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17-101425.ti City of Federal Way Community Development Dept. 33325 8th Ave S Federal Way, WA 98003 Ph: (253) 835-2607 Fax: (253) 835-2609 Project Name: LALAINE WONG SHORT PLAT Project Address: 36710 6TH AVE SW Project Description: Demolition of single family residence. Demolition Permit #:17 -101425 -00 -DE Inspection Request Line: (253) 835-3050 Parcel Number: 302104 9094 Owner Applicant Contractor LALAINE WONG LALAINE WONG OWNER IS CONTRACTOR 8318 STATE ROUTE 302 8318 STATE ROUTE 302 GIG HARBOR WA 98329-8666 GIG HARBOR WA 98329-8666 Additional Permit Information PERMIT EXPIRES Saturday, 30 March, 2019 Permit Issued on Thursday, March 30, 2017 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: Date: `3 If ® THIS CARD IS TO REMAIN ON-SITE CITY OF, Construction Inspection Record Federal Way INSPECTION REQUESTS: (253) 835-3050 PERMIT #: 17 101425 00 Address: 36710 6TH AVE SW Project: LALAINE WONG FEDERAL WAY WA 98023-7272 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. ❑ Final - Building (4050) Approved By �(� Date 0 Rough Electrical El Final Electrical Right of Way Approved Approved Approved By Date By Date By Date 41k CITY OF Federal Way PERMIT APPLICATION PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + permitcenter(dcityoffederalwaV.com PERMIT NUMBER TARGET DATE SITE ADDRESS rj SUITE/UNIT # PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL # $ In _ ba �✓' I NL�L F1�M1� TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT PROJECT DESCRIPTION PAL) L'16 ON or p 5IrvC'I- �A► L"-( tz 0 Detailed description of work to be included on this permit only NAME L pt N l LQI SMG PRIMARY PHONE °_53 -- PROPERTY OWNER MAILING ADDRESS 9 ��y� (.l E-MAIL r� r�'W, h! l#! iL- CITY /' STATE Ujtq ZIP yV NAME PHONE . ; r"111? MAILING ADDRESS E-MAIL CONTRACTOR CITY STATE ZIP FAX WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # NjAjMEii PRIMARY PHONE 71 MAILING ADDRESS E -MAI. "fo(Q . ne APPLICANT CITY STATE ZIP q Z3 FAX ti /A PROJECT CONTACT NAME i \Gk won PRIMARY PHONE _ - -G 3 '� MAILING ADDRESS 30 I E-MAIL a �b Z. CcWa1-k, nP� (The individual to receive and respond to all correspondence CITY I STATE ZIP FAX concerning this application) PROJECT FINANCING NAME ❑ OWNER -FINANCED When value is $5,000 or more (RCW 19.27.095) MAIL NG ADDRESS, CITY, STATE, ZIP PHONE 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 apart of this application. ✓� IGNATURE: �T1LVr✓i,` l� DATE SIGNATURE: 4S NAME: Bulletin #100 —January 29, 2016 Page 1 of 2 UHandoutsTermit Application Feo. deral Way COMMUNITY DEVELOPMENT DEPARTMENT 33325 8`h Avenue South Federal Way, WA 98003 253-835-2607; Fax 253-835-2609 www.ciiyoffederalwU.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. L1 Address of Demolition: 3L 9 � (2 62w Ay -e 5W i'..