Choppindemolition commercial demolition,industrial demolition,residential demolition
NOTIFICATION OF DEMOLITION Southwest Clean Air Agency · 2 ---2. TYPE OF OPERATION D Partial...
Transcript of NOTIFICATION OF DEMOLITION Southwest Clean Air Agency · 2 ---2. TYPE OF OPERATION D Partial...
NOTIFICATION OF DEMOLITION Southwest Clean Air Agency
11815 NE 99th Street, Suite 1294 Vancouver, WA 98682
Voice: (360) 574-3058 Fax: (360) 576-0925 www.swcleanair.org
(10 day waiting period from date submitted) (Form must be filled out completely)
Notification # Must include f~ Date Received
Notification Fee $60.00 -
Emergency Fee: $120.00 --
&1tr5":;ip r - ---
/q-111 I MAR 1 7 2019 1. TYPE OF NOTIFICATION (•Original D Revised D Cancelled): I L - -
2 -- -2. TYPE OF OPERATION D Partial Demolition D Complete Demolition D Ordered Demolition JA , D Emergency Demolition W Fire Training
SWCAA Reviewed JV"
3. FACILITY DESCRIPTION (Example: Residence, Barn, Carport) /
Commercial Name or Description: Residence
Address: 259 SW 15th Street
City: Chehalis state: Wa County: Lewis
Present use: Vacant Prior use: Rental
4. FACILITY INFORMATION
Owner Name: Kathleen & Brad Andres Mailing Address: 9716 East Cochise Drive
~
City: Scottsdale
I State: AZ Zip Code: 85258
-I
! I I .. -
J '
Contact: Raquel Robinson
Phone: 360-388-0009 I 1 ~'1 -'. -·"- ~
5. NAME AND AHERA CERTIFICATION NUMBER OF ASBESTOS INSPECTOR: KD '&~s #8'11R:PD~NES-012518-01 6. ATIACH A COPY OF THE ASBESTOS INSPECTION REPORT Report must include laboratory name, analyst, sample type, location sample was taken and analytical method used to detect the presence of asbestos materials.
7. ASBESTOS REMOVAL CONTRACTOR (IF APPLICABLE): 0 No asbestos present, see attached AHERA Report
Name: NW Abatement Services Inc Address:PO BOX 39246
City: Lakewood
I State: Wa Zip Code: 98499
Contact: Chris Eckholm
Phone: 253-588-0440
8. DATES ASBESTOS REMOVAL OCCURRED (mm/dd/yy) Start: _2/22/ 1 9 Complete:2/22/19 Asbestos Case Number: 19-055
9. DATES DEMOLITION WILL OCCUR (mm/dd/yy) Start: 3/31/19 Complete: 3/31/19
10. DEMOLITION CONTRACTOR or FIRE DEPARTMENT: Fire Department
Name: City of Chehalis Fire Department
Address: 455 NW Park
city: Chehalis I State: WA county: Lewis
Contact and Phone# Robert Gebhardt 360-269-3351
SWCAA FORM N0.23 REVISED 01/01/2019
- - - ---- - ---- ---
11. DESCRIPTION OF PLANNED DEMOLITION WORK .• M~THODIS\ TO ~E llSEDo
Fire dept to burn home as a training exercise.
12. FUGITIVE EMISSIONS/DUST FROM DEMOLITION ACTIVITIES MUST BE CONTROLLED/PREVENTED DURING ALL PHASES OF THE PROJECT.
13. IF UNEXPECTED ASBESTOS CONTAINING MATERIAL (ACM) IS FOUND DURING DEMOLITION, STOP WORK, NOTIFY SWCAA AND CONSULT/HIRE A CERTIFIED ASBESTOS ABATEMENT CONTRACTOR.
14. IF DEMOLITION IS ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY BELOW:
Name: I Title:
Agency:
Date of Order (mm/dd/yy) : I Date Ordered to Begin ( mm/dd/yy ):
15. FOR EMERGENCY DEMOLITIONS: (Contact SWCAA prior to work)
Date and Hour of Emergency (mm/dd/yy) (hh/mm):
Description of the Sudden, Unexpected Event:
EXPLANATION OF HOW THE EVENT CAUSED UNSAFE CONDITIONS OR WOULD CAUSE EQUIPMENT DAMAGE OR AN UNREASONABLE BURDEN: (ATTACH ADDITIONAL PAGE IF NECESSARY)
16. I CERTIF~~~;:·;~:;~~~~N IS CORRECT. I? Jitl /l_
3/6/19 (Type or Print Name) V(Signature of Owner/Operator) (Date)
HAVE YOU PERFORMED A HAZARDOUS MATERIALS ASSESSMENT ON THE STRUCTURE?. YES 0 NO
The Washington State Dangerous Waste Regulations 0/VAC 173-303) require that demolition debris be evaluated to determine if it is dangerous. The evaluation should be completed before demolition to ensure that hazardous constituents are not released to the environment and do not present a risk to human health during or after demolition. These requirements apply to all buildings being demolished and are the responsibility of the property owner. The Washington Department of Ecology's website, https://ecology.wa.gov/Regulations-Permits/Guidancetechnical-assistance/Dangerous-waste-guidance/Common-dangerous-waste/Construction-and-demolition, provides more information about the requirements and about sampling and testing construction materials to determine if they present a risk . For more information please contact a Hazardous Waste Inspector at the Washington Department of Ecology Southwest Regional Office: 360-407-6300.
