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16-102856 Demolition City of Federal Way Community&Econ.Dev.Services Permit #: 16-102856-00-DE 33325 8th Ave S Federal Way,WA 98003 Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050 Project Name: CVS PHARMACY Project Address: 33520 21ST AVE SW Parcel Number: 132103 9098 Project Description: Removal of existing fuel station and (3) underground storage tanks Owner Applicant Contractor WASHINGTON CVS PHARMACY LLC I 0 ENVIRONMENTAL AND I 0 ENVIRONMENTAL AND 100 WEST MINISTER ST SUITE 1500 INFRASTRUCTURE INC INFRASTRUCTURE INC PROVIDENCE RI 02903 2840 ADAMS AVE SUITE 301 IOENVEI880PN(10/29/16) SAN DIEGO CA 92116 2840 ADAMS AVE SUITE 301 SAN DIEGO CA 92116 Additional Permit Information Demolition Valuation 514350.00 CONDITIONS: Erosion and Sediment Control Measures shall be installed and maintained in accordance with the King County Surface Water Manual,Appendix C or D,dependent on site size. The City may inspect and require additional controls dependent on erosion or risk of erosion. Upon completion of operations,all disturbed areas shall be stabilized in accordance with the King County Surface Water Manual,Appendix C or D,dependent on site size. This can be accomplished by spreading seed at manufacturer's recommended rate and straw at a rate of 2" -3" thick or alternate method listed in the manual. PERMIT EXPIRES Sunday, June 10, 2018 Permit Issued on Friday, June 10, 2016 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 i accordance with the laws, rules and regulations of the State of Washington a , the City of Federal Way. _- Owner or agent: Date: riil0.4\ :/.44-****4%._ THIS CARD IS TO REMAIN ON-SITE CITY OF Y, Construction Inspection Record Federal Way INSPECTION REQUESTS: (253) 835-3050 PERMIT#: 16-102856-00-DE Address: 33520 21ST AVE SW Project: WASHINGTON CVS PHARMACY LI FEDERAL WAY, WA 98023-2874 Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card. SWM Precon Site Mtg(4400) 0 Initial Erosion Control(4365) Interim Erosion Control(4370) Approved To be done prior to breaking ground Approved By Date By Date 'By Date •0 Final Erosion Control(4375) El Final-Building(4050) Approved Approved By Date By Date 1 )(pro) Jr Rough ElectricalCI Final Electrical [=1. Right of Way Approved Approved Approved By Date By Date By Date • ikkik • CITY OF ...,. PERMIT APPLICATION • Federal Way PERMIT CENTER+33325 8,h Avenue South+Federal Way,WA 98003-6325 1 253-835-2607+FAX 253-835-2609+permitceRt E 1gEr\7Ebm ` ,` �cjVCU 1 ( ) _ ( 02 5 c— �� JUN 102016 PERMIT NUMBER TARGET DATE CIn OF FEDERAL WAY — - SITE ADDRESS SUITE/U>IR' $ W IC- PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL $ `e6 6t C z: ( 03 _ ct 0 c/ e ,i TYPE OF PERMIT ❑ BUILDING ❑PLUMBING ❑ MECHANICAL'DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT . L U ?Fl A e w.&-C PROJECT DESCRIPTION b��6 r ,-- I=X —'tc �l_�y� f I Lc- ‹t NI-ri c)+..1 Detailed description of work to ,O'.1 I.)S I be included on this permit only _ PRIMARY PHONE -1-3-1C •NAME ki 6.--. /'� PROPERTY OWNER J �, 1 i�- l j .,en+.) Y Z`I s --335 1 MAILING ADDRESS ! E-MAIL S"--7' 5-'1- 1)c 1114Pfc_=--- fib. T� iiitt CITY STATE ZIP tui�S1 15LersA. 1=1C--L-> liA 1 `‘of SZ 2-- x NAME PHONE MAILING ADDRESS E-MAIL CONTRACTOR iy )4 %v'LS.. etc <' , c.Gi,Ge.:1<34-Db d• cot-, CITY STATE ZIP FAX ie.c.h,.r-e--->> u%►l 1 c3 0.s 'Z WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# TO CSA/110:3- 9>6PA/ /0/ .14i / /6 Z. - Iei - 1vs 'z •o0-i3L. X NAM _ -- PRIMARY PHONE APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX PRIMARY PHONE X NAME 'n G PROJECT CONTACT r sbe_ci /� j,L(:ye.... 07 –�e ii "3®l 3 (The individual to receive and MAILtINLG ADDRESSE-MAIL _ respond to all correspondence 14- 3 q N• ' el / .T0-`= 4-. Q_-1-05 v.c C concerning this application) CITY STATE ZIP (� FAX a1_(-�t--c (1- z�v�' Z NAME PROJECT FINANCING ❑ OWNER-FINANCED When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW 19.27.095) I certify under penalty of perjury that I am the property owner or 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 claimI, which m•y be made by any person,including the undersigned,and filed against the city, but only where such claim arises o of the reli• ce of the city, including its officers and employees, upon the accuracy of the information supplied to the city as •part of th '.plication. i SIGNATURE: L,---77, / / DATE /U-/6 PRINT NAME: C c=.X U CC - 1 f{ Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application • • RECEIVEDCOMMUNITY DEVELOPMENT DEPARTMENT 33325 8th Avenue South CITY OF z x JUN 10 2016 Federal Way,WA 98003-6325 253-835-2607;Fax 253-835-2609 ` Federal Way www.citvoffederalway.corn CITY OF FEDERAL WAY CDS DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure on a subject property. Demolition of separate structures may require separate permits. fN,Address of Demolition: ?53 2 / j G� Sy ❑ Prior to submitting a demolition permit,the following items must be signed by the respective agency or their approvals attached. Items not applicable to your project should be marked N/A. ❑ A completed Construction Permit Application form is also required. 1.ASBESTOS ABATEMENT (Provide copy of Notice ofIntent from Puget Sound Clean Air Agency 5. ELECTRICITY and copy of> .ono l �(' --�, .ctorr}—r p S /tsTI Q—f P. (City of Federal Way Building,,ff ial) (Puget Sound Energy) FUEL STORAGE TANKS 6.GAS SUPPLY n :_- � Under grade tank(s)is/are present 7 Above grade tank(s)are present ❑Tank(s)has been pumped or removed under South King Fire& (Puget Sound Energy) Rescue permit prior to any dismantling or excavation (South King Fire and Rescue) 7.WATER- Public Source (Water Supplier) 3.SEPTIC SYSTEM :N /4. 8.WATER- Private Well (King County Environmental Services) N) /A (King County Environmental Services) 4.SANITARY SEWER (Lakehaven Utility District) Bulletin#122—May 13,2015 Page 1 of 1 k:\Handouts\Demolition Permit Requirements • 6/10/2016 • Approved Transaction pscleanair.org Puget Sound Clean Air Agency Notification Case #: 201602782 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AP0FD4657847 Transaction Date 06/10/16 Owner's Name The Velmeir Company Phone (248) 539-7997 Project Street Address 5757 West Maple Rd. Suite 800 City West Bloomfeild, MI Zip 48322 Contact Person Mr. Wayne Shores Phone (248) 539-7997 Mailing Address This project includes a demolition. Demolition Start Date 07/01/16 Completion Date 09/01/16 Demolition will be completed by a demolition contractor Demo Contractor IO Environmental &Infrastructure Inc. Contractor Job # Contact Jeff Keller Phone (425) 698-3093 Mailing Address 14734 NE 95th St. Redmond, WA 98052 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History Log Out If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. https://secure.psdeanair.org/Asbestos/Approved.aspx 1/1 E • • Janice Fernandez