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HomeMy WebLinkAbout18930 59TH AVE NE_035340_2026 °STY City Of Arlington Development Services 9 238 N, O�ympic Ave, o Arlington, WA 98223 S� Ta S T-y j ip L4 5' �`1 LI DO n , L-- L 0000000 (D 0000 w � m 000 m c o0 D Ll 0 ° wIz a <a G> 4 0— m -0 � a Z r Y 1 m Cr 0 o v O n D '0 000000 N m 3 ° > > a , m v m 0 cn v T � c �� Z N CD � CD t7 w. cc am RI � m Z 3 co N 3 n -V O O ' co s SD5• - n o m 0 0 (� z — � CD 5 ?: w Z O � D cc z nD Z m O m m D 'O C v - o c) r O CD 000000 U) m o O � O � E 11cnL) c� � m � o Z � �r -- -. o Cl) w cci :3 ca 0 1 m � p .. w o ri)c N m CL � D :3 w o w �l c m C r Q X '� a cn a 0 C I TY OF ARL I P4C3TOfV COhISTRUCT I C3M PERM I T PE RM I T NO_ a QD3-5341251 Owner: CITY OF ARLINGTON 238 N. OLYMPIC ARLINGTON 98223 Value of Work: $11. 000. 00 Tax ID: 153105-4-012-0009 Phone: 435-5785 Describe Work: DEMO EXISTING SHELTER Proposed Use: Legal Description: Job Address: 19118 63RD AVE HE Contractor's Name Type Address License* CORRECTIONAL INDUSTRIES GEN PO BOX 99965 TOTALS Fee / Permit Fee $100. 00 State fee $4. 50 SIGNATURE: TOTAL FEE. . . . . . . . . . . . . . . . . :104. 50 I F�'REBY CERTIFY THAT I HAVE READ AN XAMINED THIS APPLICATION AND PAYMENTS. . . . . . . . . . . . . . . . . . $0.00 KN W THE SAME TO E TRUE AND COR- RE T LL PROVISI S O LAWS AND TOTAL DUE. . . . . . . . . . . . . . . . . $104. 50 R IN NCES OVE KG IS TYPE OF O K WILL IED ITH WHETHER C FIED R N DATE RECEIPT # -- �� UI ING AL fY � 1 1 1-0 1 :&!,. 1 AILI 1 1 7 It ill I ; "hit V Aj 14 A LEI R'""No !..,I F 1. I'V1 V4 . AC I -il%A [ANA knms is X " N or "AmIny" 15 ; , In : wnod9 eQ0% -!U - ! kQ � fv : 11 nET ov . 030 . 00 : Aaow to mulsv RATIAH, WIMIL2 uMnA -, AA"W :svU bsuoquj'l tic) ijq-i i�v �yn OHGO 8 , 1W ma" WA do(- In"au"Al angibbA 040, gmam Wauj"SaWK) Ah Q9 ! WTPKnN ' 0/01TVIA30 UIATUT so! 11W4 Sol P ' mt-: :XHUTANDR! wAmn 1VAH 00 ! WAT? THWA . . . . . . . . . . . . . . . . .AAA JATUT UMA AWTA&IjKA MUT WATMOWn daA -KUj WA NUHT 48 OT 1EA& 1W WO VA NN .W . . . . . . . . — . . . . .&TmAmYA'J CAA �M AQ 0001b; =5 JAN Y?. i' 10 . . . . . . . . . . . . . . . . .SUO JA110' HFIW Wijlra"" un 1 7 IDA:! WAU Memo Date: 2/3/2003 To: City of Arlington, Kurt Patterson Cc: File From: Scott Black RE: Demo Permit#03-5340 The following must be completed prior to final sign off by the Building Department: ✓ Septic system to be abandoned per Snohomish County Health District standards and inspections. ✓ Earl Anderson of Water Department to be notified of Demo, lines to be located and capped off. Thank you, Scott Black, Building Inspector 2/3/2003 Confidential 1 I 1� 1 City of Arlington Building Dept PUBLIC WORKS CHECKLIST , z PERMIT # DATE �3 LEGAL l � q Plat Lot ax ID# r , / NAME /dialf ADDRESS `� Y' Q.