SWCAA FORM N0.23 REVISED 01/01/2019
INC .... ~ z u.I
::iE z 0 c::: > z LI.I
KD&S ENVIRONMENT AL, INC. P.O. BOX 312, MONTESANO, WA 98563
OFFICE: (360) 249-5540 FAX: (360) 249-3475 EMAIL : INFO@KDS ENY.COM
HAZARDOUS MATERIALS INVESTIGATION
ASBESTOS SURVEY
PERFORMED FOR:
DERRICK ROBINSON
PROPERTY KNOWN AS:
259 SW ism ST. C E ALIS, \VA 98321
P RFORMED BY:
j M ORAY A WILSON
HERA. CERTIFICATION: Bf1R-PD-NES -O 1251 8-0 l
December 19, 201 8
December 19, 2018 Job ff ! 8-5489
TABLE OF CONTENTS
25~) SW 15 111 ST.
Cl-I EMALIS, \\/A 9832 J
SEClIO 1.0- SCOPE OF WORK . .. ..... . ..... .... .. .. ....... .. .... ... . . .. . .. ........ .
SECTION 2.0 -ASBESTOS-CONTAINING MATERIALS (ACM)
SURVEY SUMMARY .................................................. .
SECTION 3.0-ASSESSMENT AND RECOMMENDATIONS .................. . ........ .
SECTION 4.0 - STATEMENT OF COMPLIANCE ...................... ... .......... . .. ..
APPENDIX A
APPENDIX B
APPENDIX C
APPENDIX D
APPENDIX E
ASBESTOS SAMPLE SUMMARY
LABORATORY ANALYSIS DATA SHEETS (ASBESTOS)
PICTU RES
DRAWINGS
CERTIFICATIONS
December 19, 20 18 Job fl 18-5489
SECTION 1.0 SCOPE OF WORK
On Dec:i..:mber 19. 2fll8 Moraya Wilson (Bl / R-PO-~LS-012)18-0 1 ) an accredited asbestos and hazardous materials inspector for KD&S Environmental , conducted an asbestos containing materials survey of the property known as:
259SW15 111 s·1. ( lfFH \LI~~ \VA 98.12 i
The following suspect materials were investigated:
• Asbestos Containing Material
Field inspection, data collection, and report generation were based on the following Scope of Work :
1. Perform a visual inspection of the subject property to identify and inventory all accessible suspect asbestos containing materials.
2. Bulk sampling and analysis of identified suspect asbestos containing materials. 3. Provide quantity estimates of asbestos containing materials. 4. Provide a written report including sample descriptions, sample locations, and
sample location drawing.
The survey was intended to identify any possible asbestos containing materials (ACM) which may be disturbed during demolition, remodeling or maintenance activities per 40 CFR 6 1 Subpart M and to maintain compliance with WAC 296-62-07721 and current applicable Southwest Clean Air Agency (SWCAA) Regulations. KD&S Enviromnental has made a best effort attempt to identify materials, which may be disturbed. Jn addition, the asbestos survey meets the "Good Faith" asbestos inspection requirements. It should be noted that "Good Faith" surveys are limited in scope and that those materials which required destructive means to access or sample (interstitial spaces) is not included in thi s report.
Suspect asbestos containing materials within the structure \Vere identified and classified as either a surfacing material , thermal system insulation, or miscell aneous materials. Surfacing materials are those, which arc either, spray applied or troweled-on fo r acoustical, decorati ve, or fireproofing purposes . Thermal system insulation (TSI) is insulation used to inhibit heat transfer or to prevent condensation on pipes, boilers, tanks, ducts and various other components. Miscellaneous materials include all other materials · not included in the above categories such as floor tile, ceiling tile, roofing felt , cemcntitious materials, \.vallboard systems and products such as caulking, mastics and putties. 20 Miscellaneous and Surfacing samples were collected and submitted for laboratory analysis.
