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14-104565 ' , Demolition City of Federal Way Community&Econ.Dev.Services Permit #: 14-104565-00-DE 33325 8th Ave S Federal Way,WA 98003 Inspection e Request Ph:(253)835-2607 Fax:(253)835-2609 lnS p Line: (253)835-3050 Project Name: PACIFIC HWY BUILDING DEMOLITION Project Address: 28866 PACIFIC HWY S Parcel Number: 042104 9242 Project Description: Demolition of signle family residence with associated commercial use and detached garage. Owner Applicant Contractor CITY OF FEDERAL WAY-PW/SWM TONY DOUCETTE R L CLEARING&EXCAVATING 33325 8TH AVE S CITY OF FEDERAL WAY-PUBLIC WORKS- RLCLEEI097N2(5/2/16) FEDERAL WAY WA 98003 SWM PO BOX 4203 33325 8TH AVE S FEDERAL WAY WA 98063 FEDERAL WAY WA 98003 Additional Permit Information Demolition Valuation 500 PERMIT EXPIRES Wednesday, September 7, 2016 Permit Issued on Monday, September 8, 2014 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. 0 "°Owner or agent: i� + Date: /uyi e.°, 4111........ ' THIS CARD IS TO 'MAIN ON-SITE CITY OF Construction In ection Record Federal Way INSPECTION REQUE TS: (253)835-3050 PERMIT#: 14-104565-00-DE Address: 28866 PACIFIC HWY S Project: CITY OF FEDERAL WAY - PW/SWR FEDERAL WAY, WA 98003-3802 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. 0 Final-Building(4050) Approved 'B C� Dates z6, 7/ El Rough Electrical Final Electrical Right of Way Approved Approved Approved By Date By Date By Date RECEIVED CITU OF SEP 0014 PERMITSPPLICATION Federal Way t`, CITY OF FEDERAL WAY / CDS PERMIT NUMBER / L/ if S _62 5 - TARGET DATE "' x SITE ADDRESS 111 SUITE/UNIT 11 2gg66 Afl c ihai4✓Jty ,ksmr, a4 wa ?1o03 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL - - o � � o � - 9 z i z TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL L`7 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT Aufic *iltilfr BufL /e'& ?sgNezrno^/ 1>6,404-mod AVP hIKW,t AC f Via-AR/47 114416-ihr ureD (aAmovec AL S4Ac£ PROJECT DESCRIPTION Detailed description of work to ,4r/Z .?;4677(4051) € 44111E intielnb( be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER Orr g k>156t. MAILING ADDRESS 333/4-- elf'Avo✓yc--Sa , CITY STATE ZIP > -4/4,1 pSoo3 NAME 4.L• CG7fn/G +- EXCA✓ nni(� a(c. (;523)135--igloo //.0. LIND,^ GA,,�DDRESS E-MAIL CONTRACTOR Y•0' n /OS CITY- STATE ZIP FAX 4/4 Yra W-M‘6 WA STATE CONTRACTOR'S LICENSE# .T W AT,WAY RUMNESS LICENSE EXPIRATION DATE FF E101IA/2 _ 05" /02 /,f0/6 t�S'`/(1 kf")'3- NAME _ P I Y PHONE Gry of kvailL 6✓Ay—/4uc iia4-i SG/M iw, ion✓ 835-X 753 APPLICANT MAILING ADDRESS E-MAI 33,z-s' � 11%/Wi "Soceni CITY STATE ZIP FAX 1L- �' wit &'003 NAME PJtIMARY PHONE PROJECT CONTACT -Ny 2 cE776- ?j3) '35- (The individual to receive and MAILING ADDRESS { s A. -MAIL respond to all correspondence 33.25 15 7- /ovaC 5ocen/ fid!Nt1GC17t @ eiryolk)e4WleT.(AAAI concerning this application) CITY STATE ZIP FAX } o - dAi' uA f'8p03 _ - - NAME PROJECT FINANCING [j OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW 19.27.095) I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. `� 4./4. SIGNATURE: ,_,/OP DATE 00`I/'10/y PRINT NAME: �sA/Y baGfC77L� Bulletin#100—January 1,2013 Page 1 of 3 k:AI-Iandouts\PermitApplication • 4' I RECEIVED 41/4 COMMUNITY&ECONOMIC DEVELOPMENT DEPARTMENT SEP 0 4 204 33325 8`h Avenue South Federal Way,WA 98003-6325 CITY OF 253-835-2607:Fax 253-835-2609 Federal Way CITY OFCDS FEDERAL WAY DEMOLITION PERMIT REQUIREMENTS t-VODY2_-- 2 �o t-- /2_6( 60 Pi ( lAW."-{ (S. A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and submittal of an environmental checklist may be required,which will extend the time period before a demolition permit can be issued. 0 Prior to submitting a demolition permit,the following items(as applicable)must be signed by the respective agency(see attached Demolition Permit Contact List). NOTE TO APPLICANT• Utilities shall be disconnected and services performed, if applicable,prior to issuance of the demolition permit.All applicable items below are to be signed and dated by the respective agency representatives. 1.ASBESTOS ABATEMENT 6. ELECTRICITY ' (Copy of approval form and asbestos survey from Puget Sound Clean Air (EI to beshut off a e r e ve ) p itAgncy provided) CI-4f t (7 IJ/`/�t (Puget Sound Energy) (City of Federal Way Building Official) 2.GAS SUPPLY 7.FUEL STORAGE TANKS (Gas to be shut off,meter removed and final bill paid) (Above or below grade fuel tanks, have been pumped or removed ,S Anifcfi& ow*,.-a4rel> Sly under Fire Depal lment permit prior to n dismantle/excavation) (Puget Sound nergy) $a-xnfe,/I ovM . $a of (South King Fire nd Rescue) 3.SEPTIC SYSTEM 8.WATER-Public Source (Check applicable box) (Tank to be removed or tank to be drained and filled) o Meter to be removed and final utility bill paid r rftl ter to remain and be protected 4, $e - ,Ors (534.rws6- lezea 24E2> >VOS�l/ Z4,449...---- l�W LLI RA\Er� iLt-rk( �[s-[. ( ing County Environmental Services) (Water Supplier) 914114 ******OR****** 4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box) Sewer line capped at property line — KO b(t.)G o Private well filled and capped o Existing sewer line to remain and be used by proposed new structure o Private well to be used for other purposes /1 LP E tf je0 L&mu-til -b(Vt. 5CC Amtaa Aviv c--gam rci' a O��ory (Lakehaven Utility District) 9 1,404 (King County Environmental Services) 5.GARBAGE (All household garbage disposed off and fiinal bill paid) .i E 14il,9C&I ptt.9it-x+41' D S/Z /2o/3 (Waste Management/Other Company) ❑ Completed Construction Permit Application form ❑Provide the following fees: 1. Demolition Permit Fee Based on valuation.See table on pg 4 of the construction permit application. 2.Automation Fee $20.00 3.WA State Surcharge $4.50 Bulletin#122—February 14,2013 Page 1 of 1 k:\Handouts\Demolition Permit Requirements Sk57715 Rifrt714( 11/4.