�,�� AV-P_ BUILDING USE # of BUILDING UNITS L&?MO (I, Existing Required Signature Date Water Meter Fire Hydrant 4 -: Side Sewer Permit �Al SRO"n CC" IT Monitoring Manhole Ila-Lit (,j� Cross-Connection Control /� � S Sewer: Off site ��� -`�' W I I I Vte-' I On sitep Water: Off Off site G :E(-V L On site MVv"(�S 6 WA 0 °`� Pretreatment Discharge Permit 3 Water/Sewer Fees �{ Date received S D Date Yellow returned [oEC � @ � D 1111 AN 2 2003 Date Pink returned .i Utilities Div. M ' •r i 4tiIN G TO T 2 City of Arlington Q 2 • + Division �`V4I N GAO Memo To: Kurt Patterson, Facilities Maintenance Supervisor From: Karen Latimer, Utilities Manager 11.Y Date: February 3, 2003 U Re: Utility Review, Building Permit#03-5340,Animal Shelter Demolition Your demolition building permit #03-5340 has been reviewed for compliance with Utilities Division regulations and standards. Items listed below need to be completed before building demolition begins. 1. Water service must be disconnected and capped prior to demolition. Contact Earl Anderson at 360-403-3506 to coordinate this activity. 2. Sewer service must be disconnected and capped prior to demolition. Contact Virgil Renfroe at 360403-3516 to coordinate this activity. 3. The septic system shall be decommissioned per Snohomish Health District regulations. I can be contacted at 360403-3505 to answer your questions. 0 Page i , r CI T Y OF A R L ING TON i Public Works Department (360) 435-3811 FAX(360) 435-7944 January 5, 2000 �•�t 1�� IV i Subject: Septic System Inspection The Arlington Wastewater Department is engaged in a three-year program of routine annual inspection of septic systems within the boundary of the Arlington Municipal Airport. Septic system inspections are being performed to meet the requirements of a Consent Decree negotiated between the City of Arlington and Waste Action Project. This is the third and final year septic system inspections will be performed. The Wastewater Department is scheduled to inspect your septic system on j A j1 U,J pu4, fV� 2 G 60 at AM/PM. The attached map shows your septic tank location. Please be sure this area is clear of vehicles and other obstructions. If the scheduled inspection time and/or day is not convenient for you, call me to make alternate arrangements. Inspection results and notice of corrective action (if required) will be mailed to you 30 days after the inspection. Please feel free to call me at (360) 403-3505 if you have any questions. Sincerely, CITY OF ARLINGTON y Karen Latimer Water Quality Control Technician cc: Airport Manager 816 N. West Avenue 0 Mailing Address: 238 N. Olympic Ave. O Arlington, WA 98223 � v �. r 10 b� �o 01 I i � �T ( IF r � L��, LiG LAG Ll0 V�C_°ACAjM�� too t¢ - t - HNII. - ;� r Fo;T! C a.