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14-102788"r jr e s ' - -Ouilding - Colral Chy of Federal Way Community & Econ. Dev. services Permit #: 14 -102788 -00 -Cb 33325 8th Ave S Federal way, wn 98003 Ins ection Re uest Line: 253 835-3050 Ph: (253) 835-.2607 Fax: (253) 835-2609 p q Project Name: PAYLESS SHOE SOURCE Project Address: 1812 S COMMONS Parcel Number: 762240 0010 Project Description: TI - Cosmetic upgrades to existing space and install new display fixtures. Owner ARRIlicant Contractor Lender STEADFAST COMMONS LLC KINSON WONG DIAMOND CONTRACTORS INC STEADFAST COMMONS LLC 18100 VON KARMAN SUITE 500 13400 RIVERSIDE DR SUITE 202 DIAMOC1966K4 (5/24/16) 18100 VON KARMAN SUITE 500 IRVINE CA 92612 SIIERMAN OAKS CA 91423 4224 NE PORT DR IRVINE CA 92612 LEE'S SUMMIT MO 92612 Census Category: 437 - Commercial alt / add / conversion Includes: 41 #2 #3 #4 Occupancy Class: Construction Type: Occupancy Load Floor Areas . ft. 0 0 0 0 Additional Permit Information 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. �l Owner or agent :p� Dater Ir ` - - THIS CARD IS TO MAIN ON-SITE Cl" OF Construction In ection Recor(f Federal Way INSPECTION REQ TS: (253) 835-3050 PERMIT #: 14 -102788 -00 -CO Address: 1812 S COMMONS Project: STEADFAST COMMONS LLC FEDERAL WAY, WA 98003 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. Re -steel (4215) Slab/Concrete Floor (4255) Underfloor Framing (4285) Approved to place concrete or grout Approved to place concrete Approved to sheath floor By Date By Date By Date Floor Sheathing (4105) Fire/Draft Stops (4095) eduling a Framing inspection; Approved to install flooring Approved bing & Mechanical Rough -in and By Date By Date EFire/Draftinspections must be signed-offand proved. IBC 1093.4 Gypsum Wallboard Nailing (4130) Framing (4120) Insulation (4150) Approved to insulate Approved to install wallboard Approved to install mud &c tape By Date By Date By Date Suspended Ceiling Grid (4265) Final - Fire Department (4060) Final - Planning Approved to drop tile Approved Approved By Date By Q F. Date By Date Approved ByPhL Date El Rough Electrical Approved Final Electrical Approved Right of Way -� Approved By Date By Date By Date CITY OF RECEIVED PERMIT APPLICATION 'o Federal W / : ��j� JUN 112014 NUMBER C l TARGET DATE SITE ADDRESS SUITE/UNIT # 1812 S. Corr,,„an,,- federal Way, WA PROJE VALUATION ZONING ASSESSOR'S AX/PARCEL# la -4?- 6 - () 0 TYPE OF PERM I.BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION Payless Shoesource #1824 - Seattle Market Refresh NAME OF PROJECT Minor Remodel of ExistingPayless Shoesource Tenant Space. PROJECT DESCRIPTION Removal/Relocation/Installation of new Fixtures, floor and paint. Detailed description of Mork to be included on this permit only PROPERTY OWNER NAME Steadfast Commercial Properties PRIMARY PHONE 949-623-7709 1WVanRKarman Suite 500 FMAICL CITY Irvine STATE I CA ZIP 92612 NAME PHONE E-MAIL CONTRACTOR - r -- S'f�p7jYh ZIP - FAX /�o-,I`1,F!/1 W/#�8TATE CONT CT LI" RAT O DATE FED W Y BUS*Fl LI S # NAME Kinson Wong PRIN&ItY PHONE 818-786-8960 APPLICANT MAII ING ADDRESS 13400 Riverside Dr. Suite 202 EMAIL kwong@permitplace.com CITY Sherman Oaks sLA ZIP 91423 FAX NAME EKinson Wong PTT -M-%60 PROJECT CONTACT (The individual to receive and MAILING ADDRESS 13400 Riverside Dr. Suite 202 EMAIL kwong@permitplace.com respond to all correspondence CITY Sherman Oaks SCA IP FAX concerning this application) PROJECT FINANCING NAME OWNER -FINANCED Required value of $5,000 or more MAILING ADDRESS, CITY, STATE, ZIP PHONE (RCW 19.27.095) I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied t the city as a part this application. SIGNATURE: DATE 6/11/14 PRINT NAME: S U1 Q Bulletin #100 - January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application �� Cardno July 17, 2014 ATC Shaping the Future Ms. Danielle Gass ERnet Property Resource Group Cardno ATC 801 Industrial Boulevard 6347 Seaview Avenue Northwest Gallatin, Tennessee 37066 Seattle, Washington, 98107 Phone +1 206 781 1449 RE: Limited Asbestos Survey Fax +1206 7811543 Payless ShoeSource No. 1824 www.cardno.com 1812 South SeaTac Mall www.cardnoatc.com Federal Way, Washington 98003 Cardno ATC Project Number 29.38586.0328 Dear Ms. Gass: Cardno ATC is pleased to present the findings of the limited asbestos survey completed for Payless ShoeSource No. 1824 located at 1812 South SeaTac Mall, in Federal Way, Washington. The inspection was performed in accordance with the U.S. Environmental Protection Agency (EPA) guidance document titled, "Guidance for Controlling Asbestos - Containing Materials in Buildings" (Document No. 560/5-85/024), the Asbestos Hazard Communication requirements enforced by the Washington State Department of Labor and Industries (L&I) in Washington Administrative Code (WAC) 296-62-07721; and the Asbestos Survey Requirements enforced by the Puget Sound Clean Air Agency (PSCAA) in Regulation 1I1, Article 4, Section 4.02. This report includes the procedures, methodologies, analytical results, and applicable conclusions and recommendations. Cardno ATC appreciates the opportunity to perform these services for you and we look forward to working with you in the future. In the interim, if you have questions or comments regarding the information contained in this report, or if we can be of further assistance, please do not hesitate to contact us at 206-781-1449. Sincerely, Cardno ATC Mark ewman AHERA Building Inspector for Cardno ATC Direct Line +1206 781 1449 Email: mark.newman@cardno.com George Sceniak, OHST Senior Project Manager Manager Client Services Dan Fitzgib on Senior Project Manager for Cardno ATC Direct Line +1206 781 1449 Email: daniel.fttz ibg bons2cardno.com Australia • Belgium - Canada • Colombia • Ecuador • Germany • Indonesia • Italy Kenya • New Zealand • Papua New Guinea • Peru • Tanzania • United Arab Emirates United Kingdom • United States • Operations in 85 countries 0 4tr"7) oar-dnol Limited Asbestos Survey ATC Payless ShoeSource # 1824, 1812 S. SeaTac Mall, Federal Way, WA Shaping dre Future Cardno ATC Project Number: 29.38586.0328 TABLE OF CONTENTS 1.0 PURPOSE AND SCOPE OF SERVICES.................................................................................1 2.0 GENERAL SITE CONDITIONS...............................................................................................1 3.0 ASBESTOS -CONTAINING MATERIAL SURVEY..............................................................1 3.1 Homogeneous Areas.............................................................................................................2 3.2 Hazard Assessment Factors..................................................................................................2 3.3 Sampling Strategy.................................................................................................................2 3.4 Suspect Asbestos -Containing Material.................................................................................3 3.5 Analytical Results................................................................................................................. 