€11"°1‘j pscleana r.org Puget Sound Agency, Notification Case #: 201403369 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III,4.03(a)(6)). Fee Amount Paid $275.00 Credit Card Transaction # VPEFB18AEEA7 Transaction Date 08/27/14 Owner's Name City of Federal Way Phone (253)835-2753 Project Street Address 28866 Pacific Highway South City Federal Way Zip 98003 Contact Person Tony Doucette Phone (253)835-2753 Mailing Address 33325 8th Ave S Federal Way,WA98003 This project includes asbestos removal. Project Size linear feet / 1100 square feet Project Start Date 09/08/14 Completion Date 03/08/15 Asbestos will be removed by a licensed asbestos abatement contractor Contractor F.S. &GS.Services Inc. Contractor Job# 14204 Contact Charlie lobe Phone (253) 548-1011 Mailing Address 16214 57th Ave East Ste A Puyallup,WA98375 This project includes a demolition. Demolition Start Date 09/10/14 Completion Date 03/10/15 Demolition will be completed by a demolition contractor Demo Contractor R.L. Clearing &Excavating Contractor Job # N/A Contact Pamela Linderkamp Phone (253) 735-1800 Mailing Address P.O. Box 1046 Auburn,WA98071-1046 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed.The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. • "je. Tony Doucette From: Jackson, Alfred Infrasource <Alfred.Jackson@pse.com> Sent: Thursday, August 28, 2014 11:19 AM To: �� 54691/Tony Doucette Subject: RE: 28866 Pacific HWY S &22850 Pacific HWY S I Alfred Jackson confirmed that the gas service at 28866 and 22850 Pacific HWY has been Cut& Cap Alfred Jackson I Project Coordinator- New Customer Construction I InfraSource Services, LLC 111705 83rd AVE SW, Lakewood,WA 98498 I (0) 253-617-6025 I Cell 253-380-7742 From: Tony Doucette jmailto:Tonv.Doucette@ citvoffederalway.coml Sent: Thursday, August 28, 2014 11:17 AM To: Jackson, Alfred - Infrasource Subject: RE: 28866 Pacific HWY S &22850 Pacific HWY S Hi Alfred, I spoke with your guys yesterday afternoon confirming that they had cut and capped both gas services to 28866 Pacific Highway south. Are you able to provide a confirmation email that I can use for documentation with our demo permit, or should I contact PSE? The demo permit documentation form I have to populate is attached. Thanks, Tony From: Jackson, Alfred - Infrasource [mailto:Alfred.Jackson(alpse.com] Sent: Friday, August 15, 2014 8:03 AM To: Tony Doucette Subject: RE: 28866 Pacific HWY S &22850 Pacific HWY S Hello Tony I have both cut and cap I will go ahead and process this order the cut and cap will be at the property line on both If you have any question please let me know Alfred Jackson I Project Coordinator-New Customer Construction I InfraSource Services, LLC 111705 83rd AVE SW, Lakewood,WA 98498 I (0)253-617-6025 'Cell 253-380-7742 From: Tony Doucette[mailto:Tony.Doucette©cityoffederalway.coml Sent: Wednesday,August 13, 2014 2:57 PM To: Jackson, Alfred - Infrasource Subject: RE: 28866 Pacific HWY S &22850 Pacific HWY S Hi Alfred, This is Tony Doucette from the City of Federal Way—we spoke on the phone earlier this afternoon. Below is my contact information. I am trying to contact PSE now, but in the meantime, I would appreciate if you could check your records to see if the gas connection has already been capped. I'll be in touch as soon as I hear more from PSE. Thanks, 1 Tony Doucette, P.E. SWM Engineer City of Federal Way 33325 8th Avenue South Federal Way,WA 98003 P: (253)835-2753 tong.doucette@ cityoffederalway.cam From: Jeff Wolf Sent: Tuesday, May 28, 2013 9:08 AM To: 'Jackson, Alfred - Infrasource' Subject: RE: 28866 Pacific HWY S &22850 Pacific HWY S Thanks Alfred.We will send an email. From: Jackson, Alfred - Infrasource Lmailto:Alfred.Jackson@pse.coml Sent: Tuesday, May 28, 2013 9:00 AM To: Jeff Wolf Subject: 28866 Pacific HWY S &22850 Pacific HWY S Hey Mr.Wolf here is my contact information so when you are ready to go forward with the project email me or call me. Thanks Alfred Jackson I Project Coordinator-New Customer Construction I InfraSource Services, LLC I 11705 83rd AVE SW, Lakewood,WA 98498 I (0) 253-617-6025 'Cell 253-380-7742 Alfred.Jackson@pse.com 2 • ANG Coorr7 -- 4. f kieu_s From: Tony Doucette <Tony.Doucette@cityoffederalway.com> Sent: Friday, August 22, 2014 4:01 PM To: PH EHS Septic, Help Subject: RE:As-built request for parcel 0421049242 Attachments: Bulletin 122 Demo Sign Off Form.pdf Hello, I am just following up on the request referenced below. I received an automatic response saying I would receive a response within five days and I wanted to check on the status. Please let me know if you need any additional information to complete the request. I need to get the`attached form signed indicating that septic systems and/or wells have been properly removed/abandoned if there were any on the property. Thanks, `t CoTony Doucette, P.E. 0��� 1111 gc—e SWM Engineer 4C41 `z^ y_ City of Federal Way � � AUG 2 1 33325 8th Avenue South Federal Way, WA 98003 't P 4s t. P: 253) 835-2753 �y� (Zi` Q u rs^ n tory.doucette@cityoffederalway.com k 5 na From: Tony Doucette Sent: Wednesday, August 13, 2014 9:52 AM To: `as-built.help@kingcounty.gov' Subject: As-built request for parcel 0421049242 Good morning, The City of Federal Way owns the parcel 0421049242 at 28866 Pacific Highway South and intends to demolish the buildings onsite. As part of the demolition permit, we need to verify that any septic tank has been removed or drained and filled, and that any wells have been filled and capped. I did not find results on the online drawing search and hope to receive confirmation that no septic tanks or wells exist onsite. Water and sewer to the property is currently provided by Lakehaven Utility District and I am trying to verify the status of any possible tanks or wells prior to connections with Lakehaven. We request your review of files for drawings and information about septic tanks and wells at the site. Please let me know if you need any additional information to search for records. Thanks, Tony Doucette, P.E. SWM Engineer City of Federal Way 33325 8th Avenue South Federal Way,WA 98003 P: (253) 835-2753 tony.doucette@cityoffedera lway.com ! C °✓ 1 • LA HAVEN UTILITY DISJCT SEWER SERVICE CONNECTION PERMIT SERVICE NO.1 4824 STATUS I APPLICATION PERMIT NO.I 27186 APPLICATION DATE 9/3/2014 SUPERSEDES I 8898 STUB SIZE 16 in. STUB INSTALL DATE STUB TYPE'GRAVITY STUB INSTALLED BY I STUB MATERIAL I ISSUED DATE ROUTE 0280 SERVICE House# Street Name Suite ID City State Zip Cod ADDRESS 28866 !PACIFIC HWY S FEDERAL WAY WA 98003-3802 LOT#(S) BLOCK#(S) PLAT/BSP/BLA TAX PARCEL NO. 0421049242 GRID IK-05 OWNER 'CITY OF FEDERAL WAY PHONE 1(253)835-2700 ext. BILLING House# Street Name Suite ID City State Zip Cod ADDRESS 33325 18TH AVE S (FEDERAL WAY 77178777- CONTRACTOR A 98003CONTRACTOR lR.L. CLEARING&EXCAVATING INC PHONE J(253)735-1800 ext. AUTHORIZED CONTRACTOR I PHONE I ext. CLASSIFICATION !RESIDENTIAL NUMBER OF UNITS E7 SIC 1-77 ERU CREDITS 0.91 TREATMENT PLANT 'REDONDO PUMP STATIONS r- [' SEWER ULII) SVC TYPE DISCONNECT TMP SWR SVC ❑ PRIVATE PUMP ❑ CHK VALVE REQ ❑ GRINDER PUMP MAKE I GRINDER PUMP MODEL I SPECIAL CONDITIONS 'DISCONNECTING RESIDENTIAL&COMMERCIAL STRUCTURES FEES AND CHARGES: CPILOE I $0.00 CFC I $0.00 AREA CHARGE I $0.00 CIC I $0.00 SEWER SERVICE CONNECTION PERMIT I $230.00 LPS STUB INSTALLATION DEPOSIT I $0.00 STUB FEE I $0.00 RIGHT-OF-WAY PERMIT I $0.00 RIGHT-OF-WAY PERMIT I $0.00 SERVICE CONNECTION AGREEMENT CHARGES I $0.00 SYSTEM DEVELOPMENT CHARGE I $0.00 DATE PAID TOTAL $230.00 RECEIPT# .333 — r IN PLACE PIPE TEST: I HEREBY CERTIFY THAT TESTING HAS BEEN WATER EXFILIRATION APPROVED AND THE ABOVE CONNECTION HAS BEEN NO TEST MADE AS SHOWN ON THE ATTACHED SITE PLAN. BOOK/PAGE NUMBER BY DATE • • LAKEHAVEN UTILITY DISTRICT SEWER SERVICE CONNECTION REGULATIONS AND REQUIREMENTS The undersigned hereby applies to construct a building sewer/side sewer subject to the following conditions: 1. Owner and Contractor acknowledge that they have read the regulations and requirements set forth herein and agree to fully and completely comply with all such regulations and requirements in their entirety, including the requirements set forth in the District's"Sewer Use Rules"and"Side Sewer Resolution", incorporated herein by this reference,and any amendments thereto. 