December 19, 20 18 Job # 18-5489
Limitations of the Assessment
This targeted assessment was limited to the referenced buildings and did not include areas beyond the " foot print" of the buildings. The conclusions within th is report are prolessional opinions base solely upon visual site observations and interpretation of analytical data as described in this report. Typical construction techniques can render portions of the building inaccessible. As a result, additional ACBM may be present in inaccessible areas (i.e. within wall and ceiling cavities). Suspect ACBM within inaccessible areas shou ld be presumed to contain asbestos until characterized. The opinions presented herein apply to the site conditions existing at the time of the investigation and interpretation of current asbestos regulations. Recommendations provided may not apply to future conditions that exist at the above mention site.
Survev Methodology
The supporting documentation provided within survey report includes material summary table and the appendices that included site photographs lab analytical reports. chain of custody forms. staff certification.
December 19. 20 18 Job # 18-5489
SECTION 2.0 ASBESTOS-CONTAINING MATERIALS (ACM) SUMMARY
Bulk samples collected by KD&S Enviromnental were submitted for sample analysis in
accordance with method EPA-600/R-93 / 116: " Method for the Determination of Asbestos
in Bulk Building Materials'·. Seattle Asbestos perfonned analysi s of suspect asbestos
materials. The following suspect materials were found to contain asbestos in quantities
equal to or greater than one percent ( l %).
TOT AL ASBESTOS
259S\V l5 111 S·i. l llLH \I.I~,\\.' 98~2 I
Sample Location '%ACM Descl"iption of Friable/ Total SF # Category Material Non- Friable
259-1 Utility Exterior 2% Chrysolilc Ashcstos \Vindow Nun-Fri:.1ble <3lf Round I Windo\\ Misc. Putty
259--t Exterior· I 6 1% Chrysotile Cement Asbl:'stos !\on-Friable l ,650sf Round I House Misc. Board Siding
*All sq11are.fou1av,es prul'ided are approximations and any drawings are no! lo scale. Conlrac/ors are advised to verity the 111easuremen1s on their own prior to bidding the work
December 19, 2018 Job # 18-5489
SECTION 3.0 ASSESSMENT AND RECOMMENDATIONS
ASSESSMENT
The asbestos containing materials identified in the subject property fall into the
l\rl iscellaneous Materials Category. This is an asbestos project.
RECOMMENDATIONS
All identified asbestos containing material is regulated material and must be abated prior
to any demolition or remodeling activity vhich may disturb these materials at the subject
property. A Washington State Certified Asbestos Contractor must conduct abatement of
asbestos containing materials. The asbestos containing materials identified in the subject
property fall into the Miscellaneous Materials Category. This is an asbestos project.
NARRATIVE Tms SINGLE STORY RESIDENTIAL STRUCTURE WAS BUILT IN 1900 AND HAS HAD A
LITTLE REMODELING DONE. IT IS NOCCUPIED AND THE ROOF IS COMPROMISED,
THEREFORE THE HO SE WILL BE DEMOLISHED. TOTAL SQUARE FOOTAGE IS
APPROXIMATELY 792 SQUARE FEET. IT IS A TWO-BEDROOM, ONE BATHROOM HOME.
THERE IS A SEPARATE STRUCTURE ON THE PROPERTY THAT APPEARS TO BE A SHOP
BUILDING, THIS IS NOT A PAHT OF THIS SURVEY.
EXTERIOR BUILDING MATERIALS ARE CEMENT ASBESTOS BOARD SIDING,
COMPOSITION ROOF AND BOTH VINYL ANO TWO (2) WOOD FRAMED WI NDOWS,
HOWEVER THE UTILITY ROOM WOOD FRAMED WI NDOW IS THE ONE WITH THE PUTTY
AND IS LESS THAN TllllE:E (3) LINEAR FEET.
INTERIOR BUILDING MATERIALS ARE CARPET, SHEET VINYL, LAMINATE WOOD AND
VINYL FLOORING. WALLS ARE SHEETROCK AND CEILINGS ARE EITHER CEILING TILES
OR SHEETROCK.
OF THE TWENTY (20) SAMPLES TAKEN, TWO (2) TESTED POSITIVE; THE CEMENT
ASBESTOS SIDING AND THE WINDOW PUTTY FROM THE UTILITY ROOM WINDOW. THIS IS
AN ASBESTOS PROJECT AND MUST BE ABATED PRIOR TO DEMOLITION.
December 19. 20 18 Job # 18-5489
SECTION 4.0 STATEMENT OF COMPLIANCE
In accordance with W.A.C. 296-62-07721 and current applicable ORCCA Regulations, KO& S Environmental Consulting performed an Asbestos Inspection of:
259 SW 15 111 S1. lllEH \l IS, WA 98321
Abatement of asbestos-containing materials must be conducted by a Washington State Certified Asbestos Abatement Contractor. Should employees or contract personnel encounter any suspect asbestos-containing materials it is their responsibility to:
I. Contact a representative of the owner. 2. Consult the inspection report to detennine whether or not the suspect material
contains asbestos. 3. Ensure that all employees and contractors are infonned and advised of the location
and type of materials that contain asbestos.