3 4.0 CONCLUSIONS AND RECOMMENDATIONS....................................................................4 5.0 ASSUMPTIONS AND LIMITATIONS....................................................................................5 APPENDICES APPENDIX A: TABLE NO. 1 - SUMMARY OF ANALYTICAL RESULTS APPENDIX B: BULK SAMPLE ANALYSIS REPORT APPENDIX C: SAMPLE LOCATION FLOOR PLAN APPENDIX D: INSPECTOR AND LABORATORY ACCREDITATIONS APPENDIX E: PHOTO LOG www.cardnoatc.com Limited Asbestos Survey Payless ShoeSource #1824,1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 LIMITED ASBESTOS SURVEY Payless ShoeSource No. 1824 1812 South SeaTac Mall Federal Way, Washington 98003 Cardno ATC Project No. 29.38586.0328 1.0 PURPOSE AND SCOPE OF SERVICES ATCr+dno' Shaping the Future The purpose of this project was to conduct a pre -renovation asbestos survey of suspect Asbestos - Containing Materials (ACMs) for Payless ShoeSource No. 1824 located at 1812 South SeaTac Mall, in Federal Way, Washington. Cardno ATC's scope of services for this survey included the following: 1. Review of existing asbestos reports for Payless ShoeSource No. 1824, if available. 2. Visual survey of Payless ShoeSource No. 1824. 3. Perform both visual inspection and bulk sampling in the building in accordance with the U.S. Environmental Protection Agency (EPA) guidance document titled, "Guidance for Controlling Asbestos -Containing Materials in Buildings" (Document No. 560/5-85/024), the Asbestos Hazard Communication requirements enforced by the Washington State Department of Labor and Industries (L&I) in Washington Administrative Code (WAC) 296-62-07721; and the Asbestos Survey Requirements enforced by the Puget Sound Clean Air Agency (PSCAA) in Regulation III, Article 4, Section 4.02. 4. Quantify ACMs, including material condition and location. 2.0 GENERAL SITE CONDITIONS This survey was completed for Payless ShoeSource No. 1824. This retail store is located in The Commons at Federal Way shopping center and is reportedly scheduled to undergo renovations. The retail space consists of a sales floor, storage/office area, restroom and hallway. Interior finishes consisted of painted sheetrock walls; 2 -foot by 4 -foot suspended ceiling panels; carpet and associated mastic; ceramic tile and grout; and vinyl floor tile with mastic. The flooring materials are located on a concrete substrate floor. 3.0 ASBESTOS -CONTAINING MATERIAL SURVEY The survey was conducted on July 15, 2014 by Mr. Mark Newman, an AHERA-certified Building Inspector (Certification 145335). Payless ShoeSource No. 1824 was visually inspected for the presence of accessible building materials that are suspected to contain asbestos. Bulk samples of identified suspect ACMs were collected and placed into individual containers for transport to a National Voluntary Lab Accreditation Program (NVLAP)/American Industrial Hygiene Association (AIHA)-accredited laboratory for analysis. Materials visibly identified as non- asbestos (fibrous glass, foam rubber, wood, etc.) were not sampled. The asbestos survey consisted of three basic procedures: 1) conduct a visual inspection of Payless ShoeSource No. 1824; 2) identify homogeneous areas of suspect surfacing, thermal system insulation, and miscellaneous materials; and 3) sample accessible, suspect materials. www.cardnoatc.com 0 Limited Asbestos Survey Payless ShoeSource #1824, 1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 3.1 Homogeneous Areas • �� Car�a/rso� ATC Shaping the Future Prior to sample collection, Homogeneous Areas (HAs) were identified and listed to develop a sampling strategy. A HA can be described as a material of similar appearance and texture with the same installation date and function. The actual number of samples collected from each HA may vary, based on the type of material and the professional judgment of the inspector. 3.2 Hazard Assessment Factors From the list of suspect homogeneous materials, a physical assessment was performed for each material on the list. A physical assessment includes evaluating the condition, assessing the potential for disturbance, and determining the friability of each material. Friability is a term used to describe the ease in which a building material inherently lends itself to disturbance. By definition, "friable" materials are those that can be crumbled or reduced to powder by hand pressure when dry. Each material on the list was further classified into one of three categories, which have specific sampling requirements for each category. Surfacing Materials: Refers to spray -applied or troweled -on surfaces such as plaster ceilings and walls, fireproofing, textured paints, textured plasters, and spray -applied acoustical surfaces. Thermal System Insulation: Refers to insulation used to inhibit heat gain or loss on pipes, boilers, tanks, ducts, and various other building components. Miscellaneous Materials: Refers to products and materials that do not fit in any of the above two categories such as resilient floor covering, baseboards, mastics, adhesives, roofing material, caulking, glazing, and siding. This category also contains wallboard and ceiling tile. Approximate quantities of suspect materials were estimated by field measurements. The condition (e.g., good, fair, poor) and friability (i.e., able to be readily crumbled, pulverized, or reduced to powder by hand pressure) of suspect ACM was noted for each work area. Friability of each sampled material was determined by hand -touch. 