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HomeMy WebLinkAbout16512 51ST AVE NE_BLD6668_2026 CITY OF ARLINGTON 18204 59th Avenue NE,Arlington,WA 98223 INSPECTIONS:360-403-3417-Permit Center:360-403-3551 BUILDING PERMIT Er 16512 51ST AVE NE Permit#:6668 Parcel#:31052800101000 PERMIT EXPIRES 180 DAYS AFTER DATE OF ISSUANCE. Scope of Work:Demolition of existing house(1,155 sf)and shed(293 sf). Valuation:.00 i APPLICANT CONTRACTOR 1 SINGH H/LALLI I/DHILLON D/S/R K Barghausen Consulting Engineers PENNON CONSTRUCTION 8520 79TH AVE NE 18215 72nd Avenue South 14500 Greenwood Ave N Ste A MARYSVILLE,WA 98270 Kent Shoreline,Wa 98133 4256203987 206-418-0235 UC:601-994-757 EXP:07/31/2026 LIC:PENNOCC013Q3 EXP:06/03/2026 MECHANICAL CONTRACTOR F PLUMBING CONTRACTOR LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: DEMOLITION CODE YEAR: 2021 STORIES: 1 CONST.TYPE: VB DWELLING UNITS: OCC GROUP: R-3;Residential BUILDINGS: OCC LOAD: PERMIT APPROVAL . The issuance or granting of this permit shall not be construed to be a permit for,or approval of,any violation of this Code or any other ordinance or order of the City,of any state or federal law,or of any order,proclamation,guidance advice or decision of the Governor of this State.To the extent the issuance or granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or federal law,or order,proclamation,guidance advice or decision of the Governor of this State,this permit shall not authorize such work and shall not be valid.The building official is authorized to prevent occupancy or use of a structure where in violation of this Code,any other City ordinances of this jurisdiction or any other ordinance or executive order of the City,or of any state or federal law,or of any order,proclamation,guidance advice or decision of the Governor.The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,inaccurate or incomplete information,or in violation of any City ordinance,regulation or order,state or federal law,or any order,proclamation,guidance or decision of the Governor. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.IBC110/IRC110. SALES TAX NOTICE: Sales tax relating to construction and construction materials in the City of Arington must be reported on your sales tax return form and coded City of Arlington#3101. gV, 9/5/2025 � -�� 09/05/2025 4'llic Si e Date Building Official Date - CONDITIONS - Utilities shall be disconnected prior to demolition.Call for final inspection. The property owner shall ensure that the construction project complies with all applicable zoning codes and regulations.The property owner shall also ensure that the construction project does not cause any adverse impact on the surrounding environment or community.The property owner shall be responsible for obtaining all necessary permits and approvals from the relevant authorities before commencing construction.The property owner shall ensure that the construction project complies with all applicable design review requirements. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY.ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS, MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 09/05/2025 Web Only-Demolition $100.00 09/05/2025 Credit Card Service $3.00 Total Due: $103.00 Total Payment: S103.00 Balance Due: $0.00 CALL FOR INSPECTIONS Call by 3:30 pm for next day inspection,allow 48 hours for Fire Inspections When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon INSPECTION INFORMATION I Pass/Fail Docusign Envelope ID:536A45F1-A3B6-40AB-90B7-1 EDBFCF6352D BUILDING DEMOLITION APPLICATION • Community and Economic Development City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone(360) 403-3551 QTY REQUIRED DOCUMENTS x❑ 1 City of Arlington Building Demolition Application x❑ 2 Site Plan showing the location of all structure(s); identify which one will be removed x❑ 1 A copy of the Asbestos/Demolition Notification from the Puget Sound Clean Air Agency x❑ 1 Asbestos Survey Report ❑ 1 Abatement Report, completed by an approved agency; if applicable Type of Permit: X❑ Commercial ❑ Residential ❑ Industrial TBD 51st Ave NE NA Property Address: Project Valuation: 31052800101700&31052800101000 Lot#: Parcel ID No.: Subdivision: Primary Contact: x❑ Owner x❑ Applicant ❑ Contractor Owner Name: RG Northsound Logistics LLC Office No.: 206-203-8792 jharlow@rockefellergroup.com Email Address: Cell No.: Mailing Address: City: State: zip:400 University Street STE 300 Seattle WA 98101 Applicant Name: Barghausen Consulting Engineers Office No.: 425-251-6222 pbodily@barghausen.com Email Address: Cell No.: 18215 72nd Ave S Kent WA 98032 Mailing Address: City: State: zip: Contractor Name: Pennon Construction Company, Inc Office No.: 206-418-0235 martinm@pennonconstruction.com Email Address: Cell No.: Mailing Address: 14500 Greenwood Avenue N, STE A City: Shoreline State: WA Zip: 98133 L&I Contractor License Number: PENNOCC013Q3 Expiration Date: 06/03/2026 1448 2 Building Area (Sq. Ft.): No. of Floors: No. of Buildings: Scope of Work: Demolition of an existing house(1,155 square feet)and a shed (293 square feet)for the development of a logistics center that features a 186,873 square foot warehouse building. I hereby certify