13-104003City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
* 0 Demolition
q Permit #:13- 104003 -00 -DE
Inspection Request Line: (253) 835 -3050
Project Name: SUNRISE UNITED METHODIST CHURCH
Project Address: 150 S 356TH ST
Project Description: Demolish existing 800 square foot single family residence
Parcel Number: 292104 9030
Owner
ARRlican t
Contractor
SUNRISE UNITED METHODIST CH
SUNRISE UNITED METHODIST CH
OWNER IS CONTRACTOR
150 S 356TH ST
150 S 356TH ST
FEDERAL WAY WA
FEDERAL WAY WA
98003
98003
Additional Permit Information
Demolition Valuation ..................... ........................7500.00
PERMIT EXPIRES Friday, September 11, 2015
Permit Issued on Wednesday, September 11, 2013
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. j //WJ
Owner or agent: Date: /
FINALED.,
CITY OF a
Federal Way
PERMIT #:
13- 104003 -00 -DE
1 ,
THIS CARD IS Tq&MAIN ON -SITE
Construction Inection Record
INSPECTION REQUESTS: (253) 835 -3050
Address: 150 S 356TH ST
Project: SUNRISE UNITED METHODIST CH FEDERAL WAY, WA 98003 -8650
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.
1-1 nal _ Rnilrlina !d(Kfll
Approved
Rough Electrical
Approved
Final Electrical
Approved
Right of Way —�
Approved
By
Date
By
Date
By
Date
Approved Transaction
�i
Notification Case #: 201303129
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 # VLEF9F17F39A
Transaction Date 08/30/13
Owner's Name Sunrise United Methodist Church Phone (253) 537 -5852
Project Street Address 200 SW 356th Street
City Federal Way Zip 98003
Contact Person Bruce Bade Phone (253) 537 -5852
Mailing Address 1124 112th St. East
Tacoma, WA 98445
This project includes a demolition.
Demolition Start Date 09/09/13 Completion Date 10/31/13
Demolition will be completed by a demolition contractor
Demo Contractor Rhine Demolition LLC
Contact Deanna Peters
Mailing Address 1124 112th Street E
Tacoma, WA 98445
Contractor Job # 3674
Phone (253) 537 -5852
(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.
If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058.
RECEIVED
SEP 112013
CITY OF FEDERAL WAY
CDS
https: // secure. psdeanair .org /Asbestos/Approved.aspx[8/30 /2013 1:29:36 PM]
LIMITED ASBESTOS SURVEY
FOR
SUNRISE UNITED METHODIST CHURCH
RESIDENTIAL STRUCTURE DEMOLITION
200 SW 356TH STREET
FEDERAL WAY, WASHINGTON
PERFORMED BY:
RHINE DEMOLITION, LLC
1 124 1 12T" STREET EAST
TACOMA, WA 98445
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Rhine Demolition, LLC - 1124 112`x' Street East
TACOMA, WA 98445
TABLE OF CONTENTS
Project #1006 -13
1.0 INTRODUCTION ...................................................... ..............................2
2.0 PURPOSE AND SCOPE OF WORK ................................
..............................2
3.0 BUILDING DESCRIPTION .......................................... ..............................2
4.0 INVESTIGATIVE METHODS ....................................... ..............................3
4.1 Sampling Protocols ...............................................
..............................3
4.2 Laboratory Analytical Methods
............................... ..............................3
5.0 RESULT'S OF INVESTIGATION .......................................
............................3 -5
6.0 CONCLUSIONS ......................................................... ..............................5
7.0 LIMITATIONS ...........................................................
..............................7
Attachments
Asbestos Survey Results ............................. .......................following body of survey
Chain of Custody ....... ............................... .......................following body of survey
Building Inspector Certification ................... .......................following body of survey
2
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a bateatat
September 4, 2013 Project #1006 -13
LIMITED ASBESTOS SURVEY
Sunrise United Methodist Church
Residential Structure
200 SW 356th Street - Federal Way, Washington
1.0 INTRODUCTION
This report presents the results of our asbestos survey performed exclusively for Mr. Bruce Bade,
the owner's representative for the structure located at the above named address. This asbestos
survey was conducted under the conditions set between Rhine Demolition, LLC (RD) and Mr,
Bruce, the owner's representative of the structure. Mr. Bade gave verbal authorization to RD on
09/06/13, to proceed with the performance of this limited asbestos survey.
2.0 PURPOSE AND SCOPE OF WORK
The purpose of the asbestos survey was to identify and quantify the presence of potential
asbestos - containing materials (ACMs) located on the structure. The structure is scheduled for a
demolition in the near future. The scope of work for the limited asbestos survey included
conducting a visual survey of the area, conducting bulk sampling and analysis of materials
suspected to contain asbestos, and document the findings within a report.
3.0 BUILDING DESCRIPTION
The site is commonly known as 200 SW 3561h Street - Federal Way, Washington. There was one
(1) structure located on this property that was to be surveyed for the presence of asbestos. The
total footprint of the structure is approximately 1,200sf. At the time of the survey the structure
was unoccupied and is schedule for demolition.
