HomeMy WebLinkAboutPermit D12-377 - SHOWALTER MIDDLE SCHOOL - PORTABLE DEMOLITIONSHOWALTER MIDDLE
SCHOOL - DEMO
4628 S 144 ST
D12-377
City o"Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 -431 -3670
Inspection Request Line: 206 - 431 -2451
Web site: http: / /www.TukwilaWA.gov
DEVELOPMENT PERMIT
Parcel No.: 1523049164
Address: 4628 S 144 ST TUKW
Suite No:
Project Name: SHOWALTER MIDDLE SCHOOL - DEMOLITION
Permit Number: D12 -377
Issue Date: 12/12/2012
Permit Expires On: 06/10/2013
Owner:
Name: TUKWILA SCHOOL DISTRICT
Address: 4640 S 144TH ST , TUKVVILA WA 98168
Contact Person:
Name: ROGER VERNON
Address: 13806 45 AV , MARYSVILLE WA 98271
Phone: 425 - 760 -1198
Contractor:
Name: PACIFIC MOBILE STRUCTURES, INC Phone: 360 748 -0121
Address: PO BOX 1404 , CHEHALIS, WA 98532
Contractor License No: PACIFMS033DC Expiration Date: 11/08/2014
Lender:
Name:
Address:
DESCRIPTION OF WORK:
DEMOLITION OF PORTABLE CLASSROOM/BUILDING
Value of Construction: $4,200.00 Fees Collected: $306.95
Type of Fire Protection: International Building Code Edition: 2009
Type of Construction: V -B Occupancy per IBC: 0009
Electrical Service Provided by: SEATTLE CITY LIGHT
* *continued on next page **
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D12 -377 Printed: 12 -12 -2012
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
Fire Loop Hydrant:
Flood Control Zone:
Hauling:
Land Altering:
Landscape Irrigation:
Moving Oversize Load:
N Number: 0
N
Start Time:
Volumes: Cut 0 c.y.
Start Time:
Size (Inches): 0
End Time:
Fill 0 c.y.
End Time:
Sanitary Side Sewer:
Sewer Main Extension: Private: Public:
Storm Drainage:
Street Use: Profit: N Non - Profit: N
Water Main Extension: Private: Public:
Water Meter: N
Permit Center Authorized Signature:
Date:
I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and ordinances
governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating
construction or tiyeperformance of work. I am authorized to sign and obtain this development permit and agree to the conditions attached
to this permit.
Signature:
Print Name:
R
y /
�
This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended
or abandoned for a period of 180 days from the last inspection.
Date: Ali ZAZ
PERMIT CONDITIONS:
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the
Building Official.
3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to
start of any construction. These documents shall be maintained and made available until final inspection approval is
granted.
4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary
sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other
excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of
this requirement.
5: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the City of Tukwila
Building Department (206- 431 - 3670).
6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building
doc: IBC -7/10
D12 -377 Printed: 12 -12 -2012
Department (206- 431 - 3670).
• •
7: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of,
any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits
presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila
shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the
Building Official from requiring the correction of errors in the construction documents and other data.
doc: IBC -7/10
D12 -377 Printed: 12 -12 -2012
CITY OF TUKT'A
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd, Suite 100
Tukwila, WA 98188
http: / /www.TukwilaWA.gov
Building Pei :'t No. -27
Project No.
Date Application Accepted: 1
Date Application Expires:
office use only)
CONSTRUCTION PERMIT APPLICATION
Applications and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or by fax.
* *Please Print **
SITE LOCATION
King Co Assessor's Tax No.:
Site Address: Suite Number: Floor:
New Tenant: ❑ Yes J.. No
Tenant Name: -P4t4:7141 n Ceg'ui /,t i-
PROPERTY OWNER
Name: ICIGll/32 /n raw/ Di S1,— f'
Address: 4/e ye 3- 14/9 4-4 9--
City: „.- RG4W A /4 State: WA- Zip: ti $ /GY
CONTACT PERSON — person receiving all project
communication
Name: Ri,fep, V�r-' D
Address:
Address: 13 g L' -14 jf/i(
City: mow', iipc, State: 1.01-
Zip: 4l I271
Phone: ' Zs— 7.0 ii 4 r Fax:
Email: ga e,..
GENERAL CONTRACTOR INFORMATION
Company Name: ? hL .(:•G rv►iPbil_
Address:
Address: (3 v6 4/5"--/L 4-�G
City: Ill 4evc/4 l!v State: w4
Zip: 5ffz7I
Phone: 6,2,5:-._ ?we _ /!y r/ Fax:
U
Contr Reg No.: Exp Date:
Tukwila Business License No.: gs� (q 34,7t
City:
HA Applications On Line\2012 Applications\Permit Application Revised - 2- 7- 12.docx
Revised: February 2012
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ARCHITECT OF RECORD
Name:
Address:
Company Name:
Architect Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
ENGINEER OF RECORD
Name:
Address:
Company Name:
Engineer Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
LENDER/BOND ISSUED (required for projects $5,000 or
greater per RCW 19.27.095)
Name:
Address:
City: State: Zip:
Page 1 of 4
BUILDING PERMIT INFORMATION 206 - 431 -3670
Valuation of Project (contractor's bid price): $
Existing Building Valuation: $
Describe the scope of work (please provide detailed information):
Will there be new rack storage? ❑ ....Yes
..No If yes, a separate permit and plan submittal will be required.
Provide All Building Areas in Square Footage Below
PLANNING DIVISION:
Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft):
Floor area of principal dwelling: Floor area of accessory dwelling:
*Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Compact: Handicap:
Will there be a change in use? ❑ Yes ❑ No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑ Sprinklers ❑ Automatic Fire Alarm ❑ None ❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes ❑ No
If "yes', attach list of materials and storage locations on a separate 8-1/2" x 11" paper including quantities and Material Safety Data Sheets.
SEPTIC SYSTEM
❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health
Department.
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Page 2 of 4
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
1st Floor
//
l
•) "!
