18-100705City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: VK SERVICES LL -
Project Address: 35645 9TH AVE SW
Project Description: Demolition of single family residence.
Deftl Mition
Permit #:18 -100705 -00 -DE
Inspection Request Line: (253) 835-3050
Parcel Number: 440560 0170
Owner
Applicant
Contractor
VALENTIN KHARIKVK SERVICES LLC
VALENTIN KHARIKVK SERVICES LLC
POSH LLC
35645 9TH AVE SW
35645 9TH AVE SW
POSHL**033MA (8/29/18)
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
15223 33RD AVE CT E
TACOMA WA 98446-6100
Additional Permit Information
PERMIT EXPIRES Sunday, 12 August, 2018
Permit Issued on Tuesday, February 13, 2018
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
W,ashington and the City of Federal Way.
Owner or agent: _ o• /!����%� Date: �� •���
mom/
#'
Cl" of
Federal Way
PERMIT #: 18 100705 00
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
Address: 35645 9TH AVE SW
Project: VALENTIN KHARIK FEDERAL WAY WA 98023-7226
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 L
❑
Rough ElectricalFinal
Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF VA�*&
Federal Way
PERMIT NUMBER I S _
RECEIVED
FEB 12 2018
CITY OF FEDERAL ;P�._.
COMMUN�T .,
DEV. .
i o o -7 vs_
PERMIT APPLICATION
PERMIT CENTER + 33325 81b Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(a)cityoffederalway com
•
TARGET DATE p2l / 3 ) /,
SITE ADDRESS
CV-" /4\4E-- svv fe o r wa \dA C%V2-S
SUITE/UNIT #
PROJECT VALUATION
$ L
O
ZONING
ASSESSOR'S TAX/PARCEL #
��/A
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL X DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAM&
�v es L)-c,I i%�A� h#��tl � rt
P MARY PHONE
906-Wi - I I �t�3
PROPERTY OWNER
MAILING ADDRESSE-MAIL
5ei!)oci CW -wit- �'w
CI
�t...G.�v a� ��
STATE
fit'` ,*
ZIP
/� F` 2
qW7. J
NAME P:/ Vn
�Q
0lam'
PL.7 7- 5-3 9! 400
CONTRACTOR
/� V(' F
MAILING ADDRESS 33PW
F '/ !`,
E-MAIL
CI '1�',J�SSQa/CC77�/�
y� ` In /ln
S,TAT$
ZIP / fygl'V
//
FAX
!
W 1 r
WA ST'<�I CONTRACTOR'S CENSE #
[j• /j -/A
�E /�� N DATE/�O`
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITYY
STATE
ZIP
FAX
PROJECT CONTACT
N`C.n"m r
V
AR
Pp� ��H- 64 r \ `Lk
MAILj�G ADD�EB¢ !, { i _ ��,y
.�/ G51 ��' ` -k �' ) SL -
E NAtm (-0pv
J 1 0
(The individual to receive and
respond to all correspondence
CzTVV _ n
{'Q
�L !'t,�
WA -
Zal j&) 2_1>FAx
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5, 000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
1 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 Wag regulations pertaining to the work authorized by the issuance of a permit. 1 understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal taws 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 ctat , which may be ade by any person, including the undersigned, and fitted against the city,
but only where such claim arises out of he reliance ofThe city, including its officers and employees, upon the accuracy of the
information supplied to the ci a part f this applic n.
SIGNATURE: , /L' �/ DATE 1 �t7� . 13, '104
PRINT NAME: p nh ell t � h 9i'K
J" i l
Bulletin #100 - January 29, 2016 Page I of 2 k:\Handouts\Permit Application
Federal Way
RECEIVED
FEB 12 2018
CITY OF FEDERAL WAY
COMMUNaY DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
33325 e Avenue South
Federal Way, WA 98003
253-835-2607; Fax 253-835-2609
www.ciVoffederalAa
,y.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.
67` Address of Demolition: g-5-67 � q44 AVe 671t) F�a,^L�
-------------------
lxe
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 Constructlon Peim/tApplJcatlon form is also required.
