16-103022 . _�..,
• Demoiition
City of&FcWay Permit #: 16-103022-00-D E
CommunityEcon.Dev.Services
33325 8th Ave S
Federal Way,WA 98003 �253 Request 835-3050 Inspection Line:
Ph:(253)835-2607 Fax:(253)835-2609 p
Project Name: MONTA
Project Address: 28700 28TH PL S Parcel Number: 399900 0050
Project Description: Demolish existing modular home on site
Owner Applicant Contractor
MAHARAN MONTA A PLUS DEMOLITION&EXCAVATION A PLUS DEMOLITION&EXCAVATION
28700 28TH PL S 12035 SE 236TH ST APLUSDE847CD(2/4/18)
FEDERAL WAY WA 98003 KENT WA 98031 12035 SE 236TH ST
KENT WA 98031
Additional Permit Information
Demolition Valuation 14250.00
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 Friday, June 22, 2018
Permit Issued on Wednesday, June 22, 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 in accordance with the laws, rules and regulations of the State of Washington
nd the City of Federal Way.
Owner or agent: W 3 f _ Date: G
8.141
THIS CARD IS TO ,MAIN ON-SITE
C.77'C.F 0 Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 16-103022-00-DE Address: 28700 28TH PL S
Project: MAHARAN MONTA FEDERAL WAY, WA 98003
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as
possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
0 SWM Precon Site Mtg(4400) -0 Initial Erosion Control (4365) El Interim Erosion Control(4370)
Approved To be done prior to breaking ground Approved
By Date By Date By Date
❑ Final Erosion Control(4375) ❑ Final-Building(4050)
Approved Approved
By Date By /1-0Date yi f(a /16
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
x PERMIT APPLICATION
CITY OF
Federal Way PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(acityoffederalway.com
REC SIVED
PERMIT NUMBER /(Q _ / 0 0 2 _ JUN 2 2 2016
— TARGET DATE
SIITEEAADDRESS y / C SQ{ juror WAY
CDS
6 )-00 c),2e6' /0/ 5,
PROJECT VALUATION ZONING ASSESSOR'S T / ARCEL 9
$ /T, 25-12 . O 0 Z ` c/ o c7 - 0 0 5. 1
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT al (L. l a 1 ' t Qli
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
. ,,, . PHONE
N� YYIo�-{ - .�P9 3 Tye
PROPERTY OWNER •,•, E-MAIL
�� , / 6aD3 q Ina:► 1. cane)
1I/ 5 Z 7//6 M 725M� �Ii39-WV /
CONTRACTOR
CITY STA
�c����� 3� I W�//��
1/ ) � / I / c�Y J ��
',5/- /
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
-; Pc 'L S O1 8 '1 2 / /201
NAM S. - za/fa I)c OP r� PRIMARY PHONE --..
ADDRESS
APPLICANT
MAILING! CO 33- S 6 23(Ji
2(Jit-S7- Y`US r rnoYai! 41
CITYF� V-&va— Lt�/�S ATEZIp CJ63 / z.;33 73"7 8742.0 �`' 4r
P.
PROJECT CONTACT N \�I/l/J�'C'VJ e I, P�I7( CO -- �L fq
(The individual to receive and $6 �� 5t- ;/ '/�y�j
respond to all correspondence / Ii �vlArl lev&
concerning this application) cin LM �� c
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 claim),which may be made by any person, including the undersigned,and filed against the city,
but only where such clai arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to"- city as a part of this application.
SIGNATURE: ��L. / i ` DATE ""21—Ip
i ' ��
PRINT NAME: I A A _J. fire C 6 Yeef/1
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
4111 II
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)commerciai)
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 fvcture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS)or Tub/Shower Combo) LAVS)Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS)Kitchen/Utility) WATER HEATERS(Etectrie)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEY R VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE ^ LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
5< /e f L�,6 7 Z o Z. ❑Yes ❑ No ❑Yes ❑ No
Ari
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 ❑
OTHER(describe)
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AreAREA DESCRIPTION m Occupancy Group(s) ConstInformation
Square
uare Feet TtStories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area m Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application
i
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COMMUNITY DEVELOPMENT DEPARTMENT
33325 8th Avenue South
Federal Way,WA 98003-6325
CITY OF 253-835-2607;Fax 253-835-2609
Fe d e ra I Way www.cityoffederalway.com
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure on a subject property. Demolition of separate
structures may require separate permits.
A Address of Demolition: 2e 6 2 g P Z` S F•eole-� w
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.