The structure is a single -story wood structure with a concrete perimeter foundation and a small
section with slab on grade. The exterior consisted of white painted asphaltic insulation board,
underneath cedar siding. The interior walls consisted of 2 "x 4" wood stud walls covered with
smoothed /textured sheet rock. Floor coverings consisted of vinyl sheet flooring, vinyl tile, and
carpeting. The plumbing system was neoprene and bare covered pipe and the wiring was older
style knob and tube wiring. Roofing consisted of 3 -tab style roofing.
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4.0 INVESTIGATIVE METHODS
4.1 Sampling Protocols
An initial walk- through of the accessible areas of the structure was performed to determine the
presence of suspect ACM. Materials similar in general appearance were grouped into
homogeneous sampling areas. In general, samples of suspect ACM were collected from the
following building areas: 1) floors, 2) walls, 3) ceilings. Since the roofing consisted of 3 -tab style
roofing, there was no requirement to test.
A total of 15 samples of suspected ACMs were collected from the structure. The samples were
collected by removing a small amount of the suspect material in a non - abrasive manner. Where
possible, samples were collected from existing damaged areas or loose pieces of materials. Each
sample was placed in a separate sealed plastic bag, and labeled with the project number and
sample number.
4.2 Laboratory Analytical Methods
The bulk samples were analyzed by NOVO Laboratory and Consulting Services of Burien,
Washington, to detect the presence, type, and percentage of asbestos by polarized light
microscopy method EPA /600R- 98/116 and following the procedures described in 40 CFR 763,
Subpart E, and Appendix -A (AHERA). Copies of the Certified Analytical Results and Chain -of-
Custody Records are included in Appendix A of this report.
5.0 RESULTS OF INVESTIGATION
As previously stated, 15 samples of suspected ACMs were collected from the structure. Of the
samples tested, one (1) tested greater than one percent asbestos and (8) samples tested less than
1% asbestos. Analytical laboratory results and field observations of the materials sampled has
been summarized below. Information presented in the table includes the sample number,
material description, the location where the sample was obtained, the condition, friability and the
asbestos content, the volume of ACMs identified (typically expressed in square feet or lineal feet),
and the condition of the material sampled. In addition, foot -notes have been provided to convey
pertinent information regarding the specific sample of homogeneous material.
An inspection report conducted by Fidelity Building Inspections, LLC on June 28, 2013, detected
asbestos greater than one percent in (3) samples. The insulation board on the exterior of the
structure, the joint compound associated with the interior gypsum wallboard system throughout
and in the black mastic associated with the vinyl tile on concrete. The inspection report
conducted by Fidelity Building Inspections, LLC is used in conjunction with the Rhine
Demolition Limited Asbestos Survey.
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The samples that tested greater than 1% asbestos are as follows:
Material Location
Quantity
4
Black and gold mastic on
Laundry room, bedroom by
-200 SF
concrete underneath vinyl tile'
Friable;
Asbestos Content
White painted sound
Exterior of structure and inside
1,300 SF
insulation board (Tested
of garage. Some of which is
positive by Fidelity, negative
underneath cedar shingles.
By front
b Rhine. Treated as ositive.
No
Non - detect (ND)
The samples that tested less than 1% asbestos are as follows:
Material
Location
Quuantity
Joint compound associated
Throughout residence.
3,125 SF
with the sum wallboard
Friable;
Asbestos Content
5.1 Sample Analysis
9412 Goodman Drive NW - Gie Harbor. Washineton
Sample
Material
Location of
Condition
Friable;
Asbestos Content
Number
Sam lea
Y o
S-001
Asphaltic board
By front
Poor
No
Non - detect (ND)
sidin
door
S-002
"" 11'r
On south
Poor
No
ND
side of
structure
S-003
Window glazing
Next to
Fair
No
<1% Chrysotile Asbestos
u
front door
5-004
Window glazing
Side
Fair
No
1% Chrysotile Asbestos
putty
window
S-005
Door window
Back door
Fair
No
1% Chrysotile Asbestos
azin
5-006
Joint compound
Living room
Poor
Yes
1% Chrysotile Asbestos
associated with
wall
texture on GWB
S-007
Joint compound
Bedroom #1
Poor
Yes
1% Chrysotile Asbestos
associated with
wall
texture on GWB
S-008
Joint compound
Family
Poor
Yes
1% Chrysotile Asbestos
associated with
room
texture on GWB
ceilin
i •
5
RHI'NE
®euiittee • aoatee�at
S-009
Joint compound
Bedroom #2
Poor
Yes
1% Chrysotile Asbestos
associated with
wall
texture on GWB
S-010
Wall texture on
Kitchen
Poor
Yes
1% Chrysotile Asbestos
GWB
wall
S-011
Multiple layer
Kitchen
Poor
No
ND
vinyl tile and
mastic on wood
S-012
Brown painted
Laundry
Fair
No
Vinyl Tile -
vinyl the and black
room on
ND
mastic
concrete by
Mastic - 3% Chrysotile
Bedroom #3
S-013
Heavy swirled
Bathroom
Poor
Yes
<1% Chrysotile Asbestos
texture on GWB
S-014
Bluish sink counter
Laundry
Fair
No
ND
top
room sink
S-015
Brown covered
Laundry
Fair
Yes
ND
wiring
room wall
6 CONCLUSIONS
A copy of this report must be provided to any employee or contractor conducting renovation or
demolition activities at the subject property.