that I am the 0 Owner, ❑ Applicant, ❑ Contractor, and authorized to sign this application and that the above information is correct and construction on, and the occupancy and the use of the above-described property will be in accordance with the laws,rules and regulation of the State of Washington,and the City of Arlington. Signed by: James Harlow 06.24.2025 Signature Print Name Date SAVE PRINT REV03.2022 JK Demolition & Environmental Testing 1251 Alpine Place Enumclaw WA, 98022 Pre-Demolition Hazardous Material Inspection (ACM) 06/16/2025 Prepared for: Arlington Project 16512 51 st Ave N E PURPOSE OF SURVEY A pre-demolition hazardous material inspection is intended to investigate a structure for potential ACM, sample and provide accurate results to the customer in accordance with 40 CFR 763.86,the EPA regulations for Asbestos Hazard Emergency Response Act(AHERA). Sample test results will be displayed in the survey. Depending on the material sampled,there may be multiple layers within each sample.These layers you will find broken out within each sample on the results report. Each layer of the sample is prepared onto individual slides to be analyzed to provide the most accurate result. DEFINITION OF ASBESTOS Class I: Class II: Class III: Class IV:The most potentially hazardous class of asbestos jobs.This work involves the removal of asbestos containing thermal system insulation and sprayed-on or troweled-on surfacing materials. Employers must presume that thermal system insulation and surfacing material found in pre-1981 construction is ACM.That presumption, however, is rebuttable. If you believe that the surfacing material or thermal system insulation is not ACM,the OSHA standard specifies the means that you must use to rebut that presumption. Thermal system insulation includes ACM applied to pipes, boilers,tanks, ducts, or other structural components to prevent heat loss or gain. Surfacing materials include decorative plaster on ceilings and walls; acoustical materials on decking,walls, and ceilings; and fireproofing on structural members.This work includes the removal of other types of ACM that are not thermal system insulation such as resilient flooring and roofing materials. Examples of Class II work include removal of asbestos containing floor or ceiling tiles, siding, roofing, or transite panels.This asbestos work includes repair and maintenance operations where ACM or presumed ACM (PACM) are disturbed.This work includes custodial activities where employees clean up asbestos- containing waste and debris produced by construction, maintenance, or repair activities.This work involves cleaning dust contaminated surfaces,vacuuming contaminated carpets, mopping floors, and cleaning up ACM or PACM from thermal system insulation or surfacing material. (Asbestos Standard for the Construction Industry, OSHA 3096 2002(Revised)) 'Highlighted asbestos class work are what applies to the removal of the materials found to contain ACM in this survey. If no class is highlighted, no asbestos was detected in this survey. Friability: Friable ACM is any material containing more than one percent asbestos(as determined by Polarized Light Microscopy)that, when dry, may be crumbled, pulverized, or reduced to powder by hand pressure. Non friable ACM is any material containing more than one percent asbestos (as determined by Polarized Light Microscopy)that,when dry, cannot be crumbled, pulverized, or reduced to powder by hand pressure. Under the Asbestos NESHAP, non-friable ACM is divided into two categories. Category I non-friable ACM are asbestos containing resilient floor coverings (commonly known as vinyl asbestos tile(VAT)), asphalt roofing products, packaging and gaskets.These materials rarely become friable.All other non-friable ACM are considered category 11 non-friable ACM. LIMITATIONS There are limitations to any one survey. First, surveys are designed to have the inspector take samples at random when following the method.This is important to understand because it is impossible to sample every square inch of a structure. Areas that are not addressed in this survey must be considered homogeneous materials, unless requested in an additional survey. Excluded from the survey are toilets, hot water tanks, Light fixtures, HVAC units, and all other appliances that may still be present in the building at the time of the survey but will be removed before the demolition of the structure. Other Limitations may be when the inspector cannot access areas during the survey. This could be any multitude of reasons. For example, in cases where destructive sampling is not allowed and the inspector is unable to sample beneath many layers of flooring, or behind walls, structures or tight spaces. This report is in request and for exclusive use of the client and their interested parties. The inspection and report follow the general guidance recommended byAHERA, and no any other warranty, expressed or implied, is made. Any unauthorized use or use of this report beyond its scope is strictly prohibited.Washington Asbestos Testing LLC, its inspectors and its analysts hold no liability. If any suspect materials are found that were not found during the initial survey