1. ASBESTOS ABATEMENT
(Provide copy of Notice of fntentfrom Puget Sound Clean Air Agency 5. ELECTRICITY
and copy of inspection report by AHERA-certified inspector)
GK'S GOh,�c
• (City of Federal Way Building Official) (Puget Sound Energy/Tacoma Power)
2. FUEL STORAGE TANKS 6. NATURAL GAS
❑ Under grade tank(s) is/are present QG, / 97
❑ Move grade tank(s) are present
❑ Tank(s) has been pumped or removed under South King Fire & Rescue (Puget Sound Energy)
permit prior to any dismantling or excavation
P/ q
(South King Fire and Rescue) 7. WATER - Public Source
(Lakehaven Utility District)
3. SEPTIC SYSTEM DEC�OMISSIONING
(,
l� J e&44(4;i�Ii 'e Jit N 8. WATER - Private Well
(King County Environmental Servic ) 0 i
(King County Environmental Services)
a. SANITARY SEWER
(Lakehaven Utility District) 1 p $ (lg
❑ Please Note: Erosion control measures must be in place dur' g the demolition and through
completion of the site clean-up.
Bulletin #122 — March 16, 2017 Page 1 of 1 kAHandouts\Demolition Permit Requirements
0
CEIVED
12 2018
UTY OF FEDERAL WAY
Notification Case #: 2018006313
MUNfTYDEVELOPMEN7
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 # AKOF596AB8B1
Transaction Date 02/12/18
Owner's Name VK SERVICES, LLC Phone (253) 736-5687
Project Street Address 35645 9th Ave SW
City Federal Way Zip 98023
Contact Person Gaspar Corrales Phone (206) 484-6822
Mailing Address
This project includes asbestos removal.
Project Size linear feet / 490 square feet
Project Start Date 02/12/18 Completion Date 02/12/18
Asbestos will be removed by a licensed asbestos abatement contractor
Contractor Rebuildit LLC Contractor Job # Rebu-101
Contact Gaspar Corrales Phone (206) 484-6822
Mailing Address 4127 S Sheridan Ave
Tacoma, WA 98418
(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.
,Project:. VK Services, LLC
r � T
January 23rd, 2018
ALCOTRAIN
Fircrest, WA 98466
Phone: 425-306-4583
Email victor alcotrain.com
Dear Mr: Valentin Kharik
VK SERVICES, LLC:
35645 9"' Ave SW, Federal Way, 98023
FEB 12 2018
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
On January 18th 2018, , ALCOTRAIN, conducted a residential AHERA Asbestos
Inspection -Evaluation for a residential -family dwelling located at:
35645 9th AVE SW. Federal Way, WA 98023
The purpose of the evaluation was to determine whether atypical asbestos
containing materials may be present due to the age of the dwelling. At the time of the
inspection, most of the suspected material was intact, except for the floor tile, which was
somehow loose in the living room. The samples collected full depth to the surface of the
underlying substrate; since the house will be eventually be demolish. We collected 6�Samplles
with 10 lavers in total, as initial inspection, with Batch # 511800202(EMSL ANALYTICAL
IN
To analyze our samples, we contracted the services of a third parry Certified Laboratory; EMSL
Analytical Inc, in Seattle WA. The inspection was performed utilizing applicable Federal and
Washington State regulations pertaining to asbestos including: (40 CFR Part 745), and TSCA
Title II AHERA/ASHARA (40 CFR Part 763) Asbestos regulations.
ALCOTRAIN performed this assessment in accordance with generally accepted AHERA
protocols within Washington State.
We thank you for the opportunity collaborating in this project. If you have any questions or need
further assistance, do not hesitate to contact us at 425-306-4583 or via e-mail at:
Victor@Alcotrain.com
Respectfully
Victor Arroyo, AHERA INSPECTOR
Certification #3509-18-AI01-2215
Expiration 01/20/2019
Principal/ Consultant
ALCOTRAIN
The asbestos samples were analyzed using polarized light microscopy (PLM) with dispersion staining in accordance with US EPA method
600/R-93/116 as specified in 40 CFR Chapter I (71-93edition) Part763, Subpart F, Appendix X pages 499-504. Polarizing light
microscopy quantities of asbestos concentrations at between 100% and 1% detection levels. Levels below 1% can only be stated as "trace."
