eriod from date submitted Must include fee See Consolidated Fee Schedule (Table 11) http1/

Transcription

1 Notification # I 1. TYPE OF NOTIFICATION ~riginal D Revised D Cancelled): NOTIFICATION OF DEMOLITION Southwest Clean Air Agency NE 99th Street, Suite 1294 Vancouver, WA Voice: (360) Fax: (360) Must include fee eriod from date submitted See Consolidated Fee Schedule (Table 11) http1/ 2. TYPE OF OPERATION D Partial Demolition ~omplete Demolition D Ordered Demolition Date Received ~ ~ OCT l1u SOUTHWEST CLEAN AIR AGENCY D Emergency Demolition D Fire Training 3. FACILITY DESCRIPTION (Example: Residence, Barn, Carport) Commercial Name or Description: Address: Present use: Prior use: County: {;../ _ ~h... r 4. FACILITY INFORMATION Owner Name: Mailing Address: City: Contact: 5. NAME AND AHERA CERTIFICATION NUMBER OF ASBESTOS INSPECTOR:-- A ~- / 77t!> 6. ATTACH 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: Name: City: State: Zip Code: Contact: Phone: 8. DATES ASBESTOS REMOVAL OCCURRED (mm/dd/yy) Start: 9. DATES DEMOLITION WILL OCCUR (mm/dd/yy) Start: fl, 10. DEMOLITION CONTRACTOR or FIRE DEPARTMENT: Complete: Asbestos Case Number: Name: City: Contact and Phone# State: u;jj..r County: # ~ / - ~c...f/l. SWCAA FORM N0.23 REVISED 07/13/2018

2 11. DESCRIPTION OF PLANNED DEMOLITION WORK, METHOD(S) TO BE USED: 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 SWCM 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 CERTIFY THAT THE ABOVE INFORMATION IS CORRECT. Cku~~pe1r,P!!;1~S ft (l~jt~ (Si!fi{ature of Owner/Operator) 10LzsLt8 (Date) HAVE YOU PERFORMED A HAZARDOUS MATERIALS ASSESSMENT ON THE STRUCTURE? DYES D NO The Washington State Dangerous Waste Regulations (WAC ) 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, 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: SWCM FORM N0.23 REVISED 07/13/2018

3 Jason Smith 849 Woodpecker Dr Kelso, WA Environmental Services Planning & Permitting Assessment & Analysis Project Management October 19, 2018 Patrick Marsh C/O Turnkey Homes 206 Oregon Way Longview, WA Subject: Letter of Findings for 1124 Coal Creek Road, Longview WA Asbestos Survey This letter of findings presents results of the asbestos survey performed for the single-family manufactured home located at the subject address. The survey scope performed October 17, 2018 included identification, sampling and analysis of suspect asbestos containing material (ACM) that may be disturbed during demolition. Cowlitz County Parcel Number: WL Site Address: 1124 Coal Creek Road, Longview WA Abbreviated Legal Description: SUB:COAL CREEK AC 1 LOT:21A DESC: CC01072 LOT 3 SECT,TWN,RNG:2-8N-3W Short Plat CC Fee Number PARCEL: WL The structure is listed in Cowlitz County records as a 980 s.f. structure. Owner stipulates 1990 as date of manufacture. The unit is in a state of partial demolition, including removal of wood porch and metal skirting. Interior finishes include 12" vinyl tile in the rear bedroom matched by vinyl tile in the kitchen, sheet vinyl in the rear bathroom matched by same sheet vinyl in main bathroom and Phone: Fax: WWW: castle-rose.net jason@castle-rose.net