• . .` , �' ri City of Arlington Building Dept PUBLIC WORKS CHECKLIST PERMIT # (�') .�� C DATE LEGAL f . �� J � CIO `c'`, Plat Lot ax ID# NAME ) 0 Z' lk,4 ADDRESS ( r. ('' ' 1. - .V _ BUILDING USE J' _ fl,'� s. 1p # of BUILDING UNITS fiem® Ii- do (1, Existing Required Signature Date Water Meter Fire Hydrant CA eV D h wuy `c (/1 a S wV V! <4 ide Sewer Permit Monitoring Manhole )V) ov 6� Cross-Connection Control (� ' L� Ia o V",_ Sewer: Off site �,, D� � � �,�.�I 1� U I On site V LA Cc, Water: Off site r V 0 GC On site f ; ? Inn b t'� u -dJ �_(/ b 0 P Pretreatment a Discharg FIJ I k��tt'�rl!S Permit r2,1g4 3 Water/Sewer Fees �niczft � o Date received '� Date Yellow returned Date Pink returned '" 3 i % 7 ■ fir• 7 - J r Jill M�m Oro - ■ -ir r - - - ■ - - - - - I I _ 1 ■ r ■ ■ ■ J L ` J ■oil _ r■ ■ r ■ 0 J HnkEncy imc Nu 4 27t't1 IENVIROSERV PUGET SOUND CLEkN AIR AGENCY 0.701 DateP.2/5,ed 1,10 Union,Street,Suite 500 Seattle,WA 98101-203 8 www,pseleanair.org NOTICE OF INTENT Agency Use Only - Agency Use Only A. Pro ect Type. 11. Asbestos Removal 2. Asbestos Removal&Demolition 3, ❑Demolition,No Asbestos Removal Property Owner: gLity of Arlington Phone: 360 403-3454 Mailin Address: 238 North Ol is Avenue Ci : Arlin on State WA Zip: 98223 C. Asbestos Xr-4SEPWNTCUARLY.7915 3P=BE YOURRETURNAMW "BEL Contractor: Department of Corrections/Correctional Industries Owner/CEO: Kenneth Menschin Contractor -Me°1' Address; PO Box 99965 Phone: 253 589-7370 Job No.: C: : Tacoma State: WA Zip: 98499-9965 Fax: 253)589-7388 AW 419 Site Address: 19118 63rd Avenue NE City- Arlington Zip: 98223 Site Manager: ICurt Patterson Local Phone: 360 403-3454 E.HAsbestos Survey or No.of Date Asbestos Survey Was Friable Asbestos Identified? LXJYes I No Mat'l Presumed Structures: 1 was Conducted: I2/99 Was Nonfriable Asbems Identified? Yes NNo n s required ore a emo rtran pro cc Attach a copy of the survey,if nonfriable asbestos is AHERA Building Inspector: Gary Brock identified or if no asbestos is identified on survey, Certification No.: MIP-NAI-99-09 E Date: 2/2002 State: WA F. Demolition Start No.of 1. Training Fire(List Fire Dept,) Information: Date: 02/05/03 Structures: 1 2, Ordered Demolition attach copy of Order Demolition Insert demolition contractor's malling address on hock. Will nonfriable asbestos be left in place during demo?LJ Yes No Contractor: Department of Corrections/Correctional Indus(na If yes,list type and ilty. G. Asbestos Project Work Days. T W Th F Sa Su Information: Start Date: 02/03/03 Co lotion Date: 02/04/03 Hours; 7:30am—3:30 m Will all friable asbestos Yes i Total