( W av Vii gSW3 ❑ 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 of-intentfrom Puget Sound Clean Air AgencyELECTRICITY an c py in ion r po by A -certified inspector) r ( � � ��� ; LL� C- `/ f G (Puget Sound EnOrgy) 2. FUEL STORAGE TANKS ice' ❑ Under grade tank(s) is/are present ❑ Above grade tank(s) are present ❑ Tank(s) has been pumped or removed under South King Fire & Rescue permit prior to any dismantling or excavation 6. GAS SUPPLY N I1 (Puget Sound Energy) (South King Fire and Rescue) 7Z VATER - Public Source 1 ai wvr -A L -�- c sic—' Ltd k. afar Su r �3 SEPTIC SYSTEM Qurn � Ab p u adorn m+n^l- ? Ilene 1� Evnrgrp�� So,r,,'+ct -b-On , 1-0, Lk S}"UPtnS W,A 8. WATER - Private Well (King County Environmental Services (King County Environmental Services) 4. SANITARY SEWER (Lakehaven Utility District) Bulletin 4122 —May 13, 2015 Page I of I k\Handouts\Demolition Permit Requirements PROJECT #: 16262 PROJECT: 36710 6TH AVE. SW FEDERAL WAY, WA 98023 PREPARED FOR: LALAINE WONG P.O. BOX 1342 TACOMA, WA 98401 F7 Ln Ln (D ems' m 0) c (D C c -me F.S. ;' GS. SERVICES INC. 1. STATE ACCREDITED CONTRACTOR State License and Registration Labor and Industries Contractor Registration Labor and Industries Asbestos Certification 2. ACCREDITED ASBESTOS SUPERVISOR Supervisor/Worker Certification ,; 3. AIR MONITORING RESULTS Name and Address of Analytical Lab Air Monitoring Data Sheets 4. TRANSPORTATION AND DISPOSAL OF ACM; Waste Shipment Record Disposal Facility Permit INTEMOR I CDN 5. PROCEDURES FOR ABATEMENT ACTIVITIES Puget Sound Clean Air Agency Notifications Labor and Industries Notification Daily Project Sign in/out Contaminated Entry Sign in/out SECTION 1 STATE ACCREDITED CONTRACTOR f. STATE T WASH$N(ITON Domestic Profit Corporation F.S. 8 G.S. SERVICES, INC. 16214 57TH AVE E STE A PUYALLUP WA 98375 9027 BUSINESS LICENSE Unified Business ID is 601 133 658 BusinessID #: 1 Location: 1 Expires: 12-31-2016 TAX REGISTRATION INDUSTRIAL INSURANCE UNEMPLOYMENT INSURANCE CITY LICENSES/REGISTRATIONS: BELLEVUE GENERAL BUSINESS #047176 LACEY GENERAL BUSINESS #20217 OLYMPIA GENERAL BUSINESS EATONVILLE GENERAL BUSINESS TUMWATER GENERAL BUSINESS LICENSING RESTRICTIONS: Not licensed to hire minors without a Minor Work Permit. This documenttats the registrations, endorsm eents, and iicenseaothorited fovea business narrwL,tlabove.0yacceptnigthisdocument, the fit enseecertif`iestheinkxrmatif)tGntheapplication (//J was complete, true, and accurate to the best of his or her knowledge, and that businesswiIt be conducted in compliance with all applicable Washington state county, and city regulations. Director, Department of Revenue Department of Labor and Industries PO Box 44450 Olympia, WA 98504-4450 F S & G S SERVICES INC 16214 57TH AVE E SUITE PUYALLUP SVA 98375 F S & GS SERVICES INC Rco: CC FSGSS**I20R. UBI: 601-133-658 Registered as provide y a'a Construction Contractor (CC01) - GENERAL Effective Date: 12/5/1988 .. Expiration Date: 7/6/2017 a STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES P.O. BOX 44614 OLYMPIA WA 98504 - 4614 F S & G S Services Inc 06/29/2016 16214 57TH AVE E SUITE A PUYALLUP WA 98375 CERTIFICATE # 1022 CONTRACTOR REGISTRATION # : FSGSS**120RE EXPIRATION DATE: July 06, 2017 The above referenced certificate number should be listed on all asbestos abatement contracts obtained by the named individual or company. This number must also be listed on the project notification submitted to the department as required by WAC 296-65-020. This certificate need not to be kept at project locations, but should be available for review if requested by the department. This certificate is not transferable. Application for renewal of this certificate must be received no later than May 06, 2017 . Sincerely, ASBESTOS CERTIFICATION PROGRAM I IN i i.