When building maintenance, repair, renovation or other activities disturb or damage ACMs,
asbestos fibers may be released creating a potential hazard. Therefore, removal of friable and
non - friable ACMs that have the potential to become friable during demolition and /or renovation
is federally regulated under the NESHAP (National Emissions Standard for Hazardous Air
Pollutants. The Puget Sound Clean Air Agency (PSCAA) is the responsible agency on the local
level to enforce the NESHAP. PSCAA requires that asbestos - containing materials >1% (ACM's)
be removed if impacted during the renovation or demolition activities. Additionally, PSCAA
must be notified prior to any demolition and /or renovation activities.
In addition, regulated ACM (greater than one percent asbestos) are also required to be handled in
accordance with Washington State Regulations prior to any demolition, renovation, or
remodeling that would disturb these materials. Washington State Department of Labor and
Industries require that the abatement be performed using Certified Asbestos Workers under the
direct on site supervision of an AHERA Supervisor. The requirements for handling, packaging,
and disposing of asbestos - containing materials (ACM) can be found in WAC Chapter 296 -62,
Volume I, Part I -1.
ACM with less than the regulated level of one percent asbestos is not required to be abated by
certified asbestos workers or abatement contractors. However, ACM with less than one percent
asbestos does require all workers to have Asbestos Awareness Training prior to handling or
abatement work.
i •
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Washington State Department of Labor and Industries regulations regards ACM with less than
one percent asbestos as a health hazard because it is possible that the total exposure levels for
workers will exceed the Permissible Exposure Limit (PEL). Personal air sampling is a
requirement for the first day of the project to ensure that the worker protection and abatement
procedure should include engineering controls to limit workers exposure concentration (i.e. wet
methods, half -face respirator, protective clothing).
7.0 LIMITATIONS
This survey and review of the subject property has been limited in scope. This investigation is
undertaken with the risk that visual observations and random sampling alone would not reveal
the presence, full nature, and extent of asbestos - containing materials. RD makes no
representation as to the asbestos content of materials not sampled or that were inaccessible or
unsafe to our inspector (i.e., between walls, beneath multiple floor systems, in un- accessible
crawlspaces, etc.). The asbestos sample locations and building dimensions were measured /
located in the field by measurement and referenced from existing features. Therefore, the sample
locations, building dimensions, and approximate square footage of asbestos - containing materials
should be considered accurate only to the degree implied and by the methods used.
The findings presented in this report were based on field observations, random sampling and
analysis, and review of available data. Therefore, the data obtained are clear and accurate only to
the degree implied by the sources and methods used. The information presented herewith was
based on professional interpretation using presently accepted methods with a degree of
conservatism deemed proper as of the report date. We do not warrant that future technical
developments cannot supersede such data.
This asbestos survey is not intended to be the sole basis for asbestos removal bids. Confirmation
of the condition and volume of the ACMs should be conducted by the prospective removal
contractor(s) prior to accepting removal bids. This report is provided for the exclusive use of the
client noted on the cover page and is subject to the terms and conditions in the applicable
contract between the Client and RD.
The client is the only party to whom RD has explained the risks involved and has been involved
in the shaping of the scope of services needed to satisfactorily manage those risks, if any, from the
client's point of view. Any third party use of this report, including use by the Client's lender,
prospective purchaser, or lessee will be subject to the terms and conditions governing the
contractual work between the Client and RD. The unauthorized use of, reliance on, or release of
the information contained in the report, without the expressed written consent of RD is strictly
prohibited and will be without risk or liability to RD.
Asbestos analysis was conducted by a laboratory accredited under the National Voluntary
Laboratory Accreditation Program (NVLAP) administered by the National Institute of Standards
• 0
7
E
Hi N
and Technology (NIST). The results of the asbestos analysis are accurate only to the degree and
care of ensuring the testing accuracy and the representative nature of the samples obtained.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact
our office at (253) 537 -5852.
Respectfully submitted,
Rhine Demolition, LLC
Donald Sims
AHERA Certification # 141197
Expires: April 3, 2014
0 •
N 1%V0 NOVO Laboratory & 138154th Street SW
Burien, WA 98166
Consulting, Inc.
Laboratory & Consulting services, Inc. Office: (206) 2441060
Fax: (206) 2441063
September 10, 2013
Don Sims
Rhine Demolition, LLC
1124 112th Street East
Tacoma, WA 98445 -3710
RE: Bulk Asbestos Fiber Analysis; Batch 113 -1563
Dear Don
Thank you for choosing NOVO Laboratory and Consulting, Inc. as your laboratory. Enclosed you will
find test results for the bulk samples submitted to the laboratory. The samples were examined for the
prescence of identifiable asbestos fibers using polarized light microscopy (PLM) with dispersion
staining in accordance with the U.S. EPA Method 600 /R- 93/166, "Method for determination of asbestos
in Bulk Building Materials."
The samples containing more than one separable layer were separated and given an individual result,
as required by the National Emission Standard for Hazardous Air Pollutants (NESHAP, 40 CFR - Part
61) protocol that multi - layered samples be analyzed and reported separately. Asbestos concentration
in samples is determined by visual estimation and reported by percent on a volume basis.