The following asbestos-containing materials were identified at the subject property:
Sample Location %ACM Description of Friable/ Total SF # Category Material Non- Friable
25<J- I Utilit~· Exterior 2% C hr:vsotilc Ashcstos Windtm Non-Friahlc <31f Round I \Vindtm Misc. Putty
259-.t E~terior 16'% Chr~'SOtilc Cement Asbestos Non-F riable Round I I louse Misc. Board Siding
*All square foo tages provided are approximations and any drawings are not to scale. Contractors are advised lo ver{/j' the meu.rnremenls on their own prior to bidding the work.
l Hereby Attest:
l,6S0sf
The inspection report has been made avai lable to me. l wi ll inform all subcontractors of the location and types of materials containing asbestos. I am authorized to sign on behalf of my company.
Contractor: ____________ Owner' s Rep: ___________ _
Signature: Signature: _____________ _
Print Name: Print Name: ------- --- -------------Title: Title:
--------------~ ------------~
Date: Date: -------------~ --------------~
December 19, 20 18 Joh Ii 18-5489
SAMPLE
NUMBER
259-1 Rrn '-Ii I
259-2 ROUND I
259-3 ROUND I
.~)()-.{
R<ll D I
259-1 ROUND 2
259-2 ROUND 2
259-3 ROUND2
259-4 ROUND 2
259-5 ROUND 2
259-6 Ro · •n 2
259-7 ROUND 2
259-8 ROUND 2
259-9 ROUND 2
259-10 Rou D2
259-11 Rou 'D 2
ASBESTOS SAMPLE SUMMARY 259~\\i 15 111 ST.
CH F 11 \I.I~. \\'A 98.321
MATERIAL A HERA DESCRIPTION
LOCATION CATEGORY OF MATERIAL /
ESTIMATED
QUANTITY 1-\llRhlK \ll'i< !\';Ill :-.1< 1<;
wr,u11\\ N1 ''--rRl.\BI I Wl ' . i)( l\\ Pl I I)
EXTERIOR MISC. H OUSE PAPER
H OUSE No •-FRIABLE
EXTERIOR MISC. COMPOSITION
ROOF NO -FRIAl3LE
I \ 111t1<m :\ll\\. \ ·1 II ., I \ \HI.., Ill\
H• >l \I I) I-Kl \HI I B<>IJ{,>.'11>1'-'
Krrc 1 IL: MISC. SHEET VINYL 0
FLOOR FRI AO LE TILEO W OOD
KITCHEN MISC. T !LEU DER SHEET
FLOOR NON-FRIAAl.F VINYi.ON W OOD
KITCllEN MISC. BACKSPLASI I ON
W ALL N ON-FRI!\ OLE SI IEET VINYL ON
WOOIJ
U TILITY ROOM MISC. SI IEET VINYL ON
FLOOR FRl1\l3 LE W OOD
UTILITY ROOM MISC. ROCK WOOi .
CEILJN(i No -FRIARl.E INSULATION
KITCllE MISC. CEILINCi TILE
CEJLI. G NON-FRl.l\ULE STAPLED IN PLACL:
K ITCJ-lf: i SURFACING GWB I W 1\ LL
W ALL FRIAULE O NLY
LI VI NG ROOM ENTRY MISC. CERAM IC T il.F
FLOOR NON-FRIAR! .E GROUT
LiVI NCi ROOME 1TRY MISC. FLOOR! 1Ci lJNDER
FLOOR NoN-FRli\Bl.E CERAM IC TILE
(FROM KIKllEN) LI VING ROOM MISC. CEILING TILE
CEILING ON-FRli\ULE STAPLED IN PLACE
H AL1 .W1\ Y MISC. TILE U 'DER
Fi.OOR N ON -FRIABLE L AM INAT : W OOD FLOOR! 1GON
W OOD
ASBESTOS%
2°0( IJR'r\(1JJl I
NO. E D ETECTED
NONE D ETF.CTF.O
ICl", Clll'' '.1ii111
NONE D ETECTED
NONE D ETECTED
NONE D ETECTED
ONI; D ETl'.CTEO
NONE D ETECTED
NO E D ETECTED
NCJ 11; D lTL:LTEO
NONE D ETECTED
NONE Dl-T l-:C J'ED
N ONE D l:TECT ED
N ONE D HECTEU
December 19, 2018 Job # 18-5489
259-12 B ATHROOM Ro ND2 Fl.OUR
259- 13 BATHROOM
Rou 'D2 WALIJ CEILING
259-14 B EDROOM I ROUND2 CLOSET C EILING
259-15 BEDROOM I & ROUND 2 l-I ALLW . .\Y W ALLS
259-16 M · STER B EDROOM
Ro NO 2 W ALLS
MISC.