3.3 Sampling Strategy The scope of services for this survey included the sampling of suspect ACMs at the Payless ShoeSource No. 1824, prior to planned renovation activities. Cardno ATC's asbestos inspection was performed following a modified sampling protocol as outlined under AHERA, 40 CFR 763; PSCAA Regulation I11, Article 4; Section 4.02,and L&I Asbestos Hazard Communication requirements, found in WAC 296-62-07721. If the analytical results indicated that all the samples collected per HA did not contain asbestos, then the HA (material) would be considered a non -ACM. However, if the analytical results indicate one or more of the samples collected per HA contains asbestos in quantities of greater than 1 percent asbestos by weight (as defined by EPA, L&I and PSCAA ), all of the HA (material) shall be www.cardnoatc.com Limited Asbestos Survey a"r'ra "C Payless ShoeSource # 1824, 1812 S. SeaTac Mall, Federal Way, WA ATC Cardno ATC Project Number: 29.38586.0328 Shaping the Future treated as an ACM. Materials which can visually be determined to be non-asbestos (i.e., fibrous glass, foam rubber, etc.) by the accredited inspector are not required to be sampled. Inspectors typically rely on survey observations such as the condition, friability, and quantity of material to determine what would be a sufficient number of samples to collect in order to accurately evaluate the presence or absence of asbestos materials. Actual collection of a bulk asbestos sample involves physically removing a small piece of material and placing it in a marked, airtight container. Sample containers are marked with a unique identification number, which is also noted in the field notes. 3.4 Suspect Asbestos -Containing Material Sixteen (16) bulk asbestos samples of suspect materials were collected from Payless ShoeSource No. 1824; due to layering, twenty seven (27) laboratory analyses for asbestos were completed. Detailed sample descriptions of suspect, sampled materials and laboratory results are reported in Table 1 in Appendix A. Additional ACM may be present on site in inaccessible or concealed spaces. These spaces include, but are not limited to, pipe chases, spaces between walls/ceilings/door cavities, interiors of mechanical components such as boiler cavities, interior ducts, areas beneath the foundation, etc. If future maintenance/renovation/demolition activities make these areas accessible, Cardno ATC recommends that a thorough assessment of these spaces be conducted at that time to identify and confirm the presence or absence of additional ACMs. Until then, all such unidentified materials should be treated as assumed ACM in accordance with L&I, PSCAA and 40 CFR 763. 3.5 Analytical Results Bulk samples were analyzed by the Cardno ATC laboratory located in Centennial, Colorado and is an EPA National Voluntary Laboratory Accreditation Program (NVLAP)-accredited laboratory (102031-0). EPA uses NVLAP as a quality assurance program for Polarized Light Microscopy (PLM) sample analysis. The Cardno ATC laboratory is also accredited by the National Institute of Standards and Technology (NIST). The bulk samples were analyzed using PLM according to EPA method 600/R-93/116 and analyzed based on the number of distinct layers (materials) associated with each bulk sample. For example, drywall and the associated joint compound are collected as one sample but are analyzed as two distinct materials by the asbestos laboratory. Any material that contains greater than one (1) percent asbestos is considered an ACM and must be handled according to federal, state and local regulations. Analytical laboratory results identified asbestos - containing residual black mastic under non -asbestos carpet tile mastic in portions of the main sales area. Additionally, asbestos -containing black mastic was identified under 12 - inch by 12 -inch off-white vinyl floor tile in the storage/office area. These materials are considered to be non -friable and were observed to be in generally good condition. Copies of the analytical report and corresponding chain -of -custody are included in Appendix B. Results are reported in percent asbestos by weight based on visual estimation and indicate the types of asbestos. Other common non -asbestos components may also be noted on the analytical www.cardnoatc.com 0 0 Limited Asbestos Survey Payless ShoeSource #1824,1812 S. SeaTac Mall, Federal Way, WA ATC Cardno ATC Project Number: 29.38586.0328 Shaping the Future report. Inspector and laboratory accreditations are provided in Appendix D. 4.0 CONCLUSIONS AND RECOMMENDATIONS The results of the asbestos survey for Payless ShoeSource No. 1824 indicated that two homogeneous groups were identified as positive for containing asbestos; the following materials were asbestos -containing: Residual Black Mastic under non -asbestos green carpet mastic. There is approximately 1,250 square feet of asbestos -containing residual black mastic under the two -feet by two -feet carpet tiles located in the main sales area. The non -friable material is in generally good condition. Cardno ATC's estimate for the residual black mastic was limited, based on the presence of a green/yellow carpet mastic over the residual carpet mastic throughout the Main Sales Area. Black Mastic associated with 12 -Inch by 12 -Inch Off -White Vinyl Floor Tiles There is approximately 300 square feet of asbestos -containing black mastic associated with the 12 -inch by 12 -inch off-white vinyl floor tiles with a speckle pattern, located in storage/office area. Based on the results of the limited asbestos survey, Cardno ATC makes the following recommendations: All identified ACMs should be maintained under a written Operations and Maintenance (O&M) program, by suitably trained personnel, until the building is demolished or the ACM abated. Laboratory analysis indicated that residual black mastic under portions of the sales area carpet, and black mastic under the vinyl floor tile in the storage/office areas are ACMs. Cardno ATC's limited sampling and analysis does not constitute a full characterization of ACM in the retail space. It should be noted that additional suspect ACMs, beyond those identified during this limited pre -renovation survey, may be present in areas and / or spaces inaccessible or concealed by practical and / or manual means of retrieval. Although it is not anticipated given the date of original construction, these areas and / or spaces include, but are not limited to, pipe chases, spaces between walls/ceilings/door cavities, interiors of mechanical components such as boiler cavities, interior ducts, areas beneath the foundation, etc. Cardno ATC recommends suspect ACMs not previously sampled, that are discovered during renovations, be sampled to determine asbestos content. • Prior to renovation or demolition, all ACM that could