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01-102783 City of FederalWay • CommunityDevelopment mentServices Demolition Permit. #:01 - 102783 - 00 - DE 33530 1st Way S Federal Way,WA 98003-6210 Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050 Project Name: CHINA HOUSE 11) Project Address: 31633 PACIFIC S Parcel Number: 082104 9237 Project Description: DEMO-Demolition and removal of China House Restaurant in its entirety including slab on grade. This is part of Pavilion Center Phase II A. Owner Applicant Contractor PAVILION CENTER ASSOC NONE S D DEACON CORP OF WASHINGTON 3650 131ST AVE SE#205 PO BOX 3070 BELLEVUE WA BELLEVUE WA 98009 98006-1334 NONE PERMIT EXPIRES January 12,2002,IF NO WORK IS STARTED. Permit issued on July 16,2001 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. r Owner or agent: -/flier % Tvize Date: 7-/h 0/ 110 1 WO CIT."' / A tt, 1 4V: CONSTRUIION PERMIT APPLICATION VV FEY APPLICATION NUMBER: °( - /V at-7S3 - b 6, 'JUL 1 6 2001 APPLICATION NUMBER: C) ft - I D Z {'7?� - Q 1_n CITY+' L WAY APPLICATION NUMBER: - - **The followig is requireffnformation—Please print(in ink)or type** Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. 'Z • __ ■ PROPERTY INFORMATION ..p // SITE ADDRESS: 3 1 lP ?f(4 i(_ \-L41/ ASSESSOR'S TAX/PARCEL #: OBZ)o4-773 7 r LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): • ;y:, ■ PROJECT INFORMATION - , TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL„ EMOLITION LI ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide sled description): eco ->L Ze>N'Lo1/401-( CD13t—D6 04NA' HOUSE PROJECT NAME: A-\( t L( bN CEA\(T{c-C- li- ■ PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: [-1W5,u+ -f-(\tvarmei,(r PeO rrus \ LLC_ (20(0) (003 - Lioq h i MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): CJ L1 V E_ w Su,rE I b(02 SEATTLE c.)* qe/0 ( CONTRACTOR: NAM DAYTIME PHONE: t beAC.o11 ? ©r (,13 (Zo(Q ) 571 -17 I (o MAI ADDRE5a4STREET ADDRESS;CITY,STATE,ZIP): t EVENING PHONE: 0 �O a . IJ [ o (SGL q“.e_ 1 UJP q606)9 ( )SA?AC CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: 2 0 — bo — 1018 110.00 - h t-- (1--3 )- CPIS-6006 CONT 0 REG RATION yJJMB R: (�(�j i EXPIRA ON DATE: (c �t o nor jj — 2S�'( - �f 3 / j /2 Z APPLICANT: NAME: DAYTIME PHONE: MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE: ( ) RELATIONSHIP TO PROJECT: FAX NUMBER: ❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) - , E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR - ' - •■ -DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 17,450-ea. SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • e . **NEW RESIDENTIAL CONSTRUCTION ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ PRO]ECT FLOOR AREAS s FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH OTHER FLOORS(DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: . ■ FIXTURES : .. Indicate number of each type of fixture MECHANICAL AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( ) COMPRESSOR(S),,, FURNACE(S) DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS PLUMBING BATUTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S) HWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS RINKING FOUNTAINS) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( ) INTERCEPTOR(S) SUMP(S) ':'■ DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way, but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information su lied to the city as a part of this application. NAME/TITLE: 6e=tt (J r Sb b A & 4 5Uf r DATE: 6-(A - 0( ❑ PROPERTY OWNER ❑ APPLICANT -LTJ CONTRACTOR FOR OFFICE USE ONLY: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX-253-661-4129 i . III Demo it Fee $47.00 DEMOLITION PERMIT APPLICATION Surcharge 4.50 Cash Bond 500.00 CITY OF FEDERAL WAY (Person Paying Bond) BUILDING DIVISION 33530 First Way South Federal Way,WA 98003 (253)661-4000-Fax(253)661-4129 1)SMO o- CI-Fliqfi- �S�- gt& t DESCRIPTION OF WORK PRIOR TO APPLICATION NOTE:I understand that the following utilities shall be disconnected and services performed,if applicable,prior to issuance of the demolition permit. All items are to be signed by the respective agency. 1. ASBESTOS REMOV 6. GARBAGE See A-4 acic( (Building Official) . ELECTRICITY 7. SEPTIC TANK PUMPED AND FILLED WITH CRUSHED ROCK OR REMOVED/OR SEWER LINE PLUGGED AT PROPERTY LINE.(Inspection 5 e..e A 0 act e ci - PS L. required prior to backfilling). (Puget Power) /7(--KCA';-Sf2tVV`- 3. TELEPHONE 8. WATER LINE CUT AT PROPERTY L (well capped).Inspection required prior to backfilling. (US West) b4r'-/d . 4. GAS 9. ALL UNDERGROUND TANKS PUMPED REMOVED UNDER FIRE DEPARTMENT PERMIT PRIOR TO EXCAVATION. See., A'F'facke.1 - OS E- (Washington Natural Gas) i\L:'�/I 5. WATER-DISCONNECT REQUEST 10. DELINQUENT UTILITY CHARGES PAID Se_e It flax - L Jr e laa.tre ti.. See A' I a. ,,ke,:e - 10.4ezw-ct__ INFORMATION FOR APPLICATION *� JOB ADDRESS ) (f)- 3 VAS F t i [4 W y S - F be -KI,_ W q , ' LEGAL DESCRIPTION TAX PARCEL NO D rr (Attach if lengthy.) OWNER tet--SC3e-F- PJZZI)I;aTILs S �.--C /� /, ADDRESS -S61 W t( q c cope-/ S u(/fit e 10-102- - SEAA1+€ ut T t !/f V CONTRACTOR `� l CoEA-cI �D o N S /y 0 J ADDRESS 114-5- 1 1 T''f Teske, S - SMm Co 3Pa-Et tke, I LOA- "-=0 CONTRACTOR'S LICENSE (Copy req'd) EXPIRATION DATE ›...6)0t16._ (0...Qcgi,"........) (0—S'71 —Z7)te Signature of Applicant Phone DEMOI]TI.APP R,v®3/12/99 i iJ PUGET SOUND i+P r . 2ND ii 1I r / '1�� ,Q FEDERAL A Y , frii CITY LIMITS vE. isorrer,-, n . 0 . 1 Lnici Lill ; 1 11 1 A Alf' 16-1-• ; iiViE : I � 304TH�ANIII] 4,.. 411011111M1111111I 1 ,;, ) I .. Pte• ____� t� PM L1k s �r � 20 r QJi ST 41.111.SAIVI MI el W A I "' - 4 104 411:1101W;16101 1 Vi �J�, 4 CI•TY ALL �. illikAA Ati, 'A'., . 9� ,�� 4. S 3 •TH ST q- f i- ail z kip .3 r()1,# 4 ft4-)Li ,�. S '•48T ST ili = `I S DC Z �+ //•' N , 19 Sw _."...i E a S " 1 07/03/01 12:49 FAX 2.467 8584 MED DENT BLDG Z002/006 lir •SROM JT Env, Inc. FAX NO. : 2064407367 Jun. 22 2001 04:15PM P4 06/18 In 14:45 FAS :66-46 7 a584 fit. DENT Boo 6E002402 DEmOUT1ON P RMIT APPLICATION Crri, OF FEPRAL WAY 1 cpumna titusi> 0 BULOIMt DNIZIOK , 33530 Fist Wz!$1:8:01 - _ 661.4=-fix )661.41'9 R eEIVED El¢CpaMY14N OV IN oar. ..—.-- CiiY Ur' F[:�7EhRL WAY Plaza Tel APPUCATlON Y O �s s b1!lse rad mr+dcstp �p d.Vat:obi&,pricy to it grew demoiian saves NO=1 ivsdar�d Adz S AU Iowan to besfgood IIy As rorpocti4g q cy L sCs 1 ,W R 5.55vaL cittathig awn p 35brei ° CA5645!Fauna) s. W.2wi car Xi"err L`141 mPi:•Isuv� °tc,gwcce 9. -114.20351,5piBletoLilt hint 9. A1.LC t T ".2', =cr►+ $ G4S rictAMIZTINNiaT=ATM g AVAT77W. egiih 1 n 23=01 01.0) S. N5/4=i►-Z5=-t4x5Cz'RatCC'!s= 15.DELYJWisfrf risLzin CZtadesli,k= - - UkrommATICM¢OR ArIPucanoa _ + 1 �a •I 'A / • J�Baas - ' .J . ge -,J t4X.P - • APA ! COP pa, a A L E Li•mo i. . *+ak - A=5 41 '\ - A IIIMINPAISWX:P_ ;42 so a 111 n4/1.112:rs Sz 2.1: of Appkieaac a $5o05 Mr=cr .w 07/03/01 12:50 FAX 467 8584 MED DENT BLDG 003/006 • JUL, -'03' 01 (TUE) 07: 10 GET SOUND ENERGY KENT ' 01 ( „z -7EL:253 395 6835 P. 002 /' 1,1 45 F�1 ?