From: Scot Overdick <Scoto@iosdv.com> Sent: Friday, June 10, 2016 11:47 AM To: Permit Center Subject: FW: 33520 21ST AVE SW, FEDERAL WAY Attachments: form_66-147.pdf If you could print off the attached form from CAA and this email from PSE Thank you greatly, Scot Overdick 10 Environmental and Infrastructure, Inc. 14734 NE 95th Street, Redmond, WA 98052 o. 425-497-9896 F. 425-497-9878 c. 425-417-5344 Did you know 10E1 has a wide variety of Remediation Equipment for rent? Call for Details. A Service-Disabled Veteran-Owned Small Business This message,including any attachments,may include confidential and/or inside information and is the confidential property of 10 Environmental and Infrastructure,Inc.Any distribution or use of this communication by anyone other than the intended recipient is strictly prohibited and may be unlawful.If you are not the intended recipient,please notify the sender by replying to this message and then delete it from your system. Ati SINOSBCVE From: Ball, Michelle [mailto:Michelle.Ball@pse.com] Sent: Friday,June 10, 2016 10:35 AM To:Scot Overdick<Scoto@iosdv.com> Subject: 33520 21ST AVE SW, FEDERAL WAY Good Morning Scott, Thank you for contacting Puget Sound Energy today. I have sent a request to both the electric supervisor and the gas supervisor requesting this for you. I guess I don't make up a job notification, so I don't have anything to give you on my side. I included your name, phone number, email address and the address of the demolition site.We don't get a lot of requests for this, so please be patient. I sent the form to them as well to complete! Sincerely, RECEIVED .Michelle Ball Customer Construction Representative JUN 1 0 2016 TAC CCS CITY OF FEDERAL WAY 1-888-321-7779, option 8, ext. 88-7120 CDS i 40LAKEHAVEN UTILITY DIS1CT SEWER SERVICE CONNECTION PERMIT SERVICE NO.J 19685 STATUS I APPLICATION PERMIT NO.1 27585 APPLICATION DATE _ 3/8/2016 SUPERSEDES 1 15370 STUB SIZE 16 in. STUB INSTALL DATE STUB TYPE GRAVITY STUB INSTALLED BY STUB MATERIAL ISSUED DATE ROUTE 0050' SERVICE House# Street Name Suite ID City State Zip Cod ADDRESS 33520 J21ST AVE SW 1EDERAL WAY 7:6717877= LOT#(S) PTN 1-2 !BLOCK#(S) PLATBSPBLA IKCSP 278133R KCAF 8001170451 TAX PARCEL NO. 1321039098 GRID IF-10 OWNER 'WASHINGTON CVS PHARMACY LLC PHONE 1(800)746-7287 ext. BILLING House# Street Name Suite ID City State Zip Cod ADDRESS jlONE CVS DR 1WOONSOCKET R7-70-7=-- CON TRACTOR I 02895-CONTRACTOR IT BARGERDIRTWORKS LLC PHONE 1(253)750-4952 ext. AUTHORIZED CONTRACTOR 1 PHONE 1 ext. -- CLASSIFICATION 'LEASED CFC-COMMERCIAL NUMBER OF UNITS r---,..- 1 SIC I ERU CREDITSI= TREATMENT PLANT ILAKOTA PUMP STATIONS Er- r-- r-- SEWER ULID SVC TYPE DISCONNECT TMP SWR SVC ❑ PRIVATE PUMP ❑ BCV INDICATED ❑ GRINDER PUMP MAKE I GRINDER PUMP MODEL I SPECIAL CONDITIONS 1PAID BY FI AGR 6316001 FEES AND CHARGES: CPILOE I $0.00 CFC I $0.00 AREA CHARGE I $0.00 CIC f $0.00 SEWER SERVICE CONNECTION PERMIT I $300.00 LPS STUB INSTALLATION DEPOSIT I $0.00 STUB FEE I $0.00 RIGHT-OF-WAY PERMIT' $0.00 RECEIVED RIGHT-OF-WAY PERMIT w $0.00 C L VE� SERVICE CONNECTION AGREEMENT CHARGES I $0.00 SYSTEM DEVELOPMENT CHARGE t $0.00 JUN 10 2016 TOTAL I $300.00 I CITY OF FEDERAL WAY DATE PAID CDS RECEIPT# IN PLACE PIPE TEST: I HEREBY CERTIFY THAT TESTING HAS BEEN WATER EXFILTRATION APPROVED AND THE ABOVE CONNECTION HAS BEEN NO TEST MADE AS SHOWN ON THE ATTACHED SITE PLAN. BOOK/PAGE NUMBER BY DATE • .. Pre-Demolition Asbestos Survey and Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS #78817 Proposed CVS Store #10659 33520 21st Avenue SW Federal Way, King County, Washington April 16, 2015 Terracon Project No. 81147773 Prepared for: The Velmeir Companies West Bloomfield, Michigan Prepared by: Terracon Consultants, Inc. Mountlake Terrace, Washington RECEIVED JUN 1 0 2016 CITY OF FEDERAL WAY CDS Offices Nationwide Established in 1955 Employee-Owned terrecon.com strewn „7„,125::ifa,i4AILLIVLIMPIM; .0kiLant,'Irt ;‘,114i .1.... Ix Geotechnical Environmental r Construction Materials Facilities • lierracon April 16, 2015 The Velmeir Companies 5757 West Maple Road; Suite 800 West Bloomfield, MI 48322 Attention: Mr. Wayne Shores Re: Pre-Demolition Asbestos Survey and Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 Proposed CVS Store#10659 33520 21st Avenue SW Federal Way, King County,Washington Terracon Project No. 81147773 Dear Mr. Shores: The purpose of this report is to present the findings of a Pre-Demolition Asbestos Survey and Visual Hazardous Building Materials Assessment for a proposed CVS Pharmacy (CVS #78817) site, which will be located at the site comprised of parcels located at 33520 21st Ave SW in Federal Way, King County, Washington. Terracon Consultants, Inc. (Terracon) conducted the above services on March 31 and April 1, 2015, in accordance with Terracon Proposal No. P81150095 dated March 20, 2015. We understand that these services were requested due to planned demolition of the building and canopy on the site. This project was conducted in conjunction with Geotechnical Engineering Services (Terracon Project No. 81155017) and Phase I Environmental Site Assessment Services (Terracon Project No. 81147773)that were also provided by Terracon. The following tables summarize the asbestos survey and visual hazardous building materials assessment findings: Asbestos-Containing Materials (ACM) Property Address Friable'ACM(s) Non-Friable ACM(s) 33520 2151 Ave SW 0 0 Terracon Consultants, Inc. 21905—641`Ave W, Ste.100 Mountlake Terrace, Wasington 98043 P [425]771 3304 F [425]771 3549 terracon.com Geotechnical • Environmental • Construction Materials U Facilities • • Pre-Demolition Asbestos Survey and lierracon Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 0 Federal Way,Washington April 16,2015 0 Terracon Project No.81147773 Hazardous Building Materials Property PCB Hg- Address containing containing Hg-Switches CFC units Batteries Radioactive ballasts lights Sources 33520 216' Ave SW 0 73 0 3 0 0 Hg=Mercury PCB=polychlorinated biphenyl CFC=chlorofluorocarbon *smoke alarm component Please refer to the attached report for details. Terracon appreciates the opportunity to provide these services to The Velmeir Companies. Please call us at(425) 771-3304 if you have any questions regarding this report. Sincerely, Terracon Consultants, Inc. )1,47/7 S. Kyle Long ( Chad Kean, CIH, CHMM, CPSQW Environmental Technician I Project Manager II AHERA Building Inspector rii:r5;p 1sR Resourceful e t ehiab[ • • TABLE OF CONTENTS Page 1.0 INTRODUCTION 1 1.1 Project Objective 2 1.2 Reliance 2 2.0 BUILDING DESCRIPTIONS 2 3.0 ASBESTOS FIELD ACTIVITIES 3 3.1 Visual Assessment 4 3.2 Physical Assessment 3 3.3 Sample Collection 3 3.4 Sample Analysis 4 4.0 REGULATORY OVERVIEW 5 5.0 HAZARDOUS BUILDING MATERIALS 6 5.1 PCBs 5 5.2 Mercury 6 5.3 CFC 6 5.4 Batteries 7 5.5 Radioactive Sources 