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13-102287 RESUB ITTED f �,�oF PERMIIAPPLICATION Federal Way MAY 2.3 2013 CITY OF FEDERAL WAY 12b (i.6' PERMIT NUMBER / 3 _ / (./ DS 8 - 6 � �"""'�_, __) V TARGET DATE SITE ADDRESS SUITE/UNIT# PROJECT VALUATIO i ZONING ASSESSOR'S TAX/PARCEL# $ .2(OOa —7 <) 7 3 0 - 0 / 0 0 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL LI DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION fi NAME OF PROJECT ,-3 VU e7c22t_4,l,t L' (4 x 1 t- 141.1 AE'CLt`?.k A __>1 C.l.t PROJECT DESCRIPTION 1`�� Detailed description of work to be included on this permit only NAME VV e..-1-2 C r -w j i 14-r(.CA { --,.,�P'J PRIMARY PHONE --- PROPERTY OWNER c' . t7 ( i- --r( e7 T5 `�/ MAILING? ADDRESS E-MAIL CITY STATE ZIP NAME V `i tib 1 0 t(_ At--11--72,14- j t r-1 (27 X4`4. NAILING ADDRF S E. L CONTRACTOR 11 �j r, A4 V 0 I e h /Ca () Qui Eie;re rr.-(c . 10 CITY AU 'P t.)RN STATE �oteoaj FAX 131--"1-Si WA STATE CONTRACTOR'S LICENSE Of EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE it / / NAME N-`C-: 7-1Z.. t ' 0�cLL C'6'‘ PRIMARYHONE v .� 47- to 4 `-'-4 MAILING ADDRESS E-MAIL L ( 'k t-'' r AAA) v U C< � Ck p///V 0,cl er: (: -i2t-t6 CITY STATE ZIP 9., FAX 4-0 t6 L1V- tk NAME ,( AS A v7e\.) e. PRIMARY PHONE PROJECT CONTACT (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX NAME PROJECT FINANCING re-A)S AI-1 J K ijI f t4 to�,c C`t-v +-CT V [OWNER-FINANCED Required value of$5,000 or more MAILING ADDR CITY,CISTATE,ZIP ` `--� V 'E— / f �f A PHONE/� (RCW 19.27 095) 1 ( .+.F 1 .-)l L , .L c) A" �>i ( "")A- ",� G''C` 1 — 4-4 , Aur, j 4% 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 Iaws. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person,including the undersigned,and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this ap lication. e\ttf,,,___ VAA-A R� e SIGNATURE: �J l L........- DATE !�"� PRINT NAME: ` a V/u i< S ( C Bulletin#100—January 1,2013 Page 1 of 3 k:AHandouts\Permit Application • VALUE OF MECHANICAL WORK MECHANICAL PERMIT Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial) BOILERS FURNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES VALUE OF PLUMBING WORK PLUMBING PERMIT Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. BATHTUBS(or Tub/Shower Comm) LAVS(Hand Sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS)&itcheuJUtaity)_-- - - — — WATER HRATERS-(Electric)----- HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes ❑ No ❑Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT FIRST FLOOR(or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT 0 OTHER(describe) EXISTING PROPOSED TOTAL Area Totals **NEW HOMES ONLY** ESTIMATED SELLING PRICE$ # OF BEDROOMS COMMERCIAL—NEW/ADDITION AREA DESCRIPTION Area Occupancy Group(s) Additional# of Additional Information in Square Feet Type Stories NEW BUILDING ADDITION COMMERCIAL—REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information in Square Feet Type Stories TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application /55( ----)-T _ ° T • fi) yxrt,-(-( V Tte V i' DEPARTMENTOF COMMUNITY DEVELOPMENT SERVICES - - '�' ' /v 33325 8th Avenue South 1 Federal Way, WA 98003-6325 CITY OF '. '''4-1. -,-;,';.e;-," ...:-: C 'CSS& 4- `T t2-t,C 253-835-2607;Fax 253-835-2609 WWW.c i tyo ffedera l way.c o m Federal IA/ y oc,2,5,_„,, 012 j ,, 4-,, ,...,:,„ 0?-t ---1 p(Per) et,/ fri-b7-- .7-)p . DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and submittal of an environmental checklist may be required, which will extend the time period before a demolition permit can be issued. ❑ Prior to submitting a demolition permit,the following items (as applicable) must be signed by the respective agency (see attached Demolition Permit Contact List). NOTE TO APPLICANT: Utilities shall be disconnected and services performed, if applicable,prior to issuance of the demolition permit.All applicable items below are to be signed and dated by the respective agency representatives. iNiCfi(r_ cf {i'ctom. _i- ifJIe.5-1reC`y S -t4fv �I 1. ASBESTOS ABATEMENT 6. ELECTRICITY (Copy of approval formf� and asbestos survey from Puget Sound Clean Air (Electricity to be shut off and meter removed) I ptA1 r-y -'p #-. Agency provided) 14 O .A `j�dcj -0V 1 . r- _fir I i�'l. i-2-j] i * OG —C9' ©r` (Puget Sound Energy) -WW1.