2. Owner hereby agrees to maintain the building sewer/side sewer constructed under this permit in accordance with the rules and regulations of the District and further will permit access,with entry,by authorized representatives of the District, on the property described in this permit, at any reasonable time, for purpose of inspection of the building sewer/side sewer for compliance with all District regulations. 3. To properly identify and locate existing utilities, and in accordance with State law,the contractor shall request utility locates not less than two(2),and nor more than ten(10),business days before excavation,except for emergencies,by calling 811. 4. The Owner is hereby notified that the District's sewerage system is of the sanitary type and agrees that they will not at any time connect, or allow discharge of, storm drainage from any source to the District's system. This includes, but is not limited to,the following: • Roof downspouts. • Building footing drains/sump pump discharges. • Springs on the property. • Any outside groundwater drains. 5. Owner and Contractor hereby agree to accept full responsibility and to hold the District harmless for any liability, damage and/or costs which may accrue from prosecution of building sewer/side sewer work under this permit and acknowledge that the District neither warrants nor guarantees the accuracy of sewer facilities and/or side sewer stub information on the District's record drawings, particularly with regard to the depth thereof. Any liability for damages and/or loss caused by inaccuracies in the information provided in the record drawings shall rest solely with the party who prepared the record drawings. 6. Owner and Contractor hereby agree to safeguard the work done under this permit in such a manner as to prevent injury and/or damage to the public and/or environment. Such precautions shall include the employment of all necessary ditch safeguards such as lanterns,barriers, and safe access or egress through the work area. 7. Owner agrees to employ a side sewer contractor approved by the District("Authorized Side Sewer Contractor") for any and all sewer service connection work to be performed in public right-of-way or District easement. 8. No backfilling will be allowed until the building sewer/side sewer pipe, and pump station wet well if applicable, installation are complete in place,and leak-test results have been inspected and approved by the District's inspector. 9. Owner and.Contractor agree that all public rights-of-way and/or District easement restoration and cleanup shall satisfy the requirements of the jurisdictional agency and/or District. 10. Owner and Contractor agree to obtain, at no cost or liability to the District, all other necessary permits for the work to be performed under this permit. 11. Owner agrees the District may require the use of interceptingtraps or pretreatment systems in the event of discharge of unusual or otherwise prohibited wastes as defined by the District,and wner further agrees to be fully and solely responsible for same. 12. Owner acknowledges that blasting or the use of any explosives during sewer service connection work is prohibited by the District,and will not be used. 13. The District may waive any of the above requirements. Such waiver or waiver by acquiescence by the District of any provisions or conditions stated above shall not be a waiver of any other provision or condition of this permit. 14. A "Non-billing Sewer Service Stub Connection" is intended& issued for a partial connection only. Completion of a full sewer service connection(building-to-main)will require a separate Sewer Service Connection Permit. 15. The permit fee associated with this permit covers two (2) on-site inspection visits by Lakehaven staff. Any additional inspection visits will be billed to the property owner on the basis of actual labor and overhead. OWNER/AUTHORIZED AGENT SIGNATURE: JO/ /11 Date: ?/,Zo/Y AUTHORIZATION(If Agent): (Description) CONTRACTOR SIGNATURE Date: SSCP Sig Sheet-2011.docx(Form Rev. 11/30/10) Permit No. • • Tony Doucette From: Rob Van Orsow Sent: Wednesday, May 22, 2013 3:50 PM To: Jeff Wolf 11111 Subject: FW: Service Inquiry: 28866 Pac. Hwy. South Will this suffice? From: CityDesk_WW [mailto:CityDesk WW@wm.com] Sent: Wednesday, May 22, 2013 3:45 PM To: Rob Van Orsow Cc: CityDesk_WW Subject: RE: Service Inquiry: 28866 Pac. Hwy. South Hi Rob, I found a very old account in the archives: 833-4947 STUDIO IV 28866 PACIFIC HWY S. It started in July of 2001 and canceled 10/28/2006. This is the only - record for service at this address I found. Su x Dir 64/1466" S IOC W City Debly -------- 4251f25-825-0023 "Waste Management's renewable energy projects create enough energy to power over 1 million homes From: Rob Van Orsow [mailto:Rob.VanOrsow@cityoffederalway.com] Sent: Wednesday, May 22, 2013 12:41 PM To: CityDesk_WW Subject: Service Inquiry: 28866 Pac. Hwy. South Hello Please let me know if WM has records of providing service at the following residence. If so, can you confirm if/when service was discontinued? 28866 Pacific Hwy. South 98003 Thanks! Recycling is a good thing. Please recycle any printed emails. 1 • 4ci 570 71/NIC-0 Tony Doucette From: Hugo, Jim <Jim.Hugo@southkingfire.org> Sent: Wednesday, August 13, 2014 4:20 PM To: Tony Doucette Subject: Tank decommissioned or removal. Tony, Per our discussion today; the fire marshal's office has no records on file of a tank being removed or decommissioned at the address of 28866 Pacific HWY S. Thank you. James Hugo Deputy Fire Marshal/Investigator 253-946-7245p 253-510-8427c Jim.hugo@southkingfire.org /0e. es49 .bve A"l Alint 147,00Y0/ tow?, )tS1)4Gri- • calior 47),455s 1S864 ifonc e6f}t Yam/ /tssouMet, atm Q, ca. o itioYg2Yz is NaJ. mt /1n/ Ale ORS- ,40, s t.os 1885-0 ,D/KiCic- ,hf gl✓,4y Saa?t. .SF"Am'ftota) AgeAffr Poco tf00*7a✓ / 4,/ u✓)o2aiAas gv/ifC whore_ )eco usS5oNel) (N go08. 