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Home My WebLink About312 W 5th St - Building crFY OF PORT ANGELES DEPARTMENT OF COMMUNFrY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number ..... 03-00000236 Date 3/17/03 Property Address ...... 312 E 5TH ST ASSESSOR PARCEL NUMBER: 0630000199300000 Application description . . . DEMOLITION Property Zoning ....... Application valuation .... 500 Owner Contractor -p, o, ...... structure Information DEMO SHED, GARAGE, CARPORT ..... Construction Type ..... TYPE V NON~RATED Occupancy Type ...... GARAGES, CARPORTS, SHEDS ............................................................................ Permit ...... DEMOLITION Additional desc . . Permit Fee .... 47.00 Plan Check Fee . . .00 Issue Date .... 3/17/03 Valuation .... 0 Expiration Date . . 9/13/03 Qty Unit Charge Per Extension BASE FEE 47.00 Fee sunm~ry Charged Paid Credited Due Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 47.00 47,00 .00 .00 ! Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction s uthorized is not commenced within f 80 days, if construction or work is suspended or abandoned for a period of f 80 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application End know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. ,~· Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) / / Date T:\PLANNING\FOP~MS\ 1102.15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCE/IL ANY WORK BEFORE INSPECTED ,4ND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE ~)~ - ~L-~ ~ INSPECTION TYPE I DATE ACCEPTED COMMENTS I YES I NO FOUNDATION: ~ ?oRr FOR OFFICIAL USE ONLY: ~.~.o~(,~( Date Rec.: BUILDING PERMIT - APPLICATION Pe~it~: Date Approve: Date Issued: The Building Permit ~lication must be fi~e~ out completely. Please type or print in ink. If you have any questions, please call 417-4815 Applic~t or Agent: ]~ ~ ;~ ~ Phone: ~6 o - E6 ~-/377 Owner: [~'~ ~i~ Phone: ~ Address: ~O ~oX ~0~ City: ~ ~[~$ Zip: ~chitecffEngineer: Phone: Contractor License ~: Exp: Phone: Address: City: Zip: PROJECT ~D~SS: ~ 12 E. ~4~ ~4. ZONING: ~ ~ LEGAL DESC~PTION: Lot: ~ Block: $qq Subdivision: ~o~t~ o~ ~ CL~L~ COUNTY P~CEL NUMBER: D&~ OO ~ OI.q~;0Credit Card Holder Name: * Billing Address: City:. Credit Card ~: Exp. Date: VISA MC TYPE OF WO~: SIZE~UATION: ~ Residential ~ New Consm ~ Re-roof ~ Wood-stove SF. ~ $. /SF. =~ ~ Multi-famly ~ Addition ~ Move ~ Garage SF. ~ $. /SF. = $ Comercial ~ Remodel ~ Demolition ~ Deck SF. ~ $. /SF. = $ ~ Repak D Sign ~ TOTAL VALUATION $ ~ ~ COMMERCI~SIDENTI~: Occupancy Group: Occupant Load: Cons~ction T~e: No. of Stories: Lot Size: % Lot Coverage: Existing Lot Coverage: /sq. fl. + Proposed Lot Coverage: /sq. ft. = TOTAL LOT COVE~GE: /sq. fl. PLANING USE ONLY: APPROVES: PL~ Notes: BLDG. DPW FI~ ESMWetland(s): ~ Yes ~ No SEPA Chec~ist required? ~ Yes ~ No O~er: OTHER BUILDING PE~IT APPLICATION SUBMITT~: Your application and site plan must be filled out completely to be accepted for review. The Building Division can provide you ~ more detailed infomtion on the application and plan sub~Ral requirements. Yo~ completed application, site plan (for additions) and building cons~ction plans are to be sub,Red to ~e Building Division. V~UATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This fig~e MI1 be reviewed and ~y be revised by the BuJl ding Division to comply wi~ c~ent fee sch edul es. Contact the Pe~t Coordinator at 417-48 ] 5 for assistance, PLAN CHECK FEE: Your plan check fee is due at the time the building pe~t application and cons~ction plans are subdued. All o~er pemt fees are due at the time ofpe~t issuance. EXPIATION OF PL~ ~VIEW: If no pe~it is issued wi~in 