�4l37 5964 KED DENT DLD (�on", oar DEMOLITION PERMIT APPLICATION ''S___-• 7. CITY OF FEDERAL WAY a�,Bone `� ` — S° ao.ao' BUILDING; DIVISION (Rsroo P� 160,______.,7_,0 33.510 71.4 way South adexal Way. WA WICri3 ( 3) 6161.=.Fix(Z`3)661-4129 �`�' - T DEscRIPTIoN OF Wa _ ;'co PR►aR TO APPLICATION {:tar ` i Ktr�L WAY sUILDING DEpT. Nam I ungrant ltd!hot the fodewGrtgwNlister stall be disconnected cord lei-woes perfo d (reppf/roble.prier to Cs.rste rc ofihc detnoileaRAft81it. ME Itar4.r ate to be signal by the rarpeen-1v op,rnW. 1, A-iaa-ros!Weovaz, 6- 0=34oz (auireing ClUial) .mo 7. swrIc Tara rlA4PED,iw yr r-ee orm i cxuarizn p.c.=oR 1' A£MOVIDIcRSC4.13.LLvE?CL' aPATPILO?D rtquir�prior m 1:zJJiing). T'�'LINE,(7nap�uon 9 ' '- r) P.S..E. 3. 721-7PRO NI i, WASSILIE cur aTPAOPSATYLINil(+4eR cappad).7rtupecdon reviired prior to 6dcirfyjling. (US Wm) 9. ALL um:1E1'0=n TA.W.S FtIPTFa ANZ ago=CrIVIUL Flig .,(10/414,dTXPAarkE:IT 1 'CR TCI EXC VAI OY. P•E 9. WATse--DgCQrinor1:LgQWiT JO, Dpt174gcAzarr v7a-Y ti i.44. 2s P.>? - _ INFORMAriohl FOR APPLI✓ATINN F013Aoa9s 3 ( i . . .t ' A . 1 . , 4P • i 1(41, kAqq201a3 LEC/AL DLLICILEPTZLIN L+ raxP xa * ��✓ q C.�J 1 r .1 (Attach iCirnEt�r.) ADD S 3 e . M, v — �• "`� 01a C titeMACTcii ' _ 11\ ApD 3_ Cts-rat'3 LrCI.Ms i MGC,h7'41 fiv T1oN,r)A73 07/03/01 12:50 FAX 2" 467 8584 MED DENT BLDG U1 004/006 JUL-02-2001 MON 08:08 LAI HAVEN UTILITY DIS T FAX N�253 839 9738 P. Oz/02 06/18/01 14:43 nit 2G 67 8584 NED DENT BLDG �, 2002/004 DEMOLITION PERMIT APPLICATION -~ 430 CITY or PFD WAY Boa s 33530 Arix W*y Smith Moral Way. WA Mai 0.53)661+.{,Om-Fix )'6A14129 DET.CFJPTlON OP WORK PRIOR 1'0 AP'rLtCA'nwi BUF E, : l.)-PI AVM I virdkrilaqui that ificAiawiaq11414:14s shcl be disearurerdd cnd ArviCetsferformed.r.e y1iea&le prix.d Assumed cP a da.olinavt perr.ii .411;toms ant to be.(zro+d by did►sspdctive again. t. AkauBsto:l a-4rtt. 6. GAM.= ixtjacingcnn —_„._ - 2. �•' 7. UM AMA ricsl:D AA,77:- �or cz gp.icypazz/c.R -deux i..-.r6 n..w-E:ar77[naQTV L_ ailiVErtion r-- - �`��- gmP m Gad. �uge�Power) \114vu� 3. 4Motro I. WAS=VF LLT =7sLeasn 'Lin(veil end)-bllpOon rggmr Brier to kook uoz. _. 9, ALL LI CE1 tf��p TA.ypz F.D.=mr3 IoM Ci'mk .F ` ' 1 ?I=TO E.'S�lV.�'L�t Mulling=g=v Get) �*/f, S. W - .D_ - �.- _R,3nt. . / 1G. tJ - F - 41 ,..... „ i, �/ r INVCir�t% 014 pap A PPLICA71CN '' alk N' � Ck� ' i - - w1-o-' j t( . , , .1 TAX - _, M 0 8 r4 .s 1 In t G - . , ,A...,_ . - il�> �� r■ , i ► ) ~_ k. _ V\ ..Laalas - _ 07/03/01 12:51 FAX 2 467 8584 MED DENT BLDG 2]005/006 JUN, 13 2001 4: 21PM �1M-FiUBURN — . .— _ . .—. -- 18/01 14:50 FAX 208 17 8584 53 73590S3 P_2 MED DEFT BLDG l�002/002 �. Der labPbre:t Fsa Si7,Co __ DEMOLITION PERMIT APPLICATION +s� CITY OF FEDERAL WAY r c,r,nw�a wo.as assc.aa h C>se� BUILDING DIVISION 31,530 Fiske`filmy South 1 - Fedetal Way,WA 9800] ! Q.13) 661.4000-Zia(253) 6614139 . =t . DEC IPT,CN of WCR . PRJOH TO ApaucAT1CN ,YG7�I turd�ss=*+d steal die foflo�s;-Z,-tiltclaj Aga be disedr eec xd a td:rrvlce t perfornud.Iappllee�bl0.prier.o�+4M+re?five draaoM4rtp "IL Ad;km!are b br:ipi.id byrl a rirpdrJr++s a3�tc 1. A1sLrroSAmIsay.t. 6 G ACRic. 1 r a ! I (puilaing Cttcian 11 z''1'�_1 7. 5=c 7r.elx pt ptD-&1D 711.:.=aTd Cls_!S.tom:CR 7.Z.L0% ICA=WV.L:11 TL:•-- ATvrtosffR;'tL' .Qrs■ycaus raOis+4;vizi-to t.D.4:611rtgi. (Pupt?awzr) 3 tairiCT4 S. VirA=LLvs ecru AT?2-0-Man!:7.7.(v. L1 c4opad3.inspsZort required primo ti*elr'iting. (12'S Wear) 4, ,ys 9. ALL traCPAQ111=m TANIa =,0•41:1 n to vO v; a? s aFIZ:arr 7�, 1'791M.TO rICCAv l;7cN. CiVasainsan Najtril Cas) i. wa' ..rs.7=WorEC31.:4Qr.77 10. L'C:_'`CG.a.rrV��,ltri+.aGP_"p1^ IracRhtRT:cn rCR ,PFLlC� 11CN 1 V r ': `L 1,1/:\_ ' r± I a y . , - 4 r' (� Ica A1x'��5 ` `�'ri (, i'";"1\i 1 f 1r., I 1 i 4 i , •. ��Asn �r I (-)au . r� •P ��l� r j I r L.G. .ntSC ZC i ' T.,1?i.ar3 ya 0 2- / - 3 _(,aztah;[lm 4y.) ,��M r\ IA\ a , c-�r Al.A— L r ; 0+ti V JCC=a _ • C-.. cma+.'7Lrcra¢ — fc-577 kVA 5:C:aT.orr D.1111 -- SipZ7utc 0'kpoliCZt phoae ra.k.".1-,Arr 1.9.1.0ri_T 07/03/01 12:51 FAX 2 467 8584 MED DENT BLDG X006/006 ~' 06/18/01 16:05 FAalR. 2S9&sas6o_ — -- �Q67 8584 MED DENT BID tt 2' 2 1 '�1 �f 002!00.2 Dena�Rn14 Fri ----.– --' .D 1 DEMOLITION PERMIT APPLICATION �� CITY OF FEDERAL WAY i sm.00 �a�'-rRr!wad) BuiLDING DNisicN j 3153C Fire Way 5th Foch al Way.til A 9110:13 M11.1.1.11_j I.---..._._- _...._ an) 661�7Gv-Fix(74;)661-4LS JUL i a ,J J cI i Y GPFEDERAL DING DEPT.WAY DScptzpi at•I CF WORK - -- P roR To 1L1PUC.�.T147N NOM:I�dsTs Md har Che fairowiiksktAd11 ts'skall:�disra>'u.gr cd mad;en+icrs perfrxrnad J ppllcablr.prior to rscrenec of• a_aaw_Gonlamnit All dug:ere;a be:isrrd by At respecsvc invacy. 1. MBESTas ezvai. 6. C .r4 ------------ puldirtg Ot i 1) I -=i—' 7. Si?T^.CT.4. n.14rc_P%-ti-P "7rr wG,r�T 1.?h i,7: .rR 't,�4QV C$=WE1L 2C_.r- 7ATTR=Mk7*.' -NE.allac—'icn ^. requuzd;riot s ksZ;:511i ). (Puget?gyre!) ��r. loc. —345_122.91 a. w�.�.r��7s-�u�--Y��aJa aog ).i„sFtzto1,r�ui�a prior•r lLielin)1(:)-' � .cul.14 Q w e.i*�- =. Cls 9. ALT. c Ta ?.b/../zo S.ao- s G^N» - rT 7QTt1 TO rYGVA1�Ctr- Cin va01r11 C-as] 5, Nifa.-Dnc taCR7.cir=. 10_ Dr. —Tr C,is.ara:F� L1VFCRMA�oN FaR APPI��ATICN ' ` ti - H (- f 1 ifl 11~�i i a -. Y r1, r 1 ),()rt�.i i 141 `ke J 1 1 T xrsr- .=r4 1-' 'I,.;.:?L=r Na 0 i 1 r 1.3 (.xIIsch if lendly.) Az u-, .. C [`�) . `1 P 1 N • 1 Q1-)+_ . (l f c r) -1L'_ ) l c in n 5 C.--:►-a.acT 'o I.1c24ss tc.or ral.41 E.'CM.T:aN DAT:, Si Sizrure az ipalic_nc Phone TLH ENVI.RONMENTA•NCvuc 07/13101 FRI 16:24 FAX 5 099 TIM Environmental,Inc. R 1%-o 7417-4th Avenue South Seattle, WA 98108 JU 1Phone: (206) 523-4441 6 2001 Fax: (206) 522-4099 WA St.Cont.#TLH ENI*OQOJJ CITY OF FEDERAL WAY BUILDING DEPT. July 13, 2001 Page 1 of 11 Scott Westin SD Deacon Fax No. (253) 945-6006 Re: Asbestos Abatement Services at: Pavillon Center II and China House Restaurant Pacific Hwy South Federal Way, WA 98003 TLH Job#S,,612 Dear Scott: With reference to the above property, this is to certify that we have removed and properly disposed of asbestos containing materials at the above location. All work was performed and completed in accordance with existing Federal, State and Local regulations. Air clearance samples have met or exceeded EPA and OSHA standards and all areas are safe for re- entry by unprotected workers and the general public. Enclosed are copies of the post job documents for your records: PSCAA Notification L&I Notifications Air Monitoring Results Insurance Certificate Waste Shipment Record If you require further information please do not hesitate to contact our office at any time, Sincerely, TLH ENVIRONMENTAL, INC. Jeri L. Phair Program Administrator Enclosures ' 07/13/01 FRI 16:25 FAX 5 099 LI U V B TLI1 ENVI 0NMENTASC EnvInnhAntal,Inc. 9221 Roosevelt Way NE Seattle, WA 98115 Phone: (206) 523-4441 Fax: (206) 522-4099 WA St.Cont.#TLH ENI`000JJ May 2, 2001 S.Q. Deacon P. 0. Box 3070 Bellevue, WA 98009-3070 Re: Asbestos Abatement Services at: Pavilion Center II 31811 Pacific Highway South Federal Way, WA 98003 TLH Job#S-612 Enclosed are copies of the requested post job documents for your records: PSCAA Notification L&I Notification Air Monitoring Insurance Certificate Waste Shipment Record If you require further information please do not hesitate to contact our office at any time, Sincerely, TLH ENVIRONMENTAL, INC. 7114..)4 /„. Meg Secrist Program Administrator Enclosure 07/13/01 FRI 16:25AgFAX X. 5 09fl MR ENV IRONMENTA N _ ___ ,.._v �iou4 mai��t •. ;,:; PUGET SOUND CI-FAN AIiiAGENCY Agee y t7sa Only 110 UNION STREET,SUITE 500 Case No,: JUN 1 i .