For samples with asbestos concentrations between 1 and 10 percent based on visual estimation, the
EPA recommends a procedure known as point counting. Point counting is a statistically more
accurate means of quantification for samples with low concentrations of asbestos. An alternative
method also recommended by the EPA is to have the sample analyzed by transmission electronic
microscopy methods. If you would like us to follow any of the recommendations listed above, please
contact us.
This report is confidential and will not be released without prior written approval. Samples are archived
for Fifteen (15) days following analysis. Please contact us if samples need to be archived longer than
the standard holding time.
The information you receive relates only to the items tested. Accuracy of the results is limited by the
methodology and expertise of the sample collector. The analyses at NOVO Laboratory and
Consulting, Inc. are cross - checked with other laboratories for quality assurance purposes.
Thank you for using NOVO Laboratory and Consulting, Inc. If you have any questions please don't
hesitate to call.
Crystal Wright
Laboratory Supervisor
Enclosure: Bulk Sample Results
N GV0 OOVO Laboratory & Consulting, InZ! Bulk Asbestos
138154th Street SW Analysis Report
baba +at ^.r5 a Cn.: °sul[i,>g srv�•e�, mr., Burien, WA 98166 Page 1
Office: (206) 2441060 Fax: (206) 244 -1063 Created by CrystalW, 12:05PM 9 -10 -13
WENT
CLIENT ID CLIENT CONTACT
1008.01 Rhine Demolition LLC Don Sims
JOB / 200 SW 3256TH STR Res
» BULK SAMPLE BATIK
BATCH IDy� CUENTPO - SAMPLING DATE SAMPLES TAKEN BY
113 -1563 1006 -13 9 -10-13 Don Sims _
DATE RECD SAMPLES SUBMITTED SAMPLES ANALYZED SAMPLES NOT ANALYZED SAMPLES NOT REVIEWED DATE REVD REVIEWED BY
BA9 -10-13 15 15 9 -10-13 [Crystal Wright
TCHANALYSIS SUMMARY
� 9 of the analyzed layers contained identifiable asbestos
»SAMPLE_ :x13 -15� 1 ....- .,..�_.�- �_. �__.z_ .rte_ »,��r�,.- _
CLIENT ID CLIENT DESCRIPTION LOCATION
S001 - Exterior B Front Door I
LAB DESCRIPTION 77311 NALYZED BY ANALYSIS DATE STATUS
Shingle Under Cedar Strode 09 -10-13 lAnalyzed
SAMPLEANALYStS SUMMARY I
No identifiable asbestos was detected in this sample.
>. LAYER I -,
Coating on black brittle asphaltic material
[No CoMPOSmaN caTEGORY i TYPE PERCENraGE
n- Fibrous tAsghalt Filler and Binder 100%
» UIY,ER 2
Brown loose fibrous material
COMPOSITION CATEGORY FIBER TYPE PERCENTAGE
Non - Asbestos Fibrous iCellulose 100%
» SA_MPLE1.13.1 ? _ _
`CLIENT ID K.LIENTDESCRIPTION ��T LOCATION��_
DESCRIPTION I ANALYZED BY ANALYSISDATE ISTATUS
ingle Under Cedar ! Will Strode 09.10 -13 lAnalv
PLEANALYSIS SUMMARY ^�
> identifiable asbestos was detected in this sample. _
» oyt* 1
Coating on black brittle asphaltic material
tCOMPOSRIONCATEGORY 1 RBER'TIME PERCENTAGE
Non- Fibrous (Asphalt Filler and Binder ^_100 %��
�► LAYER 2
Brown loose fibrous material
[COMPOSITION CATEGORY ) MEN TYPE PERCENTAGE 1
Non-Asbestos Fibrous Cellulose 100 %___�
CONFIDENTIALITY NOTICE: This report is tar the sde use of the intended recipent and may contain confidential or proprietary information.
Any unauthorized review, use, dsdosure, or distribution Is prohibited.
N *V0 dtOVO Laboratory & Consulting, Inf. Bulk Asbestos
138154th Street SW o
Analysis Re l't
y Rep
oft
� cvstlluing strvicfs, Iltr,. Burien, WA 98166 Page 2
Office: (206) 244 -1060 Fax: (206) 244 -1063 Created by CrystalW, 12:05PM 9 -10 -13
CLIENTID ICLIENT CONTACT
1008.01 Rhine Demolition LLC Don Sims ��
JOB ID SW 3256TH STR Res
>r BULK SAMPLE BATtf _
BATCHID CLIENT PD SAMPLINGDATE SAMPLESTAKENBY
113 -1563 1006-13 9 -10-13 Don Sims
DATE RECD SAMPLES SUBMITTED SAMPLESANALYLED SAMPLES NOTANALYZED SAMPLES NOT REVIEWED DATE REVD REVIEWED BY
9 -10-13 _15 15 9 -10-13 Crystal Wright
BATCHANALYSISSUMMARY — I
9 of the analyzed layers contained identifiable asbestos. _
�+ SAMPLE 113 -1563 / 3.