2nd Floor
3rd Floor
Floors thru
Basement
Accessory Structure*
Attached Garage
Detached Garage
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
PLANNING DIVISION:
Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft):
Floor area of principal dwelling: Floor area of accessory dwelling:
*Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Compact: Handicap:
Will there be a change in use? ❑ Yes ❑ No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑ Sprinklers ❑ Automatic Fire Alarm ❑ None ❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes ❑ No
If "yes', attach list of materials and storage locations on a separate 8-1/2" x 11" paper including quantities and Material Safety Data Sheets.
SEPTIC SYSTEM
❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health
Department.
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Page 2 of 4
PERMIT APPLICATION NOTES -
Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject
to possible revision by the Permit Center to comply with current fee schedules.
Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation.
The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be
requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition).
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER OR AUTHORIZED AGENT:
Signature:
Print Name: R 09G.,^
Mailing Address: 13g a 4' 4V
H: Applications\Forms- Applications On Line \2012 Applications\Permit Application Revised - 2-7-12 docx
Revised: February 2012
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Date: /I»fr 20
Day Telephone: 'Z- ��76G - / /ft'
city
GyA-Z7/
State Zip
Page 4 of 4
PUBLIC WORKS PERMIT INFi IATION — 206 - 433 -0179
Scope of Work (please provide detailed information):
Call before you Dig: 811
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ .. Tukwila ❑ ...Water District #125
❑ .. Water Availability Provided
Sewer District
❑ .. Tukwila
❑ .. Sewer Use Certificate
Septic System:
❑ On -site Septic System — r on -site septic system, provide 2 copies of a current septic de :n approved by King County Health Department.
❑...Highline
❑ ...Valley View 0... Renton
❑ ...Sewer Availability Provided
❑... Rent
Seattle
Submitted with Application (m
❑ .. Civil Plans (Maximum Pape
❑ .. Technical Information Report
❑ .. Bond ❑...Insurance
boxes which apply):
ize — 22" x 34 ")
Drainage) ❑ ... Geotechn.:) Report ❑ .. Traffic Impact Analysis
❑... Easement(s) ❑... Mainte ce Agreement(s) ❑ .. Hold Harmless — (SAO)
❑ .. Hold Harmless — (ROW)
Proposed Activities (mark boxes that apply):
❑ .. Right -of -way Use - Nonprofit for less than ours
❑ .. Right -of -way Use - No Disturbance
❑ .. Construction/Excavation /Fill - Right -of -way ❑
Non Right -of -way
❑ .. Total Cut
❑ .. Total Fill
❑.. fight -of -way Use - Profit for less than 72 hours
Right -of -way Use — Potential Disturbance
cubic yards
cubic yards
❑ .. Sanitary Side Sewer
❑ .. Cap or Remove Utilities
❑ .. Frontage Improvements
❑ .. Traffic Control
❑ .. Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑... Work in Flood Zone
0... Storm Drainage
0... Aban. .n Septic
0... Cur ut
0...P ement Cut
❑... .oped Fire Line
0... Grease Interceptor
❑ ... Channelization
❑...Trench Excavation
❑ ... Utility Undergrounding
❑ .. Permanent Water Meter Size (1) WO # (2) 0 # (3) " WO #
❑ .. Temporary Water Meter Size (1) " WO # (2) If # (3) " WO #
❑ .. Water Only Meter Size WO # ❑ .. Ded Water Meter Size "
❑ .. Sewer Main Extension P .lic ❑ Private ❑
❑ .. Water Main Extension blic ❑ Private ❑
FINANCE INFORMATION
Fire Line Size at Property Line Number of Public Fire Hydrant(s)
❑ .. Water ■ . Sewer ❑ .. Sewage Treatment
Monthly Service Billing t
Name: Day Telephone:
Mailing Address:
Water Meter Refund/Billing:
Name:
Mailing Address:
City
State Zip
Day Telephone:
City
State Zip
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Page 3 of 4
•
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.TukwilaWA.gov
RECEIPT
ParcelNo.: 1523049164 Permit Number: D12 -377
Address: 4628 S 144 ST TUKW Status: PENDING
Suite No: Applied Date: 11/30/2012
Applicant: SHOWALTER MIDDLE SCHOOL - DEMOLITION Issue Date:
Receipt No.: R12 -03227
Payment Amount: $306.95
Initials: WER Payment Date: 11/30/2012 03:20 PM
User ID: 1655 Balance: $0.00
Payee: ROGER VERNON
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 07888G
ACCOUNT ITEM LIST:
Description
306.95
Account Code Current Pmts
BUILDING - NONRES
PLAN CHECK - NONRES
STATE BUILDING SURCHARGE
000.322.100
000.345.830
640.237.114
Total: $306.95
183.30
119.15
4.50
r$nn• Pprts±int -f1R
Printed. 11_1n-7n17
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
CITY/OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 )Z (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
2-377
Project:
S1104GOALIFR SC',�c,OL
Type of Inspection:
pre 000.mi J2ie- 4i1?�..
w
Address:
1 &.B 5 14 LI 1
Date Called:
Special Instructions:
a
(8AiI )4 i14.AN
I0 d1ev,
06H7p -0 1
Date Wanted:.
12. i 3 l a
a.m.
.m.
Requester:
4-/
Phone No:
3 (0Q -722.-Y5 -y
--
.Approved per applicable codes.
Corrections required prior toapprovaI.
COMMENTS:
Pre 0 e~ a st rn cc! -k-, 0---1 /J/4
,. .
� r
�
f(1 ono p 1 f le f ',
4-/
Insp cter:
- Date: J
I-2-Ii3 -I
•
RE
NSPECTION FEE REQUIRED. Prior to next inspection. fee' must be
pay at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
S EPA RATE' PERMIT
REQUIRED FOR:
LeMechanical
?Siumbing
Gas Piping
Cs,'
of Tukwila
DIVISION
i
e
Gravel Road
4.t
New
tladi
(/0
4
i ' r
Tukwilla School
District 406
Restrooms Located to Building
ADA Perking ADA Perking
Parking Lot
FZLE COPY
Pe is Leo. 377
aooro`•'ai ib subject to errors and omissions.
t . ...c' , _., i,. f, :'opted codo or ordlnanc::. ,R r:.. pt
o. L: vc..0 E Gory and conditions is owteidg d.