4 Page 2 October 19, 2018 laundry area, sheet vinyl in the entry area, and tack-down carpet in all other areas. Ceiling finished by texture on drywall panels with seam strips (no joint compound). Walls finished with textile-type wall paper on drywall panels (no texture or join compound). Aluminum-framed windows had no sealant. Roof was composite. Exterior siding was retrofit vinyl lap siding over original Tlll panel siding. The scope of the survey was to identify Potential Asbestos Containing Material (PACM) that may be disturbed during demolition: 6 total samples were collected. The laboratory analyzed 9 layers (Bold= Positive for Asbestos): 1. Sheet Vinyl Flooring at Entry a. Mastic 2. Sheet vinyl - bathrooms 3. 12" Vinyl Tile - rear bedroom a. Mastic 4. Wall Panel a. Drywall b. Wall Paper 5. Ceiling Panels 6. Roofing The survey and report comply with the requirements of the Southwest Clean Air Agency (SWCAA) Standards for Asbestos Control (SWCAA 476) and 40 CFR Part 61, Subpart M (Federal Asbestos Requirements). The survey was conducted under the supervision of an AH ERA-certified building inspector: Jason Smith, Certified Industrial Hygienist EPA Certification Number: (EXP. 03 April 2019) FINDINGS Summary of asbestos-containing materials presented in Table 1: NO ACM IDENTIFIED Table 1-Asbestos Containing Material Sample Sample Location *Area (s.f.) Sample Description Results ID *Area presented for Notification to SWCAA purposes only. Actual s.f. to be verified by abatement contractor. Include this letter of findings with your permit applications for the subject structure.

5 Page 3 October 19, 2018 Should you have any questions regarding the findings of this report, please do not hesitate to contact this office. ~Jt / Jason Smith, CIH Project Manager ENCL: Laboratory Report

6 EMSL Analytical, Inc rd Ave S, Suite D 2nd floor Seattle, WA Tel/Fax: (206) I (206) hllp:/fwwn_emsl.com I seattlelall@ems.com Attention: Jason Smith Castle Rose 870 Woodpecker Drive Kelso, WA Project: 1124 Coal Creek EMSL Order: Customer ID: CSTR34 Customer PO: 1124 Coal Creek Project ID: Phone: (360) Fax: Received Date: 10/17/2018 1:35 PM Analysis Date: 10/18/2018 Collected Date: Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R Method using Polarized Light Microscopy Sample Description Appearance 1-Vinyl Sheet Flooring Entry, Sheet vinyl Gray/White Homogeneous 1-Mastic Entry, Sheet vinyl Yellow Non A Homogeneous 2 Bathroom, Sheet vinyl Gray/White Homogeneous 3-Vinyl Floor Tile Master bedroom, 12" Gray/White vinyl Non Homogeneous 3-Mastic Master bedroom, 12" Clear vinyl Non A Homogeneous 4-Wallpaper Hall, Wall system TanNarious Homogeneous 4-Wallboard Hall, Wall system Brown/White A Homogeneous 5 Living room, Ceiling Brown/White system Homogeneous Inseparable paint I coating layer induded in analysis 6 Roof, Asphaltic Gray/Black shingle Homogeneous Non-Asbestos Asbestos % % Non- % Type 30% Cellulose 60% Non-fibrous (Other) None Detected 10% Synthetic 100% Non-fibrous (Other) None Detected 35% Cellulose 60% Non-fibrous (Other) None Detected 5%Glass 5% Synthetic 95% Non-fibrous (Other) None Detected 100% Non-fibrous (Other) None Detected 25% Cellulose 75% Non-fibrous (Other) None Detected 20% Cellulose 60% Gypsum None Detected 20% Non-fibrous (Other) 20% Cellulose 3% Quartz None Detected 60%Gypsum 17% Non-fibrous (Other) 25%Glass 10% Quartz None Detected 65% Non-fibrous (Other) Analyst(s) Ehrin Baul (9) cy~z~ Lauren Kerber, Laboratory Manager or Other Approved Signatory EMSL maintains liability limited to cost of analysis. The above analyses were performed in general compliance with Appendix E to Subpart E of 40 CFR (previously EPA 600/M "Interim Method"), but augmented with procedures outlined in the 1993 ("final") version of the method. This report relates only to the samples reported above, and may not be reproduced, except in full, without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations _ Interpretation and use of test results are the responsibility of the client All samples received in acceptable condition unless otherwise noted. This report must not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST or any agency of the federal government EMSL recommends gravimetric reduction for all non-friable organically bound materials prior to analysis. Estimation of uncertainty is available on request. Samples analyzed by EMSL Analytical, Inc. Seattle, WA NVLAP Lab Code , CA 2733 (Initial report from: 10/18/ :28:39 ASB_PLM_0008_ Printed: 10/18/ :28 AM Page 1 of 1