HomeMy WebLinkAbout607 E 3rd St - Building
~ORTANGELES
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WAS H I N G TON, U. S. A.
PUBLIC WORKS & UTI~.ITIES DEPARtMENT
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. June 1,2004
Dudley Doss
3627 Snug Harbor
Olympia, W A WA 98506
RE: Port Angeles Landfill Waste Disposal Application, WDA 04-10; Building demolition
at 607 East 3rd, Port Angeles, Washington
We have received your application for disposal 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 landfill scale attendant at the time ofdisposal.
Please be advised that this disposal application is only for the materials and quantities 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,
La,~~
Gary W. Kenworthy, P.E.{)
City Engineer
Deputy Director of Engineering Services
GWK:tf
Encl.: WOA 04-10
Copy: Ken Loghry
Zenovic & Assoc.
Dana Kucban
N:\PWKSIENGINEERI WDAPPLIC\04-1 O. WPD
FILE: Landfill Solid Waste Disposal Applications
321 EAST FIFTH STREET · P. O. BOX 1 150 . PORT ANGELES, WA 98362-0217
PHONE: 360-417-4805 · FAX: 360-417-4542 . TTY: 360-417-4645
E-MAIL: PUBWORKS@CI.PORT-ANGELES.WA.US
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PORT ANGELES LANDFILL
WASTE DISPOSAL APPLICA TION
To: City of Port Angeles, City Engineer
321 E Fifth Street
P.O. Box 1150
Port Angeles, Washington 98362
Phone: (360) 417-4803
FAX: (360) 417-4709
NOTE:
All questions must be answered for waste to be approved.
1. Generator Information:
Company Name:
Mailing Address:
()()D~Y D~.ss __
"Ab27 ~No6 J.h~A(
OLYVv\P/4 1 LA.JA CJ8.s-ob
t>~'r' i)QS.S
360 - 4S7 - ;k)4 f:;).
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Contact:
Phone:
Project Name:
Project location:
2. Other Contacts (if applicable):
Consulting Firm: Z~Ov,~ t 4sscx:...J :!.,..;c
Contact: ~y G '-J~ (;1 L.
Phone: 41,-oSo I
Contra ct or Name: -.1: lJ (' (J.j14AJ a,/V,)'1"-t.~ "Il is).-..J
Contact: b~A k(.)C6(1Ai
Phone: 457 - 7/"f Z.
Laboratory: rJl/L lA~" ~.(..c-i.S 1 -L,.Jl.
Contact: NeLLY ~'1"""?"LI2:
Phone: '2Dt... SC{ ,.. nJ 00
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Cify of Por1 Angelos - Landfill Waste Disposal Arplication
Page - 1
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3. Source of Waste:
Check the appropriate box below and briefly describe the project, process, and/or cleanup that
will or has produced the waste requiring disposal. Include the gasoline service station number
(if applicable).
CERCLAlMTCA Remediation Agency Contact:
Independent Remedial Action - UST Removal
Unused Chemical Product Spill )( Other Source: &-$IUS
~~#tV{j (i~&'-t ~ /.X .b..,~ o(.,l,sik't) .(JLJ,z ?"i)
t'?cYVIJ1pDN,
4. Waste Material Composition: - (check all that apply and Include percent of total)
Soil % Foundry Slag - %
Concrete/Asphalt % Dredge Sediments - %
Preserved Wood % )G Debris " 19010
Coal Ash % Other (list)
Wood Ash % - %
_%
NOTE: Total must eQual 100%.
5. Waste Material Contaminants: (check all that apply)
Gasoline
Diesel
Metals
Heating Oil
Used Motor Oil/Waste Oil
Other Petroleum Product
Solvents
Unused Motor Oil
Other ?"U-P L~~
PCBs
Unknown
NOTE:
Supply any MSDS information with application, if available.
City of Port Angelos. landfill Waste Disposal Application
Page - 2
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6. Estimated Quantity of Waste for Disposal:
2'S""
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Cubic yards I
Drums I
Tons (estimate both)
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:
'I-
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.