0 A completed Construction Permit Application form is also required.
1.ASBESTOS ABATEMENT
(Provide copy of Notice ofInlentfrom Puget Soun• Clean Air Agency 5. ELECT' CI
and cop'of i .= 'on re • ERA -rtif ,ns.- •r)
Oaf 0 / c
OW City of Federal Way Building p ial) (Puget�d Ene y)
2. FUEL STORAGE TANKS 6.GAS SUPPLY
❑ Under grade tank(s)is/are present A/ 4
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
N i4
(South King Fire and Rescue) 7.WATER Public Source
. 0
' f
(Water Supplier)
3. SEPTIC SYSTEM
Al 8.WATER-Private Well
(King County Environmental Services) A '
(King CountyEnvironmentalEnnviirronmental Services)
4. SANITARY SEWER
( • e :ven Utility District)
Bulletin#122—May 13,2015 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
6/2/2016 ' Approved Transaction
fb
pscleanar.org
Puget Sound Agency
Notification Case #: 201602611
This nage 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 # AUOFE69C7643
Transaction Date 06/02/16
Owner's Name Maria Monta Phone (206) 783-9942
Project Street Address 28700 28th PL S
City Federal Way, WA Zip 98003
Contact Person Maria Monta Phone (206) 783-9942
Mailing Address
This project includes a demolition.
Demolition Start Date 06/14/16 Completion Date 07/14/16
Demolition will be completed by a demolition contractor
Demo Contractor A Plus Demolition &Excavation Contractor Job #
Contact Suzanne Breen Phone (253) 737-4441
Mailing Address 12035 SE 236th
Kent, WA 98031
(1) I certify that the information I have provided is to the best of my knowledge true and accurate.
(2) 1 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 projects 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.
R, Da u isi
https://secure.pscleanair.org/Asbestos/Approved.aspx 1/1
4 •
Contractor Registration#AAADNDN883KB ASBESTOS SURVEY REPORT
Asbestos Contractor#1541
RRP#1016
ASBESTOS SURVEY REPORT
Project Location: 28700 28th Pl. S.
Federal Way,WA.98003
Inspection Date: June 3,2016
Report Date: June 6,2016
Prepared For: Suzanne Breen
A Plus removal
Email: aplusremoval@comcast.net
Phone: 253-737-4441
Inspected By: Michael Neureiter
AHERA Certified Building Inspector
Certification#3509-15-09-5009
Expiration Date: 9/28/2016
Prepared By: AAA& D NW Environmental Services,Inc.
3632 49th Ave. SW
Seattle,WA 98116
Phone: 253-217-2537
Fax: 360-275-2939
Email: aaadnwinc@yahoo.com
AAA&D NW Environmental Services,Inc. Page 1 of 7 Project#016-186
•
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28700 28th Pl. S. 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 or renovated 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#016-186
4110 i
28700 28th Pl. S. 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 e 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 material 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 a 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#016-186
• •
28700 28th N. S. ASBESTOS SURVEY REPORT
Federal Way,WA.98003
On June 3, 2016 an AAA&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 double wide mobile home and detached shed
located at 28700 28th Pl. S. 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 double wide 3 bedrooms 2 bath home manufactured in 1987. Exterior
is T-11 with no foundation on concrete blocks and the roofing is three-tab composition.The wiring and
plumbing are newer.Heating is forced air with no suspect materials. Interior flooring is carpet on wood
or sheet vinyl on wood, walls and ceilings are sheetrock,insulation is fiberglass. Windows are with no
visible sealants.ACM was rarely used in manufactured housing after 1980. t
The free standing shed is also wood framed on cement,no pad with unfinished interior.
SUMMARY:
The summary of sample test results indicates no presence of Asbestos> 1%which is subject to
regulation.The owner is advised to have a Certified AHERA Building Inspector present during the
entire demolition in order to identify any possible suspect materials for determination of ACM or
PACM.
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 or renovation. 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
AAA&D NW Environmental Services,Inc. Page 4 of 7 Project#016-186
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28700 28th Pl. S. ASBESTOS SURVEY REPORT
Federal Way,WA.98003
KEY: II='HOMOGENOUS
F= FRIABLE
NF=NON-FRIABLE
ASBESTOS CONTAINING MATERIALS
Analysis ID Asbestos Type/Percent Quantities
NO ASBESTOS DETECTED
The following samples DID NOT have any Asbestos Containing Materials:
Sample# Location
NEU 01 Flooring,kitchen/dining room
NEU 02 Wall,kitchen
NEU 03 Wall,bedroom#1
NEU 04 Flooring,bedroom#2
NEU 05 Flooring, bedroom#3
NEU 06 Flooring,bathroom#1
NEU 07 Wall,bedroom##3
NEU 08 Siding, underlayment
NEU 9A Roofing,outside on top
NEU 9B Roofing,outside on top
NEU 10 Flooring,bathroom#2
NEU 11 Ceiling,bedroom#1
NEU 12 Wall, laundry room '
AAA&D NW Environmental Services,Inc.
Page 5 of 7 Project#016-186
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28700 28th Pl. S. 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.
Wallboard Systems (sheetrock)containing<1%Asbestos must meet the removal requirements found
In Washington Labor& Industries Regional Directive 23.30 which may require the presence of a
Certified Asbestos Supervisor during removal.
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 in 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#016-186
28700 28th Pl. S. 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,
/21
Michael Neureiter
`ARA Certified Building Inspector
#3509-15-09-5009
AAA& D NW Environmental Services,Inc.