Qty.to be Removed: Linear Ft, 1500 Square Ft, materials be removed? No Thermal System Insulation Boiler\Fumace Ins._LjDuct ins. LJ pipe Ins. other. Surfacing Mat'l: I LjFireproofin& Paints Plaster LJTextured Coatings Otbcr: Misc.Mat I NCernenffld. LJCemenx Pipe LjFriable Flooring or Roofing Mat'l other:Building Paper -.r Asbestos/Demolition Project Categories: Notification Period Asbestos Demolition ~1. gle-Family Residence: Pro*.Fee Surcharee A. Asbestos Removal Project Only A.Prior Notice A. $25 B. Demolition Project(with or without asbestos removal protect) B. 10 Days" B. $50 *(Asbestos removal can-begin upon notification;demolition must wait 10 days) 2.1 All Other Demolitions With No Asbestos Removal Project 10 Da $200 3.1 z 10-259 linear feet or z 48- 159 square feet of asbestos(see back) 10 Da $150 $50 4. 260-999 hear feet or 160-4,999 sT=e feet of asbestos 10 Da $300 5100 5. 1,000-9,999 linear feet or 5,000-49,999 square feet of asbestos 10 Da $750 S250 5. , >10,000 linear feet or>50,000 square feet of asbestos 10 Days $2,000 $1,000 7.!_; Emergency Asbestos Project or LJ Emergency Demolition Project Prior Notice Twice Project Fee $in a-Famil Residences are cxcnipt from emergency fee;however,pToperty owners must provide a writtcn cmcr en r uest I. I certify that t information cons ed in this notification&supplemental data is,to the best of my knowledge,accurate&Zmp, tc. Agency Use Only 19 d C- C.�-- / / Signature Repmsenting bare Reviewed By Puget Sound Clean Air Agency Form No.: 66-160(Revised 9/02)TS JAN.14.2003 4:28PM CIENVIROSERV NU. (e1 r.4/5 ' Jab NumberwLiq 1 Labor and Industries NOTICE OF Industrial Hygiene Compliance a ASBESTOS ABATEMENT (Regional addresses and phone .numbers on page 2) Amend Date PROJIJCT THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 CALENDAR DAYS PRIOR TO THE START DATE COMPLETE ALL APPLICABLE BOXES—INCOMPLETE OR ILLEGIBLE NOTICES WILL NOT BE ACCEPTED MAIL OR FAX TO THE REGIONAL OFFICE—CIRCLE CHANGES ON AMENDED NOTICES Noticc date: 01 /14/03 Initial ✓❑Amended❑ Site Work Hours Su Mo Tu We Th Fr Sa Start date: 02 /03/03 On Hold❑ Off Hold❑ 7:30 amto am K X Completion: 02 /04/ 03 Emergency❑ pm 3:30 pm Project Dates and Work Hours must be Exact CONTRACTOR PROPERTY OWNER ` Cempany Name Name Department of Corrections/Correctional Industries City of Arlington Contractor Certification Number Owner's Agent 01233 Kurt Patterson Signs J Company Samo Printed Name Address Kenneth Maxisching 239 North Olympic Avenue Phone Number City State ZIP+4 (253)589-7370 Arlington WA 98223 Job Site C.A.S. Phone number Roy S ro (360)403-3454 JOB SITE FACILITY Address Type 19118 63rd Avenue NE Animal Shelter Building Name Room Age Size Animal Shelter 59 1600 sq.ft. City ❑Rctnodel ❑✓ Demolition Arlington WA ZIP+4 County ❑Repair [I Maintenance 9B223 Snohmnish QUANTITY OF ASBESTOS TO BE: ❑✓ REMOVED ❑ENCAPSULATED Quantity 1500 square feet 0 Indoors ❑ Outdoors !