The results, assessments, conclusions and recommendations stated in this report are factually representative of the conditions and circumstances
observed at this project location on the dates of inspection. We cannot assume responsibility for any change in conditions or circumstances that
occurred after the inspection. Therefore, any materials not surveyed in this report must be treated cautiously, until determined otherwise by a CA
Inspector and/or an NVLAP certified laboratory.
Pg. 1
Project: VK Services, LLC 35645 9' Ave SW, Federal Way, 98023
SUMMARY OF FINDINGS
The following table shows all the sample results From EMSL Order Number # 511800202
Table #1
Sample ld Description ASBESTOS % Comments
A-05 Wal.lboard Material: Ceiling and wall / Living 2° Asbestos Chrysotile Texture
A-06 Living Roomm loose floor tile in living room 4% Asbestos Chrysotile IiLe
A-06 Living Room: loose floor tile in living room 5% Asbestos Chrysotile Black Masfic
CONCLUSIONS AND RECOMMENDATIONS
The bold underlined sample above, were found to have asbestos materials. This positive
sample(s) are from SHEETROCK-WALLBOARD TEXTURE in ALL THE WALLS WITHIN
THE LIVING ROOM and the BLACK TILE (LOOSE TILE ON FLOORING). Sheetrock
material is "friable" and according to L&I rules it is asbestos material Class 1, and needs to be
removed professionally and under negative pressure enclosure. The floor tile is Class 2 and it is
considered non friable.
For the abatement of this type of materials, it is required that the Asbestos Contractor get all the
proper Notification and Notice of Intent from the Department of Labor and Industries and Puget
Sound Clean Air Agency (EPA) before the job starts. A 10 calendar day waiting period its
required before commencing this type of abatement.
Asbestos Materials Background
WISI IA's requires that certain ACMs (Asbestos Containing Materials) must be removed from a building prior to "Remodel
and or Demolition". These include friable ACMs (such as pipe insulation, boiler and duct insulation, sprayed -on fireproofing,
troweled -on finishing, etc.) and non -friable ACMs that have already become friable prior to the remodel or demolition, or are
likely to become friable during the process. Friable simply means that a material when div can be crumbled pulverized or
reduced to a powder by hand pressure (and will therefore readily release its asbestos fibers from the binding matrix). Non -friable
materials cannot be crumbled pulverized, or reduced to a powder by hand pressure (,and thus will not readi,jy release
fibers from the binding matrix), Floor tiles roofing, and various mastics are considered non -friable (if they are in good
condition).
For the purposes of this inspection, suspect Asbestos Containing Material(ACM) has been placed in three (3)
material categories: thermal systems insulation (TSI), surfacing materials and miscellaneous materials. Only
materials containing more than 1% total asbestos are classified as asbestos containing material ,ACMh
The number of samples collected and their locations were based on the AHERA regulations and the guidelines
provided by the EPA document 560/5-85-030a October 1985, Asbestos in buildings: Simplified Sampling Scheme
for Friable Surfacing Materials.
Project. VK Services, LLC 35645 9' Ave SW, Federal Way, 98023
The results, assessments, conclusions and recommendations stated in this report are factually representative of the
conditions and circumstances observed at this project location on the dates of inspection. We cannot
assume responsibility for arry change in conditions or circumstances that occurred after the inspection. Therefore
any materials not surveyed in this report must be treated as Asbestos Containing Materials (ACM) until determined
otherwise by a Certified Asbestos Inspector and NVLAP certified laboratory.
QUALITY CONTROL PROCEDURES
The integrated resources, technologies, and discipline to conduct the inspection and analysis based on the following principles:
All applicable regulations are addressed in order to assure that our field inspection and lab personnel meet their
responsibilities, do so cost-effectively, and are equipped with the practical knowledge they need in order to understand
and comply with regulations that affect them.