+ . o F �:I W`1Buili Official) 3 0 , I 2. GAS SUPPLY 7. FUEL STORAGE TANKS (Gas to be shut off, meter removed and final bill paid) (Above or below grade fuel tanks, have been pumped or removed 'C'--14 5 '7. ( `� { t,t (, �1 �� , Tp under Fire Departipep _permit prior to any dismantle/excavation) (Puget Sounti Energy 4 / (South King Fire and Rescue) 3. SEPTIC SYSTEM 8. WATER- Public Source (Check applicable box) (Tank to be removed or tank to be drained and filled) o Meter to be removed and final utility bill paid ®�� ���� � (Meter to remain and be protected Ow4 �� ` 1 .,,.-_� Le�rcEtf tF CL?ct�T`f-`Zzrc-7 (King Coun nviron ntal Service 5' /,n e3 (Water Supplier) �1r!i3 ice' ***** OR****** It t 4. SANITARY SEWER (Check applicable box) 9. WATER- Private Well (Check applicable box) ID Sewer line capped at property line o Private well filled and capped ❑Existing sewer line to remain and be used by proposed new structure o Private well to be used for other purposes 1' .)I A , ',.L5---„,,, s-(a l r- (Lakehaven Utility District) (King County Environmental Services) 5. GARBAGE RESUBMITTED (All household gaTba e disposed off and final bill paid) �// MAY 2'3 2013 (Waste Management/Other Company) CITY OF FEDERAL WAY ❑ Completed Construction Permit Application form CDS ❑ Provide the following fees: 1.Demolition Permit Fee Based on valuation.See table on pg 4 of the construction permit application. 2. Automation Fee $6.00 3. WA State Surcharge $4.50 Bulletin#I22—January 1,2011 Page 1 of 1 k:\Handouts\Demolition Permit Requirements • . r DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8`h Avenue South CITY OF Federal Way,WA 98003-6325 Federal Way 253-835-2607;Fax 253-835-2609 www.citroffederalway.com DEMOLITION PERMIT CONTACT LIST This list of agencies may assist you in expediting the demolition permit process.Refer to the demolition permit requirements for signature blocks.All applicable signatures are required prior to permit approval. CT- 1. Asbestos Removal: Puget Sound Clean Air Agency 110 Union Street,Suite 500 Seattle,WA 98101-2038 206-343-8800—OR—800-552-3565 www. scleanair.or 2. ECectricitJ: I j� Puget Sound Energy Tacoma Public Utilities Attn:Construction Coordinator Customer Service Ci 22828 68th Avenue South,Suite#102 —OR— 747 Market Street Kent,WA'98032 Tacoma,WA 98402 888-225-5773 253-383-9600 or 253-383-2471 .., (A&' 4 - 5( 2-0 3. Gas. Puget Sound Energy 805 156`h Avenue NE ('zc ) e?- - q6' Bellevue,WA 98004 888-225-5773 4. Telephone: Qwest Communications 801-962-2475 (phone)/801-237-6491 (fax) 5. Water: Lakehaven Utility District Tacoma Public Utilities Technical Service Division Customer Service -4 31623 First Avenue South —OR— 747 Market Street Federal Way,WA 98003 Tacoma,WA 98402 253-941-2288 253-383-9600 or 253-383-2471 6. Garbage: Waste Management 655 Second NW Auburn,WA 98071 253-833-3333(residential)—OR—253-939-9792 (commercial) 7. Sewer: Lakehaven Utility District Technical Services Division 31623 First Avenue South Federal Way,WA 98003 253-941-2288 8. Septic: King County Environmental Services 14350 SE Eastgate Way Bellevue,WA 98007 206-296-4932 9. Fire Department: South King Fire&Rescue 33325 8th Avenue South Federal Way,WA 98003 253-946-7248 Bulletin 4109—January 1,2011 Page I of I k:\Handouts\Demolition Permit Contact List Approved Transaction Paae 1 of 1 b . • • .«..-.ter"-- '" " +.,.