180 days of the date of application, this application will expire. The Building Official can extend ~e time for action by the applicant up to 180 days upon ~itten request by the applicant (see Section 107.4 of the Unifo~ Building Code, cu~ent edition). No application can be extended more than once. 1 hereby cert~ that I have read and examined this application and know the same to be true and correct, and I am authorized to a~lyfor this permit. I understand it i~ not the CiT's legal responsibili~ to determine what permits are required; it remains the applicanD responsibili~ to determine what permits are required and to obtain such. TSFO~ S%PPS~B~ildin~c~it pORTANGELES WASHINGTON, U.S.A. PUBLIC WORKS & UTILITIES DEPARTMENT March 5, 2003 Klm A. Weimer P.O. Box 2803 Port Angeles, WA 98362 RE: Port ~mgeles Landfill Waste Disposal Application, WDA 03-03; Building demolition at 312 East 5th Street, Port Angeles We have received your application for &sposal of building demolition debris from the referenced site and reviewed the testing results for lead content. Based on the testing results the debris appears to be acceptable for use in the landfill: A copy of your approved application is attached. This approved application must be shown to the lamtfill scale attendant at the time of disposal. Please be advised that this disposal application is only tbr the materials and quant/ties listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very truly yours, Gary W. Kenworthy, P.E. / ) City. EEgineer Deputy Director of Engineering Services GWK'ff Enzl.: WDA 03-03 :~21 EAST F1FTH STF~EET ° P. O BOX 1 t50 ~ PORT ANGELES WA 98362-0217 PHONE: 360-417-4805 · FAX: 360-417-4542 · tt¥: 3eo-417-4645 PORT ANGELES LANDFrLL WASTE DISPOSAL APPLICATION To: City of Port Angeles, City Engineer Phone: (360) 417-4803 321 E Fifth Street FAX: (360) 417~4709 P.O. Box 1150 Port Angeles, Washington 98362 NOTE: All questions must be answered for waste to be approved. 1. Generator Information: Company Name: ~:~/4~ ~,4~,~.~',,~f~_ ~/~- //~'ff'~--~ Mailing Address: Contact: . Phone: ~&o~ ~-~T - ~ 37 '7 . Project Name: ~3u~.o-,.~ /~,~ c.,e~,,.~ ,,, Project Location: 2. Other Contacts (ifappiicable): Consulting Firm: Contact: Phone: Contractor Name: Conla~: Phone: Labomlo~: Contact: Phone: City of Pert' Angeles- Landfilt Waste Disposa[ Application ..... Pag.'e - ~ Source of Waste: Check the appropriate box below and briefly describe the project, process, and/or cleanup thai will or has produced the waste requiring disposal. Include the gasoline service station number (if applicable). CERCLA/MTCA Remediation Agency Contact: Independent Remedial Action UST Removal Unused Chemical Product Spill ~ Other Source: ~,~.~s.. , 4. Waste Material Composition: (check all that apply and include percent of total) Soil °,4 ~ Foundry Slag % i Concrete/Asphalt % ~ Dredge Sediments % Preserved Wood % . 1,/" Debris ..ZOO% Coal Ash % __ Other (list) Wood Ash % % % NOTE: Total must equal 100%. 5. WaSte Material Contaminants: (check all that apply.). Gasoline Metals Diesel Solvents Heating Oil ~ PCBs Unused Motor Oil Used Motor Oil/Waste Oil v/ Other ?",~v~ . ~ ~l~'~f./~ ~ Other Petroleum Product Unknown I NOTE: Supply any MSDS information with application, if available. city of Port Angeles - Landfill Waste Disposal Application Page 6. Estimated Quantity of Waste for Disposal: .~.