be disturbed must be properly removed in compliance with the L&I and PSCAA regulations. A licensed abatement contractor must remove ACMs in accordance with EPA, L&I and PSCAA asbestos standards. During abatement related activities, Cardno ATC recommends that an experienced third -party representative for the owner provide air monitoring and documentation verifying applicable regulations are followed (inclusive of final work area visual and air clearance). www.cardnoatc.com 0 Limited Asbestos Survey Car "1719 Payless ShoeSource #1824, 1812 S. SeaTac Mail, Federal Way, WA AT Cardno ATC Project Number: 29.38586.0328 Shaping the Future o Prior to abatement, the owner or owner's representative is required to submit a request for a 10 -day permit/notification for abatement activities utilizing the PSCAA website (https:Hsecure.pscleanair.org/asbestosis. o Additionally, L&I will require notification 10 -days prior to initiating any asbestos abatement procedures, using their website (hqp://www.Ini.wa. gov/Safety/Topics/AtoZ/Asbestos/ProiectForm.asp). • Subcontractors and employees working at the site should be made aware of the known ACM and the possibility of concealed ACMs that could be found during renovation or demolition activities. 5.0 ASSUMPTIONS AND LIMITATIONS This report has been prepared to assist ERnet Property Resource Group in evaluating suspect asbestos -containing materials within the Payless ShoeSource No. 1824, located at 1812 South SeaTac Mall in Federal Way, Washington 98003. Cardno ATC provided these services consistent with the level and skill ordinarily exercised by members of the profession currently practicing under similar conditions. This statement is in lieu of other statements either expressed or implied. This report is intended for the sole use of ERnet Property Resource Group. This report is not intended to serve as a bidding document nor as a project specification document and actual site conditions and quantities should be field -verified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users, and use or re -use of this document, the findings, conclusions, or recommendations is at the risk of said user. Although a reasonable attempt has been made to locate suspect asbestos -containing building materials, the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure. Additionally, other possible building material hazards such as lead-based paint were not included as part of this evaluation and may require proper sampling for identification prior to disturbance. Caution should be used during any remediation activities. www.cardnoatc.com Limited Asbestos Survey Payless ShoeSource #1824,1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 APPENDIX A TABLE NO. 1 - SUMMARY OF ANALYTICAL RESULTS Gardner" ATC Shaping the Future 9 Limited Asbestos Survey Payless ShoeSource #1824, 1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 • �� Cardno� ATC Shaping the Future Table 1: Summary of Analytical Results Payless ShoeSource 1824 1812 South SeaTac Mall, Federal Way, Washington 98003 Sample NESHApproximate Analytical Numbe Material Description Location Catego Category Quantity Results r 01 6"x6" Grey Ceramic Tile with Main Entrance N/A 250 SF ND Grey Grout Area ND Green Mastic: 02 Green Mastic from 2'x2" Carpet Tiles over Main Sales Floor Category I 1,250 SF ND Residual Black Mastic on Concrete Black Mastic: 10% Chrysotile 03 Green/Yellow Mastic from 2'x2' Grey Main Sales Floor N/A 2,500 SF ND Carpet Tiles with Dot -Pattern 04 Green/Yellow Mastic from 2'x2' Grey Main Sales Floor N/A RE:03 ND Carpet Tiles with Dot -Pattern 05 4" Black Vinyl Cove Base with Main Sales Floor N/A 150 LF ND Cream Mastic over Gypsum Board Walls ND 06 4" Black Vinyl Cove Base with Main Sales Floor N/A RE: 05 ND Cream Mastic over Gypsum Board Walls ND 07 4" Black Vinyl Cove Base with Main Sales Floor N/A RE: OS ND Cream Mastic over Gypsum Board Walls ND 08 Gypsum Wallboard and Main Sales Floor N/A 2,500 SF ND Joint Compound ND 09 Gypsum Wallboard and Main Sales Floor N/A RE;08 ND Joint Compound ND 10 Gypsum Wallboard and Main Sales Floor N/A RE:08 ND Joint Compound ND 12"x12" Off White/Grey Speckled Vinyl Storage/Office Tile: ND 11 Floor Tile with Area N/A 300 SF 10% Chrysotile Black Mastic on Concrete 12"x12" Off White/Grey Speckled Vinyl Storage/Office Tile: ND 12 Floor Tile with Area N/A RE:11 10% Chrysotile Black Mastic on Concrete 12"x12" Off White/Grey Speckled Vinyl Storage/Office Tile: ND 13 Floor Tile with Area N/A REJI ° Mastic: 10% Black Mastic on Concrete Chrysotile 14 2'x4' White Ceiling Panel with 2'x2' Main Sales Floor N/A 2,500 SF ND Desi and Fissure -Dot Pattern 15 2'x4' White Ceiling Panel with 2'x2' Main Sales Floor N/A RE: 14 ND Design and Fissure -Dot Pattern 16 2'x4' Ceiling Tile with Fissure -Dot Pattern Storage/Office N/A 300 SF ND Area SF - square feet,; LF = Linear Feet, N/A = Not Applicable, ND = None Detected (for asbestosl EPA NESHAP Category: RACM = Regulated ACM, Cat.I = Category I Non -friable ACM, Cat. 11= Category H Non-fiiable ACM, N/A = Not Applicable; Chrysotile = Chrysotile Asbestos, Bold type indicates regulated quantities of asbestos are present. Limited Asbestos Survey Payless ShoeSource #1824, 1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 APPENDIX B BULK SAMPLE ANALYSIS REPORT L7 C"rdnts1' ATC Shaping the Future ATC Shaping the Furore ANALYTICAL REPORT Prepared for: Cardno ATC -Seattle 6347 Seaview Avenue, NW Seattle, WA 98107 Project: Payless #1824 Order No.: 0018340 Report Date: 07/17/2014 Cardno ATC 8985 E. Nichols Avenue, Suite 350, Centennial, CO 80112 Ph: 303-799-6100 C� ATC Shaping the Future C� 8985 E. Nichols Avenue, Suite 350 Centennial, CO 80112 Phone +1303 799 6100 Fax +1303 799 3441 www.cardno.com www.cardnoatc.com PLM REPORT SUMMARY ALab Code 102031 Customer: 01 AlH L AIHA Lab Code 1015361536 Dan Fitzgibbons ATC Job No.: 035.90735.351C.2014.0001 Cardno ATC -Seattle Batch No.: 0018340 6347 Seaview Avenue, NW Report Date: 07/17/2014 Seattle WA 98107 Sample Date: 07/15/2014 Project: Payless #1824 Date Analyzed: 07/17/2014 Customer Project No.: Grout, Gray Identification: N/A Entryway Test Method: EPA Method 600/M4-82-020; 600/R-93/11 02 Page 1 of 4 Client No. Lab No. Sample Description / Location Asbestos Content 01 0018340-001 LAYER 1 None Detected Ceramic Tile, Gray, 23°C Entryway 01 0018340-001 LAYER 2 None Detected Grout, Gray Entryway 02 0018340-002 LAYER 1 None Detected Carpet Mastic, Green/ Yellow, 23°C