE BY LABORATORY ANALYSIS THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN 1.0 drywall/taping compound/paint NAD non -fibrous materials, entry composite cellulose, gypsum 2.0 drywall/taping compound/paint NAD non -fibrous materials, shop composite cellulose, gypsum 3.0 drywall/taping compound/paint NAD non -fibrous materials, restroom composite cellulose, gypsum 4.0 sheet vinyl flooring NAD non -fibrous materials, restroom — color: tan w/colored specks cellulose, fiberglass 5.0 mastic NAD adhesive beneath previous sample 6.0 floor tile NAD non -fibrous materials entry area, restroom & shop color: blue & white intermixed 7.0 mastic NAD adhesive beneath previous sample 8.0 acoustic ceiling panels NAD fiberglass, cellulose, suspended paint 9.0 mastic NAD adhesive, cellulose front entry — holding gray laminate on countertop continue to page 4 BBB IRIA934M CD 1429 Ave. D. #187, Snohomish, WA 98290 425-489-4040; f775-665-0420 Page 4 of 6 May 10, 2018 PAT2180503 Asbesto-Test, Inc. 425-489-4040 Pe)fio)-mance Auto Building Located Directly Behind Jacksons Shell Station I520 348"' S Federal Way, King County, Washing -ton 98003 ANALYSIS ID ASSESTOSIITYPEl1 UANTITY OTHER MATERIAL COMMON AREAS: 10.0 CMU brick NAD non -fibrous materials 11.0 mortar NAD non -fibrous materials holding previous sample 1 11.1 mortar NAD non -fibrous materials holding previous sample 2 11.2 mortar NAD non -fibrous materials holding previous sample 3 11.1 mortar NAD non -fibrous materials holding previous sample 4 11.2 mortar NAD non -fibrous materials holding previous sample 5 12.0 membrane roofing NAD polymers 13.0 torch down roofing NAD non -fibrous materials beneath previous sample tar, cellulose, fiberglass 14.0 vapor barrier NAD cellulose, tar beneath previous sample 15.0 roofing insulation NAD cellulose beneath vapor barrier - color: brownish 16.0 sealant NAD tar, cellulose, fiberglass on metal roofing edges continue to page 5 AFBB CD 1429Ave. D. #187, Snohomish, WA 98290 425-489-4040, f775-665-0420 Page 5 of 6 May 10, 2018 PAT2180503 Asbesto-Test, Inc. 425-489-4040 Performance Auto Bitildit►�► Located Directly Behind Jacksons Shell Station A 1520 348h S , Federal Way, King Countp, i''ashinztan _ 98003 BBB. r ■ 0 1 continue to page 6 0 J_7' 1429 Ave. D. 4187, Snohomish, WA 98290 425-489-4040;,f775-665-0420 Page 6 of 6 PAT2180503 May 10,2O18 Asbesto-Test, Inc. 425-489-4040 Pet fo!»tance Auto Biteldin�e Located Directly Behind Jacksons She!! Station 1520 348`h S. Federal Way, Kinz County, Washington 98003 Samples taken are listed with their corresponding analyses. If asbestos is detected, those samples containing asbestos are listed first and noted with the initials ACM". Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials, as prescribed byA.H.E.R.A. guideline. If, during demolition or renovation, any additional suspect asbestos containing materials are located [may include but not limited to: sheet vinyl flooring, the flooring, wall or ceiling texturings or paints, concrete siding or skirting, cement pipes, cement wallboard, electrical cloth, electrical wiring insulation, thermal paper, wallboard, joint compounds, vinyl wall coverings, spackling compounds, or any other suspect TSI (Thermal System Insulation)], those materials are presumed Asbestos Containing Materials unless determined to be non -asbestos by laboratory analysis. Asbesto-Test Inc. does not guarantee approximations of quantities of ACM, which may be listed with the analyses. It is therefore recommended professional abatement price and/or disposal quotes be obtained by inquiring as to fees per area of specific ACM material (i.e. square or linear ft etc.), or by on site assessment. Any and all materials identified as ACM and/or PACM in this report must be abated prior to disturbance in renovation or demolition. PLM (polarized light microscopy) has been known to miss asbestos in small percentages of some samples, which contain asbestos, thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM (scanning electron microscope) or TEM (transmitting electron microscope), to insure analytical accuracy when asbestos is reported in small percentages Analytical test method., USEPA 600/R93/116"" (PLM); WAC 296-62.07753 App. J **One percent is the USEPA regulatory limit for asbestos In bulk samples. &V.L FRIABLE"signifies "Easily Airborne" ACM signifes Asbestos Containing Material" PACM signifies "Presumed Asbestos Containing Material' CAB signifies "Concrete Asbestos Board" c signifies "less than" TSI signifies 'Thermal System Insulation" HVAC signifies "heating Ventilating Air-conditioning" NAD signifies "No Asbestos Detected" END OF REPORT ArLynn Hammond, Pros., BSc. Analytical Chemist, AIHA proficient Inspector, certified A.H.E.R.A. accred.