~' Cubic yards / /~,~'~ Tons (estimate both) Drums / Tons (estimate both) Other NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) 7. Frequency of Disposal: ~ One time ~ Monthly __ Annual ~ Other 8. Waste Sampling: Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a waste, and the frequency of sampling, will vary with the type and form of the waste. Check the appropriate box and briefly describe how and where the waste was sampled. Include site maps with sampling locations if possible. t Number of COMPOSITE samples ~ & number of discrete samples per composite ~ Number of DISCRETE samples ~ NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 0 - 25 cubic yards = 1 composite sample 25 - '100 cubic yards = 3 composite samples 101 - 500 cubic yards = 5 composite samples 501 - 1000 cubic yards = 7 composite samples 1001 - 2000 cubic yards = 10 composite samples >2000 cubic yards = 10 plus one sample for each additional 500 cubic yards NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete samples. Cily of Port Angeles - Landf~ll Wasle Disposa'l Application Page - 3 ~, Waste Analysis: The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine th appropriate analytical requirements for waste characterization. Ecology Publication #91-3( (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also bt used to characterize petroleum contaminated soils from UST releases. Submit all laboratory analytical results, QA/QC data, and Chain of Custody sheets along with this application. NOTE: The laboratory must be accredited by the Washington State Department of Ecology. a) List all analytical lest methods used: b) Provide a narrative as lo why the above analytical methods were selected: NOTE: Additional sheets attached: ,~YES NO 10. Soil Classification: (**FOR PETROLEUM CONTAMI'NATED SOILS ONLY**) Based on the analytical data and Ecology Publication f/91-30, the soil classification is: (check one) Class 1 Class 2 Class 3 Class 4 Calculated Hazard Index ,' 11. Dangerous Waste Affidavit: Based on a review of the analytical test results, site history, and the applicable regulations, this waste is classified as: (check one) Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Wasle (EHW) and Waste Code: City of Port Angeles ~ Landfill Waste DisPOsal Application ' Paoe - 4 12. Certification: We, THE UNDERSIGNED, cerlify that this application is lrue to the best of our knowledge, All information provided is correct and the enclosed analytical results represent the proposed wast, material to the best of our abilities. Printed Name Company Date City o! Port Angeles - Lendfil[ Weste O{spossl Application Page - 5 NVL Laboratories Inc AIH Tel: 206.547.01D0, Fax: 206.634.1936 ,aIHA o IH www. nvl~abs.com AJ'~S Report e1018~1 Lead (Pb) TGLP Client: Zenovic & Associates, Inc. Batch ~ 2,3~ Address: 519 South Peabody Street, Suite 4 Port Angeles Method: EPA 131;I/7~3 Client Project AtlentJon: Mr. Tracy Gudgel Samples Receive~ project LoCation: 312 E 5th St, Total SamlY, es R ~$ults Reealtl Lab ID Client Sample # m~/L ir ~mglL 13~m 2;30t 6276 03050A 0.5 < 11.5 < Analyzed by: Holly Tattle Dale: 03/04/2003 rog/L =Milligrams per liter ~.L = Reporting Limit .opm = parts par m~lllon '<' = Below ~e reporang Limit Note: Memo~ QC msult~ are ac~-~pt~ble unless stated other~se. Bench Run No: 23-0303~7 Page _ NV[ laboratories. Inc. CHAIN of CUSTODY BATCH ID ,?ce ~m ^ye., se~ut w^.~o3 SAMPLE LOG 2302539 Tel: 2Q6.~47.0t00 6meri, Pm~ ~.~4.18~ ~fl~ ..... T~~I~ ]~24~ ~4~ 8 CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~-~--~- ~ Time Received by ~ (phone, person) Location of Work to be inspected .~/ ~. ~- Name of person requesting inspection ~'~ V~ Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing~Pi~ Sewer Excav. Other Inspected: Date '~[ _~c~ ((~, Tim Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved ~-~Gravel [~]Asphalt []PCC ~]Other [] Repaired by City Work Order # ~} Repaired by Permittee ~-~ COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) crFY OF PORT ANGELES DEPARTMENT OF COMMUNFrY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number ..... 