Front of House 02 0018340-002 LAYER 2 Chrysotile 10% Residual Mastic, Black Front of House 03 0018340-003 Carpet Mastic, Green/ Yellow, 23°C None Detected Front of House 04 0018340-004 Carpet Mastic, Green/ Yellow, 23°C None Detected Front of House 05 0018340-005 LAYER 1 None Detected Cove Base, Black, 23°C Back of House 05 0018340-005 LAYER 2 None Detected Cove Base Mastic, Cream Back of House These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) — materials which are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Our laboratory utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full, and should not be used as a scope of work for abatement without consulting with Cardno ATC. 0 ATC Shaping the Future Customer: PLM REPORT SUMMARY Dan Fitzgibbons ATC Job No.: Cardno ATC -Seattle Batch No.: 6347 Seaview Avenue, NW Report Date: Seattle WA 98107 Sample Date: Project: Payless #1824 Date Analyzed: Customer Project No.: Identification: N/A Test Method: EPA Method 600/M4-82-020; 600/R-93/11 • 8985 E. Nichols Avenue, Suite 350 Page 2 of 4 Client No. Centennial, CO 80112 Sample Description / Location Phone +1303 799 6100 06 Fax +1303 799 3441 LAYER 1 www.cardno.com www.cardnoatc.com Cove Base, Black, 23°C NVLAP Lab Code 102031 AIHA Lab Code 101536 035.90735.351C.2014.0001 0018340 06 07/17/2014 LAYER 2 07/15/2014 07/17/2014 Cove Base Mastic, Cream Page 2 of 4 Client No. Lab No. Sample Description / Location Asbestos Content 06 0018340-006 LAYER 1 None Detected Cove Base, Black, 23°C Front of House 06 0018340-006 LAYER 2 None Detected Cove Base Mastic, Cream Front of House 07 0018340-007 LAYER 1 None Detected Cove Base, Black, 23°C Back of House 07 0018340-007 LAYER 2 None Detected Cove Base Mastic, Cream Back of House 08 0018340-008 LAYER 1 None Detected Joint Compound, Beige, 23°C Back of House 08 0018340-008 LAYER 2 None Detected Gypsum Board, Off White/ Brown Back of House 09 0018340-009 LAYER 1 None Detected Joint Compound, Beige, 23°C Back of House 09 0018340-009 LAYER 2 None Detected Gypsum Board, Off White/ Brown Back of House These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Our laboratory utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full, and should not be used as a scope of work for abatement without consulting with Cardno ATC. These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Our laboratory utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full, and should not be used as a scope of work for abatement without consulting with Cardno ATC. 8985 E. Nichols Avenue, Suite 350 AOS Centennial, CO 80112 Phone +1303 799 6100 ATC Fax +1303 799 3441 Shaping the Future www.cardno.com www.cardnoatc.com PLM REPORT SUMMARY NVLALab Code 102031 Customer: L AIHA Lab Code 1015361536 Dan Fitzgibbons ATC Job No.: 035.90735.351C.2014.0001 Cardno ATC -Seattle Batch No.: 0018340 6347 Seaview Avenue, NW Report Date: 07/17/2014 Seattle WA 98107 Sample Date: 07/15/2014 Project: Payless #1824 Date Analyzed: 07/17/2014 Customer Project No.: Identification: N/A Test Method: EPA Method 600/M4-82-020; 600/R-93/11 Page 3 of 4 Client No. Lab No. Sample Description / Location Asbestos Content 10 0018340-010 LAYER 1 None Detected Joint Compound, Beige, 23°C Front of House 10 0018340-010 LAYER 2 None Detected Gypsum Board, Off White/ Brown Front of House 11 0018340-011 LAYER 1 None Detected 12'x12" Floor Tile, Off White, 23°C Back of House 11 0018340-011 LAYER 2 Chrysotile 10% 12'x12" Floor Tile Mastic, Black Back of House 12 0018340-012 LAYER 1 None Detected 12'x12" Floor Tile, Off White, 23°C Back of House 12 0018340-012 LAYER 2 Chrysotile 10% 12'x12" Floor Tile Mastic, Black Back of House 13 0018340-013 LAYER 1 None Detected 12'x12" Floor Tile, Off White, 23°C Back of House 13 0018340-013 LAYER 2 Chrysotile 10% 12'x12" Floor Tile Mastic, Black Back of House These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Our laboratory utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full, and should not be used as a scope of work for abatement without consulting with Cardno ATC. • C"07) 11c4a wh 700 ATC Shaping the Future 0 8985 E. Nichols Avenue, Suite 350 Centennial, CO 80112 Phone +1303 799 6100 Fax +1303 799 3441 www.cardno.com www.cardnoatc.com Customer: PLM REPORT SUMMARY AHA ab C ded101 3631 Dan Fitzgibbons ATC Job No.: 035.90735.351C.2014.0001 Cardno ATC -Seattle Batch No.: 0018340 6347 Seaview Avenue, NW Report Date: 07/17/2014 Seattle WA 98107 Sample Date: 07/15/2014 Project: Payless #1824 Date Analyzed: 07/17/2014 Customer Project No.: Identification: N/A Test Method: EPA Method 600/M4-82-020; 600/R-93/11 Page 4 of 4 Client No. Lab No. Sample Description / Location Asbestos Content 14 0018340-014 2'x2' Ceiling Panel, White/ Beige, 23°C None Detected Front of House 15 0018340-015 2'x2' Ceiling Panel, White/ Beige, 23°C None Detected Front of House 16 0018340-016 2'x4' Ceiling Panel, White/ Lt. Gray, 23°C None Detected Back of House These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Our laboratory utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full, and should not be used as a scope of work for abatement without consulting with Cardno ATC. • ATC Shaping the Future Customer: Dan Fitzgibbons Cardno ATC -Seattle 6347 Seaview Avenue, NW Seattle WA 98107 Project: Payless #1824 Customer Project No.: Identification: N/A PLM REPORT SUMMARY Test Method: EPA Method 600/M4-82-020; 600/R-93/11 ATC Job No.: Batch No.: Report Date: Sample Date: Date Analyzed: 8985 E. Nichols Avenue, Suite 350 Centennial, CO 80112 Phone +1303 799 6100 Fax +1303 799 3441 www.cardno.com www.cardnoatc.com NVLAP Lab Code 102031 AIHA Lab Code 101536 035.90735.351C.2014.0001 0018340 07/17/2014 07/15/2014 07/17/2014 Page 1 of 1 PLM Analysis Methodology PLM samples were analyzed utilizing the Environmental Protection Agency's Test Method: Method for the Determination of Asbestos in Building Materials (EPA 600/R-93/116. July, 1993). Reporting Limit <11% Asbestos. Additional treatment and tests may be required to accurately define composition (i.e. ashing, extractions, acetone treatment, anclTEM). Unused portions of samples are archived for one year unless client requests special handling. Asbestos content of mastic/adhesive is separated from total percent asbestos and other materials. Laboratory Equipment Laboratory analysis was accomplished utilizing an Olympus BH -2 polarized light microscope. The microscope is equipped with dispersion staining lenses. Quality Control Cardno