6.0 FINDINGS AND RECOMMENDATIONS 8 7.0 GENERAL COMMENTS 9 APPENDIX A Table 1.0: Non-Asbestos-Containing Materials Table 2.0: Quantity Estimates for Environmental Hazards Observed Figure 1.0: Interior and Exterior Sample Locations APPENDIX B RGA Environmental: Analytical Reports and Chain-of-Custody APPENDIX C Inspector Certifications • • PRE-DEMOLITION ASBESTOS SURVEY AND VISUAL HAZARDOUS BUILDING MATERIALS ASSESSMENT PROPOSED CVS PHARMACY NO. 78817 33520 21ST AVENUE SW FEDERAL WAY, WASHINGTON Terracon Project No. 81147773 April 16, 2015 1.0 INTRODUCTION The purpose of the pre-demolition asbestos survey and visual hazardous building materials assessment, which was conducted for one commercial building and associated canopy located at 33520 21st Avenue SW in Federal Way, Washington, was as follows: Locate, sample (if accessible), quantify and assess suspect building materials for the presence of asbestos; and, Locate and quantify equipment (i.e., fluorescent light ballasts, tube lamps, thermostat switches, refrigerators, air conditioners, emergency lightening, exit signs, alarm systems, and fire/smoke alarms) potentially containing hazardous materials such as polychlorinated biphenyls (PCBs), elemental mercury (Hg), chlorofluorocarbons (CFCs), batteries, and/or potential radioactive sources. The site services were conducted by Asbestos Hazard Emergency Response Act (AHERA) - accredited asbestos inspectors on March 31 and April 1, 2015, in general accordance with Terracon Proposal No. P81150095 dated March 20, 2015. Homogeneous areas with suspect asbestos-containing materials (ACMs) were visually characterized and documented. Although reasonable effort was made to survey accessible suspect materials, additional suspect but un-sampled materials could be located in walls, voids or in other concealed areas. Suspect ACM samples were collected in general accordance with the sampling protocols outlined in Environmental Protection Agency (EPA) regulation 40 CFR 763 (Asbestos Hazard Emergency Response Act, AHERA). ACM samples were submitted to a NVLAP (National Voluntary Laboratory Accreditation Program) laboratory for analysis by polarized light microscopy. It should be emphasized that aggressive procedures for collecting the samples (i.e. coring through multiple building material layers, making holes in walls/ceilings to access hidden materials, etc.) were limited within the buildings due to the buildings still being occupied. In conjunction with the asbestos survey, a visual assessment for Hg-containing, PCB- containing, CFC-containing equipment, batteries in emergency lighting and alarm equipment, Responsive it Resourceful al Reliable 1 • 4111/ Pre-Demolition Asbestos Survey and ir r cC n Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 M Federal Way, Washington April 16, 2015 Terracon Project No. 81147773 and smoke alarms with radioactive sources was also conducted at the site. Where observed, these items were documented and quantified. 1.1 Project Objective We understand that the project services were requested due to planned demolition of the onsite building and canopy. EPA regulation 40 CFR 61, Subpart M, National Emission Standards for Hazardous Air Pollutants (NESHAP), prohibits the release of asbestos fibers to the atmosphere during demolition or renovation activities. The asbestos NESHAP requires that potentially regulated asbestos-containing building materials be identified, classified and quantified prior to planned disturbances. The Resource Conservation and Recovery Act (RCRA) provide the EPA with the authority to regulate the waste status of demolition or renovation debris, including Hg, CFC, radioactive, and PCB-containing materials. Specific regulatory requirements must be addressed prior to transporting, treating, storing, or disposing of hazardous wastes. 1.2 Reliance This report is for the exclusive use of The Velmeir Companies and CVS Pharmacy, Inc., its affiliates and subsidiaries and their successors, assigns and grantees for the project being discussed. No other individual or entity may rely on this report without written permission of Terracon and The Velmeir Companies reliance on this report by The Velmeir Companies, CVS Pharmacy, Inc., and all authorized parties will be subject to the terms, conditions, and limitations stated in the proposal, this report and Terracon's Professional Services Agreement. The limitation of liability defined in Terracon's Professional Services Agreement is the aggregate limit of Terracon's liability to The Velmeir Companies, CVS Caremark Corporation, and all relying parties. 2.0 BUILDING DESCRIPTIONS The site's structure was occupied at the time of this survey. It is an approximately 1,700- square-foot, rectangle-shaped, slab-on-grade building. The building is wood-framed and has tile roofing with roofing paper metal pan decking. The exterior is concrete CMU and the windows are metal-framed. Interior horizontal finishes consist of bare concrete, ceramic tile, ceiling tile and gypsum. Interior vertical finishes consist of gypsum, ceramic tile, and glass (windows). The approximate 2,000-square-foot canopy structure over gas dispensaries consisted of concrete and metal and was observed not to contain suspect ACM. Responsive i0 Rehable s Resourceful2 81147773 cvs acm haz report-draft-cdk.docx S Pre-Demolition Asbestos Survey and lierracon Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 Federal Way, Washington April 16, 2015 w Terracon Project No. 81147773 3.0 ASBESTOS FIELD ACTIVITIES The survey was conducted by AHERA-accredited asbestos inspector, Mr. S. Kyle Long of Terracon. A copy of Mr. Long's asbestos inspector certification is attached as Appendix E. The survey was conducted in general accordance with the sample collection protocols established in EPA regulation 40 CFR 763, the Asbestos Hazard Emergency Response Act (AHERA). A summary of the survey activities is provided in the following subsections. 3.1 Visual Assessment Survey activities began with a visual assessment of interior and exterior areas of the building to establish homogeneous areas with suspect ACMs. A homogeneous area consists of building materials that appear similar throughout in terms of color and texture. The interior assessment was limited to accessible areas within the currently occupied structure on site. The exterior assessment included exterior walls, roofing materials and windows. It should be noted that additional suspect but un-sampled materials could be located in walls, voids or other concealed areas. Building materials identified as concrete, glass, wood, masonry, metal or rubber are not considered suspect ACM and, therefore, were not sampled. 