Care is taken to make certain that the information provided and actions recommended are practical and cost effective in
achieving regulatory compliance.
• All project results, reports and recommendations are reviewed for accuracy, content and quality prior to presentation.
We recognize that the information in each assignment we undertake, that the information we develop, and the conclusions and
advice we provide will be used to support important management decisions.
Quality Assurance Program outline:
Provide specific objectives so that project activities can be evaluated with regards to precision, accuracy,
reproducibility, completeness, and comparability.
Provide specific guidance on the proper methodology for all activities.
• Be provided with ongoing training to enhance their technical skills.
• Be trained in QA/QC procedures and QC activities.
• Review all reports until they are acceptable in terms of technical and editorial quality and all quality assurance
activities have been successfully performed.
ASBESTOS INSPECTION & BULK SAMPLING METHODOLOGY
Asbestos Building Inspectors are certified under the requirements of the Environmental Protection Agency (EPA) Asbestos
Hazard Emergency Response Act (AHERA) 40 CFR 763, Subpart E.
Written report meets the Washington state "Good Faith Inspection" requirements as cited in RCW 49.26.016 and implemented by
Labor and Industries (L&I) regulation, WAC 296-62-07721, and reg. III, article 4 of the Puget Sound Clean Air Agency
(PSCAA).
Field information was organized as per the AHERA concept of Homogeneous Area (HA). A HA is defined as a suspect
material of similar age, appearance, function and texture.
Once collected each bulk sample was sealed in an unadulterated plastic bag. Chain of custody; procedures were followed to
maintain sample integrity during handling and data reporting to Alcotrain and the analytical laboratory as specified in code 40 of
Federal regulations (CFR) Chapter 1 (1-1 -87edition) Part 763, Subpart F, Appendix A. Each sample was analyzed using
polarized light microscopy (PLM)/ dispersion staining techniques, in accordance to US EPA Method 600/R-93/116 by EM[SL
Laboratories.
CORE SAMPLES
Core samples of friable and non -friable suspect materials were collected by penetrating the suspect material to its substrate. The
bulk samples collected were placed in sealed containers, labeled with an identifying code and a sample log was kept.
Representative samples of each sampling area were then submitted to the laboratory to be analyzed for asbestos content. The
inspection involved the following tasks:
A visual determination as to the extent of visible and accessible suspect materials and conditions of the material.
Collection of suspect building materials for asbestos content.
A Chain of Custody record was prepared to accompany bulk samples to the laboratory.
The assessment process includes classifying the material as Friable ACM or Non -Friable ACM. Friable ACM is the term given to
any material that contains more than one percent (I%) asbestos by weight and can be crumbled, pulverized, or reduced to powder
by hand or mechanical pressure.
Project,: VK Services, LLC 35645 9"' Ave SW, Federal Way, 98023
Limitations of Survey
Asbestos inspections are non -comprehensive by nature and our assessment is limited to only
those locations inspected and sampled. This survey was not designed to identify all potential
concerns or eliminate all risk associated with abatement. No warranty, express or implied, is
made. ALCOTRAIN is not responsible for materials which require destructive means to access,
or materials which are hidden from sight, those materials hidden behind walls, or materials
which cannot be found with reasonable diligence. Suspect materials that may be present
inside crawl space cavities, electrical wiring or which were otherwise inaccessible were not
included in the scope of findings for this inspection.
AHERA REPORT : January 23rd, 2018
AHERA Asbestos Inspector: VICTOR ARROYO
Certification #3509-18-AIOI-2215
Expiration: 01/20/2019
Principal/ Consultant
Project Location: 35645 91h Ave SW. Federal Way WA 98023
Customer: Valentin Kharik, VK Services LLC.
`attachments: Laboratories data results/report; Alcotrain chain of custody.