inspection, please contact us IMMEDIATELY so that we can return to the job site and test the material. Any untested suspect materials must be considered asbestos-containing unless proven otherwise. ADDITIONAL INFORMATION Health Risks:Asbestos is a known carcinogen that is highly regulated in terms of proper removal and disposal. Licensed asbestos contractors and certified asbestos workers, trained in the use of personnel protective equipment and engineering controls, are required if the matrerials will be disturbed or removed. PSCAA Notification for Demolition: The Puget Sound Clean Air Agency(PSCAA, Regulation III, Article 4) requires notification for building demolition. For a notification form, regulations, and contact information, go online at www.pscleanair.org. Demolition notification can be completed and fees can be paid online. The 10 day waiting period is waived if the notification is filed as an emergency. Point Count Analysis:This type of analysis includes testing of bulk building materials for asbestos by performing 400 point counts (EPA 600/R- 93/116). This is a more detailed method for estimating asbestos in a building material and is more accurate than a visual estimate.While the visual estimation of asbestos in a building material works well for most samples, a point count can be very important when Low asbestos concentration in a building material is detected. This methodology, which has a detection limit of 0.25%, increases the accuracy and precision of the asbestos concentration determined in a sample and is commonly used to complywith NESHAP regulations requirement of performing point counting on samples with low concentrations of asbestos. STATEMENT OF COMPLIANCE In accordance with W.A.C. 296-62-00721 and PSCAA Regulation III, Article 4, JK Demolition and Environmental Testing LLC performed an employees or contract personnel encounter any suspect ACM (asbestos containing materials) it is their responsibility to: Contact a representative of the owner or the owner themselves. Consult the inspection report (survey)to determine whether or not the suspect material contains asbestos. If the suspect material was not sampled and analyzed in the inspection report (survey), then the material must be presumed to contain asbestos until proven otherwise by sampling the new material and undergoing PLM analysis. Make sure to notify all employees and contractors working on this project of the location and type of materials found to contain asbestos. Summery of ACM Findings: ACM material was found in 4 locations throughout the home. Asbestos was found in the joint compound and texture of the drywall. Living Room (Texture/Joint Compound) 3% -Approx: 500 square feet Bedroom 1 (Texture/Joint Compound) 2% -Approx: 484 square feet Hallway(Texture/Joint Compound) 2% -Approx: 115 square feet Bathroom (Texture/Joint Compund) 2% -Approx: 250 square feet Batch#: WAT fob use onN CHAIN OF CUSTODY Client/Company Name: s ¢,tFso E . N I It cVIvtifyt-T;1.i (tC—S k Address: L L-5 1 Pt iE LL City EA Act Ax'`J State 4A- /5' ZIP l`0Z-2 Office Phone M Project Manager: J24!,A-3n Email: t�cy�'1���1L (� c�IY1['i�•�`'�I/� Project Manager Phone#: �c -(gyy—U§1`f Project Name: Jq0Ll1J,,-TL 4 P2 e,e i Project/PO Number: Project Address:ib1 12 5IS+ A y NG city 4Rj-4r1&-7u•'1 State t-)A ZIP RH'933 Asbestos Lead Mold Sample Condition PLM Bulk Asbestos Paint Chip Bulk Good Lift D PLM Tape Lift L—Jwlpe Tapeamaged PLM 400 Point Count Swab Severe Damage PLM 10DO Point Count seporote form reci—ed f—irsamples Turnaround Time::_,(J)titL)a Number of Samples: SEQ# Sample ID/Location Sample Description SEQ# Sample ID/Location Sample Description 1 ckL Apo'2 G is.v:Ne- 16 2 gQiG wI A pcw Aa -V-Xvx 17 3 LTc-I, 1 k�'J'VLk, 18 4 nn Mtuttt_�1t L.'vCl-\Yl-C-- 19 S 20 6 LtU\t\Cr �„a+� L 21 7 cY 22 8 vrQcCi 23 9 1 ►L! & v 24 10 1 Al 4t t,vnc_r_ 25 11 Wit. li Ae.:,.._ 26 12 �,� .Q- 27 13 28 14 29 15 30 Print Name Signature Company Name Date Time Sampled C�\ Zn Relinquished Delivered Received �� WAT Analyzed WAT _ Reported WAT 5 How would you like to be notified? Email Phone Washington Asbestos Testme LLC guarantees the test results proyided are of a preNsioa normal-th the type of methods recogmted—best.,analysn Wash.ngton Asbestos Testing LLC Mcepts no legal responsibility for the purpose for which the client uses he test results-By signing this Chain of Custody form the client agrees to reheye Washngton Asbestos Testing LLC of any and all liability that may arise from the teft results. 