711E $/7r/c.4►✓ SirN'z v 77,1C /o?Anr *as mak-av2 7,1s 4 i- Wiv ' 7P 7K,yousC. 'r1 Al.kif cK.ti a✓ u,ts 4-tovt'D gam ,sac rit MA4 cou v7 / 1 I RNATIONAL FIRE CODE PERM r South King Fire & Rescue 31617 - 1 Avenue South 253-839-6234 OCCUPANCY NO: 1811-567-005-000 PERMIT NO: 08-0044 Name of Business of Concern: UST Decom Address: 28850 Pacific HWY S Occupancy Class: PERMIT TO MAINTAIN, STORE, USE OR HANDLE MATERIALS, OR TO CONDUCT PROCESSES OR ACTIVITIES WHICH MAY PRODUCE CONDITIONS HAZARDOUS TO LIFE OR PROPERTY, OR TO INSTALL EQUIPMENT USED IN CONNECTION WITH SUCH ACTIVITIES. Permit For Specifics - Occupant Loads, Quantities, Container Sizes, Etc. Fee 105.7.6 300 gal tank decommission 1/30/08 $50.00 Rec'd site plan & rinse cert Filled with foam TOTAL FEES: $50.00 Permit Issue Date: 02/05/2008 Paid By: 31995 Unless specified otherwise, permit EXPIRES on: 02/05/2008 PERMIT MUST BE RENEWED PRIOR TO EXPIRATION. THIS PERMIT MUST BE POSTED IN A CONSPICIOUS LOCATION ON THE PREMISES. This permit does not take the place of any license required by law, and shall not be construed as authority to violate, cancel or set aside any of the provisions of the International Fire Code. This permit is not transferable; any change in use, occupance, operation or ownership shall require a new permit. VLC0 FILCO COMPANY INC . P.O. Box 31228 • Seattle, WA 98103 - Ph: (206) 547-8347 • Fax: (206) 548-9352 e-mail: info© FilcoEnviro.com • www.FilcoEnviro.com • Lic# FILCOCI080RU LETTER OF CERTIFICATION January 30, 2008 SCI Infrastructure LLC Mike Kangas 1508 Valentine Ave SE Pacific, Washington 98047 RE: Residential Underground Heating Oil Tank at 28850 Pacific Hwy South Federal Way, Washington 98003 This is to certify that Filco Company Inc., has pumped, triple rinsed, and filled with polyurethane foam, one 300 gallon underground residential heating oil tank from the above named property. All work was done, and contents were disposed of according to the codes and guidelines set forth by the Washington State Department of Ecology and local fire department regulations and the decommissioned tank meets these standards. 1r- Phil Suetens President Filco Co., Inc. • 11111 Filco Company Inc. Lic. #FILCOCIO8ORU EXP. 10/10/07 PO Box 31228 IFCI License# W379 4 -- aca Seattle WA 98103 City License # 206-547-8347 %M rR3t� xG y U . « <r3 r iP. 5t . y gt 4s aA '!''''''):/. ir )k4' t E Atit�a 4A4-0 T7 .2v i t , ; rw xt. # rig } tl , B ot,,, t + in x04, r . .--51-5t, M a r RF Fecieea / l i/a y� Wel. JOB SITE ADDRESS: 2 W50 Pacific 1-1-t.1Y S. c 7003 OWNER: (i ri,/ Q( Fed a ar 1)ct y ADDRESS: PHONE: Co�ar akiie add,tezI'>7,kc K n us <26k 730-ay I .S-C Z` n+?us-racTuee ACTIVITY: 0(Pump Clean and Cap) Pump&clean(triple rinse)one gallon underground oil tank. Cut off or remove vent and filler pipes and cap them permanently below grade El(Pump Clean and Fill) Pump&clean one 300 gallon underground oil tank. Fill with Structural Polyurethane Foam. Cut off or remove vent and filler pipes and cap them permanently below grade. 0(Removal) Pump out one gallon underground oil tank. Excavate and remove the oil tank then back fill the hole and dispose of tank in proper manner. 60"-ro house 150,, Pio n T I ePr- core net �045� 4).< ,0. \I _ ,,,,,,,\ ) 1 07- 6,,, Feorr- MI p/46 IF/6 HGJ y s N July 15, 2013 Vo W ENVIRONMENTAL SERVICES, INC. Environmental Consulting & Compliance Jeff Wolf City of Federal Way Public Works 33325 8`h Ave S Federal Way, WA 98003 RE: Asbestos consulting at 28866 Pacific Highway South, Federal Way, WA 98003 Dear Mr. Wolf, NOW Environmental Services is pleased to present this survey report for suspect asbestos-containing building materials and lead waste stream analysis conducted at the residence located at 28866 Pacific Highway South, Federal Way, Washington. We appreciate the opportunity to have been of service to you. If you have any questions regarding this report, please feel free to contact me at(253) 927-5233. Sincerely, Todd Rickert AHERA Building Inspector Accreditation No. I/MP-NESI-053113-03(Exp. 5-30-14) NOW Environmental Services Enclosures: Asbestos Survey Report 34004 9th Avenue South, Suite 12,Federal Way,Washington 98003 Phone: (253)927-5233 Fax: (253)924-0323 www.nowenvironmental.com • W ENVIRONMENTAL SERVICES, INC. Environmental Consulting & Compliancy Asbestos and Lead Waste Stream Survey Prepared For: City of Federal Way 33325 8th Avenue S Federal Way, Washington 98003 July 15, 2013 Subject Property: Residence and Business 28866 Pacific Highway South Federal Way, Washington 98003 Prepared By: Now Environmental Services 34004 9th Avenue South, Suite 12 Federal Way, Washington 98003 Contents Section Introduction 1.0 Executive Summary 2.0 Regulatory Compliance 3.0 Sampling Plan and Laboratory Analysis 4.0 Survey Results 5.0 Conclusions and Recommendations 6.0 Limits of Survey 7.0 Appendices Laboratory Results A Field Notes B Certification(s) C Enclosures D 34004 9th Avenue South, Suite 12, Federal Way, Washington 98003 Phone: (253) 927-5233 Fax: (253)924-0323 www.nowenvironmental.com „. •����� �=~ Section 1 .0 - Introduction On July 1 11h, 2013, AHERA Building Inspector Todd Rickert of NOW Environmental Services conducted a limited inspection for suspected asbestos-containing building materials at the business and residential structures located at 28866 Pacific Highway South in Federal Way, WA. Two TCLP samples were also collected from the residence/garage and business. Mr. Rickert is an Environmental Protection Agency (EPA) Accredited Building Inspector Accreditation No. 1/yWP'NE8|'053113'03 (Exp. 5'30'14) Accessible areas were visited and samples were taken of building materials suspected to contain asbestos (vinyl floor tile, gypsum waUhoand, roofing etc.). These samples were analyzed for the presence of asbestos. In addidon, the quantities of asbestos-containing materials were estimated.