FRIABLE
SuRrACING
FRIABLE
MISC.
NON-FRIABLE
SURFACIN I
FRIAIJLE
SURFAC'INCi FRIARl.E
GREY SHEET
VINYL ON WOOD
SMOOHIGWB
CEILING TILE
W/FLORAL
PA'ITERN
SKIM COATO
GWB
GWB W/ SKIM
COAT SAME/\
HAI.I.WAY&
BEDROOM I
NONE DETECTED
NONE DETECTED
NONE DETECTED
NONE D ETECTED
NO E D ETECTW
Oel:cmber 19. 2018 Job Ii 18-5489
SEATTLE ASBESTOS TEST, Lynnwood Lab· 19701 Scnber Lake Road. Suite rn3. WA 98036, Tel:425.673 9850. Fax-425 .673 9810 Bellevue Lab: 12727 Northup Way, Suite 1, Bellevue. WA 98005, Tel:425 861 111 . Fax:425.861 .11 18
Analyzing Quality
Sea!Ue Lab: 4500 9th Ave NE, Suile 300 Sea!Ue, WA 98 105 Tel 206.633 11 11 Fax:206.533.4747. Email·admin@seat!leasbestostest com
CHAIN OF CUSTODY O Bu ~ Asbestos
01 Hour
KD & S Environmental
Q POllll (.;cunt 400 Q r<o1nt (.;ounl 1000
02 Hours o ::;ame aay (4 to 6 Hrs.)
PO Box 312. Montesano. I/VA 98563
QPoint Counl Gra•;ime!ric
~I Day
rel: 360.249.5540
O Ull1er ::;pee:!',')
0 Oa1s
Fax. 360.249 3475
Number of Samples .4. PO# .. . 18-5489 (Robinson) Round 1 .. Project Location ... 259 SW 15th St, Chehalis .....
Project Manager (Check one or more) :
0 Chris Williams s;am1 1 ?.it::l~ ds.n 1w :::Jrn D Dean W ilson 360.310 .0025 ;eare: :c r.::s~r.rro .. r:·emal enm
D Ka th ie Wilson 360.310.0023 k iJ1h io@i\d ~Cfh' £QM [3 Moraya Wilson ~;il r-rj1 F. ~k:t:Js ~"\ I $;~ [!Jt:tal'8 '
D Ryan C. Wi lson s.:n.c1s;:!5Ji<.r.. :u: 'ICQTi D Sandie Pennant 360.589 .8094 :!a"c1e 1Dkose:i : c:Qm
Q# CLIENT SAMPLE # SAMPLE DESCRIPTION LOCATION NOTES
1 259·1 Window Putty Ext.
2 259·2 House Paper Ext.
3 259·3 Composition Roof Ext. Roof
4 259-4 Cement Board Siding Ext.
5
6
7
8
9
10
11
1 2
13
14
15
16
17
18
19
20
Print Name ASi Jnature Company Date Time ~·· p Moraya Wilson . / H If I ( I ~ /I KO}- S Environmcnt\l l Ill I 12/14/2018 4: 00 AM t~c1111qu 1
Kendra Wynn ,1T L\/' '"'IM I.A/ KO & S Envi ronmontill 12/17/2018 11 :55Am UC l \l tHO I . ,,. XO & S En vi ronmental l'(CCCIVC «::I. I /~ n./1
,.--(L { I G1 I t- .- I .\ ... - Sealtla Asbestos Tos1
~na yz. u .. __, '/ r>,,, (- . .,,.~0.;:, lf . ~ S' rl · {_ .:-.... vn I'{ r. Scanle Asbes tos Test IL/ >._ ,-../ / </,'
l"(C:po1 <: ... Scalllt Asbo5 1CS To!it
-- . -. ·-- _ ,_.,, . _ ... , .. . .... . ... . ... • - .~ .. ..... .. .. ... . ... - · · - · - - · - -·... .. . ... . . .... . .,,, · ·- . , ,.. .. ....... . . .. .. ...... .. _.~, .... ,.. . .... ,.~ .... . .... _ ,,. .,.., j !J .. . ,.. ...... ... ..... .. .......... - · ... -·--·L. .. ., ..... , - ..... ·· - ·-·• .... ... ~ , .... ... ~ .... _. or 1mpl1ed r ctud.nQ w<?r:~r.:y :f l1tne ss f :i· a c :a rhC\l ar pur:;c .sr! an;j aifa.-,ty of :r,orchanlab· 1:y Sea:ita A~b-JstJs Tc~ I ~cc~p ts r.o :;gal re spor.$.t'ilil ; fer ire Duicosa ror ~·. :i,ch ire : i•cnt
Results reporting method 0 1-'none [!jEmall 01-'ICl\-up
o composi;e all wa!lcca rd sarcpies O I ext result to pnone Snndie & Mor'1YD
O P:um count % ~ r less asbe5tos :-ia;i:: \ 1 1 ~ f : · )
SEATILE ASBESTOS TEST Lyi1n"'OOd Laborator1. 19701 Scriber Laxe RC<>d. Suite 103, Lynnwood, WA 9S036. Toi: 425.673.9850. F:u. 425.673.9310, N\/LAP Lab Code: 200765-0