� i �"*& i *� i �.. DEMOLITION, MOLDREMEDIATION CERTIFIED AS PROVIDED BY LAW AS ASBESTOS SUPERVISOR CERTIFICATE NUMBERS 2017032376A EXPIRATION DATE: 05/2412017 GRIFFITH, JARED S 1 62ND AVE E TACOMA, WA 983 4 Signature ^-�" Issued by D ARTti(ENT OF LABOR AND IND LxSTR1E5 CERTIFIED AS PROVIDED BY LAW AS ASBESTOS SUPERVISOR CERTIFICATE NUMBER: 2017014378A EXPIRATION DATE: 10/01/2017 CERTIFIED AS PROVIDED BY LAW AS ASBESTOS SUPERVISOR CERTIFICATE NUMBER: 2017033445A EXPIRATION DATE: 11/19/2017 GONZALEZ VELEZ, ANGEL M 20216 47711 AVE,E SPAC AW ,Y; WA l'STRII S CERTIFIED AS PROVIDED BY LAW AS ASBESTOS WORKER CERTIFICATE NUMBER: 2017033861A EXPIRATION DATE: 04/27/2017 MENSCHING, DOUGLAS A RAFFENSBERGER, CODY G 3502 N CHEYENNE ST PO BOX 1962 TACOMA, WA 98407 EATONVILLE, WA 98328 Signature Signature_�� Issued by DFF T HNT OF LA RAN INDUSTRIES lssued by DEP.AtT tET 01= I,_aBi7R SND FtiDL"STRTES CERT' -D AS PROVIDED BY LAW AS CERTIFIED AS PROVIDED BY LAW AS ASBESTOS SUPERVISOR CERTIFICATE NUMBER: 2017034939A EXPIRATION DATE: 09/20/2017 ROSS, DANIEL E 20112 52ND AVE Z9838i,, : SPA WAY, WASignature[sued by DEPART `" D [NDUSTRI4ES j CERTIFIED AS PROVIDED BY LAW AS ASBESTOS WORKER CERTIFICATE NUMBER: 2017025961A EXPIRATION DATE. 07106/2017 YOUNG, MICHAEL JOSEPH 9706 155TH ST CT E PUYALLUP, WA 98375 -- b UE EP�7tC iE LAAORANDINDl:STRI£S ASBESTOS WORKER CERTIFICATE NUMBER: 2017034513A EXPIRATION DATE: 04/06/2017 WOLFE, JERAMI S 171 N PRAIRIE RD 'CHEHA A 98532 r:1 ( 416\1 F L BQR'. ND',NDt ild r5 a ORION Environmental rices 34004 Ninth Avenue South, Suite Al2, Federal Way, WA 98003 Phone: (253) 952-6717 • Fax: (253) 927-4714 Email: info@oriones.net • Web: www.oriones.net WBE W21`9219763 Phase Contrast Microscopy Test Report NIOSH Method 7400A ' Client: FS & GS Services, Inc. Address: 16214 57th Avenue East, Puyallup, WA 98375 ' Attention: Doug Mensching Project Name: Lalaine Wong Project Number: 16262 1 Rpt. Date: 12/19/2016 Page: 1 of 1 Invoice: 166466 Date Rcvd: 12/15/2016 Client Orion I Sample Sample I Total Flow Rate I Volume 1 9012 ! Fibers Sample ID Sample ID ! Date Type I Min. (liters/min) (liters) LOD Fibers Fields per cc DM -01 20161215-33 12/14/2016 Pre 90 12 1080 .003 17 100 0.008 Observations: None; Living Room ' Laboratory Method Information Microscope Nomenclature Used for Analysis: Olympus CH2 ' Microscope Field Size Area: 0.00785 square millimeters Effective Collection Area: 385 mm2 Blank Count Means: 0 Fibers per 100 Fields Blank Count Fiber Density: 0.0 fibers per square millimeter Limit of Quantitation (LOQ) : 7 fibers/mm2 ORION Environmental Services participates in the AIHA PAT Program. Analyzed By (Print) n McNeal DM -02 20161215-34 12/14/2016 Area 9012 ! 