11200 Kirkland Way Ste.340A,Kirkland,WA 98033 • (425)658-7286 12811 8th Ave W Ste.8101,Everett,WA 98204 • (425)374-8706 15 S Oregon Ave Ste.204,Tacoma,WA 98409 • (253)301-1852 watestingllc.com Washington Asbestos Testing LLC Batch#: WATK2503991 AT 11200 Kirkland Way Ste.340A,Kirkland,WA 98033 (425)658-7286 NVLAP Lab Code 600040-0 Wwatestingllc.com Asbestos Analysis of Bulk Materials by App.E to Sub.E of 40 CFR Part 763 and EPA 600/R-93/116 Methods Using Polarized Light Microscopy Attn: Jeff Renati 1K Demo&Environmental Date Received:6/12/2025 IL2515 Alpine PI.,Enumclaw,WA 98022 Date Analyzed:6/13/2025 Samples Received:12 Project:Arlington Project Samples Analyzed: 12 16512 51st Ave NE,Arlington WA 98223 Analyzed By -__ Approved By_ Alexis Heath Approved Signatory(If Necessary) SEQ# SAMPLE ID LAYER DESCRIPTION % NON-ASBESTOS FIBERS % NON-FIBROUS % ASBESTOS TYPE 1 Back Window I White/Gray elastic material 2% Cellulose 98% Non-fibrous None Detected (Other) 2 Back Window 1 White/Gray elastic material 2% Cellulose 98% Non-fibrous None Detected (Other) 3 Kitchen 1 White compact powdery material with 25% Glass,Cellulose 75% Non fibrous None Detected woven mesh and paint (Other) 1 Beige sheet vinyl None Detected 100% Non-fibrous None Detected (Other) 2 Gray fibrous material 65% Cellulose 35% Non-fibrous None Detected (Other) 3 Yellow mastic 2% Cellulose 98% Non fibrous None Detected 4 Kitchen (Other) 4 Gray sheet vinyl None Detected 100% Non-fibrous None Detected (Other) 5 Gray/Green fibrous material 65% Cellulose 35% Non-fibrous None Detected (Other) 6 Trace yellow/brown mastic 2% Cellulose 98% Non-fibrous(Other) None Detected Trace white compact powdery texture with Non-fibrous 1 paint 3% Cellulose 97% (Other) None Detected 2 Brown paper with paint 75% Cellulose 25% Non-fibrous None Detected (Other) 5 Rear Entrance i Clear mastic 2% Lellulose 98% N(Other)then) us None Detected 4 Gray/Brown fibrous material 65% Cellulose 35% Non fibrous None Detected (Other) 1 Trace white compact powdery texture with 3% Cellulose 97% Non-fibrous None Detected paint (Other) 6 Living Room 2 Pink compact powdery texture with paint 3% Cellulose 94% Non-fibrous 3% Chrysotile (Other) 3 Brown fibrous material 95% Cellulose 15% Non fibrous None Detected (Other) Trace white compact powdery texture with Non-fibrous 1 3% Cellulose 97% None Detected 7 Livmg/Red paint (Other) 2 Brown fibrous material 85% Cellulose 15% Non fibrous None Detected (Other) 1 Tan compact powdery texture with paint 3% Cellulose 95% Non-fibrous 2% Chrysotile (Other) 8 Bedroom n1 2 Tan compact powdery joint compound with 35% Cellulose 63% Non fibrous 2% Chrysotile paper (Other) 3 White chalky material with paper 20% Cellulose 90% Non-fibrous(Other) None Detected The results given relate only to the items tested.The results apply to the sample(s)as received. Reports must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,or any agency of the Federal Government. Page 1 of 2 Washington Asbestos Testing LLC Batch#: WATK25O3991 AT 11200 Kirkland Way Ste.34OA,Kirkland,WA 98033 W (425)658-7286 NVLAP Lab Code 600040-C rgrn.p,.wxr.r�uc watestingllc.com Asbestos Analysis of Bulk Materials by App.E to Sub.E of 40 CFR Part 763 and EPA 6OO/R-93/116 Methods Using Polarized Light Microscopy Attn: Jeff Renatl JK Demo&Environmental Date Received:6/12/2025 12515 Alpine PI.,Enumclaw,WA 98022 Date Analyzed:6/13/2025 Samples Received: 12 Project: Arlington Project Samples Analyzed: 12 16512 51st Ave NE,Arlington WA 98223 — Analyzed By Approved By Alexis Heath Approved Signatory(n Necessary) SEQft SAMPLE ID LAVER DESCRIPTION % NON-ASBESTOS FIBERS % NON-FIBROUS % ASBESTOS TYPE 1 Tan compact powdery texture with paint 3% Cellulose 95% Non-fibrous 2% Chrysotile (Other) 9 Hallway 2 Tan compact powdery joint compound with 35% Cellulose 63% Non-fibrous 2% Chrysotile paper (Other) 3 White chalky material with paper 20% Cellulose 80% Non-fibrous None Detected (Other) 10 Bedroom 42 1 Brown fibrous material with paint 85% Cellulose 15% Non-fibrous None Detected (Other) 1 Tan compact powdery powdery texture with paint 3% Cellulose 95% 2% Chrysotile (Other) 11 Bath 2 Tan compact powdery joint compound with 35% Cellulose 63% Non-fibrous 2% Chrysotile paper (other) 3 White chalky material with paper 20% Cellulose 80% Non-fibrous None Detected (Other) 1 Gray vinyl covering None Detected 100% Non-fibrous None Detected (Other) 2 Black vinyl tile 2% Cellulose 98% Non-fibrous None Detected (Other) 3 Clear mastic 2% Cellulose 98% Non-fibrous None Detected 12 Bath (Other) 4 Beige vinyl covering None Detected 100% Non-fibrous None Detected (Other) Grey vinyl rile L''Yb Cellulose yRy Non-fibrous None Dete—d jOther 6 Clear mastic 2% Cellulose 98% Non-fibrous None Detected (Other; The results given relate only to the items tested.The results apply to the sample(s)as received. Reports must not be used by the client to claim product certification,approval,or endorsement by NVLAP,MIST,or any agency of the Federal Government. Page 2 of 2 Certificate of Completion This is to certify that Jeffrey Be Renati has satisfactorily completed 4 hours of online refresher training as an AHERA Building Inspector to comply with the training requirements of TSCA Title II, 40 CFR 763 (AHERA) EPA Provider# 1085 196648 Certificate Number Mar 5, 2025 Expires in 1 year. Instructor:David Welch Date(s)of Training Exam Score:N/A �r •Fa<ilitios (if applicable) r rerracon 'Environmental •Geotonm ntl Explom 0,s •Materials ... •N TRAINING-FORMERLY ARGUS PACIFIC 2190564TH AVE W,SUITE 100/MOUNTLAKE TERRACE, • 98 s. .. ®- DEMOLITION NOTES: DEMO PLAN 1. REMOVE EXISTING GRAVEL. DISPOSE OF OFF-SITE. DEMO LEGEND: N '° 21.PROTECT EXISTING STORM STRUCTURE TO REMAIN. FOR o e 2. CLEAR AND GRUB SITE. '�J/J%/J/J 3 W W N 22.PROTECT EXISTING OVERHEAD POWER LINE TO REMAIN. REFER TO NORTHSOUND LOGISTICS CENTER ASPHALT TO BE REMOVED 3. REMOVE EXISTING TREE (TYP.). DISPOSE OF