— Please see Table 1 for a summary of TCLP results for the residence/garage and business. Please see Table 2 for a summary of suspect PCB containing light ballasts and fluorescent bulbs for the residence/garage and business Please see Table 3 for an inventory of regulated asbestos containing building materials. Please see Table 4 for an inventory of sampled suspect building materials. Sample locations are indicated on the attached site drawings. QUANTITIES ARE APPROXIMATE AND ARE NOT TO BE USED FOR BIDDING PURPOSES. PROSPECTIVE BIDDERS MUST SITE VERIFY QUANTITIES AND SITE CONDITIONS. • • • Section 2.0 - Executive Summary Building Description The subject structures are a combination of business and residential structures located at 28866 Pacific Highway South in Federal Way, WA, is an approximately 2,200 square foot, two story residential structure with a one story business structure and single car garage. The structure consists of a concrete foundation with a wood framed structure, wood framed walls and roof truss systems. The residential roof system is a three tab composition roof system. The business roof system is a flat built-up style roof system. Exterior treatments are painted wood siding. Interior wall systems were gypsum wallboard with joint compound. Floor coverings were hardwoods, ceramic tile, carpet and sheet vinyl An additional structure included in the survey was the garage/shop. The garage/shop structure consists of a concrete slab on grade with a wood framed structure, wood framed walls and roof truss systems. The roof system is a three tab composition roof system. Exterior treatments are painted wood siding. Toxicity Characteristic Leachate Procedure (TCLP) The two TCLP samples taken both had less than the regulatory limit of 5 parts per million (ppm) lead in the leachate. This indicates that the demolition waste stream will be considered non-hazardous relative to lead. Please see Table 1 for TCLP sampling results. Table I Summary of TCLP results at the business/residence located at 28866 Pacific Highway South in Federal Way, WA. 98003 Sample Number Structures Included Analytical (Laboratory) Result(s) N13-0213-TCLP-001 Garage/Shop <0.5 ppm* N13-0213-TCLP-002 Residence/Business <0.5 ppm* mg/L = ppm PCB Containing Light Ballasts / Fluorescent bulbs The suspect PCB containing light ballasts were quantified for the business/residence located at 28866 Pacific Highway South in Federal Way, WA. 98003. Fluorescent bulbs were quantified for recycling purposes. Ballast and fluorescent bulb quantification results can be found in Table 2. Table II Table 2—Approximated ballast, mercury vapor lamps and florescent bulbs found Ballast Bulbs Mercury Vapor Lamps None 30 each None 28866 PACIFIC HIGHWAY SOUTH FEDERAL WAY,WA 98003 PROJECT 8 N13-0213 �� �_ Asbestos Please see Table 3 for a summary of asbestos-containing building materials found at the residence located at 28886 Pacific Highway South in Federal Way, WA during this survey. Please see Table 4 for an inventory of sampled suspecbuilding materials. Table III Summary of Asbestos-Containing Building Materials found at the business/residence located at 28866 Pacific Highway South in Federal Way, WA Material Description Material Sample Location Asbestos Content Friability Approx. Quantity** Cement Asbestos Exterior 8 %Chrysotile AsbestoUnknown** Board **QUANTITIES ARE APPROXIMATE AND ARE NOT TO BE USED FOR BIDDING PURPOSES. PROSPECTIVE BIDDERS MUST SITE VERIFY QUANTITIES AND SITE CONDITIONS. • 1111 . Section 3.0 - Regulatory Compliance Asbestos The intent of the asbestos survey is to comply with governing asbestos regulations required by the State of Washington and Puget Sound Clean Air Agency(PSCAA). Currently, the State of Washington requires a written "good faith inspection" for identification of asbestos-containing materials prior to any remodeling or demolition work. During demolition and construction work it is the responsibility of the owner and the contractors to make this survey document available to all concerned parties who may be handling the building materials. In addition, PSCAA requires that a copy of the written asbestos survey be made available on-site for inspection by a PSCAA Control Officer during construction and demolition work. The survey is required to be performed in accordance with 40 CFR 763.86. These federal standards require inspections to be conducted by an EPA Accredited Building Inspector with analysis to be provided by an asbestos laboratory certified by the National Bureau of Standards. The requirements are described in Article 1 and Article 4, of PSCAA's Asbestos Control Standards. All survey work was conducted in compliance with the above mentioned standards. Asbestos-containing materials are required to be removed and disposed of in accordance with Washington State Regulation 296-155 WAC, Part S prior to any demolition, renovation, or remodeling that would disturb these materials. Washington State Department of Labor and Industries and PSCAA require that the abatement be performed using Certified Asbestos Workers under the direct on-site supervision of a Certified Asbestos Supervisor in accordance with 296-65 WAC. Also see 296-62 WAC, Part I-1—General requirements for handling asbestos. 28866 PACIFIC HIGHWAY SOUTH,FEDERAL WAY,WA.98003 PROJECT#N13-0213 i • Section 4.0 - Sampling Plan and Laboratory Analysis Asbestos Objectives The objective of the survey was to determine the quantity and location of building materials (vinyl floor tile, roofing, gypsum wallboard, etc.)that contain asbestos. Asbestos Sampling Plan Protocol This survey was conducted using a protocol adapted from the Asbestos Hazard Emergency Response AAct(AHERA). The protocol is as follows: 1. Group materials into homogeneous sampling areas. 2. Quantify each homogeneous sampling area and collect samples from each area using the "3-5-7" criteria for surfacing material to determine the number of samples needed. Quantify and collect a minimum of three samples of each thermal system insulation (the number of samples collected of miscellaneous materials was determined by the inspector). 3. Samples of each material were taken to the substrate, ensuring that all components of the material were included. 4. Sampling was performed by a Certified Building Inspector, and the use of proper protective equipment and procedures was followed. Asbestos Sampling Procedure 1. Spread the plastic drop cloth (if needed) and set up other equipment, e.g., ladder. 2. Put on protective equipment(respirator and protective clothing if needed). 3. Label sample container with its identification number and record number. Record sample location, and type of material sampled on a sampling data form. 4. Moisten area where sample is to be extracted (spray the immediate area with water). 5. Extract sample using a clean knife, drill capsule, or cork boring tool to cut out or scrape off approximately one tablespoon of the material. Penetrate all layers of material. 6. Place sample in a container and tightly seal it. 7. Wipe the exterior of the container with a wet wipe to remove any material that may have adhered to it during sampling. 