3.2 Physical Assessment A physical assessment of each homogeneous area with suspect ACM was conducted to assess the friability and condition of the materials. A friable material is defined by the EPA as a material which can be crumbled, pulverized or reduced to powder by hand pressure when dry. Friability was assessed by physically touching suspect materials. 3.3 Sample Collection Based on the findings of the visual assessment, bulk samples of suspect ACM were collected in general accordance with AHERA sampling protocols. Random samples were collected for each suspect homogeneous material identified. Samples were placed in sealable containers and labeled with unique sample numbers using an indelible marker. 32 bulk samples representing 10 suspect ACMs were collected from the building. Many bulk samples collected included multiple layers. Due to safety issues, electrical and mechanical components were not sampled as part of this survey. The suspect building materials collected during the survey and submitted for analysis are included in the laboratory analytical report located in Appendix B. Respo swe Reliable a Resourceful 3 81147773 cvs acm haz report-draft-cdk.docx • • Pre-Demolition Asbestos Survey and it ! "rac rt Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 RI Federal Way, Washington April 16, 2015 Terracon Project No. 81147773 3.4 Sample Analysis Bulk samples were submitted under standard chain of custody protocol to RGA Environmental of Seattle, Washington, for analysis by polarized light microscopy with dispersion staining techniques per EPA's Method for the Determination of Asbestos in Bulk Building Materials (600/R-93-116). The percentage of asbestos, where applicable, was established by microscopic visual estimation. RGA Environmental is an accredited National Voluntary Laboratory Accreditation Program laboratory (NVLAP Accreditation No. 200613-0). 4.0 REGULATORY OVERVIEW The asbestos NESHAP (40 CFR Part 61, Subpart M) regulates asbestos fiber emissions and asbestos waste disposal practices. It also requires the identification and classification of existing building materials prior to demolition or renovation activities. Under NESHAP, asbestos-containing building materials are classified as either friable, Category I non-friable or Category II non-friable ACM. Friable materials are those that, when dry, may be crumbled, pulverized or reduced to powder by hand pressure. Category I non-friable ACM includes packings, gaskets, resilient floor coverings and asphalt roofing products containing more than 1% asbestos. Category II non-friable ACM are any materials other than Category I materials that contain more than 1% asbestos. Friable ACM along with Category I and Category II non-friable ACM which is in poor condition and has become friable or which will be subjected to drilling, sanding, grinding, cutting or abrading and could be crushed or pulverized during anticipated renovation or demolition activities are considered regulated ACM (RACM). Washington Administrative Code (WAC) 173 400 075 adopts the federal NESHAP rule by reference. In the State of Washington, authority to administer NESHAP requirements is delegated to the regional air pollution authorities (e.g., the local Clean Air Agency or the Washington State Department of Ecology). In King, Snohomish, Pierce, and Kitsap Counties, the NESHAP requirements are administered by the Puget Sound Clean Air Agency (PSCAA). As provided in PSCAA's Regulation III, Article 4: Asbestos Control Standards, the PSCAA must be notified at least 10 working days prior to the demolition of any structure with a projected roof area greater than 120 square feet, regardless of whether or not any asbestos was identified. Notification is not required for renovation projects, unless the project involves the disturbance of friable asbestos containing materials. The owner or operator must also provide the Washington State Department of Labor and Industry (L&I) with written notification at least 10 working days prior to the commencement of asbestos removal projects involving at least 10 Responsive u Reliable a Resourceful 4 81147773 cvs acm haz report-draft-cdk.docx • • Pre-Demolition Asbestos Survey andilerracon Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 Federal Way, Washington April 16, 2015 Terracon Project No. 81147773 linear feet or 48 square feet of RACM. Removal of RACM must be conducted by a State of Washington-certified asbestos abatement contractor. In the State of Washington, worker exposures to asbestos are governed by L&I's Division of Occupational Safety and Health (DOSH). The administrative rule WAC 296-62-07705 requires that employee exposure to airborne asbestos fibers be maintained below 0.1 asbestos fibers per cubic centimeter of air (0.1 f/cc) as an eight hour time weighted average. State of Washington Occupational Safety and Health rules also classify construction and maintenance activities which could disturb ACM, and specify work practices and precautions which employers must follow when their employees engage in each class of regulated work. 5.0 VISUAL HAZARDOUS BUILDING MATERIALS ASSESSMENT Materials such as mercury, CFCs, radioactive sources, batteries, and PCBs can be found in building components. These materials are considered environmental hazards and require special precautions if they will be removed in association with the demolition to prevent their entry into the environment. On occasion, manufacturers will label the equipment regarding the presence or absence of a hazardous material. To assess for these hazards, some building components were partially disassembled to locate a manufacturer's label. Quantified PCB, CFC, and mercury-containing equipment, batteries, and smoke alarms with radioactive sources are listed in the applicable appendix. 5.1 PCBs PCBs range from clear, oily liquids to white or yellowish waxy solids, depending on the degree of chlorination. They are stable, thermoplastic and non-flammable materials that were widely used as dielectric and coolant fluids in transformers, capacitors and electric motors, as plasticizers in paints and as a stabilizing additive in certain electric wire coatings. Light ballasts can contain about one ounce of the toxic substance. The transportation, disposal and spill clean-up of PCB-containing ballasts is regulated by the Toxic Substances Control Act (TSCA), which is found in 40 Code of Federal Regulations (CFR) Part 261. Terracon conducted a representative visual assessment of light fixtures and pole and pad- mounted electrical transformers to characterize PCB content. Typically, ballasts manufactured prior to 1979 are presumed to contain PCBs unless clearly marked as containing "No PCBs". Ballasts that do not contain a "No PCBs" label are presumed to be PCB-containing. No individual lighting ballasts presumed to contain PCBs were identified during the assessment of the building structures on site. No potentially PCB-containing equipment was identified