• ' ;5trdction documents Boa s i
9
90
By
Date:
City Of Tukwila
BUILDING DIVISION
S 144th St
REVISIONS
No changes shall be dam to the scope
of work without prior approval of
Tukwila Building Division_
r�C i Ov ;3io-10 will require a new plan submitt?I
LnJ mcy include additional plan review fee;.
tl7-377
REVIEWED FOR
CODE COMPLIANCE
APPROVED
DEC 11 2012
City of Tukwila
BUILDING DIVISION
RECEIVED
DLO 042012
TUKWILA
PUBLIC WORKS
RECEIVED
CITY OF TUKWILA
NOV 3 0 2012
PERMIT CENTER
0.
I a'
1 •
I
DATE:
10/19/2012
' SCALE:
SHEET:
A— 1.0
relLE COPY
L A gB S
HAZARDOUS MATERIALS SERVICES
Good Faith
Asbestos Inspection
4628 S 144th St (West Portable Only)
Tukwila, WA 98168
Prepared For
Mr. Randy Young
Pacific Mobile
13806 64th Ave NE
Marysville, WA 98271
Project Number
Inspection Date
Report Date
Inspected By
AHERA Certification
Expiration Date
2012 -697
August 23, 2012
August 27, 2012
Sam House
# 134726
December 20, 2012
REVIEWED FOR
CODE COMPLIANCE
APPROVED
DEC 1 1 2012
City of Tukwila
BUILDING DIVISION
RECEIVED
CITY OF TUKWILA
NOV 3 0 2012
PERMIT CENTER
101- n`l
l �?
1 TABLE OF CONTENTS
1
1.0 SCOPE OF WORK
-1
2.0 SURVEY METHOD
l
3.0 LABORATORY INFORMATION
} 4.0 BUILDING DESCRIPTION
5.0 FINDINGS
6.0 CONCLUSIONS AND RECOMMENDATIONS
1 7.0 LIMITATIONS OF SURVEY
APPENDICIES
A Sample Locations (Floor Plan)
B Laboratory Results
C AHERA Certification & Laboratory Qualifications
1
1
l
1
3
4-5
7
8
9
10
4628 S 144'" St (West Portable Q
Tukwila, WA 98168
Project Number. 2012 -697
1.0 SCOPE OF WORK
A good faith asbestos inspection for asbestos - containing materials was conducted on the western portable
of the school building located at 4628 S 144th St, Tukwila, WA 98168 on August 23, 2012.
Sam House, an AHERA certified building inspector, conducted this survey at the request of Mr. Randy
Young, of Pacific Mobile.
This survey was limited to the westem portable behind the school building at the subject address. The
purpose of this inspection was to identify asbestos - containing materials that would be impacted by the
planned demolition of the structure. All suspect materials that would be impacted by the demolition were
sampled. However, please note that hidden materials may exist within the structure, and all suspect
materials must be treated as asbestos containing until testing proves otherwise.
This survey constitutes a survey of accessible suspect ACM in the project area and was conducted in
accordance with:
The National Emission Standards for Hazardous Air Pollutants (NESHAP) 40 Code of Federal Regulations
(CFR) Part 61 requires a survey by an accredited asbestos inspector prior to demolition of a structure.
This asbestos survey also satisfies the requirements for "Good Faith" inspection outlined in Washington
Administrative Code (WAC) 296 -62- 07221(2), Identification, which requires the owner of a structure to
provide contractors with a written report identifying the asbestos - containing materials expected to be
disturbed during renovation or demolition.
The asbestos survey section is written to comply with the AHERA asbestos sampling procedure as stated
in 40 CFR 763.86. This protocol is required under the Puget Sound Clean Air Agency (PSCAA Regulation
III, Article IV, rev. July 13, 2000) for all asbestos surveys prior to a building demolition.
A floor plan indicating locations of samples collected by NVL personnel has been included in Appendix A.
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936 3
4628 S 1441h St (West Portable 0
Tukwila, WA 98168
Project Number 2012 -697
2.0 SURVEY METHOD
Asbestos Survey Method
The NVL Labs 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 his certificate is provided in Appendix C.
The AHERA Guidelines dictate 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 must determine whether or not material is
friable or non - friable. Friable is defined as a material, that when dry, can be crushed, pulverized, or
reduced to dust using hand pressure, and non - friable material is defined as a material, that when dry,
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.
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). Generally speaking, TSI and SM are considered to be friable, with the exception of TSI where the
structural integrity of the insulation is in tact and the protective out wrap is undamaged.
Once materials are divided into one of the categories, 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 Tess than six linear feet or six square feet;
3. Inspector shall collect in a manner sufficient, samples from areas of TSI applied to fittings, tees,
and joints.
Friable Surfacing Material:
1. Inspector shall collect samples in statistically random manner of surfacing materials 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 Tess 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 Tess 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.
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936 4
i
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4628 S 144'" St (West Portable 0`
Tukwila, WA 98168
Project Number. 2012 -697
Miscellaneous Materials:
1. Inspector shall collect samples in a manner and number sufficient to determine if the material is
asbestos - containing or not.
All Materials Determined to Be Non Friable:
1. Inspector shall collect samples in a manner and number sufficient to determine if the material is
asbestos containing or not.
In addition to these sampling requirements, the AHERA Building Inspector is required to assess the
following of each material that is found to be positive for asbestos:
1. The condition of each material;
2. Accessibility;
3. Possibility for air erosion.
Once the samples have been collected, they must be analyzed by an accredited laboratory, and they must
be analyzed using polarized light microscopy methods, commonly referred to as EPA Method 600 /R-
93/116.
NVL Labs collected samples and obtained analytical data for suspect asbestos - containing materials
identified in the building. Once collected, each bulk sample was sealed in an unadulterated plastic bag to
eliminate the possibility of cross - contamination. "Chain -of- Custody" tracking was followed to maintain
sample integrity during handling and data reporting at NVL Labs.