„ 4 pscleanair.org Puget Sound C.e,m Air Agency Notification Case #: 201301760 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 #VXHFAA5F9B16 Transaction Date 05/23/13 Owner's Name Western Washington Conference of 7th Adventists Phone (253) 681-6008 Project Street Address 1860 S.336th Street City Federal Way Zip 98003 Contact Person Peter Vukshich Phone (253) 804-5747 Mailing Address 32229 Weyerheuser Way South Federal Way, WA 98001 This project includes a demolition. Demolition Start Date 06/03/13 Completion Date 06/05/13 Demolition will be completed by a demolition contractor Demo Contractor Scotty Construction Contractor Job # Contact Peter Vukshich Phone (253) 804-5747 Mailing Address 20405 SE 344th Street Auburn,WA 98092 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed.The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure.The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification If you have questions,contact us at asbestos©pscleanair.org or 206.689.4058. RESUBMIflED MAY 232013 CITY OF FEDERAL WAY CDS https://secure.pscleanair.org/Asbestos/Approved.aspx 5/23/2013 • • • • DEMOLITION ASBESTOS SURVEY REPORT DEMOLITION ASBESTOS SURVEY REPORT Project Location: 1860 S. 336th St. Federal Way, WA. 98003 Inspection Date: April 10, 2013 Report Date: April 24, 2013 Prepared For: Parousia SDA Church Pastor Kruschetsy Phone: 253-632-4098 Inspected By: Michael Neureiter AHERA Certified Building Inspector Certification#3509-12-09-5009 Expiration Date: 9/28/2013 Prepared By: AAA& D NW Environmental Services,Inc. 240 NE Madrona Ave Tahuya, WA 98588 Phone: 253-217-2537 Fax: 360-275-2939 Email: aaadnwinc@yahoo.com RESUBMITTED MAY 232013 CITY OF FEDERAL WAY CDS AAA&D NW Environmental Services,Inc. Page 1 of 7 Project#013-018 • • • 1860 S.336th St DEMOLITION ASBESTOS SURVEY REPORT Federal Way,WA. 98003 REGULATIONS: In the event of an Asbestos Removal or Demolition Project, Regulation III Article 4 of the PSCAA Asbestos Control Standards should be consulted. This Regulation is available at the following WEB Address: http://www.pscleanair.org/reg3/reg3.pdf. This survey provides the information required in order to meet the AHERA sampling protocol as stated in 40 CFR 763.86 National Emission Standard for Hazardous Air Pollutants (NESHAP). This sampling protocol is required for all Asbestos Surveys prior to Demolition or Renovation of a building under Puget Sound Clean Air Agency Regulation III Article 4. This survey also assists the building owner in meeting the"Good Faith"Asbestos Inspection requirements stated in WAC 296.62.07721,requiring the owner of a building to be demolished to furnish contractors with a written statement whether the material to be disturbed contains Asbestos. Current Asbestos Regulations require this report be kept on the site throughout Asbestos Abatement and/or Demolition or Renovation of building structures on the property. This Asbestos Survey Report complies with the AHERA sampling protocol stated in 40 CRF 763.86 Puget Sound Clean Air Agency, Regulation III,Article 4. SURVEY PROTOCAL Asbestos Survey Protocol The AAA& D NW field inspector is an Asbestos Building Inspector,certified under the requirements of the United States Environmental Protection Agency(EPA)Asbestos Hazard Emergency Response Act(AHERA)regulation 40 CFR 763, Subpart E.A copy of this certificate is provided in the Appendix. The AHERA Guidelines state the following: The inspector must determine homogenous areas,which are defined as an area of Thermal System Insulation, Surfacing Material, or Miscellaneous Material that is uniform in texture and color. Once homogenous areas have been determined,the inspector determines whether or not material is friable or non friable. Friable is defined as a material,when dry, can be crushed,pulverized,or reduced to dust using hand pressure.Non friable material is defined