Disclaimer: This report musl nol IJe used l.ly lhff d 1onl to da1m product certification, approval. or endorsement by SealUe Asbes1os Test, LLC. NVLAP. NIST, or any agency ot the Feder.ii govemmenL
Ann.:
JobJll :
Samples RfJ'C'd :
Ms. Moraya Wilson 18-5489 (Robmson) Round 1 4
CfJen1~
Oare Analyted:
""'ioc' coc.: 259 SW 151.h St Chehalis
Lab ID Client Sample ID L•ye<
1 259-1 1
2 259-2 1
3 259-3 1
4 259-4 1
ANALYTICAL LABORATORY REPORT PLM by Method EPAl600/R-93/116
KO & S Environmental
201813822
12/20/2018 SamplH An.a.lyzC!d :
PO Box 312, Montesano, WA 98563
12/1912016
Description % Asbestos Fibers Non-fibrous Components % Non.asbestos Fibers
Off-white soft 2 Chrysotile Binder, Filler, Paint 2 j cellulose material with oain t Black asphaltic None Asphalt/binder, 64 Cellulose fibrous matrial detected Filler/binder Black asphaltic None Asphalt/binder, 21 Glass fibers material with sand detected Sand Tan cementltlous 16 Chrysotile Cement/binder, 5 Cellulose material with paint Paint
Page 1 of 1
SEATTLE ASBESTOS TEST, Lynnwood Lab. 19701 Scriber Lake Road. Suite 103. WP.. 98036. T:1:.:2s 673 9650. Fax-.125 673.98 10 Bellevue Lab: 12727 Northup Way. Suite 1, Bellevue. W A 98005, Tel:425 ea1 1111 , Fax:425.86 1. 1118
Analyzing Quality
seatUe Lab· 4500 9th Ave. NE. Suite 300. Seallle. WA 98105, Te1:206.633.111 1, Fax:206.633 4747. Email:[email protected]
CHAIN OF CUSTODY O Butk Asbes.tos
0 1 Mour
KO & S Environmental
O Point Count '100 O Point Count 1 ooo 02 Hours o~ame cay (4 to 6 Hrs.)
PO Box 312, Montesano, WA 98563
QPoint Count Gravimetric
('.I t Day
rel : 360.249.5540
o o lher (~pec1ty)
0 Days
Fax: 360.249.3475
Number of Samples .. . 16. PO# .. . 18-5489 (Round 2) .. Project Location .. .... 259 SW 15th St, Chehalis, WA 98321.. .. ..
Project Manager (Check one or more):
Q#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
O Chr is Will iams
O Kathie Wilson
O Ryan C. W ilson
CLIENT SAMPLE#
259-1
259-2
259-3
259-4
259-5
259-6
259-7
259-8
259-9
259-10
259-11
259-12
259-13
259-14
259-15
360.310.0023
sandie@kdsNW CQm
sar,d • P~kdsenv co:n
O Dean W ilson
~ Moraya Wilson
O Sandie Pennant
SAMPLE DESCRIPTION
Sheet vinyl on tile on wood
Tile under sheet v inyl on wood
Backsplash on sheet vinyl on wood
Sheet vinyl on wood
Rockwool insulation
Ceiling Tile Staple in place
GWB x1 wall
Ceram ic tile grout
Flooring under ceramic tile (from kit)
Ceiling Tile Staple in place
T ile under laminate wood on wood
Sheet vinyl grey on wood
GWB Smooth
Ceiling tile w/floral pattern
Ski m coat on GWB
360.310.0025 dean1lilkdv nvq omen•al ccm
360.589.1:!094 s:1n11'e@kc•onv ccm
LOCATION NOTES
Kit Floor
Kit Floor
Kit Wall
Util Floor
Util Ceiling
Kit Ceil ing
Kit Wall
L.R Entry Floor
L.R Entry Floor
L.R. Ceiling
Hall Floor
Bthrm. Floor
Bthrm. WIC
Bdrm. 1 Closet Ceiling
Bdrm. 1 & Hall Walls
16 259-16 GWB w/sklm coat same as hall & bdrm. 1 M. Bdrm. Walls
17
18
19
20
Prin t Name I Signature Company Date Time ::1am ... .! ..