A walk- through inspection of all accessible areas of this structure was performed to identify potential
asbestos - containing materials. The walk- through inspection included a review of the internal and extemal
aspects of this structure. The locations and types of potential asbestos - containing materials were noted.
Homogeneous Materials
Homogeneous materials are defined as an area of asbestos - containing material or presumed asbestos -
containing material which appears similar throughout in terms of color, texture, and date of material
application. The report listing for homogenous materials will appear as follows:
Sample Number
Material Description by Layer
Location
Asbestos
Quantity
Friable
Layer 1 is not asbestos - containing
1. %
#
Location description
"X" LF /ft2
Yes/No
Layer 2 is asbestos - containing
2. %
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936
5
4628 S 144th St (West Portable 0
Tukwila, WA 98168
Project Number. 2012 -697
3.0 LABORATORY INFORMATION
Laboratory Analysis: Asbestos
-)
In accordance with 40 CFR Chapter 1 (1 -1 -87 edition) Part 763, Subpart F, Appendix A, asbestos samples
are analyzed at NVL Labs using polarized Tight microscopy (PLM) with dispersion staining. If samples are
not homogeneous, then sub - samples of the components are analyzed separately. All bulk samples are
analyzed using EPA Method 600 /R- 93/116 with the following measurement uncertainties for reported %
asbestos: 1 % =0 -3 %, 5 %z1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %. Only materials containing
more than 1% total asbestos were classified as "asbestos- containing" based on EPA, state, and local
regulations.
Findings for samples containing more than one separable layer of materials are reported for each layer.
The asbestos concentration in the sample is determined by visual estimation.
NVL Labs is accredited by the National Institute of Standards and Technology (NIST) under the National
Volunteer Laboratory Accreditation Program (NVLAP) program for bulk asbestos fiber analysis; NVLAP
Lab Code 102063 -0
Laboratory Accreditation
Professional accreditations for NVL Laboratories, 'Inc. include the following:
NVL Laboratories, Inc. is currently accredited by the National Institute of Standards and Technology (NIST)
under the National Volunteer Laboratory Accreditation Program (NVLAP) program for bulk asbestos fiber
analysis.
NVLAP Lab Code 102063 -0
NVL Laboratories, Inc. is approved by the American Industrial Hygiene Association (AIHA) Asbestos
Analysts Registry (AAR) program for airborne asbestos fiber analysis.
AAR Counter ID 7412
NVL Laboratories, Inc. is currently accredited by the American Industrial Hygiene Association (AIHA) under
the Industrial Hygiene Laboratory Accreditation Program (IHLAP). The IHLAP program is designed
specifically for laboratories involved in analyzing samples to evaluate workplace exposure.
IHLAP Certification Number 563
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936
6
4628 S 144," St (West Portable O.
Tukwila, WA 98168
Project Number: 2012 -697
4.0 BUILDING DESCRIPTION
General Building Type
Primary External Components
Foundation Type
Roofing Material(s)
Window Type(s)
Flooring
Thermal Systems With Insulation
Finishing
This is a single story detached portable school building purposed
for storage.
The exterior of the building is vertical wood siding with paint.
The foundation of the building is wood pylons in concrete.
The roof of the building is tri -tab asphaltic shingles.
The building does not have any windows.
The flooring in the structure is carpet and sheet vinyl.
The building is heated through forced air with fiberglass thermal
system insulation.
The surveyed area is finished with drywall wrapped in soft wall
paper.
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936
7
1
1
1
4628,S 144" St (West Portable C''D
Tukwila, WA 98168
Project Number: 2012 -697
5.0 FINDINGS
Sample Number
Material Description by Layer
Location
Asbestos
Quantity
Friable
2012- 697 -1 -1
Gypsum wallboard wrapped with vinyl
Room 1
ND
2012 -697 -2 -1
White crush pattern ceiling tile
Room 2
ND
2012- 697 -3 -1
1: Gray vinyl cove base
2: Yellow,soft mastic
Room 1 and Room 2
1: ND
2: ND
2012 - 697 -4-1
1: Greenzarpet
2: Yellow soft mastic
Room 1 and Room 2
1: ND
2: ND
2012- 697 -4 -2
1: Black vinyl cove base
2: Clear soft mastic
3: White soft mastic
Bathroom
1: ND 1
2: ND
3: ND
2012- 697 -5-1
'1:'White /gray sheet vinyl
2: Gray fibrous backing with mastic
Room 1
1:ND
2: ND
2012- 697 -5 -2
1: White /gray sheet vinyl
2: Gray fibrous backing with mastic
Room 2
1: IND
2: ND
201.2- 697 -6-1
1: Beige laminate countertop
2: Yellow soft mastic
Room 1 and Room 2
1: ND
2: ND
2012 - 697 -7 -1
1: Gray vinyl floor tile
2: Yellow soft mastic
Fumace closets
1: ND
'2: ND
2012- 697 -8 -1
1: White wallboard with mastic
2: Brown compressed wallboard
Bathroom
1: ND
2: ND
2012 - 697 -9-1
1: Black asphaltic tri- tab,roofing
2: Black asphaltic fibrous felt
Roof
1: ND '
2: ND
2012 -697 -10-1 '
Pink, fiberglass insulation
Attic
ND
ND
None Detected
Any suspect material(s) not identified above should not be disturbed and should be tested immediately.
The suspect material must be treated as asbestos- containing until testing proves otherwise.
!NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936
8
1
4628 S 144th St (West Portable Of
Tukwila, WA 98168
Project Number: 2012 -697
6.0 CONCLUSIONS AND RECOMMENDATIONS
There were no presumed or confirmed asbestos - containing materials identified in the western portable
behind the school building located at 4628 S 144th St, Tukwila, WA 98168 on August 23, 2012.
Contractors should be aware that concealed suspect asbestos - containing building materials may be
uncovered during the course of demolition or renovation work. Contractors should have contingency plans
that include stopping work, evacuation of the immediate area and sampling by a certified AHERA Building
Inspector whenever these materials are found. Concealed suspect materials may include, but are not
limited to: non - fiberglass pipe or roof drain insulation; spray - applied coatings; cement board; asphalt or
paper vapor barriers; floorings and adhesives.