as material,when dry that cannot be crushed,pulverized or reduced to dust using hand pressure. Materials normally defined as non friable can become friable by definition if sufficiently damaged. Friability is determined at time of inspection, demolition,renovation or abatement may affect friability of material. AAA&D NW Environmental Services,Inc. Page 2 of 7 Project#013-018 S • 1860 S.336th St. DEMOLITION ASBESTOS SURVEY REPORT Federal Way,WA.98003 Once friability has been determined, the materials suspected of containing asbestos are divided into one of three categories: Thermal System Insulation(TSI), Surfacing Material (SM),or Miscellaneous Material (MM). TSI and SM are considered to be friable,with the exception of TSI where the structural integrity of the insulation is intact and the protective wrap is undamaged. Materials are divided into one of these categories and samples are collected in the following manner: Friable Thermal System Insulation: 1. Inspector shall collect three (3)randomly distributed samples; 2. Inspector shall collect a minimum of one sample of each TSI materials that appears to have been used as a patch, as long as the patch is less than six linear feet or six square feet; 3. Inspector shall collect sufficient samples from areas of TSI applied to fittings,tees, and joints. Friable surfacing material: 1. Inspector shall collect surfacing material samples in statistically random manner as follows: a. Collect three bulk samples from an area believed to be homogeneous (defined as a material that appears to be the same or similar and was installed at the same time)that is 1,000 square feet or less in size; b. Collect five bulk samples from an area believed to be homogeneous that is greater than 1,000 square feet in size, but less than 5,000 square feet in size; c. Collect seven bulk samples from an area believed to be homogeneous that is greater than 5,000 square feet. Miscellaneous Materials: 1. Inspector shall collect sufficient samples to determine if the material is asbestos-containing or not. Non-Friable Materials: 1. Inspector shall collect sufficient samples to determine if the material is asbestos containing or not. AAA&D NW Environmental Services,Inc. Page 3 of 7 Project#013-018 • • 1860 S.336th St. DEMOLITION ASBESTOS SURVEY REPORT Federal Way,WA. 98003 On April 10, 2013 an AA A& D NW Inc.AHERA Certified Building Inspector conducted a Good Faith Asbestos Survey per U.S EPA A.H.E.R.A guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State,of a single family house located at 1860 South 336th St.-- Federal Way, WA. 98003 for the purpose of identifying any Asbestos containing materials that may be present and may be impacted prior to Demolition or Renovation. NARRATIVE: The structure is a single story wood frame building with gyp board siding and a pitched composition roof on cement foundation with a crawl space. The converted garage is slab on grade. Originally built in 1955 the structure was , stated by the owner, completely renovated including interior/exterior walls, ceiling,wiring, heating and plumbing as well as the addition of a two car garage converted into living area three years ago. The building contains 3 bedrooms,2 '/2 baths, entry, dining room and a living room. The converted section includes an oversize shop, a large meeting room/Chapel, and a storage area totaling approximately 2000 sq. ft. Plumbing, heating, and electrical had all been updated and/or replaced.Windows are double pane aluminum or vinyl w/o visible sealants. Flooring is all new over wood or cement. Walls and ceilings are sheetrock. A small area of popcorn and two types of stapled acoustical tile were covered over with a drop ceiling and are suspect as well as sheet vinyl flooring used in both the shop and laundry room which are also suspect. SUMMARY: A summary of sample tests results indicate no visible/accessible presence of Asbestos> 1%which is subject to regulation. Any and all materials identified as ACM or PACM in this report(and/or additional materials associated with the structure that may be discovered and later identified as ACM or PACM),must be professionally abated prior to demolition.ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION,AS LISTED QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY. ASBESTOS CONTAINING MATERIAL Analysis ID Asbestos Type/Percent Quantities NO ASBESTOS DETECTED AAA&D NW Environmental Services,Inc. Page 4 of 7 Project#013-118 i • 1860 S.336th St. DEMOLITION ASBESTOS SURVEY REPORT Federal Way,WA 98003 The following samples DID NOT have any Asbestos Containing Materials: Sample# Location 1. NEU-CC-01 Shop and Laundry room sheet vinyl 2. NEU-CC-02 Popcorn ceiling under drop ceiling hallway between shop and chapel/meeting room 3. NEU-CC-03 Acoustic tile stapled to ceiling in chapel meeting room under drop ceiling 4. NEU-CC-04 Acoustic tile stapled to ceiling in chapel meeting room under drop ceiling AAA&D NW Environmental Services,Inc. Page 5 of 7 Project#013-118 1860 S.336th St DEMOLITION ASBESTOS SURVEY REPORT • •• Federal Way,WA. 98003 Some sample analysis listed may be representative analysis of individual and separate samplings and analysis of homogenous materials, as prescribed by A.H.E.R.A. protocol. If, during demolition or renovation,any hidden or covered suspect materials are located {may include but not limited to: sheet vinyl flooring,tile flooring,wall, or ceiling texturing, or paints, concrete siding or skirting, cement pipes, cement wallboard, electrical cloth, electrical wiring insulation, thermal paper,wallboard, joint compounds,vinyl wall coverings, spackling compounds, or any TSI (Thermal System Insulation) },they should be treated as Asbestos Containing Materials unless determined to be non-asbestos by laboratory analysis. Any and all materials identified as ACM in this report must be abated prior to ACM disturbance,renovation, or demolition.All materials identified as ACM must be professionally abated by a Licensed Abatement Contractor prior to any disturbance. Analytical test method: USEPA 600/R93/116** (PLM): Wac 296-62-07753 App.J) Key:ACM signifies "Asbestos Containing Material" PACM signifies "Presumed Asbestos Containing Material" CAB signifies "Concrete Asbestos Board" <signifies "Less than" >signifies "Greater than" TSI signifies "Thermal System Insulation" ND signifies "None Detected" **One percent is the U. S. EPA regulatory limit for asbestos min bulk samples. PLM has been known to miss asbestos in small percentages of some samples, which contain asbestos,thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM or TEM,to insure analytical accuracy when reported in small percentages. The conclusions in this report resulted from a visual walk through determining the collection of samples of suspect materials.AAA&D NW, Inc. cannot be held liable for materials requiring destructive measures to access or materials which were hidden and could not be found with reasonable diligence AAA&D NW Environmental Services,Inc. Page 6 of 7 Project#013-118 1860 S. 3366 St DEMOLITION ASBESTOS SURVEY REPORT . • • Federal Way,WA. 98003 Within the limitation of scope, schedule, and budget, our services have been executed in accordance with generally accepted practices in this area at the time this letter was prepared.No other hazardous material/waste was investigated.No other conditions, expressed or implied, should be understood. AAA& D NW Environmental Services Inc. claims responsibility for sample content only. Sincerely, ,/ i / / Mic'ael Neureiter AHERA Certified Building Inspector AAA& D NW Environmental Services,Inc. AAA&D NW Environmental Services,Inc. Page 7 of 7 Project#013-118 i • APPENDICES 1. Sample Location Map 2. Bulk Asbestos Sample Log 3. Laboratory Chain of Custody Form 4. Laboratory Bulk Asbestos Analysis Summary 5. Inspector Certificate P S • 1 ti """"` Ctz t} n m Ys 2 m ill. " Et--; t.3 xl0 E { 7s CD 474 !m cR soA = —Iihcn0L?co toc numberm-.