• SEATTLE,WA 98101-2o38 ; j;': t1 U N I 2J) f www,psnleapalr.otg • Amendment No,: Date Received NOTIFICATION AMENDMENT SI ASBESTOS PROJECT CI DEMOLITION PROJECT r�u v cYduR*fit Otis at We MK ..WARM:,.yez Coe:[ract�r: TLH Envirorunerttet1, Inc. Owner/CEQ; Timothy P. azog Maitin�Address. 7417 4th Avenue South Phot (2GF 523-4441 eatt1e se ta: WA Zip: 98108 rim ( 20f6 522-4099 AMENnMEtYIS REQUIRE AO, ,EXCEPT WORK SCHEDULE CHANGES FOR CONTRACTORS PA.RTICEFATING IN TIM WORK SCAEDttr.E FAX PROGRAM. THE FEE MUST RE ATTACHED To EACH AMENT)aMENT,UNLESS THE CONTRACTOR IS PAR"TICIPA"TYNG INTIM PRE A,PPRQvEII BLLLZNG PROGPANL ANY AMENDMENT THAT CHANGES THE PROTECT TYPE OR PROD CT CATEGORY IS SUBJECT TO THE NEW NOTIFICATION PERIOD AND MUST BE AccoN PANTED BY TIME APPROPRIATE PROJECT CATEGORY FEE. PLEASE ENTER CURRENT NOTIFICATION INFORMATION BELOW: 200101767 AGENCY CASE If: ..�'RO7,EC3'CATEGORY 114 __CONTRACTOR 7013 r# $61.2 JOB SITE ADDRESS: 31811 Pacific Hwy South, Federal Way, WA 98003 PLEASE ENTER AMENDMENT CHANGES BELOW; NF.W PROJECTTYPEt ❑ my,..JOB SITE ADDRESS:(amendment form may nes be used to add additional sttuenaes) Cl MULTIPLE STRUCTURE PROJECT: (Attach map,site addresses,type and ameant of asbestos material&k sche_dufe) ;�t PROJECT STARTING DATE: COMPLETION IAT 12/14/2001 Q 1 WORK SCHEDULE DAYS: M T W TH F SA SU; WORK SHIFT HOURS: ❑ ADDITIQL QUANTITY TO RE REMOVED: SQUARE F7` LINEAR FT FOOTAGE TOTALS: SQUARE rr LINEAR FT) NEW.TYPE OF MATERIAL TO B REMOVED(PLEASE NCLUD.E THE QUAN 1 i7 V FOR EACH TYPE): LariE O�I.ALIi\IFORMATIOIV(ATTACK SHEET IF NECESSARY); DO HEREBY CERTIFY THAT THE tNFORti ATIOY CONTAINED IN THIS APPLICATION A,%'D SIYRPLEMENTA•L DATA DESCRIBED HEREt,r I5,TO THz BEST OF MY KNOwi.EDGE,ACCURATE AYI3 CO,MIPLCTL. 6/19/Q ACG�CY c ONLY SCG AIRS F DATE CONTRACTOR: TLB Erwironrrental, Inc, `? IZYII:WED BY TELEPHONE: (_2O6) 523-4441 .,FA•x: 206 522-4099 G' PL;CET SOUND CLEAN MR AGENCY hent No.66073(Rev,9140)AM d7!1a/O1 F1tI 16:25 RAZi 099 TLH ENVI120NMENTA TNC J uuo • �`64��N���-.- PUs:i)�'I`SdUND CLEAN }1Ki�FCY Date Rece"v 110 Unian Street,Suite 500 t cd ( Searle,WA 9$1x1-2038 4 • / www.pscleanair,orgy� Agency'y use Only •, NOTICE OF INTENT C le:r,n 11ir A envy Agency Uta Only Project Type: 1, ] Asbestos Removal 2, C.] Asbestos Removal &Demolition 3, ❑ Demolirton,No Asbestos Removal Prooerty.Owner: Harsch investments 206-623-4095 Phone: ailineAddress: 509 Olive Way, Suite 1062 lot_ Seattr].eState WA 9$lO1 Zip: Asbestos PLEeSg?US C1.,IRLY.TNIS BEYOI- — ,M.I/Gl� Contractor: TLH Environmental , Inc. ©�vrex/CEO: Timothy P. Ozog 9221 Roosevelt Way NE 206-523-4441ontractflr aiIM Address: Phone; fob No,: ty: Seatt1 State: WA zit): 98115 Fax 206-523-4441 5612 Site -- --- Address: 31511 Pacii:it~ S- City: >"ederal Way 98003 Site Zip: Manager, /` Local Phone: • Asbestos Survey or No, of ti Date •AsE •s , ey Was Friable Asbestos Identified? UYes Ln © Nlat'1 Presumed Ste-,tctcrze.4 $Candtfcte, Was Nonfriabte Asbestos Identified? 0Yes C 1'o Ar '9'; ff uryrequire- . ,cetnn1uran projects Attach a Copy of the survey, if no�t-iable asbestos is A ERA iuilding Inspector; � identified or if no asbestos is idftnrifrri nrn t„R•A,r 144 c, Marion itio.: Bro,Data: State: Demolition Start ”` No.of 1. Tr�tiniag lire(I istFue nCpt.) Information: Date: ~ _ Stntctttres: 2. 0 Ordered Demolition(attach co v of Order) Demolition Irser:dtmcridon cnrlractor's m..r n3 address on bock Will not1�C:4ble asbestos be left LO place �;�ii 1n7 �l7^10? Cot aetor: If yes,list type and dry. Asbestos Project Work Days: M T W M F Sa Su Information: Start Date: 3/14/2007. co it •ca Date: 5/31/03. Hours: 7A — 5P Will ail.friable asbestos Yrs :al *tv. to be Removed: 350 Linear Ft. 0 Square kt, materials be removed? $ NQ ermaI System Insulation: • Boiler\\urnace Ins. . • Duct fns. E1Pipe Ins. w Other :facing Mac'1: • Fir .roofing ■ Pasnts • piaster ❑Textured Coatings tacker sc. l4tat'l • Cement 13d. 7 Cement Pipe Cj Friable Flooring or Roofing Mat'I I Other. y — "r""" .. -. W� Asbestos/Demolition Project Categories: Notification Period P`roiect Fee Schedule Single-Family Residence: (Check box A&H for asbestos removal&demolition) 3 15 Norc•Ret'tmdable . ❑ Asbestos Removal Project A. Prior Notice Fee Covers Asbestos . C� Demolition Pro•et:t B. 10 Da s Removal &Demolition • All Other Demo Lid=With No A.sbestas Removal Pro•eet 10 Days I 3150 2!0-259 •eai feel of 4$rt 159 squaw feet of xsl�rstes see back l0 lea s ( 150 'r 260-9991iar feet or 1150.4,999 •uare feet of asbestos I0 Days 5300 • 1.000-9,999 linear feet or 5,000.49,999 square feet of asbestos .10 nays" _ $750 1:110,004 livor feet or>50,000 s feet of asbestos 10 Days $2,000 enc Asbestos F'ro ect ar xncr exec DCmoiitioa o eet Prior Notice ?wise praicct Pee ' I de y certify beat the infcmatien contained in this nctitcanon ct supplemental date.descriEud hcefo ix,to the best of mY Agency'Use Only I070w4c16e,mune dt complex. deaf - ,r YF 5O' TLH Environmental , Inc, 3/5/01 Mir Si:Harare Rr.rerowins Platt � RNIrtW■d:y Sound Clean Air Agency Form No.66,164(Revised 9ryr00)A,,{ 1TLA ENVIRONMENTA NC a{juuo 07/13/01 FRI 16:25 FAX 5.099 ��.��� O T TQ REMOVE CSR JO0 W.Harrison St Seattle.WA 93119•+4081 7/9/01 ENCAPSULATE ASBESTOS Phone: (206)281-5473 THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DATE FAX: To Regional Offices COattPLET&ALL.tPP;UC1RLEBOICE,S•l4VCOMPLETENOTICES WILL NOT SE ACCEPTED) ' 'Mirk Shift: M Tu w ft E un ASBESTOS ABAT1WMENT PROJECT 1 lam-4pm X X X X X X X Amended? 3rars parr 'Yes 0 No 3pm - 12am 2/zs�—— - 1bpm-8am Emergency? 0 Yes ❑ No Cile/[1nn, c 12/l4/01 ', (other) . . ar Ci On Hold? C OttHold? wont:SmIrrAND FResgm-DATES xat:5TIni\AGT CONTRACTO131NFORititr+►TION Pf� _OPE RTY OWNER 1NFORMATIO1 Cwnraany Name : ties, TLH ENVIRONMENTAL, INC I.Harsch Investments Cdnoaatur Cert.tie 1 Adpros 01294 : 509 Olive Way Suite 1062 Seattle 98101 Si nature . + Z Phone Nn 4111116, 4110"'' •c'2.4„:4 ., (206)623-4096 ciPt �.un ) i oe.n& Rep. IrPhair i SQ DEACON Phone Nu : Address (206)32-.)*444 i 1 1745 114TH AVE S.E.#120$ELLEVUE,WA 98009 len Sire C A S pl+eno Na Bill Bauhler" t (206)454-5038 Job Site PROJECT INFORMATION Facility Addr zc TM,. 31811 PaCif'c Hwy S. • Retd'+1 Stere Cray S Are Federal Way SVA : 19so zit... : Site 98003 1 10.000 s covim King Indoor? Q Outdoor? OU�) lTY OF ASBESTOS To I1( 0 REMOVED.tilt ❑ EticArSt'L.• r o CONTROL NIEEASURES,A,NI?PPE No. 0 sq. ft. No. 333 In, It 1 cabs boN below i each box below i Cas=h box bctpa ✓ cull box.bclwt ❑ tireprouling 0 mag.pipe insulation 0 nee p.erwluiurc El 12 mask An 0 popcorn ceiling 0 air call pipe insulation ❑ glove bag ❑ cull face APR 0 L'Als C J cement asbesto3 board ❑ mini cm:Imucc ❑ t,APR ❑ sheet t irs.,i 0 0 wrap et,(AR EI 'I')pe C cont.lbws Elboiler insulation ❑ ] 41 t methdilS ❑ 1),pe C press d¢naand O dint paper ❑ 0 NEPA vacuum 0 _... ❑ duct tape 0 0 0 ❑ 0 ❑ 0 O . 