during the assessment of the building structures on site. Responsive IN Reliable a Resourceful 5 81147773 cvs acm haz report-draft-cdk.docx • • • Pre-Demolition Asbestos Survey and Irerr cn Visual Hazardous Building Materials Assessment - Proposed CVS Pharmacy CS#78817 Federal Way,Washington April 16, 2015 Terracon Project No. 81147773 5.2 Mercury Metallic mercury is a silver-white liquid at room temperature. Elemental and inorganic mercury compounds are used in manufacturing scientific instruments, electric equipment, fluorescent tubes, mercury vapor lamps and high intensity discharge (HID) lights. Mercury is considered a hazardous material due to its ability to bioaccumulate within the environment. Recycling mercury-containing components reduces the load of mercury entering the environment. Fluorescent light tubes and bulbs that contain mercury were identified and quantified at the site building structure during the assessment. The interior of the building has approximately 45 mercury-containing bulbs and approximately 28 exterior mercury-containing bulbs. Prior to demolition, these items should be removed intact, packaged to prevent breakage and transferred to an approved recycling facility that recovers mercury. 5.3 CFC A chlorofluorocarbon (CFC) is an organic compound that consists of carbon, hydrogen, chlorine, and fluorine. Many CFCs have been widely used as refrigerants, propellants, and solvents. Chlorofluorocarbons are believed to cause depletion of the atmospheric ozone layer. Exterior and interior building areas were investigated to determine the potential presence of CFCs. These items were quantified during the assessment. Three air-conditioning units containing refrigerant liquid mounted on the ground were noted on the east side of the building. Prior to demolition, CFCs (refrigerants) should be removed by a qualified recycling firm that recovers CFCs. 5.4 Batteries Batteries containing nickel-cadmium and lead-acid can be found in emergency lighting, exit signs, and alarm systems. The nickel-cadmium and lead-acid in these batteries are considered to be toxic. No batteries associated with emergency lighting, exit signs or alarm systems were identified during the assessment of the building. Responsive E Reliable u Resourceful 6 81147773 cvs acm haz report-draft-cdk.docx ! • Pre-Demolition Asbestos Survey andlierracon Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 a Federal Way, Washington April 16, 2015 Terracon Project No. 81147773 5.5 Radioactive Sources There are several types of smoke detectors and fire alarms. Ionization chamber and photoelectric smoke detectors are the two most common types available commercially. Ionization chamber smoke detectors contain a small amount of radioactive material encapsulated in a metal chamber. Typically, the radioactive material is a composite of americium-241. No radioactive sources were identified during the assessment of the building. 6.0 FINDINGS AND RECOMMENDATIONS Laboratory analysis did not identify any presence of asbestos in the materials sampled at this site. Our site findings are presented in Appendix A. In each appendix, the following information is provided, if applicable: • Table 1.0 Non-Asbestos Containing Materials Table 2.0 Quantity Estimates for Environmental Hazards Observed • Figure 1.0 Interior and Exterior Sample Locations • Photographs of Identified ACMs A copy of the chain of custody and analytical laboratory results for the buildings is provided in Appendix B. Identified mercury-containing lights and CFCs-containing equipment should be removed intact, segregated, packaged and recycled in accordance with applicable state and federal regulations prior to demolition of the buildings. 7.0 GENERAL COMMENTS This pre-demolition asbestos survey visual hazardous building materials assessment was conducted in a manner consistent with the level of care and skill ordinarily exercised by members of the profession currently practicing under similar conditions in the same locale. The results, findings, conclusions and recommendations expressed in this report are based on conditions observed during the on-site services conducted at the buildings. The information contained in this report is relevant to the date on which this survey was conducted and should not be relied upon to represent conditions at a later date. This report has been prepared on behalf of and exclusively for use by The Velmeir Companies and Responsive e Reliable e Resourceful 7 81147773 cvs acm haz report-draft-cdk.docx • • Pre-Demolition Asbestos Survey and llèrracon Visual Hazardous Building Materials Assessment Proposed CVS Pharmacy CS#78817 r Federal Way, Washington April 16, 2015 a Terracon Project No. 81147773 CVS Pharmacy, Inc. for specific application to their project as discussed. This report is not a bidding document. Contractors or consultants reviewing this report must draw their own conclusions regarding further investigation or remediation deemed necessary. Terracon does not warrant the work of regulatory agencies, laboratories or other third parties supplying information which may have been used in the preparation of this report. No warranty, expressed or implied, is made. Responsive a Reliable a Resourceful 81147773 cvs acm haz reportdraft-cdk docx APPENDIX A • r • APPENDIX A TABLE 1.0— NON-ASBESTOS-CONTAINING-MATERIALS 33520 21St AVENUE SW FEDERAL WAY, KING COUNTY, WASHINGTON HOMOGENEOUS r SAMPLE NO DESCRIPTION I SAMPLE LOCATION AREAI 1-FC5,MA3-1 1-FC5,MA3 1-FC5,MA3 2 8"X8"Gray ceramic tile with gray Sales area, storage room, and thin set bathroom floors 1-FC5,MA3-3 I 3-CT4-7 2'X4'White ceiling tile with worm 3-CT4 3-CT4-8 Throughout sales area and pin-holes 3-CT4-9 4-CT4-10 2'X4'White ceiling tile with tiger 4-CT4 4-CT4-11 Throughout sales area 4 CT4 12 stripes and pin-holes 5-WB1-13 5-WB1-14 Gypsum wallboard and joint 5-WB1 5-WB1-15 yp Throughout building compound 5-WB1-16 5-WB1-17 6-MG3-18 Yellow adhesive behind 4" gray Sales area, storage room, and 6-MG3 6 MG3 19 and black cove base employee office 6-MG3-20 7-MA4-21 Dark gray grout around ceramic Sales area, storage room, and 7 MA4 7 MA4 22 tile (HA-1) bathroom floors 7-MA4-23 8-MG5-24 White adhesive behind 4"X4" 8-MG5 8-MG5-25 Bathroom wall white ceramic tile 8-MG5-26 _ 1 9-MG5-27White adhesive behind 4"X4" 9-MG5 9-MG5-28 Bathroom walls white ceramic tile 9-MG5-29 10-MS5-3White and yellow paper backing Above ceiling tiles throughout 10 MS5 10MS5 311 on batt insulation building 10-MS5-32 1 11-RF2-33 I 11-RF2 11-RF2-34 White and gray roofing paper Edges of roof under roof tiles 11-RF2-35 • • APPENDIX A TABLE 2.0-QUANTITY ESTIMATES FOR ENVIRONMENTAL HAZARDS OBSERVED 33520 21ST AVENUE SW FEDERAL WAY, KING COUNTY, WASHINGTON Property PCB- Hg- Area containing CFC units Batteries Radioactive Address Sources* ballasts lights 33520 21st Interior 0 45 0 0 0 0 Ave SW Exterior 0 28 0 3 0 0 Hg=Mercury PCB=polychlorinated biphenyl CFC=chlorofluorocarbon *smoke alarm component • r,..._-- . _ erracon - (/V5 Pa `. _- 80117773_. �. r 3/. 