—' Fireproofing ❑ Boiler insulation CONTROL MEASURES C] Popcorn ceiling [I Duct paper ❑ Neg.pres.enclosure ❑ Wrap 8t cut ❑✓ CAB © VAT ❑ Glove bag 0 Wet methods ❑ Sheet vinyl ❑ Roofing Mini enclosure ElHEPA vacuum C] Asbestos paper ❑ Other F--k_,t._o_i_op-&-r?APG ❑ Critical barriers C] Manual methods Quantity linear feet ❑ Other ❑ Other 0 Mag.pipe insulation ❑Cement asbestos pipe RESPIRATORY PROTECTION ❑ Air cell pipe insulation ❑Mudded pipe ins. ❑Q '/2 mask APR ❑ Type C continuous flow ❑ Ducting/duct insulation ❑ Duct tape ❑ Full face APR ❑ Type C pressure demand ❑ Other ❑ Other ❑ PAPR ❑ Other F413-025-000 notice ofasbestos abatement project I1-01 For clean copies go to http://vrww.lni.wa.gov/forrns/ .:: � - r I , c T r ;. _ � f t T E P L A N x I 1 @ t �1 I 1 1 42.7 ; �f x / x I 143.6 I 141 .5 x Ii / I X I 142.3 / 143.8 143.0 I a x � X I I x 142.9 143.5 I � � 143.7 x I a x I i X14 .e sS -Ile am 1 / 1413. _ x 143.4 1 43.2 I JI x I ( F— �t I B 1 42.9 1 43.3 I 1 43.3 x x I x hb�a I I Co 143.5 I 143.6 i x 142.9 i X x 143.1 I I � K I � I 42.9 1 x I C/fy S`h0 S ' X 142 1 143.4 1 I 14 3.7 x X 46. � 143.1 X I 1 x 143.6 s �— — ---� x I 1 43.9 I I 142 1 � I I 142. x ——_—— 1 43.1 143.3 11� RECEIVEOr JAN 2 4 2003 No -a GT Cl�frt� ARLIN DTSMV DL'',,':.Z�• 0£ 11rh NOWICKIANDASSOCIATES 2539240323 p, ea 147 RM MAC$ LRV, INC. 4U1d-r 7 Ya,b5 P. 9 � PACs Lab, Inc.9070A Walsh Avenue Analysis Rapart Santa Gera, CA 95050-2542 i (,40e) 727.9727 Load In Palm USEPA 7000/7420 o1i+IC?'CI A AWµ Atst, Inc., P/r/Ort 10 00MOM; Rpf'a NOWiOlcJ 961 61 ath AvonUe 9, • &dd, 9 vontelCl phorh,/; (293)027.52t19 FAX phone; ( yili•03Z0 sds�U Way WA 04003 &M001 rewlwd en;. DWWnber M. iO / RepOR pr�n0 Or'r; dl01�'14er9=, t10'� u►;11:1 t JC* kumo1f: BW 077 00"WMkfa erica number. a1W Charba Bond lyat; LA�'f�(0 rf1�P1�01f: f Job 0110Pclon; ; OW/0 - North Snohomish County anima •AdInpton Cw1ft 8amae N6r►rber C" Ift-W41 t00 Lead t;rt Delcr�bn i OKPPM 77L-9 0 $041 192 192 0.077 774 NIA Irtt1 Or paInt - blue 95a 2 77L-1 t 61747 ® ® 168 0,028 60 ' WA IMer�o► Int • white 3si9�-3 77L•1 Z @xteMOr paint - allow 5047 109 0,110 11100 NIA 9�e•4 M-13 5047 19 3.630 4.00 40,000 ' WA ExtsNor 4mt - brown 31SS•s 77L•1 a 5047 ® 192 -c 0.019 4 192 Wit Ext*k0F >CF11 • rwhfte End of hpon, �. _....... ._ RECEIVE JAN 2 4 L003 CI OF AR IN-TON 1' i'report nhay rat b+►M+ed4rad oraapt In talc aM1d wM tMp�nnlaaton Ot Laub,h4Noin W the lam(a)tailed.Fnr owity Crnstrvl data Mar to ow b►dbn Number QA Pim h1AC$Ldh a iw tilt