CLII F_NTID ICIIFNTDFSCR/pmpj I�M.e TYlnr
LABDESCRIPTION ANALYZED BY ANALYSISDATE STATUS
Window Putty Jill Strode 09 -10 -13 Analyzed
SAMPLE ANALYSIS SUMMARY
0 Asbestos was detected in this sample.
» LAY '1,
ASBESTOS
DETECTED White molded chunk
011111 OSITION CATEGORY j Fit TYPE ( PERCEWAOE 1
Asbestos Fibrous tChrvsotile 4 <1% 1
4
CLIENT DESCRIPTION L�OGATION
1 Sdie Windows
LAB DESCRIPTION I ANALYZED BY JANALYSISDATE ISTATUS
Window Caulking _ Will Strode 1 09 -10-13 lAnal yzed _
SAMPLEANALVSIS SUMMARY
ble asbestos was detected in this sample.
?►
IAU Y
White molded chunk
COMPOSITION CATEWRY FIBER TYPE PEtCENrAGE
Non - Fibrous Filler and Binder _ 1000/-
CLIENTID
S005
LAB DESCRIPTION
Caulking
SAMPLEANALYSIS SUMMARY
CLIENT DESCRIPTION I LOCH TLON
detected in this
ANALYZED BY
ANALYSIS DATE
09 -10-13
�► L4YM1
ABESTOS
DETECTED Gray hard thick material
[COMPOSn10NCATEGORY i FIBERTYPE j PERCEWiAGE
Asbestos Fibrous IChrvsotile I < 19/a t
CONFIDENTIALrrY NOTICE: This report is for the sole use of the intended recipent and may contain cafidenlial or proprietary information.
Any unauthorized review, use, disclosure, or distribution is prohibited.
NO- VO *0V0 laboratory & Consulting, I0 Bulk Asbestos
138154th Street SW Analysis Report
iat povvorV b cwstilriag servd;es, Inc. Burien, WA 98166 Page 3
Office: (206) 244 -1060 Fax: (206) 2441063 Created by CrystalW, 12:05PM 8 -10 -13
�►gJENT
CLIENTID CLIENT CONTACT
1008.01 Rhine Demolition, LL C Don Sims
JOB ID 00 SW 3256TH STIR Res
�+ BULK BATCH ID CLIENTPO SAMPLING DATE SAMPLES TAKEN BY
1134563 1006-13 _ _ 9- 10 -13_ Don Sims
DATE RECD I SAMPLES SUBMITTED I SAMPLES ANALYZED SAMPLES NOT ANALYZED I SAMPLES NOT REVIEWED DATE REVD REVIEWED BY
9 -10-13 15 15 9 -10 -13 Crystal Wright_ _
34 TCH ANALYSIS SUMMARY S
9 of the analyzed layers contained identifiable asbestos. _ J
A 5AM1Z1i _�--�
FCLIENTlD �CLIENTDESCRIPTION~ ^� LOCATION
LABDESCRIPTION ANALYZEDBY ANALYSISDATE STATUS
Wall Text _ Jill Strode 09- 1_0_-13 Anal
SAMPLEANALYSIS SUMMARY
Asbestos was detected in this sample.
ASBESTOS
DETECTED Paint on off -white powder
COMROSITIONGATEtiORY 1 FIBERTYPE . PERCENTAGE
i Ilchastnc Fihrnnc I(_hnientila I < 1%
Tan papery material with white powder
r coMPOS1T1oN CATEGORY T FWER TYPE j PIACENTAGE
t$WhEj 17
CLIENTID rGLIENTDESCRIP710N LOCH7TON
S007 Bedroom 1
LABDESCRIPPON ANALYZEOBY ANALYSISDATE STATUS
Wall Text _ Jill Strode _ 09- 1_0 -13 Analyzed
SAMPLEANALYSIS SUMMARY �I
BUIBMI Asbestos was detected in this sample.
LAYS
DETECTED Paint on off -white powder
COMPOSMUCATEgoar PIBERTYPE POCEMiI•AW
Cdchactnc Fihmi m li'_hruenfilta I < 10/.
1
Tan papery material with white powder
r COMPOSM1111CATEOW r FIBERTYPE Y PERCENrAGtE t
CONRDENTIALITY NOTICE: This report is for the sole use of the intended recipent and may contain confidential or proprietary informalion.
Any unauthorized review, use, disdosure, or distribution is prohibited.
q0V0 Laboratory & Consulting, In*
NOVO 138154th Street SW
Labo,ilory & CD'PStllrttlg SPYWCQi, nu. Burien, WA 98166
Office: (206) 2441060 Fax: (206) 2441063
CUENT
CLIENT ID CLIENT CONTACT
1008.01 Rhine Demolition LLC I Don Sims
JOB 10 JOB
200 SW 3256TH STIR Res _
Bulk Asbestos
Analysis Report
Page 4
Created by CrystalW, 12:05PM 9 -10 -13
»
SULK SAMPLE 8AT ! - = - -
BATCH ID JCUENTPO SAMPUNG DATE SAMPLES TAKEN BY
113 -1563 1006 -13 9 -10-13 Don Sims
DATE RECD SAMPLES SUBMITTED SAMPLES ANALYZED SAMPLES NOTANALYZED SAMPLES NOT REVIEWED DATE REVD REVIEWED BY I
9 -10 -13 15 r 15 9 -10.13 C stal Wright _
BATCHANALYSIS SUMMARY —
jj� 9 of the analyzed layers contained identifiable asbestos. _
i�41NPLE 1134$ I B __- .