115JOB NO ..w..'_P. By ._.. :HFC F BY _ .__.� a f. )-3-----.1l '''' ,' 4 1)-35 \. 7 , i '\ 1 lo—Iv- 1 Q j �,-7 I ll q 1,� -i� , .6-i /:)71:-- io--;o1 ij,(---------1—C 5-15 g-,. .6 ___7_ i( �0 1g-2.,.i -)47 i" i Yii I-(1 7-- 7— A 11 5 1 • APPENDIX B 81147773 cvs acm haz report-draft docx • • / 0587 CHAIN OF CUSTODY Bulk Asbestos Test Turn Around Time 3-5 days Number of Samples 32 Client Job# 81147773 Client Name: Terracon Consultants Address: 21905 64th Ave. W. City: Mountlake Terrace State: WA Zip: 98043 Phone: (425) 771-3304 Fax: (425) 771-3549 Email_aastauffer@terracon.com_ Project Location_CVS Federal Way_Project Manager: Adam Stauffer Sample Condition: Good Damaged Severe Damage(Spillage) SEQ# SAMPLE ID SAMPLE DESCRIPTION Lab ID Comment A/R 1-FC5,MA3-1 1-FC5,MA3-2 1-FC5,MA3-3 3-CT4-7 3-CT4-8 3-CT4-9 4-CT4-10 4-CT4-11 4-CT4-12 5-WB1-13 Gypsum Wallboard System— Please Composite Results 5-WB1-14 Gypsum Wallboard System— Please Composite Results 5-WB1-15 Gypsum Wallboard System— Please Composite Results 5-WB1-16 Gypsum Wallboard System— Please Composite Results 5-WB1-17 Gypsum Wallboard System— Please Composite Results 6-MG3-18 6-MG3-19 6-MG3-20 7-MA4-21 7-MA4-22 7-MA4-23 8-MG5-24 8-MG5-25 8-MG5-26 9-MG5-27 9-MG5-28 9-MG5-29 10-MS5-30 • • 8 10-MS5-31 10-MS5-32 11-RF2-33 11-RF2-34 11-RF2-35 Print Signature Company Name- Date Time Sampled by Kyle Long ( Terracon 3/31/15 10:00 • I Relinquished by Kyle Long / Terracon 4/2/15 `j:00e/ Delivered by Received by ep6 , i/i 'f�CCGQ CDA- 413/15 / oo Analyzed by 1�� t� ��6� vC '' �f/'�o✓. 7 (2r) Cn 7 i 3 I G Result reported by ),,,C,4"-3,4„., tr15 i-45 k[µ� • RGA Laboratory Services Sample Log Chain of Custody INTERNAL Client: Client Contact RGA Batch#: 15-0587 Company: CVS Health RGA Project#: 81147773 Client Address: 5757 West Maple Road Client Job#: • West Bloomfield MI 48322- Number of Samples: 32 City State Zip TYPE OF ANALYSIS Phone#: 2nd or Cell#: ASBESTOS: METALS: Fax#: -- PCM(air) Paint Soil e-mail Address: X PLM(bulk) _ Wipe Air Pt.Count(bulk) TCLP Water MOLD:P&K 100 101 102 105 117 Project Manager: Adam Stauffer Other Method: Project Location:21905 64th Ave W.Mountlake Turn Around Time(otber):5 day Terrace,WA 98043 2 hour/4 hour Same Day One Day Two Days 3 Days L Price per Sample: $ Condition:Ei Good ❑ Damaged 1 Severe Damage ii ## Client Sample ID I RGA Laboratory IDI Comments # Client Sample ID I RGA Laboratory IDI Comments 1 1-FC5,MA3-1 15005524 11 5-WB1-14 15005534 2 1-FC5,MA3-2 15005525 12 5-WB1-15 15005535 _ 3 1-FC5,MA3-3 15005526 13 5-WB1-16 15005536 _ 4 3-CT4-7 15005527 14 5-WB1-17 15005537 5 3-CT4-8 15005528 15 6-MG3-18 15005538 6 3-CT4-9 15005529 16 6-M63-19 15005539 _ 7 4-CT4-10 15005530 17 6-MG3-20 15005540 8 4-CT4-11 15005531 18 7-MA4-21 15005541 9 4-CT4-12 15005532 19 7-MA4-22 15005542 , 10 5-WB1-13 15005533 20 7-MA4-23 15005543 SignatureDate Time Sampled by: l2 �' 3 t�(, 101011. Relinquished by: 1,/--((Q (�\ f '' c-- 17:631 Received by: -" Relinquished by: .. I i — Received for Laboratory by: 1 l S I / -' l Analyzed by: /ilaiirair it t 4,e o _ Preliminary Results Reported to P.M.by: wig,- 0t 1 5 — Final Report to P.M. by: Special Instructions: Due by 4/8/2015 CoC016-(Rev.1/07) *Unless requested in writing,all samples will be properly disposed of 30 days after final report date. Page 1 of 1 i 0 • Sample Log RGA Laboratory Services Chain of Custody INTERNAL Client: Client Contact RGA Batch#: 15-0587 Company: CVS Health RGA Project#: 81147773 Client Address: 5757 West Maple Road Client Job#: West Bloomfield Ml 48322- Number of Samples: 32 City State Zip Page: 2 of 2 # Client Sample II) I RGA Laboratory IDI Comments # Client Sample ID 1 RGA Laboratory IDI Comments 21 8-MG5-24 15005544 41 22 8-MG5-25 15005545 42 23 8-MG5-26 15005546 43 24 9-MG5-27 15005547 44 25 9-MG5-28 15005548 45 26 9-MG5-29 15005549 46 27 10-MS5-30 15005550 47 28 10-MS5-31 15005551 48 29 10-MS5-32 15005552 49 30 11-RF2-33 15005553 50 31 11-RF2-34 15005554 51 32 11-RF2-35 15005555 52 33 53 34 54 35 55 36 56 `�1 E 37 57 38 58 39 59 40 60 Si'nature Date Time Sampled by: le '3( 50 15 1 o ! 0v Relinquished by: 1 l (,- ( . .i Li /y1115 ( -i ; Received by: 1 Relinquished by: Received for Laboratory by: fr-A -S[c/(7,.- ----&--0----- `f/ Analyzed by: Preliminary Results Reported to P.M.by: —"'� lifit Final Report to P.M. hp. Special Instructions: Due by 4/8/2015 ,l'i'''.:. CoC017-(Rev.1/07) *Unless requested in writing,all samples will be properly disposed of 30 days after final report date. Page 1 of 1 t_ 3317 3rd Avenue S,Suite D,Seattle,WA 98134 olima it* --4-0.--i RG OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory@n}gaenv.comV..._1A4) i - G E N V I R Q N Nl F N T A 1. Bulk Asbestos Fiber Analysis NVLAP LAB CODE 200613-0 , Alrerraron rorarnw' (EPA 600/R-93/116) 1 CVS Health RGA Batch Number: 15-0587 ` Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043Number of Samples: 32 Report Key — Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components Layer Comments(if applicable) 1-FC5,MA3-1 L-1 No Asbestos Detected 100% Ceramic Tile t 15005524 Gray ceramic tile 1 1 L-2 No Asbestos Detected 50% Calcite Filler and Binder Gray cementious material 30% Sand g 20% Mineral Particles i — -- is 1-FC5,MA3-2 LA No Asbestos Detected 100% Ceramic Tile 15005525 Gray ceramic tile L-2 No Asbestos Detected 50% Calcite Filler and Binder t Gray cementious material 30% Sand g 20% Mineral Particles E 1-FC5,MA3-3 L-1 No Asbestos Detected 100% Ceramic Tile r. 15005526 Gray ceramic tile E E r L-2 No Asbestos Detected 50% Calcite Filler and Binder t e Gray cementious material 30% Sand t 20% Mineral Particles e t ( 3-CT4-7 L-i No Asbestos Detected 100% Paint rE 15005527 White paint L-2 No Asbestos Detected 60% Cellulose 20% Perlite il Tan fibrous material 20% Mineral Filler and Binder t r tiI i w t Y F This report relates only to the items tested.If samples are not collected by ROA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance pm-poses.This report shall not be reproduced except in full,without written approval of RGA Environmental.II shall not be used to claim product endorsement by NVLAP or any other agency of the U.S.Government. d Sampled By: Kyle Long - / t I Received By: Emily Kahler 4/3/2015 - - -e 4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 1 of 9 E Reviewed By: Cheuk-Wa Angela Ng Y h a r ; i • • AI 3317 3rd Avenue S,Suite D,Seattle,WA 98134 4."04% RGA OFFICE:(206)2888 FAX:(206)2818922 email:laboratoryrgaenv.com [jIJ ? A V F F. NVIRQNMF. NTA1. Bulk Asbestos Fiber Analysis 1 lrerracnn CrlurMY (EPA 600/R-93/116) NVLAP LAB CODE 200613-0 A CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043 