Rebuild It LLC CLEARANCE CERTIFICATE # 2018-02.12
CLEARANCE CERTIFICATE
To:
VK Services, LLC
35645 9" Ave SW
Federal Way, WA 98023
(253) 736-5687
February, 12`h 2018
For:
Removal of ACM Wallboard Materials *acm<.25% chrvsotile
Removal and disposal of miscellaneous black floor tile with
mixed debris
Project Address:
35645 9" Ave SW, Federal Way WA 98023
• Removal of Asbestos Containing Materials, according to Federal, State and Local
a er dpo alpf allDdebri o ize and �'Id.
'lly, u n strict engof c • trotand fo +Dwir eder
,d ce to910. ` 01 d 21 � 1910. �0
ra .actices dral a endbpsulati ld
established on 40CFR part 61,29 CFR 1926.1101and 40 CFR part 61 Subpart M. Along with
REBUIL IT LLC protocols and practices.
PERMITS :
Asbestos Disposal Certification # TB -0856 exD. 01/16/2021
After all work was complete, and the area was properly encapsulated, we achieved CLEARANCE results
as follows: <0.0029 Vec
*Please note: We used the services of a third party consultant (Alcotrain Environmental) for all the
sampling data.
Activity: clearance sample / inside regulated area.
Lab ID: 2018.10372 Sample ID: R-2018-56CL Date Sampled. 02/09/2018
Flow Rate: 10.00 Lts. Minutes: 120 Total Liters: 1200.00 Pump ID: #4 LOQ: 0.002
Fibers/Fields: 7/100 Actual fibers/CC : <0.003
Asbestos debris was properly disposed to Republic Transfer Station, Seattle.
Work finished on February 12rd, 2018.
Gaspar Corrales
REBUILDIT LLC
REBUILD IT LLC Page 1
Rebuildit LLC: REBUIIL8331)1, Exp. 3/21/2019, CR # NAT -89354-1
CLEARANCE CERTIFICATE # 2018-02.12
NORT�HWEOST
30620 Pacific Hwy S. #103, Federal Way, WA 98003
(253)941-4343
Asbestos NW Batch #:
PCM Chain of Custody
Company Name w...,_ eo- PhoneAddress: tt:
c
^y • rc : , -� Fax#:._.
Project Manager: aIt C �d'�Q Date:
Lmail: _ PM Cell#
Project Location ',+,!, �'"' , Pro ect #
Number of Samples: TurnAround: ,q Rush Samples ,
Sample ID —Z -
�
Start Time Z Fibers/
If
Location
S ��+
Sample Type �o 0,7
End Time
Sample T a +
e -a—
End Time ^.e Fields
/�
Pump # ActivityLy��
.
Total Time Fibeirs/cc
D! 2Z•
Environment F-,_
d `"
Start Rate
End Rate
Protection Worker
' y %.
End Rate Date
Total Liters Sampled
Cert #Total
Decon a Cert #
Liters
Sample ID —Ls/1,
Location
/ oefeu r��
irs r s^'`
Start'Time ,3, j
Fibers/
Fields
�J
/
Sample Type �o 0,7
End Time
PUMP # 4
Activity!�
a %��.�,, ��
Total Time 2
Fibers/ cc
O -9
Environment
Start Rate
Protection Te
Worke
t± r !O (&-J
End Rate
Date
Sampled
Decon
Cert #Total
Liters
Sample ID
Location
Date:
Start Time
Fibers/
Fields
Sample Tye
End Time
Pump #
Activity
_ _._ ..__
Date:
Total Time
Fibers/ cc
Environment
Start Rate
Protection
Worker
End Rate
Date
Sampled
Decon
Cert #
"Dotal Liters I
Sample ID
Location
Date:
Start Time
Fibers/
Fields
Sample Type
End Time
Pump #
Activity
_ _._ ..__
Date:
Total Time
Fibers/ cc
Environment
Start Rate
Protection
Worker
End Rate
Date
Sampled
Decon
Cert #
Total Liters
Sampled By:
Date:
Time: ___ ----
Relinquished By.
Received B Y
Date:
Date:
Time
Time
�!�'.�f__._
.. _
Analvzed By:
_ _._ ..__
Date:
. _.. .
