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