ATC is accredited by NVLAP Bulk Asbestos Sample Quality Assurance Program (Lab Code 102031). Cardno ATC participates in the NVLAP Bulk Asbestos Sample Quality Assurance Program and maintains an in-house QC/QA program for bulk samples whereby 10% of all submitted samples are reanalyzed and documented in a Quality Control Manual. Cardno ATC also participates in a quarterly round robin QC/QA program for bulk samples with several accredited laboratories throughout the United States. Current and past QC/QA program results are available in the laboratory for inspection. Laboratory Personnel Samples were analyzed by Jeff Lomme, Laboratory Director. Mr. Lomme is a professional geologist who has successfully completed the McCrone Institutes's "Advanced Asbestos Identification" Course. Approved Signatory Jeff Lomme NVLAP LAB CODE 102031-0 The non -detection of asbestos fibers in floor tile by PLM is of itself inconclusive. Confirmation by Transmission Electron Microscope (TEM) is recommended for negative floor tile samples. This report must not be used by the client to claim product endorsements by NVLAP or an agency of the U.S. government. This test reports only to the items stated. GCardno ATC Shaping the Future PROJECT INFORMATION Turnaround: 8985 E. Nichols Avenue, Suite 350 Centennial, Colorado 80112 www.cardnoatc.com 303.799.6100 F 203:799.34 f�3�� Same Day lei xte' '> 3-5 day i Com an y/Customer: Cardno ATC Project Name: 11!!Zleff Address: 6347 Seaview Ave. NW Collection Date: /S/ Address: Seattle, Washington 98107 Customer Number/P.O.: Phone/Fax: 206-781-1449 Collection Address: Customer Contact: Dan Fitzgibbons Special Instructions: BULK SAMPLE LOCATION Ace/ Sample Number Sample Material Re' See attached bulk sample to Sample Location Note: Sample collector is responsible for ensuring that all samples have been presen�ed and prepared to the appropriate and applicable methodology. If package has sustained damage during transit, notify collector and shipper. Turnaround time begins upon receipt of sample (s) by laboratory. XfC will not be responsible for errors or omissions in calculations from inaccuracy of original data. ATC PROJ: `-- DATE: PAZ.-OF2 LVA BULK &,..r3LE LOG AREAa� AREANAMF,/aEscwr�noN AREAS AREA NAu�EscwPTlol� OClATE3 INC Y 1 ON�G7 nbL& � I RIN 02 80REA LAOGfdG 03 BREECHNO NSULATION 04 9REECHM LAGGN3 05 CHOLER WULATION 06 CHILLER LAAMING 07 STORAGE TANKEXCHANGERNSL 08 STORAGE TAMMCHAm ALAGG 09 PUMP HOLISM INSULATION 10 PLIMP HOUSNG LAWzIN3 11 GASIO JRY 12 FLUE NSULATION 13 TRANSITS PIPE 14 PIPE FrMNG WSULATION 15 PIPE FITTING NSL LAGGING 16 PIPE RUN INSULATION 17 PPE RUN NSL LACGWG 18 PIASTER BRONR41SCRATCH COAT 19PLASTER FINISH COAT 20 PIASTE:RCOMPOSETE 21 WALLBOARD 22 JONTOOMPOLM 23 PAIMK)OATWG T- MATERAL CODES (SEE BELOW) Elm mm on IB9 24 SPRAY-APPLIEOACOUSTIC MATL 43 ROOFPLiCOMPOSRE 01�� FRMILj'[Y 26 ACOUSTIC PANEL (ROOFS 11 am 26 ACOUSTIC PAWL (2X2) 11��9091111 CAVITY 4 OCCASIONAL 1 NONFRL40LE 27 ACOUSTIC PANEL (2 X 45 ROCFNGSHr4ME 2 YECHANCAL. S CONTINUOUS 2 FRi4 W 26 ACOUSTIC TILE (12' X 12'► 46 ROWFiASHNG 10� 47 ROWNGFELT FOR LAB USE ONLY 30 ACOUSTIC TILE MASTIC mill 31RESILIENT FLOOR TRE 0r X Ir) 49 THEeAMAL IN�ATION 11111111111 32 RESLLfM FLOOR TXE (1T X 12.) 50 HEAT SHELD 33 FLOOR TMASTIC ILE 51 TAAPSITE SHEET MATT_ 34 RESIL@(TSHEETR.00RNO 52 MORfAFK*NXff 35 SHEET FLOORING MASTIC IN IN- 64 POWER LEAD INSULATION 37 BASEBOARD MASTIC 65 WALLPAPER 59 EXTEAIORSRIOOO AX 38 SPRAY,APPUEDFIREPFCOFNG 58 FABR0PROPE 11,11 39 HVAC FLEXIBLECOMECTOR67 WOODFLOORMASTC MASTIC 40 DUCT NSUTATIOH 66 FRE4iATE DANSURATED 111 41 DUCT HILUTON LAGGING DOOR CORE 62 On*RMSSCFUM 1113 1 1111 go�iiiii Nile 1111 m�mn nn=um� m�mn yen unn m �m n nmu nn Y 1 ON�G7 nbL& � I RIN 02 80REA LAOGfdG 03 BREECHNO NSULATION 04 9REECHM LAGGN3 05 CHOLER WULATION 06 CHILLER LAAMING 07 STORAGE TANKEXCHANGERNSL 08 STORAGE TAMMCHAm ALAGG 09 PUMP HOLISM INSULATION 10 PLIMP HOUSNG LAWzIN3 11 GASIO JRY 12 FLUE NSULATION 13 TRANSITS PIPE 14 PIPE FrMNG WSULATION 15 PIPE FITTING NSL LAGGING 16 PIPE RUN INSULATION 17 PPE RUN NSL LACGWG 18 PIASTER BRONR41SCRATCH COAT 19PLASTER FINISH COAT 20 PIASTE:RCOMPOSETE 21 WALLBOARD 22 JONTOOMPOLM 23 PAIMK)OATWG T- MATERAL CODES (SEE BELOW) USAGE r ---t 24 SPRAY-APPLIEOACOUSTIC MATL 43 ROOFPLiCOMPOSRE FRMILj'[Y 26 ACOUSTIC PANEL (ROOFS 1 VOIDJCHASEJ 3 STORAGE am 26 ACOUSTIC PAWL (2X2) 44 ROOFNGCAPsHEET CAVITY 4 OCCASIONAL 1 NONFRL40LE 27 ACOUSTIC PANEL (2 X 45 ROCFNGSHr4ME 2 YECHANCAL. S CONTINUOUS 2 FRi4 W 26 ACOUSTIC TILE (12' X 12'► 46 ROWFiASHNG 29 ACOUSTIC TILE (r X 21 47 ROWNGFELT FOR LAB USE ONLY 30 ACOUSTIC TILE MASTIC 48 ROOF 40 MASTIC 31RESILIENT FLOOR TRE 0r X Ir) 49 THEeAMAL IN�ATION 32 RESLLfM FLOOR TXE (1T X 12.) 50 HEAT SHELD 33 FLOOR TMASTIC ILE 51 TAAPSITE SHEET MATT_ 34 RESIL@(TSHEETR.00RNO 52 MORfAFK*NXff 35 SHEET FLOORING MASTIC 53 SMLNOEF4=TMATERIAL 36 BASEBOARD 64 POWER LEAD INSULATION 37 BASEBOARD MASTIC 65 WALLPAPER 59 EXTEAIORSRIOOO AX 38 SPRAY,APPUEDFIREPFCOFNG 58 FABR0PROPE 60 ROOFPETETRATION 39 HVAC FLEXIBLECOMECTOR67 WOODFLOORMASTC MASTIC 40 DUCT NSUTATIOH 66 FRE4iATE DANSURATED 61 CARPET MASTIC 41 DUCT HILUTON LAGGING DOOR CORE 62 On*RMSSCFUM 42 DUCT TAPE CAL AND MATERIALS PROFEMONALS NW - Seattle, WA 88107 G. PERCENTAGES CHRYBO TTIVE AMO TE TATE CAOCT QC. L11 I DAMAGE ARL40VEMENT ACCESSIBILITY a= =om am 1 N. E 1 NOWTOLAW 1 LOW 2 MNOR 2 MODERATE 2 mm 3 MAJOR 3 Hai WHITE - RETURN TO ATO WITH RESULTS (FUX COPY) YELLOW - LAB COPY PINK - ATC FIELD COPY' FEVISED 7/90 s 0 ATC PROJ: DATE:EEL.@ PAGE CLIENT. AREAS AREA NAME/DESCRIPTION AREA# AREA NAMEIDESCRI PROJECT EVALTR °F V BULK &, 4 I SLE LOG PTION ......... ,...ASSOCIATES INC. ENVIRONMENTAL, GEOTECHNICAL AND MATERIALS PROFESSIONALS 5347 Seaview Ave. NW . Seattle, WA 98107 POSA4EG. PERCENTAGES RYSOTLE 1 LOL Fr. P POSITNE QC. CRIER cSTpNATED S SOL N QUANTITY �0� 29 ACOUSTIC TILE (I- X 2) 47 ROCFNGFE•T 00111 09 PUMP HOUSIGNSULATION 30 ACOUSTIC TILE MASTIC 48 ROOFNGMASTIC :��, ��!1 t? 31 RESILIENT FLOOR TILE (Ir X r) tz0it'l b/" �OG4Ge 11 GASIEM 32 RESCIENT FLOOR TLE (12' X 12') 60 HEAT SHIELD d 12 FLIJE 14SULATION �" 51 TRANSITE SHEET MATT 13 TRANSITE PIPE �090��111 52 MORTKN6RCUT 14 PIPE FITTING INSULATION 36 SHAT FLOORING MASTIC 53 SINK UNDERCOAT MATERIAL �0� 29 ACOUSTIC TILE (I- X 2) 47 ROCFNGFE•T 00111 09 PUMP HOUSIGNSULATION 30 ACOUSTIC TILE MASTIC 48 ROOFNGMASTIC 10 PUMP H OUSNG IAOGNO 31 RESILIENT FLOOR TILE (Ir X r) II�B0�91111 11 GASIEM 32 RESCIENT FLOOR TLE (12' X 12') 60 HEAT SHIELD 12 FLIJE 14SULATION 33 FLOOR TILE MASTIC 51 TRANSITE SHEET MATT 13 TRANSITE PIPE �090��111 52 MORTKN6RCUT 14 PIPE FITTING INSULATION 36 SHAT FLOORING MASTIC 53 SINK UNDERCOAT MATERIAL 16 PIPE FITTING NSL LAGGING 36 BASEBOARD 54 POWER LEAD INSULATION 11099001111 j16 PIPE RUN NSULATIM 37 BASEBOARD MASTIC 65 WALLPAPER 50 EXTERIOR 6TUC00 I T U A 17 PIPE RUN NSLLAGGNO 38 SPRAY,APPLIEO?;V;i00FNG 60 FASRC/ROPE 80 HOOFPENETRATION 18 PIASTERBROMN6CRATpICOAT 30 HVAC FE)COLECONNECTOR 19� MASTIC 99 PLASTER FNISHCOAT 019 58 FIRE44ATEDfINSULATED 81 CARPE'TMASTIC DIRECTORS 20 PIASTER COMPOSITE 11�� DOOR CORE 62 OTHER (OESOME) II�INI11111 42 DUCTTAPE 22 .IOINTOOMPOU D 23 PAINTIOOATM WHITE - RETURN TO ATC WITH RESULTS (FILE COPY) YELLOW - LAB COPY PINK - ATC FIELD Copy' REVISED 7x90 1�� 19� 1��!