Number of Samples: 32 Report Key Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components , Layer Comments(if applicable) l 3-CT4-8 L-1 No Asbestos Detected 100% Paint 15005528 White paint L-2 No Asbestos Detected 60% Cellulose 20% Perlite Tan fibrous material 20% Mineral Filler and Binder 3-CT4-9 L-1 No Asbestos Detected 100% Paint 15005529 White paint L-2 No Asbestos Detected 60% Cellulose 20% Perlite f Tan fibrous material 20% Mineral Filler and Binder f 4-CT4-10 L-1 No Asbestos Detected 100% Paint 15005530 White paint L-2 No Asbestos Detected 60% Cellulose 20% Perlite Tan fibrous material20/o a Mineral Filler and Binder i 4-CT4-11 L-1 No Asbestos Detected 100% Paint 15005531 White paint L-2 No Asbestos Detected 60% Cellulose 20% Perlite Tan fibrous material 20% Mineral Filler and Binder i f This report relates only to the items tested.If samples are not collected by RGA Environmental personnel,accuracy of the results is limbed by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of ROA Environroentat.It shall not be used to claim product endorsement by NV LAP or any other agency of the U.S.Government. r Sampled By: Kyle Long / / e i Received By: Emily Kahler 4/3/2015 - r, tP Reviewed By: Chcuk-Wa Angela Ng4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 2 of 9 g Yr 1 1 • • ID l - 3317 3rd Avenue S,Suite D,Seattle,WA 98134 M t GR A OFFICE:(206)281-8858 FAX(206)281-8922 email:laboratory@rgaenv.com V /L1\ 1._ oarawe J111/ E N V i R C) N 1V1 E N T A 1. Bulk Asbestos Fiber Analysis A1le -aEon C0IAPA Y (EPA 600/R-93/116) NVI-AI'LAB CODE 200613-0 CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043li Number of Samples: 32 1 Report Key ; Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous 1 RGA Lab II) Layer Description Components Components Components Layer Comments(if applicable) 4-CT4-12 L-1 No Asbestos Detected 100% Paint 15005532 White paint • L-2 No Asbestos Detected 60% Cellulose 20% Pen ire e Tan fibrous material 20% Mineral Filler and Binder 5-WB1-13 L-1 No Asbestos Detected 100% Paint 15005533 Gray paint V L-2 No Asbestos Detected 70% Calcite Filler and Binder Beige crystalline material 30% Mineral Particles L-3 No Asbestos Detected 90% Cellulose 10% Filler and Binder White fibrous material II L-4 No Asbestos Detected 70% Calcite Filler and Binder White crystalline material 30% Mineral Particles 1t. h L-5 No Asbestos Detected 90% Cellulose 10% Filler and Binder l Tan fibrous material 4 L-6 No Asbestos Detected 10% Glass Fiber 60% Gypsum Filler and Binder e White blocky crystalline material 30% Mineral Particles r, l d t R This report relates only to the items tested.If samples arc not collected by RGA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of RGA Environmental.It shall not be used to claim product endorsement by NVLAP or any other agency of the U.S.Government c: Sampled By: Kyle LongC Received By: Emily Kehler 4/3/2015 l= Reviewed By: Cheuk-Wa Angela Ng 4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 3 of 9 4 1 i i ! • 3317 3rd Avenue S,Suite D,Seattle,WA 98134 w0-4-0- R G A OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory@rgaenv.com LLLLJJJJ��1111 /L1 Lr�/ E N V I R C] N N1 F. NI T A 1. Bulk Asbestos Fiber Analysis • h7Farraron ror,nnwY NVI,AP LAB CODE 200613-0 (EPA 600/R-93/116) li CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043 Number of Samples: 32 Report Key Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components 1 Layer Comments(if applicable) 5-WB1-14 L-1 No Asbestos Detected 100% Paint 15005534 Gray paint L-2 No Asbestos Detected 70% Calcite Filler and Binder Beige crystalline material 30% Mineral Particles L-3 No Asbestos Detected 90% Cellulose 10% Filler and Binder White fibrous material L-4 No Asbestos Detected 70% Calcite Filler and Binder White crystalline material 30% Mineral Particles 1 i L-5 No Asbestos Detected 90% Cellulose 10% Filler and Binder Tan fibrous material L-6 No Asbestos Detected 10% Glass Fiber 60% Gypsum Filler and Binder White blocky crystalline material 30% Mineral Particles i 5-WB1-15 L-I No Asbestos Detected 100% Paint 15005535 Gray paint i FI L-2 No Asbestos Detected 70% Calcite Filler and Binder 1 White crystalline material 30% Mineral Particles L-3 No Asbestos Detected 90% Cellulose 10% Filler and Binder 1 Tan fibrous material k 1 L-4 No Asbestos Detected 10% Glass Fiber 60% Gypsum Filler and Binder I White blocky crystalline material 30% Mineral Particles V L This report relates only to the items tested.If samples are not collected by RGA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses ore cross- E; checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of RGA Environmental.It shall not be used to claim product endorsement by s NVLAP or any other agency of the U.S.Government. Sampled By: Kyle Long Received By: Emily Kahler 4/3/2015 / - l Reviewed By: Cheuk-Wa Angela Ng 4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 4 of 9 g tla t • • 3317 3rd Avenue S,Suite D,Seattle,WA 98134 M RG OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory@rgaenv.com LLL...111 ��111 E N V I R C) N Nl F. NI T A L Bulk Asbestos Fiber Analysis NVLAP LAB CODE 200613-0 lrerrar=on or,nuv (EPA 600/R-93/116) • CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043 Number of Samples: 32 Report Key Client Sample 1D Layer Ill(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components Layer Comments(if applicable) 5-WB1-16 L-1 No Asbestos Detected 100% Paint 15005536 Gray paint 1,-2 No Asbestos Detected 70% Calcite Filler and Binder Beige crystalline material 30% Mineral Particles L-3 No Asbestos Detected 90% Cellulose 10% Filler and Binder White fibrous material L-4 No Asbestos Detected 70% Calcite Filler and Binder White crystalline material 30% Mineral Particles • L-5 No Asbestos Detected 90% Cellulose 10% Filler and Binder Tan fibrous material L-6 No Asbestos Detected 10% Glass Fiber 60% Gypsum Filler and Binder White blocky crystalline material 30% Mineral Particles This report relates only to the items tested.If samples are not collected by RGA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of ROA Environmental.It shall not be used to claim product endorsement by NVLAP or any other agency of the U.S.Government. ---._. Sampled By: Kyle Long Received By: Emily Kahler 4/3/2015 4/8/2015 Analyzed Reviewed By: Cheuk-Wa Angela Ng Y By: Matthew Breuer 4/8/2015 Pagc 5 of 9 1 • • O A RG A 3317 3rd Avenue S,Suite D,Seattle,WA 98134 CE:(206)281-8858 FAX:(206)281-8922 email:laboratory@rgaenv.com [NV 11LLJ L� 4....... r-✓ E N V I R Q N M F. NJ T A 1. Bulk Asbestos Fiber Analysis A Verrac[in corirMY (EPA 600/R-93/116) NVLAP LAB CODE 200613-0 CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043 Number of Samples: 32 Report Key Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components Layer Comments(if applicable) 5-WB1-17 