Time:
ASBESTOS
NORTHWEST
Asbestos Northwest, LLC
30620 Pacific Hwy S, #103, Federal Way, WA 98003
Phone# 25 3.941.4343 Fax# 253.94 1.4175
Attn: Victor Arroyo
Alcotrain
1010 Sunrise Lane Fircrest WA
Project Location: 35645 9th Ave SW Federal Way. WA
Project # VF Construction
Asbestos NW Batch #: 201810372
Date Analyzed: 2/12/2018
Samples Analyzed: 2
Sample ID
1
Location
Inside Res. Area
Start Time
12:00
Fibers/
Fields
29/100
Client ID
R -2018-42P
End Time
14:00
Sample Type
Preabatement
Activity
Preparation
Total Time
120
Fibers! cc
0.0122
Pump
R-04
Start Rate
9.7
Environment
1/2 FC
Worker
Gaspar Corroles
End Rate
9.7
Date
Sampled
Protection
D
Cert #
Total Liters
1 1 164
Sample ID
2
Location
Inside Res. Area
Start Time
3:50
Fibers/
Fields
7/100
Client ID
R -2018-56C1
End Time
5:50
Sample] ype
Clearance
Activity
I
Final Cleaned
I
Total Time
120
Fibers/ cc
0.0029
Pump
R-04
Start Rate
10
Environment
H
Worker
Gaspar Corroles
End Rate
10
Date
Sampled
Protection
1/2 FC
I Cert to
Total Liters
1200
�4- P, ?u � �4
Sampled By: Date:
Analyzed By: Cathy Butler Date: 2/12/2018
Page 1 of 1
EMSL Analytical, Inc.
3317 3rd Ave S, Suite D 2nd floor Seattle, WA 98134
Phone/Fax: (206) 269-6310 / (206) 900-8789
M http://www.emsl.com / seattlelab@emsl.com
Attention: Victor Arroyo
ALCOTRAIN
1013 Sunrise Lane
Fircrest, WA 98466
EMSL Order: 511800202
Customer ID: ATRN42
Customer PO:
Project ID:
Phone: (425) 306-4583
Fax: (206) 902-1063
Received: 01/18/2018 9:00 AM
Analysis Date: 02/07/2018
Collected:
Project: VK Services LLC, Valentin Kharik, 35645 9th Ave SW Federal Way WA 98023
Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using
Polarized Light Microscopy. Quantitation using 400 Point Count Procedure
Non -Asbestos Asbestos
Sample Description Appearance % Fibrous % Non -Fibrous % Type
A -05 -Texture Wallboard, ceiling and White 99.75% Non-fibrous (Other) 0.25%Chrysotile
511800202-0005 wall: Living Non -Fibrous
room/homogeneous Homogeneous
Analyst(s)
Jason Stuhr (1)
Lauren Kerber, Laboratory Manager
or other approved signatory
Disclaimer:Some samples may contain asbestos fibers present in dimensions below PLM resolution limits. The limit of detection as stated in the method is 0.25%. EMSL Analytical Inc suggests
that samples reported as <0.25% or none detected undergo additional analysis via TEM. The above test report relates only to the items tested. This report may not be reproduced, except in full,
without written approval of EMSLAnalytical Inc. This test report must not be used by the client to claim product endorsement by NVLAP or any agency of the United States Government . EMSL
Analytical Inc., bears no responsibility for sample collection activities, analytical method limitations, or the accuracy of results when requested to separate layered samples. EMSLAnalytical
Inc., liability is limited to the cost of sample analysis.The test results contained within this report meet the requirements of NELAC unless otherwise noted. Samples received in good condition
unless otherwise noted_ Unless requested by the client, building materials manufactured with multiple layers (i.e. linoleum, wallboard, etc.) are reported as a single sample.
Samples analyzed by EMSL Analytical, Inc. Seattle, WA
Initial report from: 02/07/2018 08:48:12
Printed 2/7/2018 8:48.14AM Page 1 of 1
OrderID: 511800202
2MSL AP[ALYTICA L, INC.
unowwinRr.n�oourn •m�wwa
Asbestos Bulk Building Material
Chain of Custody
EMS�cL Order Number (Lab use Only):
EMSL ANALYTICAL, INC.