AmNkan InOwWa!HYGl&Ae Asaoo!at W(AJHA)for the Walla of low h*Fit and 649 p� p 11111'c} some palm a 00"lwbmkW tao+ t1A amib4Veda mMWW fhb oast bo romovnd from the A loydr. imq Mwo fpmm w rllvks.P"fildr!4WO01np technbuafr mwi be Wed. Mmpial try ho plMa&g$4104 In kAft 1 A, ^ Mid WW�trdnVen PIP*xV/. Maiyll.11 PoRennN on a Ram+Atomic Abwrptle�n Ip+*WffM. UX)v Pn,11 d eD t*od r' PPrn-P"Per fflUA A 10,M6 ppm■1% Iota; 1 rf4ft. I mm WME MOFI XFIF kw: tow WhM the&OWW UMPW■r"IN PreVWed to tna t4lSonWpy, *A tiawu can be oaioukUamd In U14 ., y U t �n xnr<tnstrumom tow". orne„%�NO XRF m V&Uen Cam over w msda Seesaw tmo.lab or so o 0 rtbn of a normal san.pto and the area of a eorape Cant be kromr�aAar It+a t'ad 1Mttrout the aha WA M,r poser, 4k JI-II1. LCJCJ✓J 1•JJI'll 1 i Iv.V.lb o'1 LEI.-c��_�1.�- d2 t'I rt<i NOWICKIANDASSOCIATES 2539240323 P. 02 wmst.-W 1,-•5y ja?-4'7 Rh MHC& WRB. INC. ♦e8r�'i'�o6lS P. �«. MACO Lab, Inc, 70A WlWnh Avenue Quality Control IRSPOrt ; Bents ClArt, CA OWW-2U2 Celebration AA-5047 ! Element Lead Qete wrlxt Paint >deoember 22, 1999 Method Ootoctlan Umlt 0.21 ►+Oran+ Analyst MPp µG*,fj Meaeund Target AamptancoPO4%wv.--' I 1 Value Value Criterion CarIlMlon coefficient O,gl;M7 1 s0.0060o Aampfab(e 0.25 µg/rm1 Refererloe 0.936 µplml 0.28 24,06 i Ql wr,n �natr water 4c 0.817 µg/ntl b AQo�toblei I In►tkl Calibration Blank -c 0,217 µaml 0 S 0.28 Atso�ptable� Ma hod Blank Beginning •4.706 µ0 0 it12,b �ptsblo CCV 8rpinninp 4.770 µg/rt11 5,0000 *10.0% Aamptabfe ICY 8491nnlng 4.86$ µ¢Iml 6.0000 # 10e0'k AoOoptsbie, �Cl9 Before sample 1 2,8�14 up/rn1 2,7274 #10.oX Acceptable ' CCV Before ymple 11 WA µg/ml 0-0000 t 10.0'K Gee Before Sample 11 WA µgIml 0 x 0.25 k4thod SlaAk salon "Mple 11 NIA µg 0 s 12.t3 CF%V Mora sample 21 NIA 1R11 dr 10.0 CPO Brfore,srmple 21 N/A µaml 0 0000 50.26 Method Blank Before sample 21 NIA µg 0 t 12.6 COY Before sample 91 p NIA µg/ml dt.0000 f 1 Oe0% COB Before &ample 31 N/A µglml 0 t 0.99 Method 814nk Before sample 91 WA µ0 0 s 12.5 CCV After 4.861 µq/mI 5,0000 t 10.0% Aweptabfo CC9 After a 0.217 ulyml 0 x 0,25 Aoceptabl• Method Blank After -0.044 µg 0 S 12.6 Aocwptable LCS Attar 2.888 µ M11 2.7274 f 10.0% Awsptable 80ke of asmpie 83968 • 1 1001.8 µp 1000,0 t28.0% Acceptable ' $01ko of rarnoe 0 . 0 N/A YO 0.0 f 25.0% SOW Dupi(oSi• 83956 . 