8. Clean tools with wet wipes and wet mop or vacuum area with HEPA vacuum to clean all debris. 9. Seal the sampling location with caulking compound, spackle or duct tape. 10. Discard protective clothing, wet wipes and rags, cartridge filters, and drop cloth in a labeled plastic waste bag. Asbestos Laboratory Analysis The bulk samples were analyzed in our laboratory using polarized light microscopy(PLM)with dispersion staining in accordance with US EPA method 600/R-93/116 as specified in 40 CFR Chapter I (7-1-07 edition) Part 763, Subpart E, Appendix E. Polarizing light microscopy quantifies asbestos concentrations at between 100% and 1% detection levels. Levels below 1%can only be stated as "trace." For samples containing more than one separable layer of materials, the report will include findings for each layer (labeled "a" for layer one and "b" for layer two, etc.) and a total percentage for the entire sample. The asbestos concentration in the sample is determined by visual estimation. For those samples with asbestos concentrations between 1 and 10 percent based on visual estimation, the EPA recommends a procedure known as point counting (NESHAPS, 40 CFR Part 61). Point counting . a statistically more accurate means of quantification for samples with low concentrations of asbestos. 28866 PACIFIC HIGHWAY SOUTH,FEDERAL WAY,WA.98003 PROJECT#N13-0213 0 i Section 5.0 - Survey Results Asbestos Please see Table 4 for bulk sampling results of suspect building materials found during this inspection. Table IV Summary of suspect Asbestos Containing Building Materials sampled at the business/residence located at 28866 Pacific Highway South in Federal Way, WA Material Description Sample Number Material Sample Location Analytical (Laboratory) Results Popcorn Ceiling Texture N13-0213-001 Hallway Non-Detect Popcorn Ceiling Texture N13-0213-002 Bedroom Non-Detect Popcorn Ceiling Texture N13-0213-003 Living Room Non-Detect Insulation, Pink N13-0213-004 Living Room Non-Detect Insulation, Brown N13-0213-005 Stairwell Non-Detect Insulation, Yellow N13-0213-006 Stairwell Non-Detect Joint Compound N13-0213-007 Stairwell Non-Detect Joint Compound-Gypsum N13-0213-008 Living Room Non-Detect Wallboard Red Brick N13-0213-009 Living Room Non-Detect Sheet Vinyl N13-0213-010 Kitchen, Top Layer Non-Detect Sheet Vinyl N13-0213-011 Bathroom Non-Detect Sheet Vinyl N13-0213-012 Kitchen, Bottom Layer Non-Detect Sheet Vinyl N13-0213-013 Pantry Non-Detect Hardwood Slip Sheet N13-0213-014 Living Room Non-Detect Joint Compound N13-0213-015 Living Room Non-Detect Ceramic Tile, 4"x4"White N13-0213-016 Front Entry Non-Detect Tile Grout N13-0213-017 Front Entry Non-Detect Tile Mastic N13-0213-018 Front Entry Non-Detect Ceiling Texture, Sponge Applied N13-0213-019 Kitchen Non-Detect Ceiling Texture, Sponge Applied N13-0213-020 Kitchen Non-Detect Ceiling Texture, Sponge Applied N13-0213-021 Kitchen Non-Detect Popcorn Ceiling Texture N13-0213-022 2'1 Floor Non-Detect Popcorn Ceiling Texture N13-0213-023 2f'° Floor Non-Detect Brick Mortar N13-0213-024 Living Room Non-Detect Insulation, Yellow N13-0213-025 Salon, Main Room Non-Detect Joint Compound-Gypsum N13-0213-026 Salon, Main Room Non-Detect Wallboard Joint Compound N13-0213-027 Salon, Main Room Non-Detect Joint Compound N13-0213-028 Salon, Main Room Non-Detect Ceramic Tile. 8"x8" Blue N13-0213-029 Salon, Main Room Non-Detect Tile Grout N13-0213-030 Salon, Main Room Non-Detect Tile Mastic N13-0213-031 Salon, Main Room Non-Detect 28866 PACIFIC HIGHWAY SOUTH,FEDERAL WAY.WA.98003 PROJECT#N13-0213 ! 0 Table IV cont. Summary of suspect Asbestos Containing Building Materials sampled at the residence located at 28866 Pacific Highway South in Federal Way, WA Material Description Sample Number Material Sample Location Analytical (Laboratory) Results Vapor Barrier- Black N13-0213-032 Exterior Non-Detect Sheet Vinyl and Mastic N13-0213-033 Salon, Back Room Non-Detect Vapor Barrier- Black N13-0213-034 Roof Non-Detect Three-Tab Roofing N13-0213-035 Roof Non-Detect Silver Coat N13-0213-036 Salon Roof Non-Detect Silver Coat N13-0213-037 Salon Roof Non-Detect Silver Coat N13-0213-038 Salon Roof Non-Detect Silver Coat N13-0213-039 Salon Roof Non-Detect Silver Coat N13-0213-040 Salon Roof Non-Detect Silver Coat N13-0213-041 Salon Roof Non-Detect Silver Coat N13-0213-042 Salon Roof Non-Detect Three-Tab Roofing and Vapor N13-0213-043 Garage/Shop Roof Non-Detect Barrier- Black Cement Asbestos Board N13-0213-044 Main House Exterior 8%Chrysotile Asbestos Built-Up Roofing N13-0213-045 Salon Roof Non-Detect Roofing Tar N13-0213-046 Salon Roof Non-Detect Parapet Wall N13-0213-047 Salon Roof Non-Detect Joint Compound-Gypsum N13-0213-048 Garage/Shop Non-Detect Wallboard Joint Compound-Gypsum N13-0213-049 Garage/Shop Non-Detect Wallboard Joint Compound-Gypsum N13-0213-050 Garage/Shop Non-Detect Wallboard 28866 PACIFIC HIGHWAY SOUTH,FEDERAL WAY,WA.98003 PROJECT a N13-0213 • • •. Section 6.0 - Conclusions and Recommendations NOW Environmental Services is not responsible for materials which require destructive means to access, or materials which are hidden from sight, those materials hidden behind walls, or materials which cannot be found with reasonable diligence. Extreme caution should be used during renovation or demolition to ensure that additional unidentified materials are not disturbed. In the event that additional materials are discovered, the material should be sampled by an EPA Accredited AHERA Building Inspector and analyzed to determine if it contains asbestos prior to disturbance. Lead Based Paint The presence of lead-containing coatings raises concerns about worker and environmental protection. Workers disturbing lead-containing coatings are covered under the lead standard (WAC 296-155-176) until shown they are not being exposed above the action limit of 30pg/m3. The requirements for this standard include, but are not limited to, air monitoring, respiratory protection, medical surveillance, lead work plan, warning signs and wash stations. • The Demolition or Hazardous Materials Abatement Contractor is responsible to conduct any and all monitoring for exposure to lead as defined in WAC 296-155-17609. Asbestos According to Washington Administrative Code (WAC) 296-62-07721, prior to the start of work, a building owner must identify the presence, location, and quantity of ACM and/or presumed ACM (PACM) prior to renovation and demolition. This information must be communicated to contractors bidding on work, contractors performing other work, employees and tenants in or adjacent to the