Moraya Wilson ,£ IA Vi." KO & S En vi ronmental 12119/2019 11 :30AM r..111111.iUI
Kendra Wynn l'.li.V ' n If HI/ / \ JSO a.. S Envlronmontil l 12/19/2019 2:04PM · "-·" ... ....... «!re \J 1\ \/ - KO & S Environmcnlal rl ·
• Cl\IU
I f~., .-' I \j _ i.-- ( " . ___ ,,___ ~~ u Seattle A' beslos Test hh·l!v ... is': 2 "L '""".,,rd! ,... .
(. ~,...,,,,,.. •h Seattle Asbes tos Test '" ...... ~, ....-r>/ t/ ,,. 'I'.: ; )_/ z_J I . ) ' r; ii
Cpw'" SeatUa Asbos los Test ...
... ... .... ,.,. .,.,,_ .... ,., .. .... .... ...... _. ""' .. '- .......... .......... .... ...... -· ,.. ...... ........... , ·-'" -· ·- ...... ,,_.., .............. ... ... ... ...... ~ , ... .. ,,.. ... , ... ... ............... ................ ., _._ .. .. ...... ...... - ....... ..... ~ -··r ••• .. . .. ........ ...... -"t"" _ ....... ... or •O':J)lle.:1, 1nca.r.:1~9 wan <J'lty oi filno.u fe r :i par t icL. lur p:vr:x::se a"IC worro.r.:y of merc~an1r. ::: i!1 1 y Sea1:lc As::~s to 5 Tcs1 :lCC<?PIS r~ 1egu1re-s0<:.nn1c 11i1y1or tho p!..irc:ose- !or wr cri tr.J" c:!icn!
Results reporting method· O t-none oi-ax ~ Em a il Ot-1cK-up
Sandie & Moraya 0 Cornpo~ 11e all wallboar j !>ar.iples O I c.xt rCJUll IO pnone O Point counl .... '1.:i OI lass ast~stos Paye ( 1 1 ol( 1
SEATILE ASBESTOS TEST Lynnwood L,;borutorr: t 9701 Scrib~r Lake Roall . Sui10 103. Lynnwcon. W I\ 980J6. Tai· •25 67J.9e50, Fa>e: 425.673.98 10. NVtA P L..>b Cede: ~0076S-O
Disclaimer. This ropo<1 musl net be used by lhe ciienl 10 d aim product certlficaUon, approval. or ondorsemen1 by SealUe Asbestos T~sl , LLC, NVLAP, N l~T. or any agency or 1110 FederaJ government.
ANALYTICAL LABORATORY REPORT PLM by Method EPA/GOOIR-93/116
cuont KD & S Environmental
B>t<hll: 201813840
Ann.: Ms. Moraya Wilson
J ob#; 18-5489 (Round 2)
S.1mpla:i Re~'d : 16 D•le An•lyud: 12/21 /2018
259 W 15 th S t Cheha lis, WA P<ojt<t Loe.: 98321
Lab ID Clienr Sampie ID Layer
1
1 259-1 2
3
1
2 259-2 2
1 3 259-3
2
1
4 259-4 2
3
1
5 259-5 2
6 259-6 1
7 259-7 1
1
8 259-8 2
3
1
9 259-9 2
3
Descnplicn
Off-while sheet vinyl Gray fibrous material with mastic Brown brittle material
Tan sheet vinyl
Black asphaltic fibrous material with mastic Black asphaltic fibrous material with mastic and paint Brown fibrous material with oaint Beige/tan sheet vinyl Gray fibrous material with mastic Black asphaltic fibrous material Gray fibrous material Black fibrous material with glass beads Brown fibrous material with paint Off-white chalky material with paint and oaoer
Red/white ceramic
Black sandy/brittle material Gray sandy/brittle material
Yellow mastic
Tan sheet vinyl
Black asphaltic fibrous material with mastic
,.,
I
Addross: PO Box 312. Montesano. WA 98563 Oato R.caNod: 12120/201 8
Sanip~ An.l!y:ted: 16
Rov.ewcd by; Sl«!ve (Fanya:>) Zhang. ?msicent
Asbes104 Fibers Non-librous Componenls % Non-asbestas Fibers
None Vinyl/binder None detected detected
None Binder/filler. detected Mastic/binder 64 Cellulose
None Binder, Filler 2 Cellulose
detected None Vinyl/binder None detected detected
None Asphalt/binder, detected Mastic/binder. Filler
70 Cellulose
Asphalt/binder, None Mastic/binder. 66 Cellulose detected Filler, Paint
None Filler, Paint 75 Cellulose detected None
Vinyl/binder None detected detected
None Binder/filler, Cellulose, Glass detected Mastic/binder 61 fibers
None AsphaiUbinder. 63 Cellulose detected Fil ler/binder None Filler, Fine particles 187 Cellulose detected
None Fi ller. Fine
detected particles, Glass 90 Mineral wool beads
None Filler, Paint 85 Cellulose detected
None Binder/fi ller.