1 1108.7 112 1000.0 *28,0% Acceptable i plkeg Dupllcatr 0 • 0 WA µq 0.0 f 28.0% Dkolc atp of $amp)@ 83068 1 ag6 PPm 774 *27.0% AweptAble losto of gismos 0 - 0 WA ppm 127.0% Ouplk�ts u,aiysst►w rnewunmanpr or ow vaftw o1 Intenwt(In Ih4 am Med)pl+lr W kt*H15*on tore subsampiss of im t,w►o qR*4,TAe vault♦%M j0*4 to rana 0 W ■ WllS e"ailbrotin�isrtit �i to eveluo*sntyllaal w or Tuwmant preoYbn but nd time P�'4fan d seat ft r1)�ntmt Drloadan t,)rtte at the bk«l w+npla.ore W"rsd by&MAU a kip"!frees attare UM&I MAb1+� wY*M Nit n�►MM�o�e(�okKa b a VOW 4w"(w of miftk#ample for wh6h MM IA� a►Mn1 wtlm WV O etloR er n osnaaM/1M1b1�la eVa144. eoked w olas ue Uead to de*7oL►s the$Woo CO YM 01�12 aulF ulnp Cnlir ion V�rlPo�tion mathodti n►oawry NrlaisnY. The Msthed Remit is a rnbrtum r aA Oaler n ft d aerie„d Mt '+�+nlfr usedfarr �a C* N t,&a-Or Iwt matriose but orithout the nWrlrt. Time Wmph is oarAnd 1h R e1 w • Carltbl�snple•NOT Moon of Mta srulrs4 stanlry wkh ON ap9tbn stop. This etwc ev&jAW iho Ier i aomaminstbn from ms lmwgoiy.Aoouregr la the d*"el 1101`#ttm#lf rMflilNt s� Value lAt(N iEOepbd t0ara�os HWs such ss the LOS NteT OPIM-ifft saAo . k, i ft dprw to whim a set or or asrvelbns or rnsMurer W%of t�M sa,r�prepr4 aortbrmn w M+•+nuNM• NEVEA do wed upon the 4*rdorY to%-W,•t+Mb t*am aamgSa. v li D7ri 1YV'o�l � ` DEC d,4VV WSb •i NOWICKIANDASSOCIATES 2539249323 P. 03 07 :48 AM MAC-6 LOV; jNC. 1' ak78'T2'r'dF�b3 AD lax a r pMs'U►tulroy�Y ._.. � � � � �� � b '1 a r Co 1'; I ' : ❑❑ lit 41 m , � I • N � � Alt l• � �[ M } , AIN I i . r � 04 44 cz s3 N N r y � CQRlRECT'IONA/ INDUSTRIES Environmental Services/Building Assessment Asbestos/UST IS 117-203rd St.I P-.O. Box 519 Monroe,WA 98272 Phone; (360)794-2841 I Fax: (360)794-2347 Chain of Custody[ TO:( Lab ) NOWICKI&.ASSOCIATES,INC. ADDRESS- 33516-9th.Ave. South, Bldg.6, ; Federal Way,WA 98003 SAMPLE: 'IYP_E NUMBER ❑ATa _ (1 24 Hour ❑BULK 10 ❑49 Hour ❑SOIL ED 0aw Standard ❑LEAD NOTIFICATION OF ANALYSIS: ❑Telephone D Fax ❑Written ATTI=NTION: Gary Brock PROJECT NAME: North Snohomish County Animal LOCATION: Arlington JOB NUMBER: SW077 SAMPLE DATE: 12116199 SAMPLE 0 SAMPLE DESCRIPTION SAMPLE BY Cert.# 77-01-01 Sheetrock Gary Brock IIMP-NAI-99-09 77-01-02 Shestrock Gary Brock IIMP-NAI-99-09 77-01-03 Sheetrock _ Gary Brunk IIMP-NAI-99-09 77-OP-01 Plash Gary Brock IIMP-NAI-99-09 77-03-01 Mortar Gary Brock IIMP-NAI-99-09 77.04-U1 Layered Roofiny Cary Brock IIMP-NAI-99-09 77-04-02 Layered Roofing_ Gary Brack IIMP-NAI-99-09 77-05-01 Building Paper Gary Brock IIMP-NAI-99-09 77-06-01 Window Putty Gary Brock IIMP-NAI-99-09 77-06-02 endow Putty Gary Brock IIMP-NAI-99-09 RELINQUISHED BY: PRINTED NAME: Gary larock PRINTED NAME: _ SIGNATURE: / �. ,/� SIGNATURE: TIME: 6 c.2 DATE: 12116/99 TIME: ' DATE: , 7 LABORATORY-PLEASE RETURN ONE COPY OF THE CHAIN OF CUSTODY WITH WRITTEN ANALYTICAL RESULTS. NOTE: Stop testing as soon as you get 1 positive sample ln'any one sample category please. ara�.—av—tea +c+ .-'.. r rr r�v�.r.�n•r•�r��r�••.�.ry r.�.+ •ua c.-ra a`1�.