03-00000236 Date 3/17/03 Property Address ...... 312 E 5TH ST ASSESSOR PARCEL NUMBER: 0630000199300000 Application description . . . DEMOLITION Property Zoning ....... Application valuation .... 500 Owner Contractor -p, o, ...... structure Information DEMO SHED, GARAGE, CARPORT ..... Construction Type ..... TYPE V NON~RATED Occupancy Type ...... GARAGES, CARPORTS, SHEDS ............................................................................ Permit ...... DEMOLITION Additional desc . . Permit Fee .... 47.00 Plan Check Fee . . .00 Issue Date .... 3/17/03 Valuation .... 0 Expiration Date . . 9/13/03 Qty Unit Charge Per Extension BASE FEE 47.00 Fee sunm~ry Charged Paid Credited Due Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 47.00 47,00 .00 .00 ! Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction s uthorized is not commenced within f 80 days, if construction or work is suspended or abandoned for a period of f 80 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application End know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. ,~· Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) / / Date T:\PLANNING\FOP~MS\ 1102.15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCE/IL ANY WORK BEFORE INSPECTED ,4ND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE ~)~ - ~L-~ ~ INSPECTION TYPE I DATE ACCEPTED COMMENTS I YES I NO FOUNDATION: ~ ?oRr FOR OFFICIAL USE ONLY: ~.~.o~(,~( Date Rec.: BUILDING PERMIT - APPLICATION Pe~it~: Date Approve: Date Issued: The Building Permit ~lication must be fi~e~ out completely. Please type or print in ink. If you have any questions, please call 417-4815 Applic~t or Agent: ]~ ~ ;~ ~ Phone: ~6 o - E6 ~-/377 Owner: [~'~ ~i~ Phone: ~ Address: ~O ~oX ~0~ City: ~ ~[~$ Zip: ~chitecffEngineer: Phone: Contractor License ~: Exp: Phone: Address: City: Zip: PROJECT ~D~SS: ~ 12 E. ~4~ ~4. ZONING: ~ ~ LEGAL DESC~PTION: Lot: ~ Block: $qq Subdivision: ~o~t~ o~ ~ CL~L~ COUNTY P~CEL NUMBER: D&~ OO ~ OI.q~;0Credit Card Holder Name: * Billing Address: City:. Credit Card ~: Exp. Date: VISA MC TYPE OF WO~: SIZE~UATION: ~ Residential ~ New Consm ~ Re-roof ~ Wood-stove SF. ~ $. /SF. =~ ~ Multi-famly ~ Addition ~ Move ~ Garage SF. ~ $. /SF. = $ Comercial ~ Remodel ~ Demolition ~ Deck SF. ~ $. /SF. = $ ~ Repak D Sign ~ TOTAL VALUATION $ ~ ~ COMMERCI~SIDENTI~: Occupancy Group: Occupant Load: Cons~ction T~e: No. of Stories: Lot Size: % Lot Coverage: Existing Lot Coverage: /sq. fl. + Proposed Lot Coverage: /sq. ft. = TOTAL LOT COVE~GE: /sq. fl. PLANING USE ONLY: APPROVES: PL~ Notes: BLDG. DPW FI~ ESMWetland(s): ~ Yes ~ No SEPA Chec~ist required? ~ Yes ~ No O~er: OTHER BUILDING PE~IT APPLICATION SUBMITT~: Your application and site plan must be filled out completely to be accepted for review. The Building Division can provide you ~ more detailed infomtion on the application and plan sub~Ral requirements. Yo~ completed application, site plan (for additions) and building cons~ction plans are to be sub,Red to ~e Building Division. V~UATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This fig~e MI1 be reviewed and ~y be revised by the BuJl ding Division to comply wi~ c~ent fee sch edul es. Contact the Pe~t Coordinator at 417-48 ] 5 for assistance, PLAN CHECK FEE: Your plan check fee is due at the time the building pe~t application and cons~ction plans are subdued. All o~er pemt fees are due at the time ofpe~t issuance. EXPIATION OF PL~ ~VIEW: If no pe~it is issued wi~in 180 days of the date of application, this