ENT ID CLIENT DESCRIPTION �'~ -_�_ _ —_ �� _._. —. --- ,.•:,0C,4TION
ANALYZED BY
ANALYSIS DATE
Wall Text _^ _
Will Strode
1 09 -10-13
(Analyzed
SAMPLEANALYSIS SUMMARY
Asbestos was detected in this sample.
_—
WRIGIM LAYS% 1
_
ASBESTOS
DETECTED Paint on off -white powder
COMPOSn10N CATEGORY
FIBER TYPE
PERCENTAGE
Asbestos Fibrous
Ch sotile
<1%
Non - Fibrous
Filler and Binder
>r LAYERS
Tan papery material with white powder
r COMPOOMN CATEGORY
T FUSER TYPE
PERCENrAGE
�. SAMPLE _M3Z 9 _ , _
CLIENTID CLIENTDESCRIPTION_�-�- � � LOCATION
S009 I Bedroom 2
LAB DESCRIPTION ANALYZED BY ANALYSIS DATE STATUS
_Wall Text Jill Strode 09 -10 -13 Analyzed
SAMPLEANALYSIS SUMMARY
Asbestos was detected in this sample.
Q ' r LAYA*1
ASBESTOS
DETECTED Paint on off -white powder
COMPOSMON CATEGORY FIBER TYPE PERCENTAGE
Asbestos Fibrous ChMssotile _ < 1 %_
Non - Fibrous Filler and Binder
-
Tan papery material with white powder
r COMPMnON CATEGORY T FIBER` K T PERCENTAGE
CONFIDENTIALMY NOTICE: This report is far the sole use of the intended redpent and may contain confidential or proprietary information.
Any unauthorized review, use, dsdosure, or distribution is prohibited.
41i0VO Laboratory & Consulting, If Bulk Asbestos
N 138154th Street SW ol't
Analysis Re
y a
iaNirt>Cry & Co=°sulrmg "rvices, Inc. Buden, WA 98166 Page 5
Office: (206) 244 -1060 Fax: (206) 2441063 Created by Crysta /W, 12 .'05PM 9 -10-13
�► CLIENT
CLIENTID CLIENT CONTACT
1008.01 1 Rhine Demolition LLC Don Sims
JOB 1200 SW 3256TH
BULK SAMPLE B021 DATE SAMP __ _ LE _ S __
BATCH ID CLIENT PO [SA�KiNG TAKEN BY
113 -1563 1006 -13 — 9 -10-13 1 Don Sims _
DATE RECD SAMPLES SUBMITTED I SAMPLES ANALYZED SAMPLES IIOTANALYZED I SAMPLES NOT REVIEWED DATE REVD REVIEWED BY
9 -10-13 15 15 9 -10 -13 Crystal Wright _
134TCHANALYSIS SUMMARY _
MOMMI 9 of the analyzed layers contained identifiable asbestos.
-* SAMPLE113 -2563 / 10
DESCRIPTION
I ANALYZEDBY
ANALYSISDATE
STATUS
ill Text
Will Strode
09 -10-13
AnA!ge
PLEANALYSIS SUMMARY
OM Asbestos was detected in this sample.
' tM =3 LAYER 1
ASBESTOS
DETECTED Paint on off -white powder
COMPOSITION CATEGORY
RBER TYPE.
PERCEWAOE
Asbestos Fibrous
Ch sotile_
<1%
I Non - Fibrous
Filler and Binder
99 %�
x IRYBt 2 _ _
Tan papery material with white powder
r COMPOW10H CATEGORY T RWR TYPE
T PERCENTAGE -t
CONRDENTIALITY NOTICE: This report is for the sale use of the intended recipent and may curtain owlidential or proprietary information.
Any unauthorized review, use, disdosure, or distribution is prohibited.
460 Laboratory & Consulting, 10 Bulk Asbestos
N 138154th Street SW Analysis Report
Y p
Tahowcry & Co- sultfrig Ser4iCPs, Mr. Burien, WA 98166 Page 6
Office: (206) 244 -1060 Fax: (206) 2441063 C t ,4 b Cr staJW 12 050M 9 1x13
tea y y
CLWNT
CLIENTID CLIENT CONTACT
1008.01 Rhine Demolition, LLC I Don Sims
JOB ID JOB
200 SW 3256TH STR Res _^
;SULK SAMPLE BATCH
&9TCHID CLIENT PO SAMPUNGDATE SAMPLES TAKEN BY
113 -1563 1006.13 _ 9-10 -13 1 Don Sims
DATE RECD SAMPLES SUBMITTED SAMPLESANALYZED SAMPLES NOT ANALYZED SAMPLES NOT REVIEWED DATE REVD IREVIEKIEDBY
9-10-131 15 ^15 9 -10-13 Crystal Wright
BATCHANALYSIS SUMMARY
9 of the analyzed layers contained identifiable asbestos.