OFF-SITE. OVERHEAD POWER PROTECTION NOTE THIS SHEET. _ 2 I--- � 00 4. DEMOLISH EXISTING BUILDING. DISPOSE OF OFF-SITE. 23.EXISTING POWER POLE TO BE RELOCATED. COORDINATE WITH SEC. 28,TWP. 31 N., RGE 5 E., W. M. W SNOHOMISH COUNTY PUD PRIOR TO CONSTRUCTION. REFER TO .yT,F+=�'+.'i',,,1 GRAVEL TO BE REMOVED U j 5. DEMOLISH EXISTING SHED. DISPOSE OF OFF-SITE. SEPARATE SNOHOMISH COUNTY PUD FOR FINAL LOCATION. CITY OF ARLINGTON, SNOHOMISH COUNTY, WASHINGTON ;`;•'_; ,L�,w; :. _, Co 6. REMOVE EXISTING FENCE POST (TYP.). DISPOSE OF OFF-SITE. 24.PROTECT EXISTING FIRE HYDRANT TO REMAIN. U DEMOLITION NOTES: CURB TO BE REMOVED k z z 7. REMOVE EXISTING FENCE. DISPOSE OF OFF-SITE. 25.REMOVE EXISTING BLOW OFF VALVE TO FACILITATE WATER MAIN CONSTRUCTION SEQUENCE: 's Q p EXTENSION INSTALLATION. DISPOSE OF OFFSITE. 1. ALL PAVEMENTS, SLABS, GROUND COVER, UTILITIES, --- SAWCUT LINE u, J POLE. COORDINATE WITH SNOHOMISH 1. BEFORE ANY CONSTRUCTION OR DEVELOPMENT ACTIVITY,A ETC., INSIDE LI LIMITS OF DISTURBANCE MITS OF DISTURBANCE SHALL BE B. REMOVE EXISTING POWER P COUNTY PUD FOR SCOPE POLE REMOVAL. DISPOSE OF 26.PROTECT EXISTING TREE TO REMAIN. REFER TO TREE PROTECTION PRECONSTRUCTION MEETING MUST BE HELD BETWEEN THE REMOVED UNLESS OF SHOWN ON THE PLANS. j W W 0 OFF-SITE. NOTE THIS SHEET. APPLICANT,APPLICANT'S CONSTRUCTION REPRESENTATIVE,AND Cltt OF ARLINGTON. 2. CONTRACTOR SHALL CONTACT AND COORDINATE WITH 0 25' S0' 100' '�" � J 9. REMOVE EXISTING OVERHEAD POWER LINE. COORDINATE WITH 27.PROTECT EXISTING JUNCTION BOX TO REMAIN. THE VARIOUS UTILITY COMPANIES ON REQUESTING 2. POTHOLE / UTILITY LOCATES. Q Q Q SNOHOMISH COUNTY PUD PRIOR TO CONSTRUCTION. DISPOSE OF DISCONNECTIONS, REMOVALS AND/OR RELOCATION OF OFF-SITE. 28.PROTECT EXISTING LOT LIGHT TO REMAIN. 3. FLAG CLEARING LIMITS. EXISTING SERVICE. DUST CONTROL NOTES: SCALE:'I 4. INSTALL STABILIZED CONSTRUCTION ENTRANCE. CONTRACTOR SHALL DETERMINE THE APPLICABILITY OF DUST 4 4 $ LU 10. REMOVE EXISTING POWER METER. COORDINATE WITH PURVEYOR 29.PROTECT EXISTING GRAVEL ROAD TO REMAIN. 3. CONTRACTOR SHALL ENSURE THAT ALL NECESSARY CONTROL AND APPLY APPROPRIATE DUST CONTROL MEASURES AS 9: 3 d 0 PRIOR TO CONSTRUCTION. DISPOSE OF OFF-SITE. 5. INSTALL FILTER FABRIC FENCE AS INDICATED ON PLAN. PERMITS AND CONSTRUCTION APPROVALS HAVE BEEN NEEDED. 4 g 8 U) > 30.PROTECT EXISTING SEWER PIPE TO REMAIN. OBTAINED PRIOR TO COMMENCING WORK. = Q INSTALL OFFSITE CATCH BASIN PROTECTION. 11. REMOVE EXISTING GROUNDWATER MONITORING WELL. REFER TO 6. 1. WATER ALL ACTIVE CONSTRUCTION AREAS AT LEAST TWICE o 0 31.PROTECT EXISTING SEWER STRUCTURE TO REMAIN. 4. CONTRACTOR SHALL REPLACE ALL EXISTING CURB, GROUNDWATER MONITORING WELL NOTE THIS SHEET. DISPOSE OF 7. CLEAR AND GRUB AREAS OF THE SITE TO BE ROUGH GRADED DAILY. Cn OFF-SITE. OR FILLED. PAVEMENT AND/OR LANDSCAPING DAMAGED AS A ry O r 32.PROTECT EXISTING TELECOMMUNICATION LINE TO REMAIN. RESULT OF CONSTRUCTION ACTIVITY. 2. WATER OR COVER STOCKPILES OF DEBRIS, SOIL, SAND OR L0 12. REMOVE EXISTING LOT LIGHT. DISPOSE OF OFF-SITE. B. CLEAN STORM DRAINAGE SYSTEM, ON AND OFF SITE, OF ALL OTHER MATERIALS THAT CAN BE BLOWN BY THE WIND. \ 8 z 33.REMOVE EXISTING BARBED WIRE FENCE. DISPOSE OF OFF-SITE. SEDIMENT AND DEBRIS. 5. CONTRACTOR SHALL, PRIOR TO CONSTRUCTION OR m g1 13. REMOVE EXISTING GATE. DISPOSE OF OFF-SITE. REMOVAL OF IMPROVEMENTS, FIELD VERIFY AND 3. COVER ALL TRUCKS HAULING SOIL, SAND,AND OTHER LOOSE r 34.REMOVE EXISTING SOLAR CAMERA. DISPOSE OF OFF-SITE. 9 REMOVE TEMPORARY EROSION CONTROL FACILITIES WHEN SITE CONFIRM LIMITS OF DEMOLITION AS WELL AS EXISTING n + ' ~ IS COMPLETELY STABILIZED. MATERIALS OR REQUIRE ALL TRUCKS TO MAINTAIN AT LEAST z 14. REMOVE EXISTING MAILBOX. DISPOSE OF OFF-SITE. UTILITIES AND IMPROVEMENTS TO REMAIN. TWO FEET OF FREEBOARD. 19 35.PROTECT EXISTING WATER MAIN TO REMAIN. ' W O 15. REMOVE EXISTING STORM DRAIN. DISPOSE OF OFF-SITE. 4. SWEEP DAILY (PREFERABLY WITH WATER SWEEPERS)ALL N z CD 36.CONTRACTOR TO BACKFILL EXISTING TEST PIT LOCATION PER OVERHEAD POWER PROTECTION NOTE GROUNDWATER MONITORING PAVED ACCESS ROADS, PARKING AREAS AND STAGING AREAS F 16. REMOVE EXISTING PVC PIPE. DISPOSE OF OFF-SITE. GEOTECHNICAL REQUIREMENTS. THE CONTRACTOR SHALL CONTACT SNOHOMISH COUNTY PUD PRIOR WELL NOTE: AT CONSTRUCTION SITES. TO CONSTRUCTION TO CONFIRM OVERHEAD POWER CLEARANCE CONTRACTOR SHALL COORDINATE WITH GEOENGINEERS tiles �_ 17. DEMOLISH EXISTING ASPHALT PAVEMENT. DISPOSE OF OFF-SITE. 37.CONTRACTOR TO COORDINATE REMOVAL OF SOIL SAMPLE REQUIREMENTS, AND ANY RESTRICTIONS OR REQUIREMENTS RELATING FOR THE DECOMMISSIONING OF ANY EXISTING 5. SWEEP STREETS DAILY (PREFERABLY WITH WATER SWEEPERS) o w 0 O FLAG/EQUIPMENT WITH GEOENGINEERS. TO GRADING ACTIVITIES. GROUNDWATER MONITORING WELLS PRIOR TO REMOVAL. IF VISIBLE SOIL MATERIAL IS CARRIED ONTO ADJACENT PUBLIC t4 z z U r 18. DEMOLISH EXISTING CURB RAMP. DISPOSE OF OFF-SITE. STREETS. I 5 J U) OD 38.CONTRACTOR TO PROTECT EXISTING RIP-RAP TO REMAIN. TEMPORARY EXCAVATION SLOPE NOTE: RESEEDING NOTE: W 0, __1CT)19. DEMOLISH EXISTING CONCRETE PAVEMENT. DISPOSE OF OFF-SITE. CONTRACTOR TO ENSURE TEMPORARY SLOPES HAVE A MAXIMUM ALL EXPOSED GROUND MUST BE RESEEDED WITHIN 30 6. CITY STREETS ARE TO BE KEPT CLEAR OF DIRT AND DEBRIS I Z iU O Q 20. PROTECT EXISTING STORM PIPE TO REMAIN. SLOPE INCLINATION OF 1.5H:1V. CONTRACTOR TO REFER TO THE DAYS OF THE COMPLETION OF CONSTRUCTION. IF AT ALL TIMES DURING CONSTRUCTION. DUST SUPPRESSION AND IW U) W GEOTECHNICAL ENGINEERING STUDY PREPARED BY GEOENGINEERS RESEEDING IS NOT PRACTICAL DUE TO WEATHER OR STREET CLEANING MUST OCCUR AS DIRECTED BY THE PUBLIC ; ? 