�� 11117111111 �0��0�1� II�DAD01111 I��Oa��n nuuunn �os��o�n un�um� �'aa�v�n_ a111 R navo�am� nnin�nn 11 .............. .......... ILLLLlijj .11 1 1 1 1 1 01 Eoa ai rnt,tAwTgN * L MATERIAL CODES (SEE BELOW) 4 02 SOLER LJLOONO L AREA USAGE 1 -� • 03 SPAMO WO INSULATION 24 SPRAY -APPLIED A000STICMATL 43 ROOFING COMPOSITE � FRIABL17Y DAMAGE AIR MOVEMENT ACCESSIBILITY 04 SREECNHNOLJKiGNG 26 ACOUSTICPAPEL (ROOFCUT) 1 VOID/CHASE7 3 SMAGE mm � ,� I OS CHILLER INSULATION 28 ACOUSTIC PANEL.(2X2) 44 ROCFHGCAPSHEET CAVITY 4 OCCASIONAL 1 NNONFRASLE i NCAE I NONETOLOW 1 LOW 06 CHs18i LAGGING 27 ACOUSTIC PANEL (2' K 41 45 ROOFNGSNHIMSLE 2 MECHANICAL 5 CONTINUOUS 2 FRL48LE 2 MINOR 2 M�tATE 2 LION 07 STORAGE TANKJEXCHANIGER IASL 28 ACOUSTIC TILE (12' X 121 48 ROOF FLASHING 3 MAJOR 3 HIGH 08 STORAGE TAN VE7CKV43M LA03 29 ACOUSTIC TILE (I- X 2) 47 ROCFNGFE•T FOR LAS USE ONLY 09 PUMP HOUSIGNSULATION 30 ACOUSTIC TILE MASTIC 48 ROOFNGMASTIC 10 PUMP H OUSNG IAOGNO 31 RESILIENT FLOOR TILE (Ir X r) 49 THERMAL INSULATION 11 GASIEM 32 RESCIENT FLOOR TLE (12' X 12') 60 HEAT SHIELD 12 FLIJE 14SULATION 33 FLOOR TILE MASTIC 51 TRANSITE SHEET MATT 13 TRANSITE PIPE 34 AESIL1ENTS►EETFLOORNO 52 MORTKN6RCUT 14 PIPE FITTING INSULATION 36 SHAT FLOORING MASTIC 53 SINK UNDERCOAT MATERIAL 16 PIPE FITTING NSL LAGGING 36 BASEBOARD 54 POWER LEAD INSULATION j16 PIPE RUN NSULATIM 37 BASEBOARD MASTIC 65 WALLPAPER 50 EXTERIOR 6TUC00 I T U A 17 PIPE RUN NSLLAGGNO 38 SPRAY,APPLIEO?;V;i00FNG 60 FASRC/ROPE 80 HOOFPENETRATION 18 PIASTERBROMN6CRATpICOAT 30 HVAC FE)COLECONNECTOR 67 WOODFLOORMASTIC MASTIC 99 PLASTER FNISHCOAT 40 DUCT INSULATION 58 FIRE44ATEDfINSULATED 81 CARPE'TMASTIC DIRECTORS 20 PIASTER COMPOSITE 41 DUCT INSULATION LAGGING DOOR CORE 62 OTHER (OESOME) 2/ WALLBOARD 42 DUCTTAPE 22 .IOINTOOMPOU D 23 PAINTIOOATM WHITE - RETURN TO ATC WITH RESULTS (FILE COPY) YELLOW - LAB COPY PINK - ATC FIELD Copy' REVISED 7x90 • ATC Shaping the Future Dan Fitzgibbons Cardno ATC -Seattle 6347 Seaview Avenue, NW Seattle WA 98107 Collected: 07/15/2014 Collected By: Mark Newman Collection Address: Customer Project No.: Description: Payless #1824 Date Received: 07/16/2014 Date Analyzed: 07/17/2014 Date Reported: 07/17/2014 Comments: 30% BATCH NO. 0018340 NVLAP Lab Code 102031 AIHA Lab Code 101536 Asbestos Non -Asbestos Lab ID Sample Location / Constituents Constituents Sample # Sample Description N N 0018340-001 Entryway None Detected Cellulose Fiber (Incom) 10% 01 LAYER 1 Aggregate 30% 04 Ceramic Tile, Gray, 23°C Non -Fibrous Material 70% None Detected Cellulose Fiber (Incom) <11% LAYER 2 Aggregate 60% 0018340-005 Grout, Gray None Detected Binder/Filler 39% 0018340-002 Front of House None Detected Cellulose Fiber (Incom) 5% Cove Base, Black, 23°C Synthetic Fiber (Bie) 15% 02 LAYER 1 None Detected Aggregate 10% Carpet Mastic, Green/ Yellow, 23°C Carbonates 70% Cove Base Mastic, Cream Chrysotile 10% Cellulose Fiber (Incom) 10% Analyzed by: LAYER 2 OBSERVATION SET#1: Aggregate 15% Residual Mastic, Black Wavy Fibers Tar Binder 65% Sign of Elongation (+) Parallel Extinction Non -Pleochroic @ 40x Birefringence (Low) Color: Clear Becke Line Used Initial Characterization: Chrysotile OS#1: Para.=1.554, Perp.=1.549 0018340-003 Front of House None Detected Cellulose Fiber (Incom) 10% Synthetic Fiber (Bie) 15% 03 Carpet Mastic, Green/ Yellow, 23°C Aggregate 15% Binder/Filler 60% 0018340-004 Front of House None Detected Cellulose Fiber (Incom) 10% Synthetic Fiber (Bie) 15% 04 Carpet Mastic, Green/ Yellow, 23°C Aggregate 15% Binder/Filler 60% 0018340-005 Back of House None Detected 05 LAYER 1 Carbonates 25% Cove Base, Black, 23°C Non -Fibrous Material 75% None Detected Cellulose Fiber (Incom) 10% LAYER 2 Binder/Filler 90% Cove Base Mastic, Cream Analyzed by: Reviewed by: Page 1 of 4 0 ATC Shaping the Future Dan Fitzgibbons Cardno ATC -Seattle 6347 Seaview Avenue, NW Seattle WA 98107 Collected: 07/15/2014 Collected By: Mark Newman Collection Address: • Customer Project No.: Description: Payless #1824 Date Received: 07/16/2014 Date Analyzed: 07/17/2014 Date Reported: 07/17/2014 Comments: 25% BATCH NO. 0018340 NVLAP Lab Code 102031 AIHA Lab Code 101536 Asbestos Non -Asbestos Lab ID Sample Location / Constituents Constituents Sample # Sample Description N N 0018340-006 Front of House 06 LAYER 1 Cove Base, Black, 23°C LAYER 2 Cove Base Mastic, Cream None Detected Carbonates 25% Non -Fibrous Material 75% None Detected Cellulose Fiber (Incom) 10% Binder/Filler 90% 0018340-007 Back of House None Detected 45% Binder/Filler 07 LAYER 1 30% Carbonates 25% Gypsum Cove Base, Black, 23°C Non -Fibrous Material 75% None Detected Cellulose Fiber (Incom) 10% LAYER 2 Binder/Filler 90% Cove Base Mastic, Cream 0018340-008 Back of House None Detected Cellulose Fiber (Incom) 10% 08 LAYER 1 Carbonates 45% Joint Compound, Beige, 23°C Binder/Filler 45% None Detected Cellulose Fiber (Incom) 30% Fibrous Glass (ISO) 5% LAYER 2 Gypsum 65% Gypsum Board, Off White/ Brown 0018340-009 Back of House 09 LAYER 1 Joint Compound, Beige, 23°C LAYER 2 Gypsum Board, Off White/ Brown 0018340-010 Front of House 10 LAYER 1 Joint Compound, Beige, 23°C LAYER 2 Gypsum Board, Off White/ Brown None Detected Cellulose Fiber (Incom) 10% Carbonates 45% Binder/Filler 45% None Detected Cellulose Fiber (Incom) 30% Fibrous Glass (ISO) 5% Gypsum 65% None Detected Cellulose Fiber (Incom) 10% Carbonates 45% Binder/Filler 45% None Detected Cellulose Fiber (Incom) 30% Fibrous Glass (ISO) 5% Gypsum 65% Analyzed by: Reviewed by: Page 2 of 4 0 ATC Shaping the Future Dan Fitzgibbons Cardno ATC -Seattle 6347 Seaview Avenue, NW Seattle WA 98107 Collected: 07/15/2014 Collected By: Mark Newman Collection Address: Customer Project No.: Description: Payless #1824 Date Received: 07/16/2014 Date Analyzed: 07/17/2014 Date Reported: 07/17/2014 Comments: Sample Description BATCH NO. 0018340 NVLAP Lab Code 102031 AIHA Lab Code 101536 LAYER 2 12"x12" Floor Tile Mastic, Black Chrysotile 10% OBSERVATION SET#1: Wavy Fibers Sign of Elongation (+) Parallel Extinction Non -Pleochroic @ 40x Birefringence (Low) Color: Clear Becke Line Used Initial Characterization: Chrysotile OS#1: Para.