work area. The Puget Sound Clean Air Agency Regulation III, Article 4 requires that an asbestos survey be conducted prior to any renovation or demolition of existing buildings. This survey was intended to meet these regulatory requirements. Asbestos-containing materials are required to be removed and disposed of 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 and PSCAA require that the abatement be performed using Certified Asbestos Workers under the direct on-site supervision of a Certified Asbestos Supervisor. The only exemption is for resident owners performing removal of asbestos- containing materials other than furnace interiors and direct applied mudded asbestos insulation. ACM is identified as those building materials containing greater than one percent (>1.0%) of asbestos as verified by laboratory analysis. All building materials fabricated prior to 1980 are assumed to contain asbestos unless proven otherwise by a licensed building inspector. Materials that contain 1.0% or less asbestos are not regulated for disposal purposes. However, removal of materials containing 1.0% or less asbestos is considered an unclassified asbestos operation by OSHA and WISHA. Unclassified asbestos operations cover employees likely to be exposed in excess of the permissible exposure limit (PEL), and who are performing operations not covered by Class I through IV. For construction work involving unclassified asbestos the applicable requirements will include: an exposure assessment, use of vacuum cleaners equipped with HEPA filters, use of wet methods and prompt cleanup of debris, use of respirators and protective clothing, training, and record keeping. The possibility exists that additional ACMs may be present in wall and ceiling cavities. Any previously unidentified material encountered during construction activities should be sampled prior to impact. Work 28866 PACIFIC HIGHWAY SOUTH.FEDERAL WAY WA.98003 PROJECT 9 Ni 3-0213 that may be impact asbestos should be performed by personnel having proper training and utilizing proper worker protection according WISHA standards. NOW Environmental Services recommends that a Certified Asbestos Project Designer design any asbestos abatement project to ensure that the job is completed according to regulatory standards. 28866 PACIFIC HIGHWAY SOUTH.FEDERAL WAY,WA.98003 PROJECT#N13-0213 • • Section 7.0 - Limits of Survey TCLP testing and asbestos surveys are non-comprehensive by nature and subject to many limitations including those presented below. Our assessment has considered risks pertaining to asbestos; however, this survey is limited to only those locations sampled. This survey was not designed to identify all potential concerns or eliminate all risk associated with asbestos. Not all hazardous materials were not included in the scope of work during the course of this survey. Other risks that were not evaluated with this survey; Risks such as 1) toxic and hazardous substances in (or in contact with or associated with) soil or ground water; 2) risks associated with structural, electrical, or mechanical working of the building; 3) risks associated with radon gas, slope stability, building settlement, moisture, or site drainage and flooding have not been evaluated during this survey. No warranty, expressed or implied, is made. The site visit consisted of a thorough visual walk-through of building for the purpose of viewing and sampling potential asbestos-containing material. Mercury vapor lamps were not identified during the survey. NOW Environmental Services performed this survey in accordance with the generally accepted standards of care that exist in the industrial hygiene profession in Washington State at the time of this study. The asbestos survey was performed in preparation for removal of asbestos-containing materials in accordance with NESHAPS regulations. This survey is not intended for use as plans and specifications. These estimates are for approximating actual bid prices from contractors only, and may not reflect the actual final costs of asbestos and/or lead abatement. They do not include sales tax, or Owner costs such as abatement project oversight and monitoring for compliance to law and/or compliance to project plans and specifications. These estimates assume that adequate, professional plans and specifications are prepared and the abatement costs are minimized by professional project management, and that all asbestos containing materials are abated during one project by the same asbestos contractor. Written By: Todd Rickert AHERA Building Inspector Accreditation No. I/MP-NES1-053113-03 (Exp. 5-30-14) Reviewed By: (7)Qt,stiV Dennis Ra�Tschenberg General Manager 28866 PACIFIC HIGHWAY SOUTH,FEDERAL WAY,WA.98003 PROJECT 9 N13-0213 0 APPENDIX A Laboratory Results i i . .. ORION Environmental Services 34004 Ninth Avenue South,Suite Al2, Federal Way,WA 98003 >rVir".;, tai Compliance&Consulting Phone: (253)952-6717 • Fax: (253)927-4714 Email: info@oriones.net • Web: www.oriones.net WBE W2F9219763 Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client: City of Federal Way-Public Works Rpt. Date: 7/12/2013 Address: 33325 8th Ave S, Federal Way,WA 98003 Page: 1 of 4 Attention: Jeff Wolf Invoice: 133339 Project Name: 28866 Pacific Highway South ASBIN and TCLP Date Rcvd: 7/11/2013 Project Number: N13-0213 % Client Orion Material Sample Asbestos Asbestos Other Containing Sample ID Sample ID Description Treatment Material Type Fibers 01 20130711-86 Popcorn Ceiling Texture ND cellulose I 02 20130711-87 Popcorn Ceiling Texture ND cellulose 03 20130711-88 Popcorn Ceiling Texture ND cellulose 04 20130711-89 Pink Wall Insulation ND fiberglass 05 20130711-90 Brown Ceiling Insulation ND fiberglass 06 20130711-91 Yellow Wall Insulation ND fiberglass i I 07 20130711-92 Joint Compound ND cellulose 08a 20130711-93 Joint Compound ND cellulose 08b Wallboard ND cellulose 09 20130711-94 Brick crush ND 10 20130711-95 Vinyl Sheeting no backing ND man-made I fibersVinyl 11 20130711-96 ShBacking with Felt ND cellulose 12a 20130711-97 I Vinyl Sheeting with Felt ND cellulose Backing 12b Tan Mastic chloroform ND cellulose 13 20130711-98 Vinyl Sheeting with Felt ND cellulose Backing 14 20130711-99 Slip Sheet chloroform ND cellulose 15 20130711 Joint Compound ND cellulose -100 I 16a ?001 0711 Ceramic Tile crush ND • • Polarized Light Microscopy Test Report (cont.) Client: City of Federal Way-Public Works Rpt. Date: 7/12/2013 Address: 33325 8th Ave S, Federal Way,WA 98003 Page: 2 of 4 Attention: Jeff Wolf Invoice: 133339 Project Name: 28866 Pacific Highway South ASBIN and TCLP Date Rcvd: 