0 = U > _ DATED NOVEMBER 21, 2024 FOR EXCAVATION AND SLOPE SEASON RESTRAINTS, THE GROUND MUST BE COVERED WORKS INSPECTOR. o - L' ARLINGTON 51ST ST LLC s Z � � LLI ARLINGTON 51ST ST LLC �\ ' I \\` rnx PARCEL No. REQUIREMENTS. WITH MULCH AS DIRECTED BY THE CITY ENGINEER. J J TAX PARCEL NO ,�� 3105 800102500,. I L=t���� A i i 31052800102600 � � �� 1 �'--ARLINGTON 51ST ST LLC �L1 LL(/�/ � ' I0 z 31 '-� / TAX PARCEL N0. ARLINGTON 51ST ST LLC �L�LL�11�/ n / 'i ` LLB PROPOSED TEMPORARY �� �J I � - /- S0- 31052800102400 I TAX PARCEL N0. ARLINGTON 51 ST ST LL� ARLINGTON 51 ST ST LLC I i'y,� CONSTRUCTION EASEMENT I: V, U J �_ -�_ I ,� 31052800102300 TAX PARCEL NO. I TAX PARCEL NO. 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N�19'S4"W 997.89' 33 y ti 36 L, `.::g;„: e.' r;:;=i;' ._x` 7 I W C 13 M L-- - PROPOSED TEMPORARY \�--� \ p � y"t y� 3 I� CONSTRUCTION EASEMENT ` 32 116 �� `��'16' Q -__--- \ \/ r - __ �716� 15 :v� 17 i Do N --------- _ __ L '----- •SY02'29'W 51.79' +� -" ---_ C ------- __ PROPOSED TEMPORARY --- -� -_ ______] 1EM RALD SPRINGS NORTH, LLC l-\ 34 i t � H -CONSTRUCTION EASEMENT_�. -- 31052800101800 23 _______ N87'19'54"W 270.02' 7 22 11CALMON1I r- L1 " KLEIN FA ILY 31O5280011012005, LLC / - REFER TO OVERHEAD POWER CO V 10'P.U.D.N0. 1 OVERHEAD&U/G EASEMENT.-_ 0 UTILITY POTHOLING NOTE: / AFN.201009080540 15 1 I PROTECTION NOTE THIS SHEET. EXCEPTION NO. 14 PROPOSED TEMPORARY THE CIRCLED LOCATIONS ARE REQUIRED TO BE POTHOLED TO VERIFY VERTICAL AND HORIZONTAL CONSTRUCTION EASEMENT 30 LOCATION OF EXISTING UTILITY AND/OR POTENTIAL CONFLICTS WITH EXISTING UTILITIES. POTHOLING / 31 I 'I SHALL BE PERFORMED PRIOR TO INSTALLING ANY PROPOSED UTILITIES. CONTRACTOR SHALL NOTIFY 35 II BARGHAUSEN CONSULTING ENGINEERS, LLC. OF ANY CONFLICTS. 38 TREE PROTECTION NOTE' 20 zo M UTILITY CONFLICT NOTE EXISTING TREES TO REMAIN SHALL BE PROTECTED. CONTRACTOR TO ENSURE NO DAMAGE CITY OF ARLINI THE CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION, DIMENSION, AND DEPTH ON TREE ROOT ZONES OCCUR. CONTRACTOR TO INSTALL/IMPLEMENT TREE PROTECTION CONSTRUCTION DRAWING REVIEW APPROVAL OF ALL EXISTING UTILITIES WHETHER SHOWN ON THESE PLANS OR NOT BY POTHOLING THE MEASURES AS NECESSARY. UTILITIES AND SURVEYING THE HORIZONTAL AND VERTICAL LOCATION PRIOR TO CONSTRUCTION. THIS THIS PLAN SHEET HAS BEEN REVIEWED AND APPROVED PER THE SHALL INCLUDE CALLING UTILITY LOCATE AT 811 48 HOURS IN ADVANCE AND THEN POTHOLING ALL Know what's below. CONDITIONS ON THE TITLE SHEET. L'V OF THE EXISTING UTILITIES AT LOCATIONS OF NEW UTILITY CROSSINGS TO PHYSICALLY VERIFY ;; Call before OU di NOTIFICATION REQUIREMENT NOTE " N Ln WHETHER OR NOT CONFLICTS EXIST. LOCATIONS OF SAID UTILITIES AS SHOWN ON THESE PLANS ARE y g• PROPOSED DEVELOPMENT INCLUDES WORK THAT MAY ENCROACH THE NEIGHBORING BY Development Services Manager E CO BASED UPON THE UNVERIFIED PUBLIC INFORMATION AND ARE SUBJECT L VARIATION. IF CONFLICTS I Dial 811 °Pn' fl9 o SHOULD OCCUR, THE CONTRACTOR SHALL NOTIFY BARGHAUSEN CONSULTING ENGINEERS, LLC. TO / PROPERTIES TO THE SOUTH, NORTH,AND WEST. CONTRACTOR TO CONFIRM AUTHORIZATION TO M PROCEED WITH WORK ON ADJACENT PROPERTY WITH RG NORTHSOUND LOGISTICS, LLC. PRIOR DATE THIS APPROVAL VALID FOR 18 MONTHS N RESOLVE ALL PROBLEMS PRIOR TO PROCEEDING WITH CONSTRUCTION. N TO CONSTRUCTION. Notification Case #: 202503353 Owner: Pennon Construction Company INC - Martin Mitzlaff, (360) 710-4750 Project Address: 16512 51 st Ave NE Arlington,WA 98223 Contact: Pennon Construction Company INC - Martin Mitzlaff, (360) 710-4750 Mailing Address: 16512 51 st Ave NE Arlington, WA 98223 scan for current status Project Includes ASBESTOS REMOVAL Project Size: 1550 square feet of Wallboard Project Duration: 8/25/2025 - 9/2/2025 Asbestos Removed By: Licensed Asbestos Abatement Contractor Contractor: Global Asbestos Abatement Services LLC Contractor Job#: 25-0545 Contact: Brian Romero Phone: (425) 314-6474 Mailing Address: 7533 West Bostian Rd. Woodinville, WA 98072 Asbestos Certification Number: ABCN0000171 Project Includes DEMOLITION Demolition Duration: 9/3/2025 - 9/17/2025 Demolition Completed By: Demolition Contractor Contractor: Demolition Man, Inc Contractor Job#: 25044 Contact: John McFarland Phone: (206) 650-3366 Mailing Address: 8129 Occidental Ave S Seattle,WA 98108 By submitting this notification: I certify that the information I have provided is to the best of my knowledge true and accurate. 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. 