application will expire. The Building Official can extend ~e time for action by the applicant up to 180 days upon ~itten request by the applicant (see Section 107.4 of the Unifo~ Building Code, cu~ent edition). No application can be extended more than once. 1 hereby cert~ that I have read and examined this application and know the same to be true and correct, and I am authorized to a~lyfor this permit. I understand it i~ not the CiT's legal responsibili~ to determine what permits are required; it remains the applicanD responsibili~ to determine what permits are required and to obtain such. TSFO~ S%PPS~B~ildin~c~it pORTANGELES WASHINGTON, U.S.A. PUBLIC WORKS & UTILITIES DEPARTMENT March 5, 2003 Klm A. Weimer P.O. Box 2803 Port Angeles, WA 98362 RE: Port ~mgeles Landfill Waste Disposal Application, WDA 03-03; Building demolition at 312 East 5th Street, Port Angeles We have received your application for &sposal of building demolition debris from the referenced site and reviewed the testing results for lead content. Based on the testing results the debris appears to be acceptable for use in the landfill: A copy of your approved application is attached. This approved application must be shown to the lamtfill scale attendant at the time of disposal. Please be advised that this disposal application is only tbr the materials and quant/ties listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very truly yours, Gary W. Kenworthy, P.E. / ) City. EEgineer Deputy Director of Engineering Services GWK'ff Enzl.: WDA 03-03 :~21 EAST F1FTH STF~EET ° P. O BOX 1 t50 ~ PORT ANGELES WA 98362-0217 PHONE: 360-417-4805 · FAX: 360-417-4542 · tt¥: 3eo-417-4645 PORT ANGELES LANDFrLL WASTE DISPOSAL APPLICATION To: City of Port Angeles, City Engineer Phone: (360) 417-4803 321 E Fifth Street FAX: (360) 417~4709 P.O. Box 1150 Port Angeles, Washington 98362 NOTE: All questions must be answered for waste to be approved. 1. Generator Information: Company Name: ~:~/4~ ~,4~,~.~',,~f~_ ~/~- //~'ff'~--~ Mailing Address: Contact: . Phone: ~&o~ ~-~T - ~ 37 '7 . Project Name: ~3u~.o-,.~ /~,~ c.,e~,,.~ ,,, Project Location: 2. Other Contacts (ifappiicable): Consulting Firm: Contact: Phone: Contractor Name: Conla~: Phone: Labomlo~: Contact: Phone: City of Pert' Angeles- Landfilt Waste Disposa[ Application ..... Pag.'e - ~ Source of Waste: Check the appropriate box below and briefly describe the project, process, and/or cleanup thai will or has produced the waste requiring disposal. Include the gasoline service station number (if applicable). CERCLA/MTCA Remediation Agency Contact: Independent Remedial Action UST Removal Unused Chemical Product Spill ~ Other Source: ~,~.~s.. , 4. Waste Material Composition: (check all that apply and include percent of total) Soil °,4 ~ Foundry Slag % i Concrete/Asphalt % ~ Dredge Sediments % Preserved Wood % . 1,/" Debris ..ZOO% Coal Ash % __ Other (list) Wood Ash % % % NOTE: Total must equal 100%. 5. WaSte Material Contaminants: (check all that apply.). Gasoline Metals Diesel Solvents Heating Oil ~ PCBs Unused Motor Oil Used Motor Oil/Waste Oil v/ Other ?",~v~ . ~ ~l~'~f./~ ~ Other Petroleum Product Unknown I NOTE: Supply any MSDS information with application, if available. city of Port Angeles - Landfill Waste Disposal Application Page 6. Estimated Quantity of Waste for Disposal: .~.