7/11/2013 Project Number: N13-0213 Client Orion Material Sample Asbestos Asbestos Other Containing Sample ID Sample ID Description Treatment Material Type Fibers 16b Mastic crush ND 17 20130711 Grout crush ND -102 18 20013 0711 Mastic chloroform ND -119 -104 20130711 Ceiling Texture ND cellulose 20 2005 130711 Ceiling Texture ND cellulose 21 2006 130711 Ceiling Texture ND cellulose 20130711 22 107 Popcorn Ceiling Texture ND cellulose 20130711 23108 Popcorn Ceiling Texture ND cellulose 20130711 24109 Grout I crush ND 20130711 25 110 Yellow Insulation ND fiberglass 20130711 26 111 Wallboard ND I cellulose 27 2 20130711 Joint Compound ND cellulose -1120130711 28 113 Joint Compound ND 3 cellulose 20130711 111129a 114 Ceramic Tile crush ND 29b 1 I Mastic chloroform ND I 30 2015 0711 Grout crush ND 31 201630711 Mastic chloroform ND 20130711 32 117 Exterior Vapor Barrier chloroform ND cellulose 33a 201$0711 Vinyl Sheeting ND 33b Mastic chloroform ND cellulose • • Polarized Light Microscopy Test Report (cont.) Client: City of Federal Way-Public Works Rpt. Date: 7/12/2013 Address: 33325 8th Ave S, Federal Way,WA 98003 Page: 3 of 4 Attention: Jeff Wolf Invoice: 133339 Project Name: 28866 Pacific Highway South ASBIN and TCLP Date Rcvd: 7/11/2013 Project Number: N13-0213 Client Orion Material Sample Asbestos Asbestos Other Containing Sample ID Sample ID Description Treatment Material Type Fibers 20130711 34 119 Vapor Barrier 1 chloroform ND cellulose 35 20130711 Three Tab Roofing ND cellulosetfiberg -120 lass 20130711 i 36 Silver Coat chloroform ND cellulose -121 37 20130711 Silver Coat chloroform ND cellulose -122 i 38 2023 0711 Silver Coat chloroform ND cellulose 39 20130711 Silver Coat chloroform ND Mill cellulose -124 40 2025 0711 Silver Coat chloroform ND cellulose -141 1250711 Silver Coat I chloroform ND cellulose { I 42 20130711 Silver Coat chloroform ND cellulose -127 I 43a 201$0711 Roofing ash ND cellulose 43b Building Paper 1 chloroform ND cellulose/fiberg lass 44a 201 0711 Cement Asbestos Board I crush Chrysotile cellulose 44b Building Paper chloroform ND i cellulose 45a 201 0711 Silver Coat ND cellulose 30 45b I Built up Roofing cellulose/fiberg ND lass g cellulose/fiberg 45c Built up Roofing ND lass 46 131 0711 Roofing Tar ; chloroform ND cellulose 47 201230711 I Roofing Side Sheeting chloroform ND cellulose 48a 133 20130711 I Joint Compound ND MI cellulose 48b Wallboard 1 ND cellulose • Polarized Light Microscopy Test Report (cont.) y Rpt. Date: 7/12/2013 Address:Client: City 33325of 8thFederal AveWaS, FederalPublic WayWorks, WsA 98003 Page: 4 of 4 Attention: Jeff Wolf Invoice: 133339 Project Name: 28866 Pacific Highway South ASBIN and TCLP Date Rcvd: 7/11/2013 Project Number: N13-0213 Client Orion Material Sample Asbestos Asbestos Other Containing Sample ID Sample ID Description Treatment Material Type Fibers 49a 2034 0711 Joint Compound ND cellulose 49b Wallboard ND cellulose 50a 2101 0711 Joint Compound ND cellulose 50b Wallboard ND cellulose Dup:Laboratory QA/QC Duplicate;M;Mastic[(a),(b),(c),etc.]:Sample layers numbered from front to back. Comments: For layered samples,each component has been analyzed separately. ND means non-detect for asbestos fibers by EPA Method 600/R-98/116.Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus,these laboratory results represent due diligence,however negative or<1%PLM results can not be guaranteed. Per EPA guidelines samples will be archived for 30 days then will be disposed of. This report may only be reproduced in full with written approval of ORION Environmental Services. Analyzed By(Print) Date Reviewed By(Print) Date Dennis Rauschenberg 7/12/2013 Don McNeal 7/12/2013 Anal y( gna e) Time Rev'By(Signature) Time • • .11111 AIIIIIIIIIIIIIIIIIIIIMill 1 En enme al Compliance&Consulting Test Report TCLP METAL EPA 1311 Client NOW Environmental Services, Inc. Date July 15, 2013 34004— 9th Avenue South, Suite # 12 Page Page 1 of 1 Federal Way, WA 98003 Invoice 133340 Date Received July 11, 2013 Client Name/Number N13-0213 Project Name 28866 Pac Hwy S Federal Way Client Orion SDL EPA Method Number Number TCLP Lead (mg/1) TCLP-001 130711-136 <0.5 0.5 7420 TCLP-002 130711-137 <0.5 0.5 7420 Results reported in PPM (mg/1). NOTE: SDL— Sample detection limit. Quality Assurance Information Method Blank: <0.5 mg/kg Linear Regression Lower Limit: 0.990 Actual Batch Linear Regression:0.999 Check Standard Per Set: ±0.2 mg/I Analyzed By ,li� Reviewed By A en Clark Donna McNeal Laboratory Analyst Laboratory Director, CEO 34004 9th AN enue South Suite A5-Federal\Ya ,Washington 98003 p.253.952.6717-f.253.927.4714 NI ww.oriones.net-info@`oriones.net %VRF IV/PPM-761 • • APPENDIX B Field Notes 01 M ; '1 .I r I I I I I 1 1 1 ; 1 1 1 1 1 I 1 1 ;1 1 1 1 r 1 1 1 ; ; ' M I 1 I 1 1 r I I 1 1 I I I I I 1 I 1 r 1 1 I I 1 1 I ._._J____l____l_.______J___.J____1__..a___.l_.-J____J____J___. ____�.-______J_...J-.__ •__-�.--.1 J____J____a____ M M I I 1 1 1 I 1 I 1 1 I 1 I I 1 1 t I I I 1 r I I i� ....4____;_..., 4....4....r....., V _ --------,-___4-_-.4_4.---,-------- --------,....4-....T____;....., -------,--^i----i---- N Co) I r 1 1 1 1 I 1 r I r 1 I r ; ; ; 1 ; I ; ; 'i 1 I 1 1 r M I I 1 r I r I 1 I r I 1 I I I 1 i t 1 t I I _ ___J____a____a__._� J.___J_.._a___.a_.__I. 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ORION Environmental Services ! r � N \ Toxic Characterization Leaching Profile(TCLP) Data Form WBE W2F59I2535 Technician: Client Name I Project Number Project iame ProjectC \'VNI - U4\ \IN'3.\1? Number Sample Number Date 111 1f p 111 l \-31 � \3o PART 1 Estimated Waste Stream Painted Matrix Identification Color Percen�tagee by weight) Matrix 1 �, tA)8 Matrix 2 .J', ; ;,C}L - i `0 Matrix 3 I e V r-i1/' �4r!t!S} ��etd .d /0 Matrix 4 )64- i\ ,` Matrix 5 c. tt rr M I ._ Matrix 6 , Matrix 7 Matrix 8 Total Weight Percentage of Painted Waste Stream PART 2 Estimated Waste Stream Non-Painted Matrix Identification (inert components) Percentage(by weight) Matrix 1 Matrix 2 I � �"red- Matrix p f'd-- ?� ' Matrix 3 I P�! 5 Matrix 4 ( � vL Matrix 5 Matrix 6 Matrix 7 Matrix 8 Total Weight Percentage of Inert Components Total Weight of Waste Stream (Part 1 +Part 2) = 100% Size of Disposal Container: Comments: • 34004 9th Avenue South 21 Building A, Suite 5 Federal Way, Washington 98003-6740 Seattle (253) 874-8118 + Tacoma(253) 952-6717 + Facsimile(253) 927-4714 + email ORION6717@aol.com WASHINGTON +OREGON +ALASKA ! • APPENDIX C Certifications I L~ ,,,y„� {i i ! ..,.t' i't°fii, _.c`r..✓" t $ ' .tit a , »te 7 A,3 . 33-'3..V 11 et' '3 ....'*. 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