detected Gypsum/binder. 34 Celiulose Pa int
None Ceramic/binder None detected
detected None
Sand, Filler, Binder 3 Cellulose detected None
Sand, Filler, Binder 3 Cellulose detected None
Mastic/binder 2 Cellulose detected None
Vinyl/binder None detected detected
None AsphalVbinder, detected Mastic/binder, Fi ller 69 Cellulose
Page 1of 2
SEATTLE ASBESTOS TEST Lynnwood Laboratory: 19701 S0'11:erlako Road, Suite 103, Lynnwood, WI\ S8036, Tel. 42.5.673.9850, Fax: 425.673.9810. NVLAP Lab Coda: 200768·0
Disclaimer. lnls raper: rt-.ust not be used by the cfont le daim product certification, approval, or endorsement by SealUe Awestos Test. LLC. NVlAP. NIST, or any agency of L'le Federal govemment.
ANALYTICAL LABORATORY REPORT PLM by Method EPA/600/R·93/116
Ann.: Ms. Moraya Wilson Jobi: 18-5489 (Round 2)
Semple• R0<'d: 16
Cliont. KD & S Environmental Bmh.e: 201813840
Oate/\nolyud: 12/21 /2018
259 \/'/ 15th SI Chehalis. WA "'*'' Loe.: 98321
Lab ID Client S811ple ID Layar Desmption
9 259-9 4 Brown wood debris
10 259-10 1 Brown fibrous material with oaint
1 Gray brittle material
2 Trace clear mastic
1·1 259-11 3 Tan sheet vinyl
Black asphaltic 4 fibrous material
with mastic
5 Brown brittle material
1 Gray sheet vinyl
12 259-1 2 Gray fibrous 2 material with
mastic
1 White powdery material with oaint
13 259-13 White chalky 2 material with oaoer
14 259-14 1 Gray fibrous material with oain t Trace whi te
1 powdery material
15 259-15 with paint and oaoer
2 White chalky material with oaoer Trace white
1 powdery material
16 259-16 with paint and
loaper
2 White chalky material with oaoer
%
Add'"": PO Box 312, Montesano, WA 98563 O>to Rocweo: 12120/2018
Sempl., An olyzed: 16
Asbestos Fibers Non-fibrous Components " ,, Non-asbestos Fbels
None Wood debris 5 Cellulose
detected None Filler, Paint 92 Cellulose detected None Binder, Filler 3 Cellulose detected None Mastic/binder 2 Cellulose detected None Vinyl/binder None detected detected
None AsphalVbinder, 65 Cellulose
detected Mastic/binder, Filler
None Binder, Filler 7 Cellulose
detected None
Vinyl/binder None detected detected
None Binder/filler, 63 Cellulose detected Mastic/binder
None detected Binder. Filler. Paint 3 Cellulose
None Binder/tiller, 24 Cellulose, Glass detected Gvosum/binder fibers None Paint, Filler, Perli te 67 Cellulose detected
None detected Bimler, Fi ll er, Paim 21 Cellulose
None Binder/fil ler, 28 Cellulose, Glass detected Gvosum/binder fibers
None deiectcd Binder. Filler. Paint 20 Cellulose
None Binderifi ller, 22 Cellulose, Glass detected Gvosum/binder fibers
Page 2 of2
PHOTOS:
Kitchen Backsplash on Sheet Vinyl NEGATIV E Utility Room Wood Framed Window w//\,hcstos Putty
December 19. 2018 Job # 18-5489
Bedroom I NEGAT IV E Bedroom 2 NEGATIVE
December 19, 20 18 Job fl 18-5489
Bdrm. 1
Closet
Closet
~th rm .
• L.R.
Derrick Robinson
259 SW 15th Street
Chehalis, WA 98321
• M. Bdrm.
Hall Util
Kit
)IC <31f Window w/ Asbestos Putty
l ,650sf CAB Siding
Closet
.........__
ack Door
(/./ / _/J 5v { ~~?~rr& y< ~;-t'?~r;r~;,/?
NOW Environmental Services or Federal Way. Washington c.:crtiti es to all that
Moraya Wilson 011./01111wy _5'·11 20 /8 !wsfi1f/ill£'cl the r eq11ire111e111s o/'
AHERA BlJILDING INSPECTOR & PROJECT
DESIGNER REFRESHER I la ~ utto::ndcd and satisfactorily completed all n.;q11in.:1n.:11ts to be accredited as an
l 11sp1.:~Lor i11 ac wrdance wi th the Toxic Substance' Contro l ;\ ct Title (Section 206)
and ~() CTR 7(1 :: .\ II r1.:qttir1.:111c11b h> th· .1ccr1.:ui1ation ;1s :in Al II· R,\ liui ld ing lnsp<:clor in ;:icwru am:c 11 ith the