0 ❑ 0 FSt.t-0:f-a}Wnotice orlows'coInninrdgnedesuixesinks= 447 07/.13/01 FRT 16:26 FAX 4099 TLII ENVIRONMENT A NC lam)/300 W.Harrison St 5612 NOTICE O TENT TO REMOVE OR Seattle.WA 981 10 4081 6/20/01 ENCAPSULATE ASBESTOS Phone: (206)2s 1.5473 THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DATE ' _ FAX To Regional Offices COMPLETE ALL APPLICABLE BOXES-iNCOMPLETE NO riCES WILE.NOT BE ACCEPTED ASBESTOS ABATEMENT P OJ GT Work Ift: M Tu 1 Th F Sat 51r ,t 7nm-4pm X X X X X x x 1 Stars Dare; Amended? ® Yes 0 No 3pm- 12am r. _ - 212131og1. I I pm-8am Emergency. © Yes 0 No i Completion: 12/14/01 i (other} ® On Hold? a Off Hold? -, WORK SPOT AN aNum ECT PATES MUST aEENACT CONTRACTOR INFORMATION r PRQPERTY OWNER INFORMATION Company Name : Name TLH ENVIRONMENTAL, INC a Har ch Inv stmenrs COITa;kUT Ce¢.NO. : Address 01294 t 1O9 Olive Way Suite 1062 Seattle 98101 51 natureY Phone No. r> - � .. ..Mt .C,+fG+CGeZ-+Y (206)623-4996 Name; Owntfs Rap. 1111.'eri Phair $0 DEACON Plvme No. ; Address (206)523-444 I s 1745 114TH AVE 5.E.#120 BELLEVUE,WA 98009 Job SileC.A 9 ; Mena No. Bob f rankl in (206)454-8038 Job Site PR ECT INFORMATION Facility AJdfos Type 'M 31811 Pacific Hwy S. Retail Store Cir? - Age Federal Way WA ? ism 21P-4 : Situ 9$003 10,000 sf Ceenu = King : Indoor? © Outdoor'? QUANTITY OF tiiSI3ESTOS TO 13E 0 RENIOVED,O1> 1__I ENCAPSULATED CONTROL 1IEASURES, ND PPI: No. 0 sq. ft. No. 335 In, ft, s/ each box below ,/ each box below V/ creep box below ,/ ench box below 0 Fireproofing LI mag.pipe insulation 0 neg.p.enclosure 0 112[Mask APR O poptvrn ceiling ❑ air cell pipe insulation Q glove bug Q run race APR ❑ C:US Ei cement asbestos board © inial encltnore 0 PA PR ❑ sheet vinyl 0 i E] wrap&cut 0 Type C cunt.now O huller insulation 0 ❑ wet methods ❑ Type C pre$$demand O duct paper ❑ 0 HrrPA vacuum fl • duct tape ❑ ❑ O 0 ❑ 0 El El 0 0 P413.0,0-0o0,ktlhEeorintrnt cor .elerapW4144ibd[ot 4,9T ••r 07-/1.3/01 FRI 16 26 FAX-5 099 TLH ENVIRONh1ENTA NC to l wins 300 W.Harrison St u 2 NOTICE.0 TENT TO REMOVE OR Seattle,WA 98119-4081 6119/01 ENCAPSULATE ASBESTOS Phone; (206)281-5473 THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DATE FAX: To Regional Offices COMPLETE ALL APPUICARLEBOXYE'S-INCOMPLETE NOTICES WILL NOT BE ACCEPTED ASBESTOS_ABA'XEMEiT.I'ROJTCT Wojc Shit M W Thi F un � � •• lam -4pm x x x x x x x `start oam: Amended? ! l Yes ?5 No 3pm- 12am • 2/28r2001 • llpm-Sam Emergency? El Yes El No - romp 12e/t`1] 01 (other} ti / / a a/ PROJE�y On Hold? I Off Hold? won swiKTAND CtiAiryN \ C' CONTRACTOO INFORMATION P PE Y OWNER INFO MATZO Company Mama No Ile TLH ENVIRONMENTAL, INC Harsch Investments Ctlntraader C .No. Address 01294 509 Olive Way Suite 1062 Seattle 98101 Si nature : Phpt4u No. AM— !;, X209 623-4996 Na ') tYwnen'a Rep. . Inc eri Phair = SD DEACON Pllpoe No. Ad4rs13 (206)523-444 I 1745 114TH AVE S.E.#120 BELLEVUE,WA 98009 Joh Sits C A.S. Phone Np BOb Franklin (206)454.5038 Job Site FRO,lECT 1t�IFORI ATION Facility Address 1'YN 31811 Pacific Hwy S. Retail Store City ' Aga Federal Way WA ZiP*4 sir 98003 .10,000 sf County King Indoor? ❑ Outdoor? QUANTITY OF ASBESTOS TO IRS ❑ REMOVED,OR ❑ ENCAPSULATED CONTROL ME,!SURES AND PPE No. 0 sq. It. No. 355 In.ft. ,/ each box below - each box be1pw each box below ✓ each box below ❑ rircproolit,; mai.pipe insufotion ❑ neg,p.encloser 0l�2 rtiask APR O popcorn cell in air cell pipe insulation Q glove bag ❑ full face APR ❑ CAB cement IIsbestos board 0 mini enclosure ❑ PAPP ❑ Sheet vinyl ❑ wrap&cut ❑ Type C cont.how boiler insulation WCL methods ❑ Type C press demand ❑ duct paper J[ ❑ 1-HEPA vupuutn 0 Elduct[ape tt—❑ 0 0 © ❑ . ❑ ❑ _ ❑ - ❑ © 0 P411-025.000 nave. rWant to remoodinatpsutarc mobcap, 447 N 07./3.3/01 FRI 16:26 FAX 5•O99ANCTLH ENVIRONHENTA•C IR. LATE ASBESTOS tw 1.11.1t1 Seattle.WA 93119-40a1 /674) ,r/ r Phone: {246}28t-5 73 THI t?TlC3HtuST RE RECEIVED NO LATER.TH,. .•O DA}S PRIOR TO THE S7ART D.d7E FAX: To Regional Offices CO (PL�TErtLLRPPL(CI BCE SQ.k'ES-IvC0.11PLETSh't7TJCE5 it'lLLNOT SEACCEPTrrA Wgrk Shift: M . , W F r.... ASBESTOS ABATEMg.NT PRO.1EC_I X X ;� X X lam-4pJn r'4nrtogo ..,.. ,. • Amended? ® Yes LNo 3prJS . Ilam 3./14/01 .. }Ipm. 8arn Emergency? 0 Yes © No ; coMP� eran - 5/31/01 {other) 12.On Hold? 7.Off Hold?t50Rh$HIFT.1 DPROJECT OtTE3 t!I ST BE EXACT CONTRACTOR INI:OI?titf+TCQ`i PRQ,QERTY _____ .R i,r't4. TIUN Cam N.me game TLH ENVIRONMENTAL,INC Harsch Investments Canrrai or Cm.No. Add rem 01294 509 olive war Suit:1062 Seattle 48101 swip.rrc Phalli(No A , ..• (20)423-4096 Aar Name) Jeri Phair SD DEACON Phone Na : Address (206)523-4441 1745 114TH AVE S E.#120 E LLEVUE.WA 99009 Joh Site C A 5 Phpne So L 4 Q "7 Gh• er)>L {20614!45003 Job Site PROJECT INFORIv(-kT10i`I 1«acility. .tdd:esi Type 3131 i Pacifi:H;v f S. t, v - i24t9i1 4;ifs Federal way ��fA it ZM...1 S•:t $$003 . 10,CC.Sf . L-.:,00r`' O:a_aor? King QEANTITY OF ASBESTOS. TO BE 0 REMOVED.OR ❑ ENCAPSI LATER CONTROL NIEA51•RFS AND PPE N0. 0 sq. ft, ilio. 355 In. ft. ,/ a _h boy bria.. ✓ 43h box,halo:: f ^ach bo•c t ! each bus booty ❑ t:;,pwat;r r.. C .g pipe icsula;ion ❑ r r` p.e' • • •••-•• El 1'2 mask APR.❑ pCp.t3rn e:iliog. 0ai;cell pipe insulation ❑ 3 Jve Oa; ❑ (IU(ace APR. ❑ C.38 0 cement as6ai:os board [,:l :es..-:Cn.;cs_•: ❑ D.aPR O st:c:',ir1 ❑ C4 t:c�?d:c-: ❑ TtipcC;pm Bo- ❑ h4ilCr Ins IatiQn ❑ Q 1:e;me:heC: ❑ T;pr C press dem.r: ❑ d:. papas ❑ a Hip v :...-. ❑ ❑ duct tape ❑ 0 0 ❑ , 0 0 0 ... ... .. El 0 ..... F413.O25400 FOridt draw(mremovetenngwti i ba'i a-0 . 07./13/01 FRI 16:27 FAX 5040919 _ TLH ENVIRONMENTA NCto Lilo , Seattle,ti4A98I19-0081 if/5-M/ ENCUST'RTE ASBESTOS Phone; (ZOOM-5473 THLyivOTICA3 MUST BE RECEIVED NO LATER TH.-6-10 DAIS PRIOR To THE START DATE FAX: To Regional Offices COMPLETE ALL APPLICABLE BOXES•fvCOMPLETENOTICES WILL NOT BEACCEPTeD - Work.,Shirt: Iii To W . Ui ASBESTOS A73ATEEN MLIEOJECT ,r X lam-4pmN. a Start Date • Amended? Yes 0 N •l 3pm- 12am _.3./14/01 .•z 11pm- gam Emergency? ❑ Yes ©No Campytion . 5/31/01. (other) ..,On Hold? Off Hold? w oRK SU P-r AND PROTECT DATES tiI1:5T SF.ENACT CONTRACTOR INFORMATION : PROPERTY OWNER INFORMATION Company Name • Name • TLH ENVIR.QNMIENTAL, INC s Harsch investments' ContravorCen No, : Adean 0129 t 509 Olive Way Suits 1962 Seattla 93101 5ynarare ! Phnee Na ,it, M''' i/.94 / i (206)623-4096 iiiiiis sumo : Choral aRap Jeri Phair t SD DEACON Phone No ' Address i (206)523-4441 ...• 1745 114TH AVE S.E.*120 BELLEVUE.WA 98009 Jab Sire C A S : Phone Na 1..40¢1 '_"7 LrJi '/bbi ' — ; (208)4E4.5038 Job Site PROJ>rCT INFORMATION Facility Ai+rru = Type • 31 31 1 Pacific Hwy S. i Retail Store Federal Way WA i , 1°50 95003 10.000 sf • Ca.en 0 h(Ipor? ❑ Qutc!oor? King - QUANTITY OF 6S33ESTOS TO RE ❑ REMOVED.OR ❑ ENCAPSULATED tiTRO4 NI ASURES AND PPE No. 0 sq. It. No. 357 In. It. f Ca.:lr bo bdc'. .7 each bo c bdlQw ✓ each bra to .'.,. ✓ each box below ❑ tir,prooting C nig.pipe insulation ❑ reg p.en.;::.