L-1 No Asbestos Detected 100% Paint 15005537 Gray paint L-2 No Asbestos Detected 90% Cellulose 10% Filler and Binder White fibrous material L-3 No Asbestos Detected 70% Calcite Filler and Binder li White crystalline material 30% Mineral Particles L-4 No Asbestos Detected 90% Cellulose 10% Filler and Binder Tan fibrous material L-5 No Asbestos Detected 10% Glass Fiber 60% Gypsum Filler and Binder White blocky crystalline material 30% Mineral Particles 6-MG3-18 Yellow adhesive No Asbestos Detected 60% Resin and Binder 15005538 40% Mineral Particles 6-M63-19 L-I No Asbestos Detected 60% Resin and Binder 15005539 Yellow adhesive 40% Mineral Particles e L-2 No Asbestos Detected 90% Cellulose 10% Mineral Particles Tan fibrous material r Li k r This report relates only to the items tested.If samples are not collected by ROA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross- checked gg with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of RGA Environmental.It shall not be used to claim product endorsement by Ib. NVLAP or any other agency of the U.S.Government. Sampled By: Kyle Long e Received By: Emily Kohler 4/3/2015 ----- Reviewed By: Cheuk-Wa Angela Ng 4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 6 of 9 r 5 is C 1 • • - , A. a-zzii RG Pk 3317 3rd Avenue S,Suite D,Seattle,WA 98134 OFFICE:(206)281-8858 FAX:(206)2814922 email:laboratory@rgaenv.com Hv A ENVIRQNm E. NTAi. BulkAsbestos Fiber Analysis A lferracon COMPANY (EPA 600/R-93/116) IQVLAP LAB CODE 200613-0 CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043Number of Samples: 32 1 Report Key Client Sample ID Layer ID(if applicable) Asbestos Non Asbestos Fibrous Non Fibrous RGA Lab ID Layer Description Components Components Components Layer Comments(if applicable) 0 E 6-MG3-20 L-1 No Asbestos Detected 60% Resin and Binder 5 15005540 Beige adhesive 40% Mineral Particles L-2 No Asbestos Detected 90% Cellulose 10% Mineral Particles Tan fibrous material i E. 7-MA4-21 Gray cementious material No Asbestos Detected 50% Calcite Filler and Binder 15005541 30% Sand 20% Mineral Particles K 7-MM-22 Gray cementious material No Asbestos Detected 50% Calcite Filler and Binder 1 15005542 30% Sand k 20% Mineral Particles 111, 7-MA4-23 Gray cementious material No Asbestos Detected 50% Calcite Filler and Binder 15005543 30% Sand 20% Mineral Particles 8-MG5-24 L-1 No Asbestos Detected 60% Resin and Binder I 15005544 White adhesive 40% Mineral Particles 1 L-2 No Asbestos Detected 90% Cellulose 10% Mineral Particles White fibrous material l t t 1 P. This report relates only to the items tested.If samples are not collected by RGA Environmental personnel,accuracy of the results is Limited by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of RGA Environmental.It shall not be used to claim product endorsement by NVLAP or any other agency of the U.S.Government. ---- Sampled By: Kyle Long Received By: Emily Kahler 4/3/2015 --- - 4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 7 of 9 Reviewed By: Cheuk-Wa Angela Ng Y 1 k 9 I • • ' Att, RG 3317 3rd Avenue S,Suite D,Seattle,WA 98134 �i A OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory ct rgaenv.com UfJ ? \ \�( //,\ 1 �J ..,i ! t 1 EN VI Fe 0 NM F NJ TA L BuJk Asbestos Fiber AnaIyss A.//emot=ion COMPFhY (EPA 600/R-93/116) NVLAP LAB CODE 200613-0 s CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043 Number of Samples: 32 Report Key Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components Layer Comments(if applicable) 8-MG5-25 L-1 No Asbestos Detected60/°° Resin and Binder 15005545 White adhesive 40% Mineral Particles L-2 No Asbestos Detected 90% Cellulose 10% Mineral Particles White fibrous material 8-MG5-26 L-1 No Asbestos Detected 60% Resin and Binder 15005546 White adhesive 40% Mineral Particles L-2 No Asbestos Detected 90% Cellulose 10% Mineral Particles White fibrous material l t t 9-MG5-27 White resinous material No Asbestos Detected 60% Resin and Binder 15005547 40% Mineral Particles 9-MG5-28 White resinous material No Asbestos Detected 60% Resin and Binder 15005548 40% Mineral Particles 9-MG5-29 White resinous material No Asbestos Detected 60% Resin and Binder 15005549 40% Mineral Particles 10-MS5-30 L-1 No Asbestos Detected 50% Synthetic 50% Plastic Particles 15005550 White plastic material with fibers L-2 No Asbestos Detected 90% Cellulose 10% Filler and Binder Tan fibrous material This report relates only to the items tested.If samples are not collected by RGA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of RGA Environmental.It shall not be used to claim product endorsement by NVLAP or any other agency of the U.S.Government. Sampled By: Kyle Long Received By: Emily Kahler 4/3/2015 � < .__..-__. Reviewed By: Cheuk-Wa Angela Ng 4/8/2015 Analyzed By: Matthew Breuer 4/8/2015 Page 8 of 9 r • el , . c ....,0 RG A 3317 3rd Avenue S,Suite D,Seattle,WA 98134Ai. ('\n[\ � A �. OFFICE:(206)281-S858 FAX:(206)281-8922 email:laboratory@rgaenv.com W \`�l J/ 1 ENVIRONMENTAL Bulk Asbestos Fiber Analysis NVTAPLABCODE200613-0 01r -rarun r❑n+rsuv (EPA 600/R-93/116) t, CVS Health RGA Batch Number: 15-0587 Project Location: 21905 64th Ave W.Mountlake Terrace,WA RGA Project Number: 81147773 98043Number of Samples: 32 Report Key Client Sample ID Layer ID(it applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous RGA Lab ID Layer Description Components Components Components Layer,Comments(if applicable) 10-MSS-31 L-1 No Asbestos Detected 50% Synthetic 50% Plastic Particles 15005551 White plastic material with fibers L-2 No Asbestos Detected 90% Cellulose 10% Filler and Binder Tan fibrous material e E 10-MS5-32 L-1 No Asbestos Detected 50% Synthetic 50% Plastic Particles 15005552 White plastic material with fibers L-2 No Asbestos Detected 90% Cellulose 10% Mineral Particles Tan fibrous material 11-RF2-33 Brown fibrous material No Asbestos Detected 80% Cellulose 20% Mineral Filler and Binder r. 15005553 — 1 11-RF2-34 Brown fibrous material No Asbestos Detected 80% Cellulose 20% Mineral Filler and Binder € 15005554 11-RF2-35 Brown fibrous material No Asbestos Detected 80% Cellulose 20% Mineral Filler and Binder 15005555 tk l f ii t; N This report relates only to the items tested.if samples am not collected by RCA Environmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross- checked with other laboratories for quality assurance purposes.This report shall not be reproduced except in full,without written approval of RGA Environmental.It shall not be used to claim product endorsement by j- NVLAPorany other agency ofthe ll.S.Government. - - - -- u Page 9 of 9 r 4/8/2015 Sampled By: Kyle Long 4/3/2015 Received By: Emily Kahler Reviewed By: Cheuk-Wa Angela Ng 4/8/2015 Analyzed By: Matthew Breuer i, l i: ., 0 • , JI.. , .-::':%_;.,;.;i.5 ; ` „g p ��a: '.. 5, ,. 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