Number of COMPOSITE samples t & number of discrete samples per composite ~
Number of DISCRETE samples ~
Otfr~~~ - (l~OSI'1<. ~.Ptri d- ()( ~l'-'4't.101~ "?"~""'" J Slk"~
5,ol.-vll (2. '-o{#I <(R>NS) ~ ~1c-4 f='l4_....;~ .
NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling
frequency will be used:
0-25
25 - 100
101 - 500
501 - 1000
1001 - 2000
>2000
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
=
1 composite sample
3 composite samples
5 composite samples
7 composite samples
10 composite samples
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.
City ot Port Angeles - landfill Waste Disposal Application
Page - 3
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9. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine the
appropriate analytical requirements for waste characterization. Ecology Publication #91-30
(Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also be
used to characterize petroleum contaminated soils from UST releases. Submit all laboratory
analytical results, QNQC 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 test methods used:
(";/\ 1311/ ")~
.
b) Provide a narrative as to why the above analytical methods were selected:
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NOTE:
Additional sheets attached: ~ YES
NO
10. Soil Classification: (....FOR PETROLEUM CONTAMINATED SOILS ONLY")
Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check
one)
Class 1
Class 3
Class 4
Class 2
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 (OW) nor Extremely Hazardous Waste (EHW)
Dangerous Waste (OW)
and Waste Code:
Extremely Hazardous Waste (EHW) and Waste Code:
City of Port Angeles. Landfill Waslo Disposal Application
Pago - 4
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12. Certification:
We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All
information provided is correct and the enclosed analytical results represent the proposed waste
material to the best of our abilities.
~Ge~ture
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Printed Name
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Company
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Date
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City of Port Angelos - Landfill Wasto Disposal Application
Page - 5
MAY-28-2004 07:31
NVL LABS
2066341936
P.02
NVL Laboratories, Inc. . ..
4708 Aurora Ave. N., Seattle, WA 98103 A",--.
AIHA - IH ~. J_
Tel: 206.547.0100, Fax: 206.634.1936 I
www.nvnabs.com Analysis Report #101861 - OMW. -f
Toxicity Characteristic Leaching Procedure - Lead (Pb)
Client: Zenovic & Associates, Inc. Batch tJ:: :a407011.
,-
Address: 519 South Peabody Street, Suite 22 - Matrlx:-BuIM-:
Port Angeles, WA 98362 Method: E~A 1311nOOOEJ.
Attention: Mr. Tracy Gudgel Client Project #:041_
Project Location: 607 E. 3rd St, Port Angeles Samples: Recei:ved: it .
Total Sa~ AnaIyzed:1[
Lab 10
24038670
Client Sample .,
04168A
RL
mgl L
0.5
Results
In mgIL
0.9
Resula In
ppm
0.9
t
Sampled by: Client
Analyzed by: Holly Tuttle
Date: OS/27/2004
DRAFT
mgI L =Milligrams per liter
ppm = parts per million
Note : Method QC results are acceptable unless stated otherwise.
Bench Run No: 24-0526-10
RL ~ Reporting- limit. :
'<' = Below die reporting 1I~
Page 1 Of 1
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MAY-28-2004 07:31
.
Nl.A.. LABS
2066341936
P.03
Port AngeleS
Pro)eet Menager TB=;Gudael ..4
PwQJect Location Ii. '3 - ~ J 1c:J"l. or A.u4"4:;.~
CHAIN of CUSTOO~ ~.
SAMPLE LOG SA TCH 'D - -. ~ -
2407073.'00 -
NYl Batch Numbv. ..' .'
CUtnt Job Number (:;)-4.f1lse
Total Stmplea f.
T..-n Around Tme 0 1-Hr 0 24... 0 of o.vs
O~~ D~Qaya~~'~
04-Hr8 03 Dava 06:60 10 ~
~_fDrTAT""." HIs ..,...,..
Emeladdren ~.,. ~ .!~-..tc..1'V1-;
NVL Laboratories. Inc.
4708 Autor8 Ave N. Seattle. WA 98103
Tel: 206.547.0100 Emerg. Pager: 206.344.1878
1.888.NVLLABS (685.5227)
Client Zenovic & Associates, Inc.