-e ❑ 1:2 mast'APR O pcpcorn ceiling ❑ air Ceti pipe insulation ❑ grove bag ❑ full face APR 0 CAB E cement asbeStaa board ❑ mini cntlei_-: 0 PAPR • s1:ae:vim! 0 ❑ IA rap&ce: ❑ Tspc C con[,flow O boiler insulation : 0 •tar melbas ❑ T; TLH ENVIRONMENTA iNC _ dull 07/ .3/01 FRI 16:27 FAX 5099 `j/ r --- Phone (206)231.5473 THIS_ . ''Gasq fUST Re RECEIVED NO LATER? 4r i Y'S PRIOR TO THE START D.4 TE ,..r FAX: To Regional 0r ices CO.I1PLET ALLAPPLICA9LEPDX�ES4 COSIPLETEovOTICES1vILL NOT BEACCEPTED W'or1:19: til al 14' Th F §21 Sun.... BES 0 B.TEN1 tiT P• *J. CT lam -4pm X x x X X N (51111D" � ...._. Amended? ® Yes Na Spm- 1?am . .3/14/O1 ..i l Ipm .Sam • Emergency? 0 Yes © No comprcion 5/31/01 (other) ... IN On Hold? ]Off Hold? %IDAKSItuF tr&:It)FROJnCTOCHSMICSTBi.VOCE" CQNTRACTOR itiFO_R i I O` PR R Y OWNER ZeNFO_RUAT1ON COm?any Name 1 Nam* Ti.H ENVIRONMENTAL. INC I Harsch Investments conrrsav Cm.No : Address 01294 ? 509 Olive 11i3y Suit:1062 Seattle 93101 3.5rpstnr■ 2 !hoar So .+1111*, ' ±�•' .., i (306)623.4096 ,. a Name) • o•nade Iv"' 2 Jeri Phair ; SO DEACON Pitons No : AdArn{ (206) 523-4441 : 1745 11411'1 AVE S;-P120 BELLEVUE.WA 98045 lab Spec C A S ! Pboee So Jack Vay i I2061 434.503 Jab Site PROJECT 1nL PRMATIO:N, Facility A4..ss T,pc 31St I Pacifc Hwy S. 40Retail 5Y:e Ail Fetera:V4y \VA -,,,,,,Qv4 ZIP-4 5." 93C3 10,000 s` cJa.... El t^ccor? LI Ot:::zor? Kir QLTtTY Of ASBESTCr TO BE Q RE'IOVED,OR ❑ ECAPS1 LATED �_ `T.PI 'iE.&$ RES AND PP1s. `a_ 0 sq. fr. ;Na. 355 In. ft. I a::!r bo.b:14,1 ✓ e::`bur bet.:-.L ✓ _-. bo%:� .1 c.1411 bill below I':r_a:J3ir,,7 0 f2,3Pipe in4..at:un ❑ ,., M e: ::. ❑ 1.2 mask APR. 0Nps:pu ecIti'/ E air ec11 pip:i^tulatiur, I] r,, ;bq ❑ C:dl (•a:e APP. ❑ CAB a ,, :a„„a$Yeitgi board El] ,,..:e^.,:c, , 0 PAP ❑ shoe biml ❑ ❑ .7:1.!S:2 Q T. pcCCOOL tlov. 0 builer insul:v.i14 ❑ ❑ 1,v.:ncth4e. ❑ T;;a C press dcrns'� ❑ Cu:.papc: ❑ El 'r.cPA.a.:^ ❑ ❑ dttct tap. ❑ El 0 ❑ 0 0 ❑ .. ❑ ❑ . . 0C1 ... ° .. Fat7-0:l.4Cc+sucsalnico;'semer.VviPqu4Id ribUlI J. TLH ENVIRONMENTA NC tr�ul� • 07/13/01 FRI 16:27 FAX 5099 8612 '"hc. ' TENT TO REMOVE OR Scuttle, W, WA Harrison81 9 ENCA 'S"C:,,,_„.ATE ASBESTOS Scuttle,W A 98114 4D31 3/16/01 Phone: (206)z81-5473 THIS NOTICE MUST BE RECEIVED NO LATER TH.4,V 10 DAYS PRIOR TO THE START DATE FAX: To Regional Offices COMPLETE ALL APP'LfcAOLE BOX54'bVCOMPLETENOTICES WILL NOT R ACCEPTED A E ToS ABATEMENT PROJECT lya Shift: m, W n1 E la Sun lam-4pm x x x x X x N a Slut Rate, ........ ..._... Amended? ❑ Yes 9 No E. 2 3pm - 12am 3114/01 ' iipm-barn Emergenc ° eampietiae. S ... y ❑ Yes No 5/3 1/01• (other} • a I _ On Hold? 13 Off Hold? 11nR1iPUT AND PROdECrDATts%STatENACT' r 0 gTRAC,�Q,�,,[N�OItIYXAT(ON N 4 FROPUTY OWNER INFORMATION Company Name . Name ILK ENVIRONMENTAL,INC I Harsch€p9stments Contrsctof Celt Na. : Address 01294 S 509 0tivc Way Suite 1062 Seattle 98101 SisMlswra _ Phone No 4111.1, ,s,.� 9� 1 (206)623-4096 t Name) -� : Owncre Rp Jeri Phair i SO DEACON Phone Na 7 Addren (206)523-4441 : 1745 114TH AVE S,E.#120 BELLEVUE,WA 98009 Job Sile C A 5 i MIMIC'S° Jack Vay (2.0$)4544038 Job Site £OJECT INFORMATION; Facility .„, : Type Add,as 31811 Pacific Hwy S. Retail S::4-:a City • : Ave Federal Way WA 1960 z1P--4 : Size 9800310.000 s! Caw-t, 2 ❑ i.".dcOi? 0 O111C00r? King . QUANTITY'OF ASBESTOS TO BE ❑ RENIOVED.OR 9 ENCAPSULATED CONTROL M AURES AND PPE No. 0 sq. ft. No_ 355 In.ft. ,/ cath bo.e belov. f each box below ,/ -a_ box be:..‘ ✓ alclt box below ❑ ti;eprooting X❑ mag.pipe insulation 9 .a; p.enc::;:: ❑ 1:'3 mask APR O papcnn ceilin, ❑ air cell pips insulation 9 f:wt.bag 9 to face APR ❑ cAs 0 cement asbestos board 9 r...ni ancloi-: 0 PAM O Sheet vinyl ❑ 9 a rap s.ct:: 0 TypC C cont,COW ❑ boiler insolation ❑ El «s;method; ❑ Type C press dcman.! ❑ daz paper LI ❑ iiEPA vae::::rn 0 ❑ duct tape I I Li�❑ 0 ❑ ❑ 0 ❑ 0 ........ ... Ra I3.a.s.o00 vsiea ofiotent to eemcveAnospWfafe*heaths *97 Orr' 07/13/01 FRI 16:28 FAX 4099 TLH ENVIRONMENTA INC ' 300 W,Flarrison St S t512 'Num' c. Nx ;�v r TO REMOVE o . Seattle,WA 98119-4081 ...._.//3/3 101 L. ENCAPS �ATE ASBESTOS Phone! (206)281-5473 THIS NOTICE,WUST BE RECEIVED NO LATER THAN 10 DAYS PRIOR TO THE START DATE FAX: To Regional Offices COM& TE ALL A?PL!CA$1.5 BOXE$-Th'CQMPLET$NO7ICS WILL NOT HE ACCEPTED ASBESTOS ABATEMENT PROJECT Worn Shift: 1 "Ey. W Ii e la au +" . Tarn-4pm x x x x X x x e Start Dew; — Amended? 0 Yes El No i : 3pm- 12am ',.3./14/01 .1 I1pm-8am Emergency? 0 Yes Q No : Complmtont 7 (other) ... .,� 5/31J01 r; // to On Hold? ❑Off Hold? WORN SHIFT AND PROJECT DATES MUST BE ENACT CQNT A.CTUR INFORMATi'QN 1 PROPERTY OWNER lNFORMATION Company Name 1 Name TLH ENVIRONMENTAL, INC i Harsch Investments Caocommatof Cert.No. : Addrma 01294 ; 509 Olive Way Suite 1062 Senate 98101 Signature Photo Na. AIM/ a:/.'ler (206)623-4096 diattir No •• : Owner'gap, Jeri Pharr so DEACON 1 Phone No 1 Addrett (206)523-4441 1. 1745 114TH AVE S,E,#120 BELLEVUE,WA 98009 Job Site C.A,S. i Phone Na John AsSeiin i (208)454-S038 Job Site PROJECT•INFORMATION Facility Address ,:`' Type 31811 Pacific Hwy S, Retail Store all* Aye Federal Way WA 1860 ZIP—.t : Sian 98003 s 10,000 sf County King ElIndoor? 0 Outdoor? QUANTITY OF ASBESTOS TO RF 0 REMOVED,OR 0 ENCAPSULATED CONTROL.MEASURES ANT)PPE No. 0 sq. ft, No. 355 In. ft. ,/ each box be[ocv ,/ each box below ./ each box below / each box below O fireproofing X❑ rnag,pipe insulation ❑ ncg,p.enclosure 0 112 mask APR O popcorn coiling 0 air cell pipe insulation 0 glove bag 0 full face APR ❑ CAB 0 cement asbestos board ❑ mini enclosure ❑ PAPR ❑ sheet vinyl ❑ [Q wrap&cut ❑ Type C cont.flow ❑ boiler insulation Q wet methods ❑ Type C press demand Elduct paper ❑ 0 NEPA vacuum 0 rjduct rape ❑ 0 0 ❑ 0 0 ❑ ❑ ❑ , 0 (14 I3-03 s-goo noun of Want to remo,elencepsutnrc aebutw 4-57 ' 07/1.3/01 FRI 16:28 FAX 5241/099 TLH ENVIRONMENTAL•C anATHA � LLA Accredited Lab#101857 C o n s u l t. I n g Traintn9 6/22101 L at. Art, 0 V — t t Iv—.,_�,.•r Office !1', r hi•, TLH Abatement,Inc. 41` ,� }, 7417 4th Avenue South %i ` \ t:/ \ Seattle,WA 98108- \ , RE: Airborne Asbestos Dust Analysis; Batch # 12366 \'... _..,,----- -,,----- Dear -- —,Dear Office, Enclosed please find the test results for the air samples submitted to our laboratory for analysis. Examination of these samples was conducted in accordance with the NIOSH 7400 method for airborne asbestos testing. Results are reported in fibers per cubic centimeter (fibers/cc), Filter density,reported in fibers per square millimeter(fiberslmm2),is provided to assist you in determining the best flow rates and sampling times for future air sampling. The ideal filter density for the NIOSH 7400 method is between 190 and 1,300 fibers per square millimeter. This report is considered highly confidential and will not be released without your approval. Samples are archived for thirty (30) days following analysis. Samples that are not retrieved by the client are discarded after thirty(3Q)days. This report relates only to the items tested. If samples are not collected by Prezant Assoc. personnel, accuracy of the results is limited by the methodology and expertise of the sample collector. Quality assurance and quality control procedures for this analysis are followed in accordance with the ATHA . guidelines for airborne asbestos analysis. Inter-and Intra-laboratory relative standard deviations and applicable quality control data is available upon request. We appreciate the opportunity to be of service to you on this project, and look forward to working with you again in the future. Please feel free to contact us if we may be of additional assistance. Sincerely, George G.McCastin Laboratory Director Enclosure: Air Sample Results Pro:.?nt Al it+�tu.,Inc. 3.111 MI Avenue Pigott, Suite CHIC S,:attic.WA!IFI p Vuirr,�;NA:.1:11.8858 r,,:M..81.3922 07/13/01 FRI 16:28 FAX 4099 TLH ENVIRONi41ENTA•NC 'VA 11" • • P +��ii nt 330 6th Ave.North,Suite 200 Seattle,WA 98109 OFFICE:(206)281-8858 FAX:(206)281-8922 Airborne Asbestos Dust Analysis (NIOSH 1400 Method) TLH Abatement,Inc. PAI Batch Number: 01-2386 7417 4th Avenue South Client Job Number: Seattle,WA 98108- Number of Samples: 1 Project Location: Pavilion Center II Blank Average,: 0 31811 Pacific Highway South Field Area: 0.00785 Lab Sample ID: 01012039 Client Sample ID: 5612-01 6/19/01 Time: .