3317 3"DAVES., SUITE D
SEATTLE, WA 98134
PHONE: (206) 269-6310
FAx:(206)900-8789
n
Company:
Street:
EMSL-8111 to: ❑ Same' ❑Diferent
If i1I to is Different note Instrcti ins in Comments—
Third Party Billing requires written authorization from third party
City: State/Province: Zi /Postal Code: County:
Report To (Name):
p Li Telephone #:
Email Address:
Fax #:
Purchase Order:
Project Name/Number: 3�` �f .4
S Please Provide Results: ❑ Fax ❑ Email
Cr &I y
Wa 9 3 CT Samples: ❑ Commercial/Taxable 4 ❑ Residential/Tax Exem t
Turnarou d Time TATO tions* - Please Check
❑ 3 Hour ❑ 6 Hour ❑ 24 Hour
48 Hour ❑ 72 Hour I ❑ 96 Hour ❑'i 1 Week ❑ 2 Week
'For TEM Air 3 hr through 6 hr, please call ahead to schedule. * ere is a premium charge for 3 Hour TEM AHERA or EPA Leval 11 TAT. You wilt be asked to sign
an authorization form for this service. Anal sis completed in accordance with EMSL's Terms and Conditions located in Ithe Analytical Price Guide.
ALM -Bulk (reportinq limit)
TEM -- Bulk
PLM EPA 600/R-93/116 (<1%)
❑ P M EPA NOB (<%) - - - - - -
Point Count ❑ 400 (<0.25%) ❑ 1000 (<0.1%)
Point Count w/Gravimetric ❑ 400 (<0.25%) El 1000 (<0.1%)
FNIOSH 9002- (<1%)
❑ NY ELAP Method 198.1 (friable in NY)
❑ NY ELAP Method 198.6 NOB (non -friable -NY)
❑ OSHA ID -191 ModifiedL1-- - - - - - -- - - -- -- - - - -- ---- ----.----.. _ ..
❑ Standard Addition Method
El TEM EPA NOB - EPA 600/R_93/11 S tion 2,5.5.9
❑ NY ELAP Method 198.4 (TEM) ---
Q Chatfield Protocol (semi -quantitative)
❑ TEM % by Mass - EPA 600/R-93/116 Section 2.5.5.2
---- ..❑
.. - --t- --- - • - ----- ----------
❑ TEM Qualitative via Filtration Prep Technique
❑ TEM Qualitative via Drop Mount Prep Technique
Other j
❑ Check For Positive Stop - Clearly identify
omo enous Group
Date Sampled:
Samplers Name: p ,rZ
A202_d b
Samplers Signature: s
Sample # HA # Sample
Location
Material Description
I
I
1
77L
4
4
Client Sam le # s :
- Total # of Sarn les: —
Relinquished (Client):
D
Date: /a �0��
Time:
Received (Lab):
Date:
Time:
Comments/Speci Instructions•
Ccn ofted Oowment—Asbestos CDC—R2-41911073
Page 1 of pages
Page 1 Of
OrderlD: 511800202
.s
EMSL ANALYTICAI- INC.
—o—rnooU r 1—
Asbestos Chain of Custody 33
EMSL Order Number (Lab use only):
X51 1 8®®24
EMSL ANALYTICAL, INC.
7 3RD AVE S, SUITE D
SEATTLE, WA 98134
PHONE: {206}269-6310
FAx: (206)900-8789
Additional Pages of the Chain of Custody are only necessary if needed for additional sample infolrmation
Sample #
Sample Uescription
Volume/Are2
HA # Bulk
(Air)
Date/Time
Sampled
1
f pU /(Q 1 dpi GL�I�
v Pl
�� DSIV 17 CPel
o Z-0Un dr
�pB��P�df
I
"Comments/Special Instructions:
9 V V)
Controlled Doom ert —Asbestos CDC — Rt — 3/18/2009
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Page 2 Of