Street 619 South Peabody Street, Suite" 2,2.
Phone: (360) 417-0501 Fax: (360) 417.0514
o Asbestos Air o PCM (NIOSH 7400) .0 TEM (NIOSH 7402) 0 TEM (AHERA) 0 TEM (EPA Level II) 0 Olhei: .
o Asbesms Bulk o PLM (EPAI6OOIR-931116) 0 PlM (EPA Polnl Counl) 0 PLM (EPA Gfavimetty) 0 TEM a.a .
METALS DeL Until Matrix RCRA MetaIl5 DAle -!"""_.
o Total Metals ~ 0'" Flier 0 Pan Chip5 o Arsenic (As) 0 lead (Pb) 0;,,* a
'8-TClP o ppb (~ 0 Drinking water 0 Peint Chips (Area) o Barium (88) 0 Men:ury (Hg) o COpper (Cu)
\8 ~lwipe _. 0 Waste Watef o Cadmium (Cd) 0 Selenium ~) o Nickel (Ni)
o Chromil.m (ee) 0 SiIvet' (Ag) o Zinc (Zn)
l:' Other Types o Fiberglass o Nuisance Dust U Rotometer c.libration 0 Other (Specify)
of Analysis 0 Silica o Respirable Oust (] MoIdIfungus
Condition of Package: 0 Good 0 Damaged (no splIage) 0 Severe damage (spillage)
Seq.II l..8b ID Client Sample Number ComIM'I_ AIR
1 C')t.JI~ ,tI Pc.~ M~ e~~~ - -ttLP c....~ A-0fO
2
3
4
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6
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7
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8
9
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10
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11
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12
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13
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Print Below
h.. Sampled -....:~ii.A;~.... -..
Relinquished by
\_. 'R~iYed by
r- .... =P-
I Analyzed by .
1 R~1ts ~cd by .
~~ ~~lledby _ ..: I .-=~: _ . I' ~ :.- "i;.
I Sp.cial Instructions: Un~~~ '~sled ill writing. an samples w': be diS~SCd 01 two (2) wc~ks afte~ a_.
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TOT~ P.01
TOTAL P. 03
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CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457.0411
PERMIT NO. ;;;? {} .:s
7/ZLJfr z.
DATE
ELECTRICAL PERMIT
Installed By:
o READY FOR
INSPECTION
License Number:
~WILL CALL FOR
INSPECTION
Phone:
Site Address:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
)<1 RESIDENTIAL
o COMMERCIAL
o BASEBOARD KW _
o FURNACE KW _
o FAN/WALL KW _
o HEAT PUMP KW_
o SIGN
o TEMPORARY SERVICE
o PERMANENT SERVICE
o NEW CONSTRUCTION
o REMODEL
15{ ADD/ALTER CIRCUITS
tJ SERVICE UPGRADE/REPAIR
o SPECIAL EQUIPMENT
(LIST BELOW)
)5" OVERHEAD SERVICE
o UNDERGROUN~~VlCE
VOLTAGE: I Z&. 0
~ SINGLE PHASEf-
o THREE PHASE.. ._
SERVICE SIZE ='6LV AMPS
Details/Description:
)'(frA /(~r t,cPuSF
11M cK~/AJ j,~1- ;d-~-/
.
W.S. No. SERVICE SIZE
CAPACITY:
o OK NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection OK
./f,tAtA Rough-in/cover O.K.
~ O.K. to connect service
.rinalOK
Site Address:
Installer:
.:l~ .
Permit/Receipt No.
';J 70 .J
New Meters
.
Notify Port Angeles City Lig t by Street Address and Permit Number when ready for inspection. Work must not be covered
before inspection and O.K for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building Permit PHONE 457-0411, EXT. 224.
~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
) $
Eleclricallnspector
<J.GJ
~()-
Permit Fee
WHITE - File by address
YELLOW - file by number
PINK - Top: Eng, Bottom, Customer
GREEN - Top: Meter Dept., Bottom: City Hall
OLYMPIC PRINTERS INC