1080 .003 3 100 I <0.00 Observations: Decon Entrance _ DM -03 20161215-35 12/14/2016 E/STEL 30 2 60 .045 2 100 <0.04 Observations: Scraping Ceiling ' DM -04 20161215-36 12/14/2016 Per 210 1.9 399 .007 3 100 <0.00 Observations: Scraping Ceiling DM -05 20161215-37 12/14/2016 CL 90 12 1080 .003 2 100 <0.00 1 Observations: Living Room; Popcorn Texture DM -06 20161215-38 12114/2016 FBL_ 0 = 100 000 ' Observations: Field Blank ' Laboratory Method Information Microscope Nomenclature Used for Analysis: Olympus CH2 ' Microscope Field Size Area: 0.00785 square millimeters Effective Collection Area: 385 mm2 Blank Count Means: 0 Fibers per 100 Fields Blank Count Fiber Density: 0.0 fibers per square millimeter Limit of Quantitation (LOQ) : 7 fibers/mm2 ORION Environmental Services participates in the AIHA PAT Program. Analyzed By (Print) n McNeal Date 12/16/2016 Reviewed By (Print) Dennis Rauschenberg Date 12/19/2016 /Alyz Signature) Time enature) Time I I I I I I I I I I a`a L L s; N ',f+ y A f'� o N Q A 1 0 6! � I I a`a L d V d 3 C o � a a L 0 V\ w w F A V) W F A Vz C.LI F A 0 � � 1 e bo �- E- U) W Eo cv F Ln cz°i F° cis W F a Y U Y U Y U O 1 U L rOii � 2 t' R ^CS m � m � U L 3•. C G _� G V)UCL L L y i /� C GUIUCL. L � -2 � GQrUU- L C- N ate+ N_ BULL. u�y u�.2F07 ci;xFmLL. xFm o n, to _ lu �JD i� ~ t 3 U V U U o r a, m of JtUi Z s Z V) 'Zo o o y 0 y _ i.. R 0 3v z3u z3u z3u z ® 1-4 S`ri T 71, 3 j V, O O aZ a pfj LU. L d a ,o � Q s� e 0 a a L y' cz cs c w o E- ro A i c C�5 w O E- A 9 z ^� J u d _ a v v v Y v Y F c c 0] ro c CO U GQC V]co U LL CQC V]U GQC U LL GQCc ULL v vFy LLTF-m LT. m tz TF -m r:.SF- m y L O F to •v °0 3 ° U U U U ^y ° L L — o x bD i c> i CL >. E; �J m- 'U •� .N C O j •U ci f pfj LU. 9�> tM, / © ,» ,. ,N � ~§ . .. . 'i � � ^ Y -c= y - . \� SECTION TRANSPORTATION AND DISPOSAL OF A.C.M. F.s.- cs. $FRvI(1$ INC. � r �,IREPoOR WASTE SHIPMENT REPORT Job# 16262 Container # AP1�j-3 1. Waste Generated Site Name and Address: Owner's Name: Owners Phone No: 36710 6th Ave. SW Lalaine Wong 253-857-8777 Federal Way, WA 98023 2. Operator's Name and Address: Operator's Phone No: G F.S. & GS. Services Inc., 16214 -57th Ave E, Suite A, Puyallup, WA 98375 253-548-1011 E N 3. Waste Disposal Site (WDS) Name, Address, and Physical Site Location: WDS Phone No: E Columbia Ridge Landfill 541-454-3318 18177 Cedar Springs Lane, Arlington, OR 97812-9709 R 4. Responsible Local, State or EPA Agency Name and Address: A PSCAA, 1904 3m Ave, Suite 105, Seattle, WA 98101 T5. Description of Waste Materials: 6. Containers 7. Total Quantity No. Type M3 (yd3) 0 � vie 810'..1n ,i. R FRIABLE 6 h Asbestos Containing Materials 8. Special Handling instructions and additional information: 9. OPERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations. Printed/Typed Name Signature Month Day Year t2cz ' � Z /a � 6 T 10. Transporter 1 Acknowledgment of Receipt of materials R Printed/Typed Name Sig ture Month Day Year A N JonatWaZibbons 12 12 1 s 11. Transport 2 Acknowledgment of Receipt of materials P Printed d Name Sig t o M h �,Dj leer 0 R 12. Tr n orter 3 Acknowledge nt of Receipt of materials T Printed/Typed Name yP S'gnat re 9 Month Da Year R l� �� l W 13. Discrepancy Indication Space A s T E 14. Authorizecj Wy3ste Disposal Site Owner or Operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item 13 ((-�}//�� S I Printed/Typed Name Signat Month Day Year TPA,���-.