-a r.v •-. v� -Layer 6 No lox Cahuioro -Layer 7 Na �-4 20%Flberplaee -Layer 6 No 20%Cs1U1058 -Layer 9 No 20%CaDW105e T7-05-01 6670.08 Building Paper Yes 15% Chrysotlle 10%CGNLgode 77.06.01 , 667'0-De Window Putty No 71-M-02 6070-10 Window Putty No Comments- Analyst: Michael Q. Lam �+ ti Elizabeth GlIbertson Analyst Signature 11Ue#v{rx1 nvrY oNy bs ryprUduwd In RrN an0 whin pormlesbn hdr•t IM NAI kaorelary. lhO day contained In MIS MW mom UN crUM461110 of Only uw hems euOmRnd. Eanblee Mdl ba dhao�rad o1 wYhi�an.ieys arlo.ar+eiye?o. NN bYeralwy I��arUtad Dy o+a Whonal Vofunldry Leboralory Ax►edlullon P+oQ1m(NVtAfr)wile Lap Cooa ? UnIMI olhanv{ea Adlayrad.no analog wee perfomrod OY a N enQonanlMl' NtirLAA a an Pa dP+�rq tuO-QOntriCMd NVLAo eeeredfird Iabogtpry. fie rNulle of INS raporl do not arfpatt N+Y Aswurate roauki an dldeudr wmcu,r we i o U M�orsmimdl nbranoe fRWI��as re{6 ad a�i.M. In Method =25,TrIM anaM K,s hl►oleemmindd has ban eed. CCW EPA e�darrd tf ACM I1 1%by v dphl Peeprr,rrpo@ by PLMare WrwJ Lin whin a deteehan kmh of appmjiMgWy I%. tl � DEC-16-9y Lu :q* P-M Nuw1�F.�ri�air��u� �r. � + �,•_ — ---- c NOWICKI & ASSOCIATES, INC. POLARIZED LIGHT MICROSCOPY Labdratory Services BULK ASBESTOS MATERIAL ANALYSIS 33516 V Avenue SoUth, Bldg 06 � Federal Way, WA 98CO3 (253) 927-5233 - (253) 924-0323 Fax Client- CarrecUonal Industries Contact Person; Gary Brack Project: North Snahomish County Animal Hosp Aneysls Date; 1Z-16-99� NW-077 _ Lab lD # 0070 Analyst; MIQa Special Instructions: PO #%2600 Client NAI Lab Doearlption o1 Sample Asbestos '"1 T yp@ Other ID ID Do* Wd Fibrous Material 77-01-01 8670-01 Gheet Rock No ao�o ceNu.00 77-01.02 6670.02 ` Sheet Rack No 50%COW" 77-01-0 0670.03 Sheet Rock No 50%ce1lubse f J 77.02.01 607" Plaster ` yes 2% Chrysotile 77.03.01 0070.05 Mortar No 77-04-0-1-�} 6670-06 Layered Roofing �+ I -Layer 1 Slivar coat No .�..-1_ayer 2' No 15%Fibmiass Layer 3 No 20%Ulubse -Layer 4 No 15%Klwmlaas -Layer 5 No 20%Cellulose -Layer 6 No 15%Fibergion -Layer 7 No 20+A Conubse -Layer ® No 15%Fib®rplee3 77-04.02 070-07 Layered Roofing -Layer 1 No —V� O°/u Cenuiose -Layer 2 No 20%Flbargiass Layer 3 No I 20%Fiberoass _ -Leyor 4 _— No _ w, � _20%Fibergleea -Layer 5 No 20%Cellulose i �' w • } City of Arlington Building Dept PUBLIC WORKS CHECKLIST PERMIT # s � DATE LEGAL �� /�!`,`I/5 - 'O�d ��W)/ Plat Lot ax ID# n � NAME In0J 1 ADDRESS �) 1�3r A BUILDING USE . m o3 SL,R # of BUILDING UNITS Existing Required Signature Date Water Meter Fire Hydrant Side Sewer Permit Monitoring Manhole Cross-Connection Control Sewer: Off site On site Water: Off site On site Pretreatment Discharge Permit Water/Sewer Fees Date received Date Yellow returned Date Pink returned � I ' ' I r I I " I. 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