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. I understand the fees for this notification are non-refundable and any charge disputes I file that result in a refund of the fees will void this notification. Puget Sound Clean Air Agency(206) 689-4058asbestos@pscleanair.gov CHAIN OF CUSTODY 112ooK�kla d,WA98033 PCM AIR SAMPLING (425)65 WATestingLLC@gmaii.com ,�,�,,nfrtyrmAVe9o5Te5t 3tLC .com Client Name: Global Asbestos Abatement Services Address: 7533 West Bostian Road,Woodinville,WA 98072 Phone: (425)486-8383 Project Manager: Brian Romero Phone: (425) 314-6474 Email: brian@servproseattlenw.com Project Name/PO#: #of Samples: Turnaround Time: Address: N,L1 City: State:wis Zip: �� 22 Sample ID . .a—,0`✓ -,ram Location Sample Type Pee Activities k-ev W -;k- p` L r eta Protection Rush Worker A,. irl Decon Start Stop Total Mika tes Environment Time 01.Z I q ', Lite!rss Fibers/Fields Fibers/cc ® Pump# _ Averages -X" Date 57102, Rate Sample ID •-0 Location rov ,.r. Sample Type j Activities tVV'-\ Protection ia 19,jL. Rush Worker i1A./1 d .2 f\ rn-Z-,dl,F.AI+J- Decon 1 Start Stop Total Minutes Environment rajy i Time Ja00 0 Liters Fibers/Fields Fibers/cc Pump# Average Date q -7,6 Rate .3 3 Sample ID Location , Sample Type I—W rN Activities Protection r(}+ a Rush Worker Decon D—s Start Stop Total Min tes Environment ,_-� Time `�f� f3.;UU 10 Liter Fibers/Fields Fibers/cc Pump#— (A —P. Average Date 6,' �- ,L,, Rate Sample ID o ) Location Sample Type Activities T) 'l, Protection Rush Worker Q j r\ _ �< c y��� 1 t/i n Decon Start Stop Total Minutes Environment Time�O 3-10 a0 0 Liters Fibers/Fields Fibers/cc Pump# _ Average ` 6-60 Date _ Rate / 1 Sample ID Location �•F—� U►� L � �'C)�J s,,® Sample Type ® Activities _ �.►�,�lC , Protection Rush Worker 'XcLqk-�r o'(lo�l a. 6;� iyl e ova' 0 Decon Start Stop Total Minute Environment Time 3-()0Z) Liters Fibers/Fields Fibers/cc Pump# 0 — V, Averages iV Date -? --1 Rate l j` 15 14) Print Name S!gpature Company Name Date Time p Global Asbestos Abatement Services Sampled 5- 2 - Relinquished Global Asbestos Abatement Services C/ 2 . r Delivered Global Asbestos Abatement Services 7-9_ Received WAT �� Analyzed WAT Reported WAT Sample Types Controls P Pre Abatement CL Clearance RESP.PROT DECON Environment A Area FB Field Blank PA Pressure Dem.Air D.S Decon.w/Shower H HEPA Vac I Inside Reg.Area TB Trip Blank CA Continuous Flow Air D Decon.w/o Shower N Negative Air 0 Outside Reg.Area BZ Breathing Zone(TWA) PAPR G Glove Bag Batch #: 5'-Q;"''A %VA 11200 Kirkland Way#340A CHAIN OF CUSTODY Kirkland, WA98033 PCM AIR SAMPLING (425)65 -7286 i.com WATestingLLC@gmail.com Client Name: Global Asbestos Abatement Services Address: 7533 West Bostian Road,Woodinville,WA 98072 Phone: (425)486-8383 Project Manager: Brian Romero Phone--(425)314-6474 Email: brian@servproseattlenw.com Project Name/PO#: 03�4/4' #of Samples: Turnaround Time: Address: L !Q 7j �-5-154— ilif N,.,L City: l i State: zip: $ " Sample ID Location Sample Type Activities Protection RushEl Worker 3 v� Decon n^_ Start Stop Total Minutes Environment N� a Time Liters Fibers/Fields Fibers/cc Pump# Average _Q 6?J2. .IL Date �, 1 - 5- Rate d Sample ID Location Lo e- &VVT f'n /7 e�L 40 �A4kvo r - Sample Type r-- Activities Ylq Protection 0, Rush Worker +e , Decon V-5 Start, - Stop To al Minutes Environment f Time 3 U(') 7/5 Iters Fibers/Fields Fibers/cc Pump# Average Date , Rate —.? 3 Sample ID 0 71 Location Cx Sample Type Activities %A,� i ii_-_V Protection Rush Worker �efui `2�4voi, t a1v'5 119 vE V-kN "64 Decon Start Stop Total Minutes LA-[f''v- r--cktn'n-+ Environment Time 2,20 30 G) Liters Fibers/Fields Fibers/cc Pump# Average V Date -Z? T Rate ` J• Sample ID j ,y e(_5'_ Location��i�r'1�cf y-p- rw-� Sample Type ActivitiespC C\ Protection c ( Rush[:] Worker c/a Decon Start Stop Total Minutes Environment i Time :w r rlO 3 G Liters Fibers/Fields Fibers/cc Pump# Average cl-0 Date Rate Sample Location L\, y.ti Sample Type w Inj Activities D Protection Rush Worker Decon Start Stop Total Minutes Environment _ - ^ Time q,,xd ,ku0 -30 0 Liters Fibers/Fields Fibers/cc Pump#Date Rat .3 Average _ "'� e Print Name Sig ture Company Name Dateyy L Time Sampled .,�.. Global Asbestos Abatement Services Relinquished /vte �� 4 Global Asbestos Abatement Services PL 2 _ 2 Delivered Global Asbestos Abatement Services Received WAT Analyzed WAT Reported WAT Sample Types Controls P Pre Abatement CL Clearance RESP.PROT DECON Environment A Area FB Field Blank PA Pressure Dem.Air D.S Decon.w/Shower H HEPA Vac I Inside Reg.Area TB Trip Blank CA Continuous Flow Air D Decon.w/o Shower N Negative Air 0 Outside Reg.Area BZ Breathing Zone(TWA) PAPR G Glove Bag 6 Batch 11200 Kirkland Way#340A CHAIN OF CUSTODY Kirkland,WA98033 PCM AIR SAMPLING (425)658- WATestingLLC@gmail.com om Client Name: Global Asbestos Abatement Services Address: 7533 West Bostian Road,Woodinville,WA 98072 Phone: (425)486-8383 Project Manager: Brian Romero Phone: (425)314-6474 Email: brian@servproseattlenw.com Project Name/PO#: 2 15-0 �(5 #of Samples: Turnaround Time: 4 Address: 16 !P 2 ?j l S� (lA k Iv, city:City: jr (i-!), State:l,,(/1 /�Zip: Sample ID .05 Location iJU 4— -41Jb,1 Sample Type rActivities Protection Rush Worker _'CFSv.S a nor CC_gG, n el " Decon 5tart Stop Total Minutes Liters Fibers Fields Fibers/cc Environment Time r , L y� / Pump# Average Date a 2,q .2, Rate Sample ID _�L j_ d.y 4 Location Sample Type j(� Activities Protection '�,t Rusho Worker Decon Start Stop .Total Minutes Environment Time Liters Fibers/Fields Fibers/cc Pump# 0 . — Average ( _ Date f6_Z Rate 7 Sample ID r�J' 5 1() J5" Location ti1.2 Sample Type T 1"W Q . Activities YN W-�, Protection i �!