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kAA& D"W Fn'sironrnentai Services.Inc. Paaeiof 7 Project#-4974-1St
0
APPENDICES
1. Chain of Custody Form
2. Bulk Sample Log
3. Laboratory Test Results
4. Inspector Certification
' A&& VRltry IN�YIJautmrstuf�.DMrn.a�,am
t1.a.n.dooetAhttelxntServicet G
ezi.erIre aisA.saoomilies,Mtewrrwa�e.a arra s
te,4sai�1/S�4VSR
� 4A>�AStAOsoWQ IDe
WANNel/.C>,teea
irirlskimJ}aassedtimed Clitradbe lerAc4yrld lbranffines.
PrimmantiMistitta ft Lind What kusidlftessamovedoe gam.
Derrll YeydrtmbfltlSeJlti+c,SeleaaeO`pog3emDr aam. -likir
MatesSono nsmut,aebookraWtiii Air Rat>p•' •
ttleiW Rematy '-
r �ty� t X
0.
'....., }(� tso�as
Sample Log
—Bulk Asbestos— .' �' I
_36
ling '1 ,'' `_? t -,
�rw Bulk Asbestos Sample Loft •
}}
Moot Sample iATL 0 Lawtioutl)escilpt on.w Notes
c,-,-.), \-t3c\c,r,r\ ,,k. --) Li:a-1u -- .
. ,\,_ , i
t.z1 ; ..). 0
c, A._
77.i
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: C V7-1-5A CO-) -,. '.) V.--- k cc)r-k (7•CA‘ ' a Q0 4,
/r
[ cr,T+,-
q(c- Pf.._-4-y--0.--, \ • i----.10-(.,(-I 0---.c:,,,-- ,,,,-1,.,- \-,,,, T,
t`e`f=. r �.) tom'— :(-- C ri . •)
IF_____ \ 0 V'*\--)n-y---) -47 \--.\(.-coic-i . .=1:-:..."--..,
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• S
TRIANGLE ENVIRONMENTAL SERVICE CENTER, INC.
13509 East Boundary Road, Suite B, Midlothian,VA 23112 s
804-739-1751•fax:804-739-1753
BULK ASBESTOS SAMPLE ANALYSIS SUMMARY
CLIENT: AAA&D Northwest Environmental Services,Inc. TESC LOGIN#: 160606G
3632 49th Ave SW
Seattle,WA 98116 DATE OF RECEIPT: 6/6/2016
DATE OF ANALYSIS: 6/6/2016
CLIENT JOB/#: DATE OF REPORT: 6/6/2016
JOB SITE: 28700 28th p1.S.Federal Way,WA ANALYST: F.Jiang
TESC I CLIENT SAMPLE ID ESTIMATED I NON ASBESTOS NON FIBROUS
SAMPLE# &GROSS DESCRIPTION ' %ASBESTOS %FIBERS %MATERIALS
1 NEU 01/Red lino.,gray fibers NAD 20%Cellulose 80%
2 NEU 02/White powder.brown fibers NAD 20%Cellulose 80%
3 NEU 03/White powder,brown fibers NAD 20%Cellulose 80%
4 'NEU 04/Brown lino.,gray fibers NAD 20%Cellulose 80%
5 NEU 05/Tan lino.,gray fibers NAD 20%Cellulose 80%
6 NEU 06/Tan lino.,gray fibers NAD 20%Cellulose 80%
7 NEU 07/White powder,brown fibers NAB 20%Cellulose 80%
8 NEU 08/White foam+brown fibers NAD 20%Cellulose 80%
9A NEU 09-Shingle/Black tar-like NAD, 20%Fiberglass 80%
9B NEU 09-Mastic/Black adhesive NAD 100%
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/l 16,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(TEM),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.
NVLAP Lab Code:200794-0 [LEGEND NADNo Asbestos Detected,Lino.=Linoleum,JC=Joint Compound]
Reviewed By Authorized Signatory: L/ ~.
Feng Jiang.MS Senior Geologist,Laboratory Director
Yuedong Fang,Senior Geologist
Monday,June 06,2016 Page 1 of 2
S
Contractor Registration Asbestos Certification #1541
#AAADNDN883KB RRP #1016 INVOICE
INVOICE: 016-186
A.A.A. Ft D NW ENVIRONMENTAL SERVICES, INC DATE: JUNE 6, 2016
3632 49TH Ave. SW. Seattle, WA. 98116
253-217-2537 - Fax:360-275-2939
aaadnwinc@vahoo.com
TO: Suzanne Breen
Phone: 253-737-4441
Email: aplusremoval@comcast.com
SALESPERSON ' JOB 1 PAYMENT TERMS DUE DATE
28700 28th Pl. S.
Michael NeureiterFederWay, Due upon completion Due upon completion
al WA.
; UNIT LINE
Q'TY DESCRIPTION RICE TOTAL
Asbestos Survey Report
P
$500.00
•
(Please put the Invoice number on your check)
(9.5%tax)
Make checks payable to AAA Et U NW Environmental Services, Inc. SUBTOTAL $500.00
3632 49th Ave. SW. Seattle, WA. 98116
SALES TAX -0-
THANK YOU FOR YOUR BUSINESS!
TOTAL $500.00
- 4