=1.554, Perp.=1.549 Cellulose Fiber (Incom) 10% Aggregate 15% Tar Binder 65% Analyzed by: Reviewed by: Page 3 of 4 Chrysotile 10% Asbestos Non -Asbestos Lab ID Sample Location / Constituents Constituents Sample # Sample Description N 65% 0018340-011 Back of House None Detected 11 LAYER 1 Carbonates 65% 12"x12" Floor Tile, Off White, 23°C Binder/Filler 35% LAYER 2 12"x12" Floor Tile Mastic, Black Chrysotile 10% OBSERVATION SET#1: Wavy Fibers Sign of Elongation (+) Parallel Extinction Non -Pleochroic @ 40x Birefringence (Low) Color: Clear Becke Line Used Initial Characterization: Chrysotile OS#1: Para.=1.554, Perp.=1.549 Cellulose Fiber (Incom) 10% Aggregate 15% Tar Binder 65% Analyzed by: Reviewed by: Page 3 of 4 Chrysotile 10% Cellulose Fiber (Incom) 10% LAYER 2 OBSERVATION SET#1: Aggregate 15% 12"x12" Floor Tile Mastic, Black Wavy Fibers Tar Binder 65% Sign of Elongation (+) Parallel Extinction Non -Pleochroic @ 40x Birefringence (Low) Color: Clear Becke Line Used Initial Characterization: Chrysotile OS#1: Para.=1.554, Perp.=1.549 0018340-012 Back of House None Detected 12 LAYER 1 Carbonates 65% 12"x12" Floor Tile, Off White, 23°C Binder/Filler 35% LAYER 2 12"x12" Floor Tile Mastic, Black Chrysotile 10% OBSERVATION SET#1: Wavy Fibers Sign of Elongation (+) Parallel Extinction Non -Pleochroic @ 40x Birefringence (Low) Color: Clear Becke Line Used Initial Characterization: Chrysotile OS#1: Para.=1.554, Perp.=1.549 Cellulose Fiber (Incom) 10% Aggregate 15% Tar Binder 65% Analyzed by: Reviewed by: Page 3 of 4 0018340-015 Front of House None Detected Cellulose Fiber (Incom) 25% Fibrous Glass (ISO) 45% 15 2'x2' Ceiling Panel, White/ Beige, 23°C Organic Matrix 15% Pedite 15% 0018340-016 Back of House None Detected Cellulose Fiber (Incom) 30% Fibrous Glass (ISO) 40% 16 2'x4' Ceiling Panel, White/ Lt. Gray, 23°C Organic Matrix 15% Pedite 15% Analyzed by: Reviewed by: Page 4 of 4 • BATCH NO. . � r-dno" 0018340 ATC NVLAP Lab Code 102031 Shaping the Future AIHA Lab Code 101536 Dan Fitzgibbons Customer Project No.: Cardno ATC -Seattle Description: Payless #1824 6347 Seaview Avenue, NW Date Received: 07/16/2014 Seattle WA 98107 Date Analyzed: 07/17/2014 Collected: 07/15/2014 Date Reported: 07/17/2014 Collected By: Mark Newman Comments: Collection Address: Asbestos Non -Asbestos Lab ID Sample Location / Constituents Constituents Sample # Sample Description N N 0018340-013 Back of House None Detected 13 LAYER 1 Carbonates 65% 12"x12" Floor Tile, Off White, 23°C Binder/Filler 35% Chrysotile 10% Cellulose Fiber (Incom) 10% LAYER 2 OBSERVATION SET#1: Aggregate 15% 12"x12" Floor Tile Mastic, Black Wavy Fibers Tar Binder 65% Sign of Elongation (+) Parallel Extinction Non -Pleochroic @ 40x Birefringence (Low) Color: Clear Backe Line Used Initial Characterization: Chrysotile OS#1: Para.=1.554, Perp.=1.549 0018340-014 Front of House None Detected Cellulose Fiber (Incom) 25% Fibrous Glass (ISO) 45% 14 2'x2' Ceiling Panel, White/ Beige, 23°C Organic Matrix 15% Pedite 15% 0018340-015 Front of House None Detected Cellulose Fiber (Incom) 25% Fibrous Glass (ISO) 45% 15 2'x2' Ceiling Panel, White/ Beige, 23°C Organic Matrix 15% Pedite 15% 0018340-016 Back of House None Detected Cellulose Fiber (Incom) 30% Fibrous Glass (ISO) 40% 16 2'x4' Ceiling Panel, White/ Lt. Gray, 23°C Organic Matrix 15% Pedite 15% Analyzed by: Reviewed by: Page 4 of 4 s Limited Asbestos Survey Payless ShoeSource #1824,1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 APPENDIX C SAMPLE LOCATION FLOOR PLAN Cnr "Awo ATC Shaping the future 0 16 07 M 13 15 04 10 • LEGEND 01 Suspect Bulk Asbestos Sample Location J6347 Seaview Avenue NW ATC Seattle, WA 98107 8.1:"i.0 (206) 781-1449 PROJECT NO.: 29.38586.0328 DESIGNED BY: DF SCALE: NTS DRAWN BY: MN DATE: 07/2014 FILE: FIGURE 1 11 05 08 12 02 14 03 01 0 FIGURE 1 SAMPLE LOCATIONS Payless ShoeSource #1824 The Commons at Federal Shopping Center 1812 South Seatac Mall Federal Way, Washington 98003 CJ Limited Asbestos Survey Payless ShoeSource #1824,1812 S. SeaTac Mall, Federal Way, WA Cardno ATC Project Number: 29.38586.0328 APPENDIX D INSPECTOR AND LABORATORY ACCREDITATIONS Car- "4711 ATC Shaping the Future • i ® �Q10NSOF0 04"9 National Voluntary U� V CrJ Laboratory Accreditation Program *Nlreq Olta SCOPE OF ACCREDITATION TO ISO/IEC 17025:2005 Cardno ATC 8985 E. Nichols Avenue, Suite 350 Centennial, CO 80112 Mr. Jeffrey Lomme Phone: 303-799-6100 Fax: 303-799-3441 E -Mail jefflomme@cardno.com BULK ASBESTOS FIBER ANALYSIS (PLM) N'VLAP LAB CODE 102031-0 1WLAP Code Designation /Description 18/AO I' EPA 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600/R=93/116: Method for the Determination of Asbestos in Bulk Building Materials 2014-07-01 through 2015-06-30 Effective dates Page 1 of 1 4-u- V. Q0.0 For the National Institute of Standards and Technology NVIAP-01S (REV. 2005-05-19) United States Department of Commerce National Institute of Standards and Technology Q Certificate of Accreditation to ISO/IEC 17025:2005 NVLAP LAB CODE: 102031-0 Cardno ATC Centennial, CO is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for: BULK ASBESTOS FIBER ANALYSIS This laboratory is accredited in accordance with the recognized Intemational Standard ISO/IEC 17025:2005. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint ISO-ILAC-IAF Communique dated January 2009). OF 2014-07-01 through 2015-06-30 Effective dates y�`Oo �� For the National Institute of Standards and Technology aT*iES Q4 p NVLAP-01C (REV, El 0 ft Certt'f trate of Complett'on This is to certify that Mark L. Newman has satisfactorily completed 4 hours of refresher training as an Asbestos Building Inspector to comply with the training requirements of TSCA Title II / 40 CFR 763 (AHERA) If AMOL.--, - Instructor EPA Provider Cert. Number: 1085 145335 Certificate Number D C1 W AF TRAINING -CONSULTING C7 Jan 22, 2014 Date(s) of Training Exam Score: NA Expiration Date: Jan 22, 2015 Argus Pacific, Inc. • 1900 W. Nickerson, Suite 315 • Seattle, Washington • 98119 - 206.285.3373 • fax 206.285.3927 40 LI