� Rush Worker v y� Decon Start Stop Total Mi utes Environment r� Time (�.'.'t.�td a 00 ( (� Liters Fibers/Fields Fibers/cc Pump# Average Date; —2A—��5 Rate j Sample ID � OS-1A57' Location Sample Type Cam... Activities JFq V /'1^E v► Protection ta( , Q Rush Worker f;{ (�— Decon — ,S Start Stop Total Minutes Environment ty Gw r— Time t,-00 _' kx:' Liters Fibers/Fields Fibers/cc Pump# C)`?---' 2— Avera a C-.t9. Date Rate /f- Ilam l Sample ID Location Sample Type Activities Protection Rush Worker Decon Start Stop Total Minutes Environment Time Liters Fibers/Fields Fibers/cc Pump# Average Date Rate Print Name ign re Company Name Date Time Sampled Global Asbestos Abatement Services f-25, Relinquished M �. Global Asbestos Abatement services ?i �n^ 2 Delivered (J� Global Asbestos Abatement services _ 2-Q 2 Received WAT Analyzed WAT Reported WAT Sample Tvpes Controls P Pre Abatement CL Clearance RESP.PROT DECON Environment A Area FB Field Blank PA Pressure Dem.Air D.S Decon.w/Shower H HEPA Vac I Inside Reg.Area TB Trip Blank CA Continuous Flow Air D Decon.w/o Shower N Negative Air 0 Outside Reg.Area BZ Breathing Zone(TWA) PAPR G Glove Bag 'C CHAIN OF CUSTODY 11200 Kirkland rklad,WA 9 033 VTAr Kirkland,WA 98033 PCM AIR SAMPLING (425)658-7286 A>hta:c,Tes; 3 lC WATestingLLC@gmail.com Client Name: Global Asbestos Abatement Services Address: 7533 West Bostian Road,Woodinville,WA 98072 Phone: (425)486-8383 Project Manager: Brian Romero Phone: (425)314-6474 Email: brian@servproseattlenw.com Project Name/PO#: R5- 0.3-� S7 #of Samplee: Turnaround Time: Address: �. ��� � 7� ��17 �c i City: �j�t 1 �1 '�--c�i°� State:j"Zip: 9E3 2?_3 Sample ID r t _,�` Location C)� �' ��.� f fir*- Sample Type Activities Protection Rush❑ Worker t'__�y; /9✓t f- Decon Start Stop Total Minutes Environment Tim :O_� -0,5— Lit rs Fibers/Fields Fibers/cc Pump# o ( Average Date ),_ Rate �r Sample ID 5 U 1f Location L`�� 'M ��� y,x Sample Type S 7—C Activities Dj'_!> - , , Protection f Rush❑ Worker µSe f'v ti Decon L_ Start Sto Total Minutes Environment Time ct L, `, 70 Liters Fibers/Fields Fibers/cc Pump# Average ' Date Rate _a 3. Sample ID o? —© ; 5' Location bcl 4h wrr Lt,-Lki! lrovf-v ( i` e Sample Type C" Activities Z+0l,"` k W Protection�T Rush Worker❑ _>S� Tv� uh c�vl cU Decon " _ Start Stop Total Minutes Environment Time _ 00 Liters Fibers/Fields Fibers/cc Pump# ' Ave�e Date 2_ Rate �, If ���� } Sample ID —(��� Location �v jn , �y Jte•lfnf M r r-cle Sample Type Activities Protection —CA t— Rush Worker cy (ss Decon T) . Sta t Stop Total Minutes Environment " ✓ Time -' j-� 1 �d0 Liters Fibers/Fields Fibers/cc Pump# 677— Average 12-06 '?- P00 Date Z=Z 51 Rate l f r Sample ID Location Sample Type Activities Protection Rush Worker Decon Start Stop Total Minutes Environment Time Liters Fibers/Fields Fibers/cc Pump# Average Date Rate UPrintSig Lure Company Name Date Time SampledGlobalAsbestosAbatement Services .. (Y7Relinquished Global Asbestos Abatement ServicesDelivered ` Global Asbestos Abatement Services —02- � ?-- Received WAT Z Analyzed WAT Reported WAT Sample Types Controls P Pre Abatement CL Clearance RESP.PROT DECON Environment A Area FB Field Blank PA Pressure Dem.Air D.S Decon.w/Shower H HEPA Vac I Inside Reg.Area TB Trip Blank CA Continuous Flow Air D Decon.w/o Shower N Negative Air 0 Outside Reg.Area BZ Breathing Zone(TWA) PAPR G Glove Bag Y ASN 4 ASBESTOS WASTE SHIPMENT REPORT FORM PLEAS&PRBVT OR TYPE!",1--have I'-'......M"your local DBQ Regional OtLcc in Portland at(503)229- + 5364,Salem et(503)378-8240 ext.272,Mod erd at(541)776-6010 eet.235,or Bend at(541)388.6146 W.226,OR :call(800),452-4011 for the loeetion of your local reg(ovel DEQ.o1Bce. i WASTE GENERATOR:Peevmm,Fufgty,m rayenm0 d .1. Asbesms removal site name end address: 22 3 ' 16512 5/SL fF vt;N L 0.r(�r�kyh S i lti -cA $- /7 arylamm _�"s 31 y 66/ —_ Contest pmson: V Yi 0.n `2 o— '3 —Phone; Z 2, Opemmr's name daddre th AS eSC Phone: //25�/�j�i b 3 H 3 '�533 LU b cl 1 G rd11 n le (UfR Sn (7oM'r� 9b0�Z saw cRrlsmle 3. Wes.disposal eft.: -r'Y,exr./C..,anG.)AD A II Ph..:sU t iLr )rs �2 lJa nZo'FS saeet cram cm r "° 4. Describe mbest.s mataeieh: 5. Covmivers: Number -f Type: Fla .6. Totel gasntity(cubic yams} ,? 2 o n OPERATOR'S CERTIF[CATTON:I hereby declare that the wnteats'of this c.vsigomert ace fuLLy and eccueamly descnbed above by proper shipping Maroc end are classified,p.&aged,marked end labeled,.nd are in all mspeets in proper wndition for transpon:according to all government¢gulations.All movement of this aebesms-nentaining material is recorded on this Waste Shipment Record Fonn. . c.mpa.y m�ca�Lk`e! !Ab xeme: Signature: Dam: TRANSPORTER(S): 8. Transporter#1:(Acke.wledgment of receipt.fmatedels) Agent Company:d� Address: 1QDg F I nl Dili I-1`-:' Phone: x�-x1ty.'p'r`1 Sign— Date: 9, Txa.sportar#2:(Aclumled®nevtofineeipt.fmatedals) Agent: _Company: --- Address: Phone: Signature: Date: — DMOSAL:(Certification ofreceipt ofaebWs mazeeials wvmedby this manifest,except ea notedis item 11 below) 10. Waste Disposal Site: Nerve and Tide: Dew Signa= Phone:T 11. DISCREPANCYSPACE:(Addmtacbvremsesnceded); • (Revised&03)