If discovered, all asbestos - containing materials that will be disturbed as a natural part of renovation and /or
demolition are required to be removed and disposed of in accordance with Washington State regulations.
Washington State Department of Labor and Industries and PSCAA require that the abatement be
performed using Certified Asbestos Workers under the direct on site supervision by a Certified Asbestos
Supervisor. Further, NVL suggests that an AHERA inspector review this property after abatement to
ensure all asbestos - containing materials have been removed by the contractor.
NVL recommends that an AHERA inspector /project manager be on site at the time of renovation /demolition
to ensure that any potentially asbestos - containing materials uncovered during the process of
renovation /demolition be dealt with properly.
Based on our conclusions, NVL Labs, Inc. is making the following recommendations regarding asbestos:
1. A copy of this inspection report should be maintained at the project site during the duration of any
renovations.
2. A copy of this inspection report should be provided to the General Contractor and any Sub
Contractors working on the renovation project.
3. The inspection report is not intended to serve as a design document, or scope of work prior to
renovation.
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936
9
4628 S 144" St (West Portable C
Tukwila, WA 98168
Project Number. 2012 -697
7.0 LIMITATIONS OF SURVEY
The purpose of this survey report is to document asbestos - containing materials discovered by NVL
Laboratories personnel on the August 23, 2012 survey of the western portable behind the school building
located at 4628 S 144th St, Tukwila, WA 98168.
This survey was limited to the western portable behind the school building at the subject address. The
purpose of this inspection was to identify asbestos - containing materials that would be impacted by the
planned demolition of the structure. All suspect materials that would be impacted by the demolition were
sampled. However, please note that hidden materials may exist within the structure, and all suspect
materials must be treated as asbestos containing until testing proves otherwise.
This site visit consisted of a thorough visual walk- through of the building for the purpose of viewing and
sampling potential asbestos - containing materials. As hazardous material surveys are non - comprehensive
by nature, NVL Laboratories, Inc. cannot be held liable for materials which require destructive means to
access, materials which are hidden from sight (e.g. materials hidden behind walls), materials which cannot
be found due to their obscure nature, or which otherwise cannot be discovered with reasonable diligence.
This document is the sole property of NVL Laboratories and the property owner, or his agent, authorizing
this survey.
I nspe ed By Reviewed By
Sam House
AHERA Building Inspector
AHERA Certification # 134726
Expiration Date December 20, 2012
Syed Hasan
Manager Field Services
NVL Laboratories, Inc.
4708 Aurora Ave N
Seattle, WA 98103
Phone (206) 547 -0100 • Fax (206) 634 -1936
10
IN'' IL.
L A s B rt*S
Appendix A
Sample Locations (Floor Plan)
IN \YIL
L A B S
AAZAAEMUS MATERIALS SERVICES
4708 AURORA AVE N SEATTLE. WA 98103.6516
T E L 208.547.0100 F A X 2 0 6. 6 3 4. 1 9 3 6 Page of
Location 442 S iLHI4 -11AKWILA, (V4q
Client PAC 1c. NloQ1L
Prof 6 ) ►-,01VI 6911'
Date �CPUS1 (2.1n, 20Y2.
b
Made by S1&M ko+- E
i L+
•
— 1I
F— I.LI.i__
L! j
._L
ASBESTOS. LEAD, RCRA METALS, MHO
I•):. . • _kilt) _
www.nvIlabs.eom
1.888.NVL.LABS (685.5227)
Appendix B
Laboratory Analysis Report
NVL Laboratories, Inc.
GINJaht*
4708 Aurora Ave. N., Seattle, WA 98103 For the scope of accreditation under NVLAP Lab Code 102083 -0
Tel: 208.547.0100, abs 8.634.1938
www.nvllabs.co m Bulk Asbestos Fibers Analysis
co
By Polarized Light Microscopy
Client: NVL Field Services Division
Address: 4708 Aurora Ave. N.
Seattle, WA 98103
Attentlon: Mr. Syed Hasan
Project Location: 4628 S 144th Street
Tukwila, WA 98168
Batc n #: 1213226.00
Client Project #: 2012 -697
Date Received: 08/23/2012
Samples Received: 12
Samples Analyzed: 12
Method: EPA/600R- 93/116
Lab ID: 12078084 Client Sample #: 2012 - 697 -1 -1
Location: 4628 S 144th Street
Layer 1 of 1
Description: White chalky material with paper and soft material
Non - Fibrous Materials:
Gypsum /Binder, Binder /Filler
Other Fibrous Materials:%
Cellulose 23%
Glass fibers 11%
Asbestos Type: %
None Detected ND
Lab ID: 12078085 Client Sample #: 2012 - 697 -2 -1
Location: 4628 S 144th Street
Layer 1 of 1
Description: Gray fibrous material with paint
Non - Fibrous Materials:
Binder /Filler, Paint, Perlite
Glass beads
Other Fibrous Materials:%
Cellulose 31%
Glass fibers 30%
Asbestos Type: %
None Detected ND
Lab ID: 12078086 Client Sample #: 2012 - 697 -3 -1
Location: 4628 S 144th Street
Layer 1 of 2
Layer 2 of 2
Description: Gray rubbery material
Non - Fibrous Materials:
Rubber/Binder
Description: Yellow soft mastic
Non - Fibrous Materials:
Mastic/Binder
Other Fibrous Materials:%
None Detected ND
Other Fibrous Materials:%
Cellulose 5%
Asbestos Type: %
None Detected ND
Asbestos Type:
None Detected ND
Lab ID: 12078087 Client Sample #: 2012 - 697 -4 -1
Location: 4628 S 144th Street
Layer 1 of 2 Description: Green/white woven fibrous material
Non - Fibrous Materials:
Binder /Filler
Other Fibrous Materials:%
Synthetic fibers 81%
Asbestos Type: %
None Detected ND
l
Sampled by: Client
Analyzed by: Lori Tseng
Reviewed by: Nick Ly
Date: 08/24/2012
Date: 08/24/2012
Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600/14
-82-020 Method with the following measurement uncertainties for the reported % Asbestos (1% =0-3%, 5 % =1 -9 %, 10 %= 5-15%, 20%=10-30%, 50 %=40
-60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results Is limited by the
methodology and acuity of the sample collector. This report shall not be reproduced except In full, without written approval of NVL Laboratories, Inc. It shall
not be used to claim product endorsement by NVLAP or any other agency of the U5 Government
Page 1 of 4
NVL Laboratories, Inc.
aj
4708 Aurora Ave. N., Seattle, WA 98103 For the scope of accreditation under NVLAP Lab Code 102063-0
Tel: 206.547. Fax: 206.634.1936
www. nvllabs.com • Bulk Asbestos Fibers Analysis
www.nvIlabs.com
By Polarized Light Microscopy
Client NVL Field Services Division
Address: 4708 Aurora Ave. N.