� Rate: greathing Zone Start: 9:05 2 Southside of.Iobslte End: 10:38 2 Protection: Half Fare APR Minutes: 93 Avg. 2 Deron: Suit Environment: Liters: 186 Worker: Robert Frankin --• SSN: Pump ID: 010-438 Comments: Wrapped Translte pipe in Pofy LOD LOQ Min. LOQ Max. Fibers/Flus Fibers/m*m Fibers/cc 0.015 0.207 2,691 10,5! 100 13.4 0.028 • • Sampled By: Client • Received By: Aaron Mohr 6121101 ------- — Reviewed By: George McCaslin 6/22/01 Analyzed By: John McCaslin 6122101 PagcIofI 07/13/01 FRI 16:28 FAX 5.099 TLH ENV . ..... C..._,,,,,,,, „ ;I r;yC�'� IRONMENTA ,� r,1F.�C'�1..7): . TLH Abatement, Inc. .,,fir Saaple 'Data Sheet Page: 1 . Ot k__ Job Location",' . s 4l 1 "?1 i lre.Ac.� .` .O , 10 ,fob#:g(:+i I. Sampled B B . ►+ .� r Date: ? Time: -Sample ID: 61 o l Location: tLI ut , - A + 1 = Sample TypT - Work Activity: • „� - * ''b `� �'� - , Protection: YY �Observati J y ri ` . ►-�;`oµ'/ _l :' moi_ i Decon: , Wore . ” :ti r 3 ,��r r1 SS#: Cert# /faM►gess Environment: "--- Time: Start 9105'01 Rate: Start ,2.,x ���"� Time: End t Rate: find Fibers Fibers Pump#: e,T`.. la :.' $i Liters !field /cc 24 ict 0 1 Minutes C,��}� — Average • I� , 0'0 Sample ID: Location W�_ Sample Type: Work Activity: Protection: Observations: Decon: Worker: SS*: Cert#: Environment: Time: Start Rate: Start Time: End Rate: End Fibers Fibers Pump#:� Liters !field /cc Minutes= Average Sample ID; Location: _ lample Type: Work Activity: Protection: Observations:, Decon: Worker: SS#: Cert#: Environment: Time: Start Rate: Start Time: ,End Fibers Fibers Rate: End Pump#: '77' ��, Liters /field /cc Minutes= Average Sample ID: Location: _— Sample Type: Work Activity: - Protection: Observations: �_— _---- -� ` Decor: _Worker: ____W. SS#: Cert#: .4. Environment: Time: Start Rate: Start Ti—me: EndRate: Fibers Fibers Pump#:- _ at Rate: End e_ — Liters Yield /cc Minutes= Average Sample ID: Location: Sample Type:V.— Work Activity: — ._ Protection: Observations: n---� • Decon: Worker; SS#: Cert#: Environment: Time; Start Rate: Start Time: End gate: End Fibers Fibers Pump#:_ .- Liters !field !cc F.,i,. v�] Minutes•= Average — ..-. 07/13/01 FRT 16:29 FAX 54,099 TLH ENVIRONMENTANC San to Log / Chain of Customs LAB: - . .Client Company: UH Ahatemet flC. _ LAB Job Number: Number of Samples: Client Address: 9221 Roosevelt Way NE _ Seattle, WA 98115 TLH Job Number: Sto 4. Number: (206) 523-4441 Job Lacatiarl ma , _,,_ iia Fax Number: .12j2§1.!2_2-4 _ F 1 11 S,�.,r.�r/� Report Results Xe: A. : 1- „ *a- Ev:::i At PHONE Number ASB S LEAD PCM (air) EJ Paint 11:1 At PACER Number SoilED Oust/Wipe(area?) [:1FAX Results f'y ® MAIL Hard Copy n PCM (bulk) [J Air(volume?) 1_3 TCLP __.._. EMU In RUSH Condition of Package: Good [1:1Damaged (No Spillage) [—z) Severe Damage (Spillage) Lab ID Sample ID NR Lab ID Sample ID NR Lab ID Sample ID NR 111311 s.�r5.,-0 T 17 9 - 2 • 10 18 3 11 x.. 18 4 12 20 MEM 13 21 6 1422 15 23 8 16 ..� __ 24 --- _ Signature Date Time Sampled S . 000-40. 1r�►`+\ ��r�• . _ --�--. Delivered - '�� ' r ._..,. .� '#:!*�v,..,.,:„.-mtv__.__._ --- ea 1 di • i ._ ea ti epj I Received 6y: ." «1,,,,/_ , /� "� Analyzed By: a ' • '"-" -2-V----- _ , 12,/,„ c/2.1_______1_5:= /-15-- _ 1.Reported'By,' — —� .13 i w ppµ 1Jri T1. :fe --------Y�_. Special: Read Abatement Sample# ONLY if Sample# is Greater Than .01 f/cc Led V a.V TLH ENVIRONMENTAL.007/ .3/01 FRI 16:29 FAX 5 099 &) KVI3A? March 02,2001 TLI-1 Abatement,Inc. ��� 9221 Roosevelt Way N.E. 4 2.0. P� Seattle, WA 98115 RE: Bulk Asbestos Fiber Analysis; NVL Batch # 2.1- 01707.00 Dear Sirs/Madam: Enclosed please find test results for the bulk samples submitted to our Laboratories for analysis. Examination of these samples was conducted for the presence of identifiable asbestos fibers using polarized light microscopy(PLM) with dispersion staining in accordance to U.S. EPA 6Q0/R-93/116 Test Method. For samples containing more than one separable layer of materials, the report will include findings for each layer(labeled LAXER 1 and LAXER 2,etc,for each individual layer). The asbestos concentration in the sample is determined by visual estimation. For [hose samples with asbestos concentrations between 1 and 1.0 percent based on visual estimation, the EP'A'recommends a procedure known as point counting(NESHAPS,40 CPR Part 61). Point counting is a statistically more accurate means of quantification for samples with low concentrations of asbestos. If you would like us to further refine the concentration estimates of asbestos in these samples using point counting,please let me know. This report is considered highly confidential and will not be released without your approval. Samples are archived for two weeks following analysis, Samples that are not retrieved by the client are discarded after two weeks. Thank you for using our laboratory services. Please feel free to call if there is anything further we can assist you with. HAZARIfflU$MATERIA!S MANAGEMENT Sincerely, TRAINING LABORATORY SEF'.ICES Munaf Khan NVL LABORATORIES INC Laboratory Director 4708 AUROfMA AVE.N. SEATTLE.iNA se103 TOLL FREE I.898.NVL,fAHS (EBS•52z7� • TEL Z06.547.0100 Enc.: Sample Results X 208,634.1936 E-MAIL Info@rwIIans.com www rwVaos.cc m • 07413/01 FRI 16:29 FAX 5 4099 TLH ENV I RONMENTA•NC _ `a',,— Tel: 206.547.0100 . NVQ'., Laboratories Inc. Fax: 206,634.1936 4708 Aurora Ave.N.,Seattle,WA 98103 ATM.P BulkAsbestos Fiber Analysis #102063 Client: TLH Abatement,Inc. NVL Batch Number:21-01707,00 Address: 9221 Roosevelt Way N.E. Client Project#:S61.2 Seattle, WA 98115 Number of samples:I Project: 31811 Pacific Hwy_ S., Federal Way, 98003 Client Sample #: S-612-01 Lab ID#:21026 l07 Sample Description: Grey cementitious material NON-FIBROUS MATERIALS: Calcareous binder,Mineral/binder ,c" OTHER FIBROUS MATERIALS: Cellulose 2% ASBESTOS TYPE: PERCENT Chrysotile 34% Sampled by; Client Analyzed by: John Terrill Date; 03/02/2001 �. +1�_ .,.k 0. Reviewed by- Munaf Khan Date: 03/02/2001, Munaf , L.bor ,.