~' Cubic yards / /~,~'~ Tons (estimate both) Drums / Tons (estimate both) Other NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) 7. Frequency of Disposal: ~ One time ~ Monthly __ Annual ~ Other 8. Waste Sampling: Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a waste, and the frequency of sampling, will vary with the type and form of the waste. Check the appropriate box and briefly describe how and where the waste was sampled. Include site maps with sampling locations if possible. t Number of COMPOSITE samples ~ & number of discrete samples per composite ~ Number of DISCRETE samples ~ NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 0 - 25 cubic yards = 1 composite sample 25 - '100 cubic yards = 3 composite samples 101 - 500 cubic yards = 5 composite samples 501 - 1000 cubic yards = 7 composite samples 1001 - 2000 cubic yards = 10 composite samples >2000 cubic yards = 10 plus one sample for each additional 500 cubic yards NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete samples. Cily of Port Angeles - Landf~ll Wasle Disposa'l Application Page - 3 ~, Waste Analysis: The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine th appropriate analytical requirements for waste characterization. Ecology Publication #91-3( (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also bt used to characterize petroleum contaminated soils from UST releases. Submit all laboratory analytical results, QA/QC data, and Chain of Custody sheets along with this application. NOTE: The laboratory must be accredited by the Washington State Department of Ecology. a) List all analytical lest methods used: b) Provide a narrative as lo why the above analytical methods were selected: NOTE: Additional sheets attached: ,~YES NO 10. Soil Classification: (**FOR PETROLEUM CONTAMI'NATED SOILS ONLY**) Based on the analytical data and Ecology Publication f/91-30, the soil classification is: (check one) Class 1 Class 2 Class 3 Class 4 Calculated Hazard Index ,' 11. Dangerous Waste Affidavit: Based on a review of the analytical test results, site history, and the applicable regulations, this waste is classified as: (check one) Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Wasle (EHW) and Waste Code: City of Port Angeles ~ Landfill Waste DisPOsal Application ' Paoe - 4 12. Certification: We, THE UNDERSIGNED, cerlify that this application is lrue to the best of our knowledge, All information provided is correct and the enclosed analytical results represent the proposed wast, material to the best of our abilities. Printed Name Company Date City o! Port Angeles - Lendfil[ Weste O{spossl Application Page - 5 NVL Laboratories Inc AIH Tel: 206.547.01D0, Fax: 206.634.1936 ,aIHA o IH www. nvl~abs.com AJ'~S Report e1018~1 Lead (Pb) TGLP Client: Zenovic & Associates, Inc. Batch ~ 2,3~ Address: 519 South Peabody Street, Suite 4 Port Angeles Method: EPA 131;I/7~3 Client Project AtlentJon: Mr. Tracy Gudgel Samples Receive~ project LoCation: 312 E 5th St, Total SamlY, es R ~$ults Reealtl Lab ID Client Sample # m~/L ir ~mglL 13~m 2;30t 6276 03050A 0.5 < 11.5 < Analyzed by: Holly Tattle Dale: 03/04/2003 rog/L =Milligrams per liter ~.L = Reporting Limit .opm = parts par m~lllon '<' = Below ~e reporang Limit Note: Memo~ QC msult~ are ac~-~pt~ble unless stated other~se. Bench Run No: 23-0303~7 Page _ NV[ laboratories. Inc. CHAIN of CUSTODY BATCH ID ,?ce ~m ^ye., se~ut w^.~o3 SAMPLE LOG 2302539 Tel: 2Q6.~47.0t00 6meri, Pm~ ~.~4.18~ ~fl~ ..... T~~I~ ]~24~ ~4~ 8 CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~-~--~- ~ Time Received by ~ (phone, person) Location of Work to be inspected .~/ ~. ~- Name of person requesting inspection ~'~ V~ Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing~Pi~ Sewer Excav. Other Inspected: Date '~[ _~c~ ((~, Tim Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved ~-~Gravel [~]Asphalt []PCC ~]Other [] Repaired by City Work Order # ~} Repaired by Permittee ~-~ COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)