#1628675(Expires July 26, 2018) 4P B ® CID 1429Ave. D. #187, Snohomish, WA 98290 425-489-4040: f775-665-0420 Jacksons Car Wash & Convenience Store Asbestos Report CA-T sbesto-Test, Inc. 1429Ave. A #187, Snohomish, WA 98290 425-489-4040 www.asbe.stolesf.rom: info&jnUbeslolesl.tom ASBESTOS SURVEY Occupied and "Irr Use "'Jackson's Store & Car Wash #636 (fuel canypy not included a 1520 3+1r St. S., Federal Way, King, County, Washington 98003 Page 1 of S December 23, 2016 C2161221 Jackson Food Stores 3450 E. Commercial Ct., Meridian, ID 83642 208-954-2084 Attn.: Joe Hempel joe.henape1Ca jackso«5.com On December 19, 2016, Asbesto-Test personnel conducted an Asbestos survey (per U.S.E.P.A./A.H.E.R.A. guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State) of the occupied and "in use" Jackson's Store and car ai,ash rr' 1520 348m St. S Federal Wav, 1Cirr Goun Waslrin orr 98003. This survey purpose is to identify asbestos containing materials prior to demolition. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The store is one story on a concrete slab. The siding is metal. The membrane roof and vapor barrier materials were sampled. The sealant at the roofing penetrations and seams was also sampled. The roofing of car wash is torched down materials. The torch down roofing was sampled. The siding of the carwash is brick and mortar materials. These brick and mortar materials were sampled. INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior construction is metal. The tile flooring materials were sampled. The masonry tile materials and associated mortar and mastic materials were sampled. The mist. mastic materials were also sampled. INSULATION: There was no relating suspect ACM located, except the fiberglass material under the roofing membrane that was sampled. continue to page 2 g� I NA7 460JJ-� Page 2 of 5 December 23, 2016 C2161221 Asbesto-Test, Inc. 425-489-4040 Occu ied and "fit Use " Jackson's Store & Car Wash #636 (fuel cangpE not included 1520 348'' St. S , Federal Way, Kinz County, Washinzion 98003 ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM. HEATING AND VENTILATION SYSTEM: There is a gas forced air furnace in the structure. There was no visible relating suspect ACM located. THERE MAY BE ACM TSI PRESENT (ASSOCIATED WITH THE FURNACE AND/OR DUCTING) IN THE STRUCTURE THAT IS CONCEALED FROM VIEW (i.e. within the walls, ceilings, and/or floors, inside additional ducting areas, or within the furnace unit itself). ALL TSI THAT MAY BE LOCATED THAT IS NOT VISIBLY FIBERGLASS AND/OR FOAM MATERIAL IS PRESUMED ASBESTOS CONTAINING. Note: It was not possible to dismantle the furnace and ducting to locate and/or evaluate any additional suspect ACM which may be concealed, inside the unit, or associated in hidden areas. It is our opinion any further handling of the furnace system should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect asbestos containing materials are located prior to and/or during any demolition or renovation, any and all additional related suspect materials should be considered to be ACM (Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. MISC.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None. # of structures included in survey: one commercial structure, one carwash Requested by: Joe Hempel Carl Dykstra Inspector, certified A.H.E.R.A. Accred. #157128 exp. May 11, 2017 continue to page 3 . � p936 (:E� � 1429 Ave. D. #187, Snohomish, WA 98290 425-489-4040; / 775-665-0420 Page 3 of 5 December 231. 2016 C2161221 Asbesto-Test, Inc. 425-489-4040 Occupied and "lit Use "Jackson's Store & Car Wash #636 (frsel canopy not included) �a) 1520 348'' St. S., Federal Way. XinF Co;arty, Washington 98003 Any and all materials identified as ACM or PACM in this report (and/or additional materials associated with the structure that may be discovered and later identified as ACM or PACM), must be professionally abated prior to demolition. ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION, AS LISTED QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY. SAMPLES #146 ARE ASBESTOS CONTAINING MATERIALS, EXCEPT THOSE SAMPLES LISTED AS "NAD" ANALYSIS ID ASBESTOS/ITYPE/1 UANTITY OTHER MATERIAL STORE: 1.0 roofing membrane NAD polymers, fiberglass, on roofing surface -color: white surface cellulose 2.0 ROOFING SEALANT yes H chrysotile H 2% non -fibrous materials, FRIABLE ACM polymer ROOFTOP @ SEAMS & PENETRATIONS UNDER MEMBRANE -COLOR: BLACK QUANTITIES OF ASBESTOS CONTAINING ROOFING SEALANT MATERIAL (FOR ABATEMENT ASSESSMENT AND/OR PRICING FOR REMOVAL) SHOULD BE DETERMINED BY ON SITE EVALUATION. 