Seattle, WA 98103
Attention: Mr. Syed Hasan
Project Location: 4628 S 144th Street
Tukwila, WA 98168
Batch #: 1213226.00
Client Project #: 2012 -697
Date Received: 08/23/2012
Samples Received: 12
Samples Analyzed: 12
Method: EPA/600R- 93/116
Layer 2 of 2
Description: Yellow soft mastic
Non - Fibrous Materials:
Mastic/Binder
Other Fibrous Materials:%
Cellulose 6%
Asbestos Type: %
None Detected ND
Lab ID: 12078088
Client Sample #: 2012 - 697 -4 -2
Location: 4628 S 144th Street
Layer 1 of 3 Description: Black rubbery material
Non - Fibrous Materials:
Rubber /Binder
Layer 2 of 3 Description: Clear soft/elastic material
Non - Fibrous Materials:
Binder /Filler
Layer 3 of 3 Description: White soft/elastic material
Non - Fibrous Materials:
Binder /Filler
Other Fibrous Materials:%
None Detected ND
Other Fibrous Materials:%
Cellulose 4%
Other Fibrous Materials:%
Cellulose 2%
Synthetic fibers 1%
Asbestos Type: %
None Detected ND
Asbestos Type: %
None Detected ND
Asbestos Type:
None Detected ND
Lab ID: 12078089 Client Sample #: 2012 - 697 -5-1
Location: 4628 S 144th Street
Layer 1 of 2 Description: White /gray sheet vinyl
Non - Fibrous Materials:
Vinyl /Binder
Layer 2 of 2 Description: Gray fibrous backing with mastic
Non - Fibrous Materials:
Binder /Filler, Mastic/Binder, Wood debris
Other Fibrous Materials:%
None Detected ND
and wood debris
Other Fibrous Materials:%
Cellulose 59%
Glass fibers 15%
Asbestos Type: %
None Detected ND
Asbestos Type: %
None Detected ND
Lab ID: 12078090 Client Sample #: 2012 - 697 -5 -2
Location: 4628 S 144th Street
Sampled by: Client
Analyzed by: Lori Tseng
Reviewed by: Nick Ly
Date: 08/24/2012
Date: 08/24/2012
Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600/M4
- 82-020 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0-3 %, 5 % =1 -9 %, 10 %= 5-15 %, 20 %= 10 -30 %, 50 %=40
-60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results Is limited by the
methodology and acuity of the sample collector. This report shall not be reproduced except In full, without written approval of NVL Laboratories, Inc. It shall
not be used to claim product endorsement by NVLAP or any other agency of the U5 Govemment.
Page 2 of 4
D
NVL Laboratories, Inc.
GeV
4708 Aurora Ave. N., Seattle, WA 98103 For the scope of accreditation under NVLAP Lab Code 102063-0
Tel: 206.547.0100, abs.com 34.1938 Bulk Asbestos Fibers Analysis
www.nvllabs.com
By Polarized Light Microscopy
Client NVL Field Services Division
Address: 4708 Aurora Ave. N.
Seattle, WA 98103
Attention: Mr. Syed Hasan
Project Location: 4628 S 144th Street
Tukwila, WA 98168
Batch #: 1213226.00
Client Project #: 2012 -697
Date Received: 08/23/2012
Samples Received: 12
Samples Analyzed: 12
Method: EPA/600R- 93/116
Layer 1 of 2
Layer 2 of 2
Description: White/gray sheet vinyl
Non - Fibrous Materials:
Vinyl/Binder
Other Fibrous Materials:%
None Detected ND
Description: Gray fibrous backing with mastic and wood debris
Non - Fibrous Materials:
Binder /Filter, Mastic/Binder, Wood debris
Other Fibrous Materials:%
Cellulose 65%
Synthetic fibers 6%
Glass fibers 2%
Asbestos Type: To
None Detected ND
Asbestos Type: %
None Detected ND
Lab ID: 12078091 Client Sample #: 2012 - 697 -6 -1
Location: 4628 S 144th Street
Layer 1 of 2 Description: Gray rigid /brittle material with trace paint
Non - Fibrous Materials:
Binder /Filler, Paint
Layer 2 of 2 Description: Yellow soft mastic
Non - Fibrous Materials:
Mastic/Binder
Other Fibrous Materials:%
Cellulose 80%
Other Fibrous Materials:%
Cellulose 6%
Asbestos Type: %
None Detected ND
Asbestos Type: %
None Detected ND
Lab ID: 12078092 Client Sample #: 2012- 697 -7 -1
Location: 4628 S 144th Street
Layer 1 of 2 Description: Gray vinyl tile
Non - Fibrous Materials:
Vinyl/Binder, Mineral grains
Layer 2 of 2 Description: Yellow soft mastic with wood flakes
Non - Fibrous Materials:
Mastic/Binder, Wood flakes
Other Fibrous Materials:%
Cellulose 2%
Other Fibrous Materials:%
Cellulose 4%
Synthetic fibers 3%
Asbestos Type: %
None Detected ND
Asbestos Type: %
None Detected ND
Sampled by: Client
Analyzed by: Lori Tseng
Reviewed by: Nick Ly
4_/
Date: 08/24/2012
Date: 08/24/2012 N� M
i
Note: if samples are not homogeneous, then subsamptes of the components were analyzed separately. All bulk samples are analyzed using EPA 600/M4
-82 -020 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0-3 %, 5 % =1 -9 %, 10 %= 5-15 %, 20 %= 10 -30 %, 50 %=40
-00 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results Is limited by the
methodology and acuity of the sample collector. This report shall not be reproduced except In full, without written approval of NVL Laboratories, Inc. It shall
not be used to claim product endorsement by NVLAP or any other agency of the US Government.