» SAP - 113- ��11 : _ .._.�.� -� _ - —,—_— r
CLIENTID CLIENTDESCMP770N LOCAnON -
S011 I I Kitchen
LAB DESCRIPTION ANALYZED BY ANALYSIS DATE IsrArus
Multi Layer Flooring /Mastic lCrystal Wright 09 -10 -13 Analyzed_,_ J
SAMPLEANALYSIS SUMMARY
No identifiable asbestos was detected in this sample.
�► iU!'ER 1,:
Gray /peach pliable material
COMPOSITION CATEGORY FIBER TYPE PERCENTAGE
Non- Fibrous Filler and Binder 100% j
LAYER Z
Clear sticky mastic
LCOMPOSITION CATEGORY i RBER TYPE PERCENTAGE
on- Fibrous IFifler and Binder 100 %.�
)P. LAYER 3
White /tan floor the
COMPOSITION CATEGORY r RBER TYPE j PERCENTAGE
Non- Fibrous (Filler and Binder f _ _ 100%
>r LAYER 4
Gold mastic
COMPOSITION CATEGORY FOER TYPE PFJtCE'WAGE
Non-Fibrous and Binder! 100%
�YA1"f5
Tan vinyl with green fibrous backing
r' COMPOSITION CATEGORY r ROER TYPE T PERCENTAGE
:G4f',ER 6
Black asphaltic fibrous material
r- COMPOSITION CATEGORY I FMRTYPE I PERCENTAGE
CONFIDENTIALITY NDTICE: This report is for the sde use of the intended reoipent and may contain confidential or proprietary information.
Any unauthorized review, use, disclosure, or distribution is prohibited.
NOVOi.
060 Laboratory & Consulting, Is
138154th Street SW
Burien, WA 98166
Office: (206) 244 -1060 Fax: (206) 244 -1063
Bulk Asbestos
Analysis Report
Page 7
Created by CrystalW, 12 :05PM 9 -10-13
.LZMT
ENTID CLIENT CONTACT
_ 1008.01 Rhine Demolition LLC _ iDon Sims
31D JOB
200 SW 3256TH STR J Res
► L SAMPLE BATM
BATCH ID CLIENT PO SAMPLING DATE I SAMPLES TAKEN BY
113 -1563 1006 -13 9-10-13 Don Sims
DATERECD SAMPLES SUBMITTED SAMPLES ANALYZED SAMPLES NOT ANALYZED SAMPLES NOT REVIEWED DATE REVD REVIEWED BY '
9-10-131 15 15 1 9 -10 -13 Crystal Wrght _
B4TCHAN4LYSIS SUMMARY
9 of the analyzed layers contained identifiable asbestos.
� SAMPLE�f1�'- 15532
CLIENT I D CLIENT DESCMPTION 1 LOG177UN
LABOESCRIPTION ANALYZED BY ANALYSISDATE STATUS
Vinyl Tile(Mastic _ C stal Wri ht 09-10 -13 Analyzed
S4MPLEANALYSIS SUMMARY
OMM Asbestos was detected in this sample.
�► LAYER z . -.
White the with streaks
COLHKMMN.CATEGORY F=R TYPE PERCENrAGE
Non- Fibrous Filler and Binder 100 %_.�,
DETECTED Gold and black asphaltic mastic
r COMPOSnIONCATEGIM T FIBER TYPE T PERCENTAGE 1
SAMPLLr t13 -15 ? ! 13
CLIENT ID CLIENT DESCRIPTION LOCI T/0N
S013 _ Bathroom_
LAB DESCRIPTION ANALYZED BY ANALYSIS DATE STATUS
Heavy Swirled Text Crystal Wright 09 -10 -13 Anal zed !_
SAMPLE ANALYSIS SUMMARY i T
IMMM Asbestos was detected in this sample.
» L UER.1
DETECTED Paint on off -white powder
[COMPOSRIONCATEGORY FI9ERTYPE 1 PERCENWE
Asbestos Fibrous lChrvsntila I < 10/. f
Tan papery material with white powder
r• COMPOSITION CATEGORY T I MffR TYPE T PERCENTAGE T
CONFIDENTIALITY NOTICE: This report is for the sole use of the intended recipent and may contain confidential or proprietary information.
Any unauthorized re hew, roe, disclosure, or distribution is prohibited.
NOVO rorwr c.
XtEW
%0V0 Laboratory & Consulting, Iris.
138154th Street SW
Burien, WA 98166
Office: (206) 2441060 Fax: (206) 2441063
Bulk Asbestos
Analysis Report
Page 8
Created by CrystalW, 12:05PM 9 -10-13
!ENTID CLIENT CONTACT
1008.01 1 Rhine Demolition, LLC Don Sims
910 JOB — - -- --
200 SW 3256TH STR Res
» BUCK 5AKPL.F BA7tif _ _ _
BATCH 16 CLIENTPO SAMPLING DATE SAMPLES TAKENBY
113 -1563 1006 -13 _ _ 9-10 -13 1Don Sims
DATE RECD SAMPLES SUBMITTED SAMPLES ANALYZED I SAMPLES NOTANALYZED SAMPLES NOT REVIEWED DATE REVD REVIEWED BY
9-10-131 15 15 9 -10 -13 lCrystal Wright
BATCH ANALYSIS SUMMARY]
9 of the analyzed layers contained identifiable asbestos.