� tt�;cm° 'nG}ii 1' �� -:sir • 14 ,E * m „ . • , "471, , „,‘„, ,,,... ,. Licit= 111 silt lit 1 I. 41 his , :47:31:77; vt4046"47:1 i '. iiiiiiiiiiiiiiiiiiiliiiii�,. _ ......._ ,, ),„it...1 ,.,,, .�-� -- -.e, ID Pi_ i21,z1 yo y b z 11111111 IN 1111111 111111111111111111111 1%4 111111 ea. 111111111111111111111111111111111 1 PLM Point Count,t100 = 0 11111111 1 1f PaintCr�unt'{ t} 1 Ixi .,fi., "--� m curs, B 435(So! only} 1 1 f e 4 'AHE Alt Rt. — I/II { 0 0 113 c Ste,`. _:-1) 1111111111111111111111111111liri .,, € S P so Po 1111111/1 I 73 11� 1.11 1111 1 PE r5 4 mcota (Pb) Q co co� 0. Go el m 31311111111111111111 17 i .5 )11111 s .,.Fame CD m i 1 7371703$' r 1 7.2 11111111 111111111111111111 ,:ULKCO Z 1 _ VolDI c/Eg ume(L) 11/4 „. 1 7 4, p Are2(f} wArea(cma) �t T t 4. rrMt it SOME M��:IMr!)1111010.111111100 rrrre 11.....*Mini are rrrra rN6 NNW' i 8 Stt 111 CID k n tEl . NN IN ez 70 -11101 cal a m1, rn ye 0 PZI I • • • TRIANGLE ENVIRONMENTAL SERVICE CENTER, INC. 13509 East Boundary Road, Suite B, Midlothian,VA 23112 804-739-1751•fax:804-739-1753 BULK ASBESTOS SAMPLE ANALYSIS SUMMARY CLIENT: AAA&D Northwest Environmental Services,Inc. TESC LOGIN#: 1304I6S 240 NE Madrona Avenue Tahuya,WA 98588 DATE OF RECEIPT: 4/16/2013 DATE OF ANALYSIS: 4/18/2013 DATE OF REPORT: 4/19/2013 CLIENT JOB/#: JOB SITE: 1860 S.226th,Federal Way,WA ANALYST: Y.Fang TESC I CLIENT SAMPLE ID I ESTIMATED I NON ASBESTOS I NON FIBROUS SAMPLE# &GROSS DESCRIPTION %ASBESTOS %FIBERS %MATERIALS 1 NEU CC 01 /Gray vinyl NAD 100% 2 NEU CC 02/White powder NAD 100% 3 NEU CC 03/Brown,yellow fibers NAD 98%Cellulose 2% 4 NEU CC 04/Brown fibers NAD 98%Cellulose - 2% Total Samples/Layers Analyzed: 4 Samples are analyzed in accordance with"Interim Method for the Determination of Asbestos in Bulk Insulation Samples'.EPA 600/M4-82-020.Dec. 1982 and"Method for the Determination of Asbestos in Bulk Building Materials".EPA 600/R-93/116.July 1993.None Detected:not detected at/or below the detected limit of method(Reporting limit: 1%Asbestos).Glass fiber is analyzed for quality control blank.TESC recommends by point count or Transmission Electron Microscopy(1 EM).for materials regulated by the EPA NESHAP(National Emission Standards for Hazardous Air Pollutants)and found to contain less than ten percent(<10%)asbestos by Polarized Light Microscopy(PLM).Both services are available for an additional fee.This report shall not be reproduced.except in full written approval of Triangle Environmental Service Center.Inc.This report must not be used by the customer to claim product certification,approval.or endorsement by NVLAP.NIST.or any agency of the Federal Government.This test report relates only to the item(s)tested. 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"IP'-'.. ! ��� y f��� ��:.,�x �''a z .a”-4'tx7 •,^! a ,t`''t h-r"'�=,�' a' '. �i � f _,-....„,-/..411- ..,..,,...,i--zf ''Y - ��-"&i -j" r #" x �+3 �! II-- •�:..\441.`{t i .y - • • APPENDICES 1. Sample Location Map 2. Bulk Asbestos Sample Log 3. Laboratory Chain of Custody Form 4. Laboratory Bulk Asbestos Analysis Summary 5. Inspector Certificate ti AAA.&D NW ENVIRONMENTAL SERVIIIIINC V - • Professional Abatemerrt&Mew .1-1- .....• . ''.:. , Asbestos Abatement,ATEBRA CnrciDed Suntan • s;" Inspentions,CertifiedAntleness?mines Design, ''- Tesgdug a C° ll nsuing.Mad.= • Air QuatitgTesang ( D) (f' 1 `'S' .,,......, _ ' Yarisnel Hostetter , . - • . prkepni — f, *.., 253-217-M7 Frac 360-275-2939 aaldaWinc61231""m Samvie Log , -Balk Asbestos- -go...74... 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