- E C Ll RS" 'rt.:F oe•rc WASTE SHIPMENT REPORT Job# 16262 Container # 14 ?,3 (0 n 1. Waste Generated Site Name and Address: Owner's Name: Owner's Phone No: 36710 6th Ave. SSV Lalaine Wong 253-857-8777 Federal Way, AIA 98C23 2. Operator's Name and Address: Operators Phone No: G F.S. & GS. Services Inc., 16214 -57th Ave E, Suite A, Puyallup, VVA 98375 253-548-1011 E N3. Waste Disposal Site (WDS) Name, Address, and Physical Site Location: MAIDS Phone No: E Columbia Ridge Landfill 541-454-3318 18177 Cedar Springs Lane, Arlington, OR 97812-9709 R4. Responsible Local, State or EPA Agency Name and Address: A PSCAA, 19134 3- Ave, Suite 105, Seattle, NIA 98101 T5. Description of Waste Materials: 6. Containers ^No.1 7. Total Quantity Q !� F-; l � r Tom: L1 � � , C> � o �:✓r, �.L .� Type N13 (yd3) R FRIABLE Asbestos Containing Materials 8. Special Handling instructions and additional information: 9. OPERATORS CERTiFICA T ION: I hereby declare that the contents of this consignment are fully and accurately described above by proper snipping name and are classified, packed, marked and !abeled, and are in alt respects in proper condition for transport by highway according to applicable international and government regulations. Printed/Typed Name Signature pFlonth Day Year T 10. Transporter 1 Acknowledgment of Receipt of materials - R A Printed/Ti yped `lame Sig lure Month Day Year N Jonathan Gibbons 17— j-+ 11. Transporter 2 Ac,v^owledgment of Receipt or materials pPrinted/TI`lame Signatur klonth a' e r 0 R 12. T r,3r3poCer 3 Achnewledgeme t of Receipt cf materials E PrintedT ped h3me Sig t ? d,Icnth i Gay (e3f ryivl-t�r '?-- r Cis,repancy IrCica[icn 3Cace A s . T j E I 14 ;-Gtror`Z9d Dl:Sccsal Site ,,vrer �r JCer3[Or .erliiC3IICn of r>>eiCt f 3SZeStCS materlal5 ccvered cy tl'is manifest except a5 rCted in I item 13 C V14 C_ SPrinted/71 yced PI3me it lu e Sana. r� .I r c th Y , i may,,--+ (3f E I l J24..' � r t HAZARDOUS WASTE PERMIT- FOR THE' !' STORAGE, TREATMENT, AND =1 DISPOSAL OF otc-WQM HAZARDOUS WASTE Dep mnemat Emqrormertai ou" Issued in accordance w4 th the applicable provisions of ORS Chapter 466 and the regulations promulgated at OAR Chapter 340 Divisions 100 through 120, azd, the Solid Waste Disposal Act, ars amended by the Resource Conservation and Recovery Act (RCRA), the Hazardo" and Solid Waste Xm.endments of 1984 (HSWA), and the regulations promulgated at Title 40 of the Code of Federal Regulations as adopted into Oregon Rules by CAR 340-140-0002. This Permit is effective as of August 21, 2006, and ahAll re, air. in effect =—til AuSuat 21, 2016, finless revoked and reissued (40 CFR §270.41), terminated (40 CFR §270.43), or continued in accordance with OAR 340-105-0051. TSSMD TO: Chemical :haste Management of the Nor_hwes-lac. 17629 Cedar Springo Lane ,h-: ington, OR 97912 Telephone; (541) 454-2643 TSSIIED �BY s � snpton, Chair Oregon Environmental Quality Commission k *k . L��A-j - E ,Zi Hammond, Regional Administrator rn Region. -16- IDA Ce a-- pscleanair.org Puget Sound Clean Air Agency Single -Family Notification Case #: 201605913 '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)). I I I I I I I I Fee Amount Paid $25.00 Credit Card Transaction # AQOFDFD58998 Transaction Date 12/12/16 Owner's Name Lalaine Wong Project Street Address 36710 6th Ave. SW City Federal Way Contact Person Lalaine Wong Mailing Address 8318 State Route 302 Gig Harbor, WA 98329 Phone (253) 857-8777 Zip 98023 Phone (253) 857-7777 phis project includes asbestos removal. project Size linear feet / 802 square feet?