•K, Dire. J `ate: If samples are not homogeneous,then subsax pies of the components were analyzed separately. All bulk samples are analyzed using EPA J0/R-93/Il( Method with the following measurement uncertainties for the reprted%Asbestos(1%=y0-3%,5% ?1-9%,10%-5.25%,20%410-30"o, 51)%s=40-60%). This report relates only to the items tested. If samples were not collected by NVL personnel,then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full,without written approval of NVL Laboratories,Inc- It shatt not be used to claim product endorsement by NVL AP or any other agency of the US.Government. Page 1oft ENVIRONMENTAC ��� 7 07/13/01 —F.—RI-16730 FAX 52 099 TLH / , / St. vie Loi, / Chain of OW iyc2 )-6 . LAB: ;Bent Company: MIte1fl6iri_ 1110. LAB B Job Number: Number of Samples: Client Address: 9221 Roosevelt Way NE _.. . Seattle, WA 98115 _ ._ TLH Job Number: cj , 17-- Phone Number: (206) 523-4441 ..lpb Location: 3 f i t ____ Fax Number: (206).522-4099._.._ _. __ �, Ow; 5, Ff c/5.9O A 71r lic,. ,i6(,-) (-Yea �� .51S he A( & Co RePOrtReSldt$TO:,-7,.11 )1Lf(''Ar� SE /Zp tcu- Type of Analysis (Check One1 ii+i aSe041 ASBESTOS LEAB At PHONE Number [TI PCM(air) rn Paint (.Soil [:11 At PARER Number I I Dust/Wipe(area?) �- -- PCM (bulk) I 1 Air(volume?) FAX Results MAIL Hard Copy (-1_i"CLP �-- OLAR 1i USNE6 .-- rilCondition of Package: Good,,,, D Damaged(No Spillage) Severe Damage(Spillage) Fhr � Lab ID Sample ID AIR Lab ID Sample ID AIR Lab 1D ' Sample ID A/R __- 1 ,S- f� l - i s� _ 9 - 1177 ..____ 8 311 19 —.+ 12 20 4 5 1321 — . , 6 1422 — --- 7 i 15 23-- __ 8 16 r-r-- - 24 -- - - — — — --i n e Date Time ..,-- Sampled By; I// ..,%J/. - Z -'7.-e, '- Delivered By: ,4i# �►/ ~-_ �� `^cam /f fly �. a Received By:� .i/ .�rl�'" �. ..,.4 I //, •. c7` ' !� : y q 43"1 -. Analyzed By: .,.; � F -' --- T - ; .-Repv rt,eit Bj�s` _-�__ — �__ . ___. °Ma(ledjy ----- _________ ^ ,,,,L,...2„,,,,,,„ Fw1 r , ,7,t"InvoiceBy ^ Special: Read Abatement Sample At ONLY if Sample# _is Greater Than ,01 flcc -- TLH ENVIRONMENTA •""� Or___ ��� ��� �'l C�'�CERTIFICATENUMBER 07/i3/01 FRI 16:30 FAX 5 y S N G� -00033749200 7 iM AK ,t1 U S , I ''E,^"`' ' '� THIS CERTIFICATE Is 13S(J .-.di A MATTER OF INFORMATION ONLY AND GONFERs PRODUCER NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE Marsh USA Inc. POLICY,THIS Ct:RTiFIGATE GOES NOT AMEND,EXTEND OR ALTER THE COVERAGE 121524 Financial Center AFFORDED BY THE POLICIES DESCRIaao HEREIN, — Suite#h Avenue ' COMPANIES AFFORDING COVERAGE Suite#2300 Seattle,WA 98161^149$ COMPANY 34905--CAS- 5612 KME A NAT'L UNION FIRE INS CO OF PA INSURED COMPANY TLH Environmental,Inc. B COMMERCE AND INDUSTRY INS CO 9221 Roosevelt Way NE COMPANY Seattle,WA 98115 C AMERICAN STATES INSURANCE CO ` COMPANY D COVERAGES ' - ';;;-*'' ;';•;This•'certificate';upersedeS'and feplaces•anypreylouSly issued certificate for the policy period noted;,bejow:; :;' 1 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE. INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED, NOTW ITHSTANOINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY OE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERRN IS SUBJECT TO ALL THE TERMS,COhtOITlONS AND EXCLUSIONS OF SUCH POLICIES.LIMITS SI-'OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLIGYR iI POLICY EFFECTIVE POLICY EXPIRATION LIMITS — LTR TYPE OF INSURANCE _W I DATE{MM/O01YY} DATE{MMfDOlYV) OENERALUABtLITY MI7780147 03131/00 03/31/01 GENERAL AGGREGATE $ 2,OOO,000 A 2,aao,aao X COMMERCIAL GENERAL LIABILITY pRODUCT3-COMP/OP AGG PERSONAL E ADV INJURYS INCLUDED 1 CLAIMS MADE U OCCUR $ 1,000,000 EACH OCCURRENCE OWNER'38CONTRA I-)ARATOT FIRE DAMAGEfAnyone Ere) $ 100.000 X • „ • S LFAf)ARAT 5,000 X A STOP GAP _ _ -\ MED EXP{Any gneXersort) _$ B AUTOMOBILE UABILGTY CA 766 5976 03/31/00 T 03/3 01 1 COMS1NED SINGLE UMn' $ 1,000.000 01CC 683131-2 03/31100 . 0313 1 L . . —C ANY AUTO --' '.:; \ BODILY INJURY X ALL SCHEDULEDowNEO AUTOS @`2,\''' '' (Per person) r.^ n. .. r,�• ' —_ X HIRED AUTOS ��✓'- ), � i St./OILY INJURY $ 1 — (� I (Por accident)X NON-OWNED AUTOS \ S ;.` X "OLLUTION LIABILITY C 1 I PROPERTY DAMAGE �$ X UDDEN&ACCIDENTAL GARAGE uABILITY i AUTO ONLY•EA ACCIDENT $ —_ ANY AUTO 1 OTHER THAN AUTO ONLY: ". •, EACH ACCIDEur 1$ AGGREGATE EXCESS LIABILITY �—. EACH OCCURRENCE I$ _-_1 umBRELLA FORM �— AGGREGATE I S ,SP,THAN UMBREL1_^.FORM -- '�[). 1t}YN i1y� "-- WORKERS COMPENSATION AND TORY OATS l ER ' EMPLOYERS'LIABILITY 8L EACH ACCIDENT {��. .., THE PRGPRIETOR! INCL EL DISEASE-POLICY LIMIT `1 PARTNER.E ECUTIVE EL DI$EASE•EAGH EMPLOYEE] OFFICERS ARE: ,EXGL --- •- I DESCRIPTION OF OP ERATIONSJLOCATIONSNEHICLES1SPt=CTALITEMS{WMITS MAY BE SU cut Cr TO DEDUCTIBLES OR RETENTIONS) AUTOMOBILE LIABILITY-$2,000,000 COMBINED SINGLE LIMIT APPLIES TO POL,NO,CA7665976,CARRIER= COMMERCE&INDUSTRY INS. CO. SD Deacon is an additional Insured as respects their interest in the operations of named insured as required by written contract regarding General Liabiilr; Re:Job#5612-Pavilion Center 11,31811 Pacific Highway S.Federal Way.WA 98003. �T _ CERTIFICATE tiOI.OER ,. r ..• CANCELLATION " _•..,, • i __'.S• ;::.;t..i`.�r'-r.,...:...5».u. ,r.'ri ... .. - ..x SHOULD ANY OF THE PQLIQIKS CESCRIbRG HEREIN SE CANCELLED BEFORE ri-i exp,RATON CA'5 7''G'+E:, THB INSURER AFFGHDING GOVERAOE WILL, qniaqmpplTo MAIL 45 EATS WRITTEN NOT CE'0 1745SD DEACON114THCERTIFICATE HOLCEE NAMED HfiNEIN,OUT PMMLURE TO MAIL SUCH NOTICE SHAM.UAPOSB NO CU iCAT'C' BELV AVE #120 BELL,EVUE,WA 98009 LA9FL17YOf.tuYK,NOUPONTNBINSURERAF=ORDINOGf,1VERA(J6,1T9ACBNTSORREPRESENTATIV°S MARSH USA INC. BY: Sandia J.Dillman ,L ti " "' "'a"wil`". x 31 , t1;T'izi ..;D'.' h, `, f,r 14MM 1(9199y: "T''`tin_n— i- �d1" 03122'01 099 TLH ENVIRONI4SENTA C _r-'... "'. wr.wwr.7't - °"w` 7 ' 07/13/01 FRI 16.30 FAX 5 �' eeRTlF1cATE NUMeeR mntresn rusio► �' e RXA CAT , a 1NSURANC w ,,,,, r .,..,,,,,,,,•••!‘,..,,,,,,,,,,,I. A 100397468,0 PRODUCER ", THIS CERTIFICATE IS tSSUb_,,,.5 A MATTER DF INFORMATION ONLY AND CONFERS Marsh USA Inc. NQ RIOHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE The Financial Center POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE + 1215 4th Avenue AFFORDED SY THE POLICIES DESCRIBED HEREIN, — Suite#F2300 COMPANIES AFFORDING COVERAGE Seattle,WA 98181-1095 — - — COMPANY r$14905--CAS- S612 KME A NATTL UNION FIRE INS CO OF PA tN SL RED COMPANY ��-�•-, TLH Environmental,Inc, 8 COMMERCE AND INDUSTRY INS CO ` 9221 Roosevelt Way NE COMPANY Seattle,WA 98115 C AMERICAN STATES INSURANCE CO COMPANY 0 COVERAGES - Y- �'«..Thle-certificate'superEede5'and,replaces any prevlodslyissued certificate for the policy period noted be'lOW.-;;,: . 2 MA.:.al.,. THIS IS TO CERTIFY'(HAT POLICIES OF INSURANCE DESCR1HEiO HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICICC DESCRIBED HL:RC:N 13 SUBJECT TO ALL THE TERMS,CONDITIONS AND EXC!,USI0FiS OF SUCH POLICIES.LIMI T S SHCv.'ti MAY HAVE BEEN REDUCED BY PAID CLAIMS, __,�, , CO TYPE OF INSURANCE POIJCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATEIMM/00NY) DATE IMM/OONY) A GENERAL LSABIUTY AAI77$0147 —03/31/00 03!31101 GENERAL AGGREGATE $ 2,000,000 X COMMERCIAL GENERALLIABILITY PRODUCTS•COMelOPAGG $ 2,000,000 `CLAIMS MADE X OCCUR PERSONAL&ACV INJURY $ INCLUDED OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 X ,ASBESTOS R,!P . 