5A1# 3 =13x6 / 14
CLIENT ID 1CLIENTIDESCRIPTION -T LOCATION I
JLAOLltS 1111'r9vM AAIALYZEDBY ANALYS/SDATE STATUS
Counter Vinyl _ Crystal Wriqht 1 09 -10-13 Analvzed I
SAMPLEANALYSIS SUMMARY t
No identifiable asbestos was detected in this sample. _^ I
�► LAYER 1 _
Blue /gray vinyl with black asphaltic fibrous material
r COMpOsmHCATEGORY T Fl®ERTYPE T PERCEWAGE -t
�► LAYER Z
White /black powdery material
COMPOOMN CATEGORY FIBER TYPE PERCENTAGC
j
[Non- Fibrous IFiller and Binder 100 °/�
r''ky/ 15
CLIENT DESCRIPTION : _ _-..r. _• - -° --- � _.� �•...It [K".AiION
ANALYZED BY ANALYSIS DATE STATUS
Crvstal Wright 1 09 -10 -13 1 Anal
! EANALYSIS SUMMARY - - - -�-
identifiable asbestos was detected in this sample.
�• LAW!
Black woven fibrous material
r CbMt+OSMIlIdATEGORY i RTYPE T PEW&WAN -r
[End of Batch]
Crystal Wright, Lab64iory Supervisor
CONRDENTIAUTY NOTICE: TNs report is for the sde use of the intended re spent and may contain confidential or p Widary information.
Any unauthorized review, use, disclosure, or distribution is prohibited.
N n�VO
Laboratory & Consulting Services, inc.
138 S.W. 154th Street
Suite B
Burien, Washington 98166
Phone: 206.244.1060
Fax: 206.2441063
Project Location: O)
CHAIN OF CUSTODY RECORD
NO_ VO Lab Batch ID:
Number of Sam les: S
PLM (Asbestos Bulk): X
PCM (Asbestos Air):
Other
Tucn: Around ltepluest:
2 Hour: _qtr JOI,
Person Catted:
DatelTime:
24 Hour 3 Day
5 Day 10 Day
Samples) Size: Accepted Rejected
Non Conformance Memo: Yes No
Condition of Packaoe•
Good Damaged Severe Damage
Samples will be disposed of after thirty (30) days unless otherwise requested by client.
Method #NLCS -011 06 -06 Revised #3 by CWR
Page,_ of _
0 •
N V 0
Laboratory a, Consulting Services, inc. CHAIN OF CUSTODY RECORD
138 S.W. 154th Street
Suite B
Burien, Washington 98166 - NOVO Lab Batch ID:
Phone: 206.244.1060
Fax: 206.244.1063
Project Location:a Y S W SSII —I Tf
�r t
.� tUc ►�
PLM (Asbestos Bulk):
PCM (Asbestos Air):
Other
Tura.. Ar.:o_ uund fteauest:.
2 Hour• s
Person Called:
Date/Time:
24 Hour 3 Day
5 Day 10 Day
Sampte(s) Size: Accepted Rejected
on Conformance Memo: Yes No
Condition of Package-
_ Good Dama ed Severe Damage
Samples will be disposed of after thirty (30) days unless otherwise requested by client.
Method #NLCS -011 06 -06 Revised #3 by CWR
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• PERMIZ�PPLICA'T'ION
Federal Way RECEIVED
T _
PERMIT NUMBER l 17-7 _ I 0 et " 0 ✓ SEP 1 12013 _
— TARGET DATE CITY OF FEDFRAI WAY
me
SITE ADDRESS
SUITE /UNIT #
PROJECT VALUATION
ZONING
A83 TAR /PAR #
F- -!Er
— —
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL DEMOLITION ❑ ENGINEERING 1:1 FIRE PREVENTION
NAME OF PROJECT
�D D � 5 b' SV/�t (�� V N (TM> Kj-`D p1s
PROJECT DESCRIPTION
Detailed description of work to
O
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
? UL M
zS3 ' 1 �! ;?
MAILING ADDRESS
E-MAIL
CITY
"ATEE
ZIP
NAME e}- 11 VD&— C, L L
234 3^ 5E5Z-
MAD.IIi DRESS
11 t1 Tr
-MA
E IL
CONTRACTOR
�
CITY -1*.
STATE
ZIP �
1i 7 Lt
FAX
C--,
A,
D S
WA STATE CONTRACTOR'S LICENSE #
ERPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME v 1JI- -C T \ / 6 0% �
V
�. ! Z-7-,% O u k
MAILING ADD
E -MAIL
APPLICANT
CITY
I STATE
ZIP /
3
FAX G 3
NA ME
PRIMA✓ R Y PHONE
PROJECT CONTACT
MAILING ADDRESS
E -MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER - FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27095)
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 su arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information sup ed to th city as a part is application.
SIGNATURE: 1 (�./- `----� DATE �3
PRINT NAME: I --C- P, ID
Bulletin #100 - January 1, 2013 Page I of 3 k:\Handouts\Pennit Application