Page 3 of 4
NVL Laboratories, Inc.
4708 Aurora Ave. N., Seattle, WA 98103 For the scope of accreditation under NVLAP Lab Code 102063-0
Tel: 206.547.0100, www.nvilabs.com Bulk Asbestos Fibers Analysis
www.nvllabs.com
By Polarized Light Microscopy
Client: NVL Field Services Division
Address: 4708 Aurora Ave. N.
Seattle, WA 98103
Attention: Mr. Syed Hasan
Project Location: 4628 S 144th Street
Tukwila, WA 98168
Batch #: 1213226.00
Client Project #: 2012 -697
Date Received: 08/23/2012
Samples Received: 12
Samples Analyzed: 12
Method: EPA/600R- 93/116
Lab ID: 12078093 Client Sample #: 2012- 697 -8 -1
Location: 4628 S 144th Street
Layer 1 of 2 Description: Brown fibrous material with soft material and mastic
Non - Fibrous Materials: Other Fibrous Materials:%
Binder /Filler, Mastic/Binder Cellulose 70%
Layer 2 of 2 Description: Brown compressed fibrous material with paint
Non - Fibrous Materials: Other Fibrous Materials:%
Binder/Filler, Paint Cellulose 65%
Asbestos Type: %
None Detected ND
Asbestos Type: %
None Detected ND
Lab ID: 12078094 Client Sample #: 2012 - 697 -9 -1
Location: 4628 S 144th Street
Layer 1 of 2 Description: Black asphaltic fibrous material with granules
Other Fibrous Materials:%
Glass fibers 23%
Non - Fibrous Materials:
Asphalt/Binder, Binder/Filler, Granules
Layer 2 of 2 Description: Black asphaltic fibrous felt
Non - Fibrous Materials:
Asphalt/Binder, Binder /Filler
Other Fibrous Materials:%
Cellulose 75%
Asbestos Type: %
None Detected ND
Asbestos Type: %
None Detected ND
Lab ID: 12078095 Client Sample #: 2012 - 697 -10 -1
Location: 4628 S 144th Street
Layer 1 of 1 Description: Pink fibrous material
Non - Fibrous Materials: Other Fibrous Materials:% Asbestos Type:
Binder /Filler Glass fibers 89% None Detected ND
Sampled by: Client ,4 !
Analyzed by: Lori Tseng Date: 08/24/2012 d�,i %1��� —'`►
Reviewed by: Nick Ly Date:08/24/2012 Nic c -t«�1�
...�;.�� %� J
Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600/M4
-82 -020 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0-3 %, 5 % =1 -9 %, 10 %= 5-15 %, 20 %= 10 -30 %, 50 %=40
-60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the
methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall
not be used to claim product endorsement by NVLAP or any other agency of the US Government
Page 4 of 4
1
1
1
1
1
NVL Laboratories, Inc.
4708 Aurora Ave N, Seattle, WA 98103
Tel: 206.547.0100 Emerg. Cell: 206.914.4648
1.888.NVL.LABS (685.5227) www.nvllabs.com
Client NVL Laboratories Inc
n
CHAIN of CUSTODY
SAMPLE LOG
Street 4708 Aurora Ave N
Seattle. WA 98103
Project Manager Sved Hasan
Protect Location 4628 S 144th Street
Tukwila, WA 98168
Phone: (360) 572 -5011
Fax:
BATCH ID
1213226.00
NVL Batch Number
Client Job Number 2012-697
Total Samples 12-
Tu
•
m Around Time ❑ 1-Hr ❑ 8-Hrs 2 Days ❑ 5 Days
❑ 2 -Hrs ❑ 12-Hrs ❑ 3 Days ❑ 6-10 Day
❑ 4-Hrs ❑ 24-Hrs ❑ 4 Days
Please call for TAT less than 24 Hrs
Email address randw(pacificmobile.com
Cell (360) 722 -1554
• Asbestos Air
❑ PCM (NIOSH 7400) • TEM (NIOSH 7402) • TEM (AHERA) • TEM (EPA Level II) • Other
Client Sample Number Comments
lig„Asbestos BulkXPLM
(EPA/600/R- 931116) • PLM (EPA Point Count)
• PLM (EPA Gravimetry) • TEM BULK
• Mold/Fungus
• Mold Air •
Mold Bulk 1 ❑ Rotometer Calibration
METALS
Det. Limit
Matrix
3
Other Metals
• All 3
• Copper (Cu)
■ : Nickel (Z(Ni) Zinc n)
RCRA Metals • All 8
• Total Metals
• FAA (porn)
• Air Filter • Soil
• Arsenic (As) • Chromium (Cr
• TCLP
• ICP (ppm)
• Drinking water Ii Paint Chips in %
Ill Barium (Ba) ID Lead (Pb)
• Cr 6
• GFAA (ppb)
• Dust/wipe (Area) ❑ Paint Chips in cn
❑ Cadmium (Cd) • Mercury (Hg)
6
5(
❑ Other Types
of Analysis
• Fiberglass • Silica • Nuisance Dust ❑ Respirable
Dust • Other (Specify)
61
Condition of Package: CI Good ❑ Damaged (no spillage) ❑ Severe damage (spillage)
Seq. #
Lab ID
Client Sample Number Comments
AIR
1
`?t 3o
2pn - t qr- H
2.1
111111n1.1111
1
2
2:.'0
3
��
merit Lill'
3-I
, , . ►��ri:'Ii
lltit—
im
8r' ' %-
4
Analyzed by
4 -(
�t .--G:
Results Called by
5
`l-1
Results Faxed b
6
5(
7
Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after analysis.
Results report to �,,\.,
61
8
6-t
9
1•(
10
%61
11
4 -(
12
1O•i
13
14
15
bats
Sam •led by
A • t -4_
4 d^ —
M'J d.r
—12.