'Fir FIRE 4AMAGE(Any One F $ 100,000 X WA STOP GAPMED E A(A�v ana Pe sones $ _ 5,000 B AUTOMOBILE LIABILITY CA 766 5976 03/31/00 103/31/01 COMBINED SINGLE LIMIT $ 1,000.000 C ANY AUTO 01CC 683131-2 03/31/00 03/31/01 —_ XALL OWNED AUTOS BODILY INJURY $ •_ , { I (Per pmrsan) _ _ SCHEDULED AUTOS r " •....._.-.— - --T-•-- X HIRED ALMS BODILY INJURY $ (Pei BCtiderll) X NON-OWNED AUTOS POLLUTION LIABILITY 1 PROPERTYOAMAGE $ X SUDDEN&ACCIDENTAL GAR AG a LIABILITY AUTO ONLY-EAACC!DFNT $ , ANY AUTO -•f,.-�'` (C. _ !OTHER THAN AUTO ONLY: , _ ,m t ; EACH ACCIDENT $, - - - `p\P;--- - r� IAGGREGATE $EXCESS UASILITY - - 1 E•ACH OCCURRENCE _ _ $ I 't� , t -' AGGREGATE $ UMBRELLA FORM ` �' —GREG-. - ,. —t• ..�• �1 OTHER TI IRCLLAI;R1.; �.., $ riURkERs COMPENSAYION AND — 1 - TOCP MITE ER EMPLOYERS'LIABILITY 1 EL EACH ACCIDENT $ THE PROPRIETOR! INCL i EL DISEASR•P01 j(LIMIT __$ PARTNERS/EXECUTIvB OFFICERS ARE: Ent. _ •,- T,, 'EL DISEASE-EACH EMPLOYEE $ IbtHr:R DESCRIPTION OF OPERATIONS!LOCAtI1NSPJEHICLE$1SPECIALITEMS iUMITS MAY BE SUBJECT TO DEDUCTTSLSA OR RETENTIONS( AUTOMOBILE LIABILITY-$2,000,000 COMBINED SINGLE LIMIT APPLIES TO POL.NO.CA7655976,CARRIER= COMMERCE&INDUSTRY INS CO. Harsch investments is an additional insured as respects their interest in the operations of named Insured Es required by written contract regarding Gs.ieral Liability. Re:Job#5612-Pavilion Center 11,31$11 Pacific Highway S.Federal Way,WA 98003. CERTIFICATE HOLDER " --.•." w- , .. ., ., •• ::�.�•.•_, --�•._..� c .•• .;. :.•.:,.` CA1,lClWLI.ATQN .,-.. ,. _., ,. •_ :: . • {' BNQUL0 ANY CF PIEPOLICIESD.SCRI !C MERLIN BE CANCELLED WORE 7.N5 EXP'RATION CS-E""2^f."=` 11N5 INSURER OPOROING COVERAGE WILL FNOEAVOR TO MAIL_._4.5 PAYS wRf1YEN NC'•r ,D TMi. HARSCH INVESTMENTS CERTFlOA1E MOLDER NAMED HEREIN,OUT FAILURE TO MAIL SUCH NOTrC5 SMALL IMPOSE NO DE.CA'=Y O^ 509 OLIVE WAY,STE 1062 SEATTLE,WA 98101 LuBfUTY OF ANY FINE UPON THE INSURER APFCROINO COVERAGE.ITS AOENTS OR R4PR(SINTAT•/ca MARSH USAINC, BY: Sandra J,Pulman dm .57"'G4'1al'rc"- �,.L _';; _l____�j`y,�{ +M�,_ 'n.X.Ti„t��.t,�-•—_•O3f22141 I,A L" 'M� F R-1{r-n..1t'�'ILM1-.is .,•..["•' yY •lq,u`14i� .'tom �,I r.X^-v v'Y^.F,.....w• -`R1M1�9f9.7/ w-T R'� .SIV AYI�O� �. -707/ ._-_.__.,...-. ..._.""---.^.-.- ..-..... fir. v 4 u 0T '1.-3-/-0-1 -3/01- _ FRT ]6:31 FAX 5 099 TLH ENVIRONMENTAL/10C 4 �1 TLH ABATEMENT, INC. S612 WASTE SHIPMENT RECORD .,.;.x Owner's Names Owner's Phone No.: '`�:',$ Harsch investments 206--6234096 + 1. Write Generated Site Name and Address: 'laW,$..490 Pavi1-Ion Center 11 414 31811 Pacific Hwy S " ,'' >;edaral Way, WA 99003 _ DpbrC,torx Phone Na: +t•{'F" 2. Operator's Nome and Address; ;0y:is,,ul TL}i Abatement, Inc. (206)523-4441 i,,A.'!gf 9221 Roosevelt Way N.E. FAX:(206)622-4099 Seattle,Washlr'gtan 4311$ yi• ai Site Location: WOS Phone No,: ',� t�_ $,Wpbte Disposal Site(Wf751 N©�.Addrmas,clad Physic 40116111101011400 .:;P; x; 4. Responsible tacal.state or EPA Agency Name and Address: v 1.10 Union St. , Suite s' :.:.' !pep Seattle, WA 98101. 4.,,,, ,. ---- §1.11 -- '4.x;fla 7. Tgtol QuonttY 1. ,; 6. Containers�,�:��'�; 5. fJesgrlptidn of Waste Mcrt�eri����,.,, �..,` Vez 40 A" Yh'C ;j. ` ,,,,Ir FriQdia As4estas Cont. ter . ._.^. 4.8 — I/ ;01: ' Non•Foable.As`•Dest• . �ming h, s, slats Q , g i7', '' key r^2� < s > 5spacial NO • sa InforrnQtn;THIS r1RETURNED TCTLH 44td, ABATEMENT,1hC,B' '+- ENT w FI 'ER TWETRANSPO TER OR WASTE DISPOSAL 5E OPERATOR. Al,e; \ 4474, e., ,'ik?A >:°, 9.df'ERAt4R'S CERI7FICATlc7hr: 1 hereby G�eCkara that the Content;or the consignment are stilly anti accurately describeG above by iii` a'r. proper shtpping name and are classified.pocked,marked and labeled.turn are In oh respects In proper GonditiBn for tronspar-c', ij�1,3iI ,,•A�::4 highway according to applicable internGtbnai and government feBL?ations, ...i3O,:1 tJlOrnh Day Ye a. Signaturb ''1`, ;'— Prlr,tedllyped Nome j :0<,.,:r•sci"i.l CA C.).-.C.4)‘..-- - e. xi x<:. '�,g.;, SQ.'Transporter 1 Acknowledgment a'Recei-t of Materiaist _� i ';f4f,: T Signature Month Day YeCtr iN s,£;�'`.� Prlr,tedlTYr�'B Nome illi;g};!' "'iw; 11.Tronspartor 2 ACkriowrf ledgrnent of Receipt of Maieais 4ir' Printed/Typed Nome Signature Month Oay 113 s§:'"" 12. DezrePCIYInd coition SpcCe i>•??d� ti{ei 3�*' Vis: GVN}k "„_ 13, Authorized Waste DIsposof Site owner or Operator: CertiticatIon of receipt of asbestos materials covered by this manifest exce:.-, • as noted In item 12. _ *ravv, Month pay Yell‘" Rimed/Typed Nome 5lWn° r 9 .1i '4'1, r 1.• 5 . , ,cil , P 2 . : • .1, A ', -al. • _wader 4... -.. WNr1L Mrun to Orh+rarer YittoW: WOO%SMD 1M'C:Tres/19 of SOW; 06911070f— _. . - ,7.. R fir,7maT4:av WIT cnnn ^r..n .nrr nn,w.... w” '�"'7..-- .7. .14k ' '07jI3/01 FRI 16:31 FAX 52 099 TLH ENVTRONDZENTA TLH ABATEMENT, INC. s 612 WASPS'SHIPMENT RECORD t. wastQ Gart.rolac3lite Name and ltdetiest; : " ? pavil licm �10Ez IS � ►et�►p +'s Phone Ne,t s�. =:' 31211 Recitic s. r ch Invaet ttk� 206-623-4036 1j=,�K ' „t+.'1 tnTL.1 r 9144 I lAti,' 2, CtpataIor's Nonto and Addratt: ^�' .', TIN Abatement.inc. aperotbti�npnaHa: "g.�, 9mf tiocs•veaway t�.E, 'w "4.7,-t 4ectile,V0asr'T kt{;tQn 681 t4 t206)623.444, 1� "' " t°Ax;(2CbiZ'4044 a,4Vc>Jte Cttpas " '�..-J Norm.Addrirtsr,ertld Dflyslr�tt�(h ka}ian: --'r'""'r_ — ----- .4 ' a• , . dq8 wris i Pt'wnt►Nc: 1817 • - Spring Larne1,1E 01/111,t�' L." 541-454-2030 $� . Kemple Larflt.Slate or • Auoncy t AcIctraW -«-"'- ••M. -•---.—�._----- --.,.. sr.5. 110 Union st., softs BOO . Seatt2.0 r Wit, 510,G1 , ,� 5, otsscriptlon of Woste Materiafat __-—.,�... �- `-' �yj 6, Cot'rtairwts 7. Total Cuefrtf P 1 6,•-• No, lyse 0 tet132 •:.*4 Pabfo Al besta-s c. art falnkMotet* �, ' ' Nan FrtbiNCrAa-bt)asatitolp Mote rlizI} "; ?. E. sp ;nt eganpilnq InstruatfGt,s a `�" !,',k:'#):: ,‘ii ,es�' ABATEMENT,1h'C,8E-FOREPAyANrt E}INcfd 1k OR TER O WASTE Ct$POSALSOc INENT MUST 15CITB OPERAtOR RGTUf�iNi D Tb Tl1 • kie "`iti}-i' 7.OPERA.1L7R'4 CERilFtt;AndP4; I trareby de-ctara}tlor via Qantas*as KtltatiVtahreent arq t<:' Propat it�l�y4np nacho oncJ org eleWJfled, flay arsct rarTtuOtaty dCSaribCd Cave ny y,;'(i:. packed.Ttc/146d once lnbelyd.ant we In all r Y'=:,,,,:y h' `sway occordfno fa ttppffcobta frrterruelar1Ct and Gmrermaint 6>�C4 In pd4Det t:ant�tian trrr frt7n xsrf by %A-. teaulGt#crty Tib° P;inladrYPou Note �?1,, Sgnaturs / / y °".!:.t,,,1/4F:' 10, iranzportet 1.gck^awfacs8'ment of Rrceipt a!Ma'1° t ,gi ; ; AilitPdrYPaef //,Name &gnat �'� -.rs- � i ,�-� i�►� .. itt tit rY�a/gr ° '' 1 t.Trarsponisr ACstt>oW� ..n - . 200100/,": ..�r!! .ul 44 V f .Y., grrSenl Re - dt tJICis61iC. %� ' '*.. Prtrted/7 pod Noma 1111 ;; ivlanth acy 'uY 'l t 3, Orth „,, �l r4 •R�1C}'tr"4ECQilt;(1sp.” tt .. 73. Auttrrrt$ad WC t orpor4T SItO C,�rmee Qtr ,, trs notnci� T m 12 '...,•;:,,..4..11.........••104..--r-..s.0.•••••••..,- teli Cartlftcofk7rt of 01 pt m ertgs Rla8+df4refl aered br ma=weea,ravpf 0. ... Atreapllypod Narrd t fr 0„ I L3 Stperfuni Manfhr r7t�1' yitclr t� J-ej\ .. it dial r /n *Olt P..hrol it,4.arlate Ittsrna WQtte 24 Mot ftereaerat