3.0 FLOOR TILE yes // chrysotile // 2% non -fibrous materials TILE IS NON -FRIABLE ACM OFFICE — COLOR: GRAY 4.0 mastic NAD cellulose, adhesive beneath previous sample listed QUANTITIES OF ASBESTOS CONTAINING FLOOR TILE MATERIAL (FOR ABATEMENT ASSESSMENT AND/OR PRICING FOR REMOVAL) SHOULD BE DETERMINED BY ON SITE EVALUATION. CAR WASH: 5.0 torch down/built-up roofing roofing surface 400 B13f3 NAD continue to page 4 CE� cellulose, tar, fiberglass, non -fibrous materials 1429Ave. D. #187, Snohomish, WA 98290 425-489-4040; f775-665-0420 �.__, ,__. _ ... Page 4 of 5 December 23, 2016 C2161221 Asbesto-Test, Inc. 425-489-4040 Occupied and "In Use"Jackson's Store & Car Wash #636 (fuel canooy not included) (e7 1520 348" St. S. Federal Way, King CounM Weshirr ton 98003 ANALYSIS ID ASBESTOSHTYPEU UANTITY OTHER MATERIAL CAR WASH CONT: 6.0 ROOFING FELT yes // chrysotile //2% non -fibrous materials, ACM tar, cellulose • NOTE: THE ROOFING FELT IS NON -FRIABLE AS IT IS BOUND UP IN TAR BASED MATERIALS THE ASBESTOS IS IN THE BOTTOM LAYER OF ROOFING FELT MATERIAL OVER THE CARWASH. APPROX. 900 SQ. FT. NOTE: ANY ADDITIONAL COLORS OR KINDS OF VINYL FLOORING AND/OR TILE WITH ANY RELATING MASTICS/BACKINGS THAT WERE NOT DISCOVERED IN THIS SURVEY AND MAY LATER BE LOCATED IN THIS STRUCTURE ARE ALSO PRESUMED TO CONTAIN ASBESTOS UNLESS TESTED OTHERWISE BY LABORATORY ANALYSIS THERE WAS NO ASBESTOS DETECTED IN ANY OF THE REMAINING SAMPLES STORE: 7.0 masonry floor tile NAD non -fibrous materials retail area — color: dark gray 8.0 mortar/mastic NAD adhesive, cellulose, holding previous sample listed non -fibrous materials 9.0 mastic NAD adhesive, cellulose retail area holding black base cove 10.0 mastic NAD adhesive, cellulose counter top holding red laminate 11.0 acoustic ceiling panels NAD cellulose, fiberglass, paint suspended CAR WASH: 12.0 mastic NAD adhesive, cellulose holding black base cove in restrooms 13.0 exterior brick NAD non -fibrous materials 14.0 mortar NAD non -fibrous materials holding previous sample 1 14.1 mortar NAD non -fibrous materials holding previous sample 2 14.2 mortar NAD non -fibrous materials holding previous sample 3 continue to page 5 BBB CD 1429 Ave. D. #187, Snohomish, WA 98290 425-489-4040; _ f 775-665-0420 Page 5 of 5 December 23, 2016 C2161221 Asbesto-Test, Inc. 425-489-4040 Occupied and `Yn Use" Jackson 's Store & Car Wash #636 (fuel canopy not included) aA 1520 348h St. S., Federal Way, King County, Washingtor'1 98003 Samples taken are listed with their corresponding analyses. If asbestos is detected, those samples containing asbestos are listed first and noted with the initials ACM". Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials, as prescribed byA.H.E.R.A. guideline. If, during demolition or renovation, any additional suspect asbestos containing materials are located [may include but not limited to: sheet vinyl flooring, the flooring, wall or ceiling texturings or paints, concrete siding or skirting, cement pipes, cement wallboard, electrical cloth, electrical wiring insulation, thermal paper, wallboard, joint compounds, vinyl wall coverings, spackling compounds, or any other suspect TSI (Thermal System Insulation)], those materials are presumed Asbestos Containing Materials unless determined to be non -asbestos by laboratory analysis. Asbesto-Test Inc. does not guarantee approximations of quantities of ACM, which may be listed with the analyses. It is therefore recommended professional abatement price and/or disposal quotes be obtained by inquiring as to fees per area of specific ACM material (i.e. square or linear foot etc.), or by on site assessment. Any and all materials identified as ACM and/or PACM in this report must be abated prior to disturbance in renovation or demolition. PLM (polarized light microscopy) has been known to miss asbestos in small percentages of some samples, which contain asbestos, thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM (scanning electron microscope) or TEM (transmitting electron microscope), to insure analytical accuracy when asbestos is reported in small percentages Analytical test method. USEPA 600/R931116'- (PLM); WAC 296-62-07753 App.1 --one percent is the USEPA regulatory limit for asbestos in bulk samples AIM FRIABLE' signifies "Easily Airborne" ACM signifies "Asbestos Containing Material" PACM signifies Presumed Asbestos Containing Material" CAB signifies Concrete Asbestos Board" c signifies "less than" TSI signifies "thermal System Insulation" HVAC signifies Heating Ventilating Air -Conditioning' NAD signifies "No Asbestos Detected" END OF REPORT ArLynn Hammond, Pres., BSc. Analytical Chemist, AIHA proficient Inspector, certified A.H.E.R.A. accred.#158283 (Expires July 27, 2017) 40 BE3s CD 0) 1419 Ave. D. #187, Snohomish, WA 98190 425-489-4040; f 775-665-0410