`?t 3o
Relin • utshed b
111111n1.1111
1
2:.'0
Received b
��
merit Lill'
n 1a nt..
, , . ►��ri:'Ii
lltit—
im
8r' ' %-
.. ' e;
t Ca)
Analyzed by
. � J
�t .--G:
Results Called by
Results Faxed b
Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after analysis.
Results report to �,,\.,
L AFB 5
Appendix C
Inspector's Certifications & Laboratory Qualifications
United States Department of Commerce
National Institute of Standards and Technology
Certificate of Accreditation to ISO /IEC 17025:2005
NVLAP LAB CODE: 102063 -0
NVL Laboratories, Inc.
Seattle, WA
is accredited by the National Voluntary Laboratory Accreditation Program for specific services,
listed on the Scope of Accreditation, for
BULK ASBESTOS FIBER ANALYSIS
This laboratory is accredited in accordance with the recognized International Standard ISO /IEC 17025:2005.
This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality
management system (refer to joint ISO- ILAC -IAF Communique dated January 2009).
sva9"Tcw
•
Effective dates
e4TE5 O`
2011 -10 -01 through 2012 -09 -30
For the National Ins • ute of Standards and Technology
NVLAP -01C (REV. 2009- 01 -28)
1
National Voluntary
1
n a
.� Laboratory Accreditation Program
1
1
1
1
1
1
i
SCOPE OF ACCREDITATION TO ISO /IEC 17025:2005
NVL Laboratories, Inc.
4708 Aurora Avenue N.
Seattle, WA 98103
Mr. Nghiep Vi Ly
Phone: 206- 547 -0100 Fax: 206- 634 -1936
E -Mail: nick.1 @nvllabs.com
URL: http: / /www.nvllabs.com
BULK ASBESTOS FIBER ANALYSIS (PLM) NVLAP LAB CODE 102063 -0
NVLAP Code Designation /Description
18/A01 EPA- 600/M4 -82 -020: Interim Method for the Determination of Asbestos in Bulk Insulation
Samples
2011 -10 -01 through 2012 -09 -30
Effective dates For the ational In ute of Standards and Technology
Page 1 of 1 NVLAP-01S (REV. 2005- 05-19)
st
has satisfactorily completed
4 hours of refresher training as an
to comply with the training requirements of
TSCA Title II / 40 CFR 763 (AHERA)
Instructor
EPA Provider Cert. Number: 1085
Dec 21, 2011
Date(s) of Training
Exam Score: NA
Expiration Date: Dec 20, 2012
Argus Pacific, Inc. • 1900 W. Nickerson, Suite 315 • Seattle, Washington • 98119 • 206.285.3373 • fax 206.285.3927
CO I : COP?
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D12 -377 DATE: 11 -30 -12
PROJECT NAME: SHOWALTER MIDDLE SCHOOL - DEMO
SITE ADDRESS: 4628 S 144 ST
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # After Permit Issued
DEPARTMENTS: :
gdin 'vision
�b
NpaLtlic Wo'YRs
A-v\ N /A- 1�T
ire Prevention
Structural
Planning Division
Permit Coordinator fj
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 12 -04 -12
Complete
Incomplete
Not Applicable
n
Comments:
Permit Center Eke Only: •: _ .
INCOMPLETE LETTER MAILED:
LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUESITHURS ROUTING:
Please Route
Structural Review Required
❑ No further Review Required
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved
Notation:
n
Approved with Conditions
Le
DUE DATE: 01 -01 -13
Not Approved (attach comments) n
REVIEWER'S INITIALS: DATE:
Permit Center•Use Only. . • •
cis iN 4...r.�4• • .
CORRECTION LETTER MAILED:
Departments issued corrections:
Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents /routing slip.doc
2 -28 -02
I
Contractors or Tradespeople Peter Friendly Page
•
General /Specialty Contractor
A business registered as a construction contractor with Lal to perform construction work within the scope of
its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name PACIFIC MOBILE STRUCTURES INC UBI No. 600498022
Phone 3607480121 Status Active
Address Po Box 1404 License No. PACIFMS033DC
Suite /Apt. License Type Construction Contractor
City Chehalis Effective Date 3/3/1997
State WA Expiration Date 11/8/2014
Zip 98532 Suspend Date
County Lewis Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
License
Name
Type
Specialty
1
Specialty
2
Effective
Date
Expiration
Date
Status
PACIFMS097D0
PACIFIC MOBILE
STRUCTURES INC
Construction
Contractor
General
Unused
3/20/1991
2/20/1997
Archived
PACIFML150QL
PACIFIC MOBILE
LEASING INC
Construction
Contractor
General
Unused
11/13/1985
10/28/1997
Archived
Business Owner Information
Name
Role
Effective Date
Expiration Date
HAAKENSON, RICHARD E, OWNER
Member
01/01/1980
Amount
HAAKENSON, GARTH PHILLIP
President
11/04/2010
01C131839030
HAAKENSON, JEAN ANN
Secretary
01/01/1980
MOORE, GRETCHEN LEE
Treasurer
11/02/2010
AMERICAN
ECONOMY INS
CO
Bond Information
Page 1 of 2
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
9
WESTERN SURETY CO
69913574
05/26/2005
Until Cancelled
$12,000.00
05/25/2005
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
17
American
Economy
Insurance Co
01C131839030
01/31/2012
01/31/2013
$1,000,000.0002
/06/2012
16
AMERICAN
ECONOMY INS
CO
01C13183901
01/31/2011
01/31/2013
$1,000,000.0001
/26/2012
15
AMERICAN
ECONOMY INS
CO
01C1131839010
01/31/2010
01/31/2011
$1,000,000.0002
/02/2010
14
TRAVELERS
INDEMNITY CO
OF AMER
660238J24201ND
01/31/2007
01/31/2010
$1,000,000.00
01/23/2009
13
TRAVELERS
INDEMNITY CO
OF AM
660238J2420TIA
01/31/2005
01/31/2007
$1,000,000.00
01/20/2006
Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx
12/12/2012