� project Start Date 12/12/16 Completion Date 12/16/16 4sbestos will be removed by a licensed asbestos abatement contractor I certify that: '(1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile. (2) The information I have provided is to the best of my knowledge accurate and complete. (3) I understand the fee for this Notification is nonrefundable. I I Create Another Notification View History If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. I I I I I I I I I I I I I I Log Out Dept. of Labor & Industries, Division of Occupational Safety & Health Asbestos Project Notification Form Form ID: 135999##1022FSGSS101813 Notice Date: 12/14/2016 Start Date: 12/13/2016 Completion Date: 12/31/2016 Status: Amended Site Work Hours: 8:00 am - 3:00 pm Site Work Days: Monday Tuesday Wednesday Thursday Friday Contractor: F S & G S Services Inc Job Site C.A.S.: Jared Griffith Your email address: wanda cufsandgs.com Contractor Phone Number: 253-548-1011 Property Owner ' Name: Lalaine Wong Owner's Agent: ' Company: ' Address: P.O. Box 1342 City: Tacoma State: WA Zip+4: 98401 Phone: 253-857-8777 ' Job Site Address: 36710 6th Ave. SW Building Name: ' Room: City: Federal Way ' Zip + 4: 98023 County: King ' Facility Type: Residential Age: ' Size: Type of activity: Demolition Quantity of Asbestos to Be Removed Indoors Quantity: 802 square feet Popcorn ceiling Other:Sink Undercoat Quantity: linear feet Control Measures Neg. pres. enclosure Wet methods 1 HEPA vacuum Critical barriers Manual methods Respiratory Protection P Y ' Type C pressure demand Comments: ' Amended to place project on hold 12-12-16 at 9:30 am Amended to take project off hold 12-13-16 Date/Time Submitted ' 12/14/2016 9:51:33 AM Dept. of Labor & Industries, Division of Occupational Safety & Health ' Asbestos Project Notification Form Form ID: 136041##1022FSGSSO44346 ' Notice Date: 12/15/2016 ' Start Date: 12/13/2016 Completion Date: 12/14/2016 tStatus: Amended Site Work Hours: 8:00 am - 3:00 pm Site Work Days: Monday ' Tuesday Wednesday Thursday ' Friday Contractor: F S & G S Services Inc Job Site C.A.S.: Jared Griffith ' Your email address: wanda@fsandgs.com Contractor Phone Number: 253-548-1011 Property Owner ' Name: Lalaine Wong Owner's Agent: Company: ' Address: P.O. Box 1342 City: Tacoma State: WA Phone: 253-857-8777 ' Job Site Address: 36710 6th Ave. SW ' Building Name: ' Room: Zip+4: 98401 ' City: Federal Way ' Zip + 4: 98023 County: King Facility ' Type: Residential Age: ' Size: ' Type of activity: Demolition Quantity of Asbestos to Be Removed Indoors Quantity: 802 square feet Popcorn ceiling g Other: Sink Undercoat Quantity: linear feet Control Measures ' Neg. pres. enclosure Wet methods 'HEPA vacuum Critical barriers Manual methods Respiratory Protection Type C pressure demand ' Comments: Amended to place project on hold 12-12-16 at 9:30 am Amended to take project off hold 12-13-16 Project completed on 12-14-16 ' Date/Time Submitted 12/15/2016 8:34:45 AM Dept. of Labor & Industries, Division of Occupational Safety & Health Asbestos Project Notification Form Form ID: 135889##1022FSGSS954891 Notice Date: 12/12/2016 ' Start Date: 12/12/2016 Completion Date: 12/31/2016 tStatus: Amended On Hold ' Site `York Hours: 8:00 am - 9"30 am Site Work Days: Monday Tuesday 'Wednesday Thursday Friday ' Contractor: F S & G S Services Inc Job Site C.A.S.: Jared Griffith 1 Your email address: wanda@fsandgs.com Contractor Phone Number: 253-548-1011 Property Owner Name: Lalaine Wong b Owner's Agent: Company: ' Address: P.O. Box 1342 City: Tacoma State: WA Zip+4: 98401 Phone: 253-857-8777 ' Job Site Address: 36710 6th Ave. SW Building Name: I Room: ' City: Federal Way Zip + 4: 98023 ' County: King ' Facility Type: Residential i Age: ISize: Type of activity: Demolition iQuantity of Asbestos to Be Removed Indoors • Quantity: 802 square feet ' Popcorn ceiling Other: Sink Undercoat IQuantity: linear feet Control Measures Neg. pres. enclosure Wet methods HEPA vacuum Critical barriers Manual methods ' Respiratory Protection Type C pressure demand ' Comments: Amended to place project on hold 12-12-16 at 9:30 am Date/Time Submitted 12/12/2016 9:30:25 AM I Dept. of Labor & Industries, Division of Occupational Safety & r Health ' Asbestos Project Notification Form Form ID: 135570##1022FSGSS260206 Notice Date: 12/2/2016 Start Date: 12/12/2016 Completion Date: 12/31/2016 Status: Initial Site Work Hours: 8:00 am - 4:00 pm Site Work Days: Monday Tuesday Wednesday 'Thursday Friday Contractor: F S & G S Services Inc Job Site C.A.S.: Jared Griffith ' Your email address: wanda@fsandgs.com Contractor Phone Number: 253-548-1011 'Property Owner P Y ' Name: Lalaine Wong Owner's Agent: Company. Address: P.O. Box 1342 Citv: Tacoma State: WA Zip+4: 98401 Phone: 253-857-8777 ' Job Site Address: 36710 6th Ave. SW Building Name. ' Room: ' City: Federal Way Zip + 4: 98023 County: King Facility Type: Residential Age: Size: Type of activity: Demolition Quantity of Asbestos to Be Removed Indoors Quantity: 802 square feet ' Popcorn ceiling Other:Sink Undercoat Quantity: linear feet y ' Control Measures Neg. pres. enclosure Wet methods HEPA vacuum Critical barriers Manual methods Respiratory Protection Type C pressure demand ' Comments: Date/Time Submitted 12/2/2016 2:07:08 PM F.S.�GB. �g SB.- iNG Q � a °Vw4 DAILY PROJECT SIGN IN SHEET PROJECT: Lalaine Wong DATE: PROJECT# 16262 DAY f►'1� „ d �; �, LUNCH —1/2 1 WORK SHIFT _ 8 10 OTHER OVERTIME YES �<, NO Time sheets will be prepared from this form. Failure to sign in or out will cause delay in receiving your proper pay. CREW MEMBER TIME IN /TIME OUT / /'^11 I'rr�'1 (� �00 l 0110 �. )z c� s 70 0 i /O der r70d 4 I G, ject - Pf / Supervisor Signature F.S )fIiV.-G 4L 1F"i°R DAILY PROJECT SIGN IN SHEET PROJECT: Lalaine Wong DATE: PROJECT# 16262 DAY✓p t�n S c �:: LUNCH 1/2 1 WORK SHIFT 8 10 x OTHER OVERTIME YES < NO Time sheets will be prepared from this form. Failure to sign in or out will cause delay in receiving your proper pay. CREW MEMBER TIME IN / TIME OUT f"l�nSc %CU arc rnv Supervisor Signature u U rA cd E� L) 0 a � Upa�� E-� cz bn ., p ?� U > 04 Upa o o z� cj �3 RS� r >y� U Cd o E d Uo. ' H a U�z o .5 b E p A o -- 5 rD o i Q •p � Q W I m 0 z I o° z v� �w z � o s 3 0 { b a� w j C7. L v R R � ¢ I r r,✓ W . L.7 i Li C a F � � � C W I G Ll c U rA cd E� L) 0 a � Upa�� E-� cz bn ., p ?� U > 04 Upa o o z� cj �3 RS� r >y� U Cd o E d Uo. ' H a U�z o .5 b E p A o -- 5 rD o i Q •p � Q W I m