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This map is not intended to be used as a legal description.
This map/drawing is produced by the City of Port Angelesfor its own use and purposes
Any other use of this map/drawing shall not be the responsibility of the Ci~l'.
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WAS H I N G TON, U. S. A.
PUBLIC WORKS & UTILITIES DEPARTMENT
October 11, 2004
Ray Gruver
210 East 7th Street
Port Angeles, W A 98362
RE: Port Angeles Landfill Waste Disposal Application, WDA 04-26 Building demolition
at Lot 3, Block 270,Building located on 300 Block East 8th Street, 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 of disposal.
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,
~~r
Gary W. Kenworthy, P .E.
City Engineer
Deputy Director of Engineering Services
GWK:tf
Enc1.: WDA 04-26
Copy: Ken Loghry
Zenovic & Assoc.
N:\PWKS\ENGINEERIWDAPPLIC\04-26. WPD
FILE: Landfill Solid Waste Disposal Applications
321 EAST FIFTH STREET · P. O. BOX 1150 · PORT ANGELES, WA 98362-0217
PHON E: 360-417-4805 · FAX: 360-417-4542 · TTY: 360-417-4645
E-MAIL: publicworks@cityofpa.us
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To:
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PORT ANGELES LANDFILL
WASTE DISPOSAL APPLICA TION
City of Port Angeles, City Engineer
321 E Fifth Street
P.O. Box 1150
Port Angeles, Washington 98362
NOTE:
Phone: (360) 417-4803
FAX: (360) 417-4709
All questions must be answered for waste to be approved.
1. Generator Information:
Company Name:
Mailing Address:
Contact:
Phone:
Project Name:
Project Location:
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2. Other Contacts (if applicable):
Consulting Finn:
Contact:
Phone:
Contractor Name:
Contact:
Phone:
Laboratory:
Contact:
Phone:
2'7/1101//(.. t Ass DC. ) S/Vc
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\('17-0SO\
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I)V6 - 5'17-0100
--.-----.-..--.--- ---------. -_.- ---~--_._-----._-_._----
City of Port Angelos - Landrill Waste Disposal Application
Page - 1
..
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I
3. Source of Waste:
Check the appropriate box below and brieny describe the project, process, and/or cleanup that
will or has produced the waste requiring disposal. Include the gasoline service station number
(if applicable).
CERCLNMTCA Remediation Agency Contact:
Independent Remedial Action UST Removal
-
Unused Chemical Product Spill )( Other Source: .6~6~<
1i~.t>?iN4 ~S/z.. ~ ~4. b~()u.5~ 4L.(yVtj w"-r~ 2 ~..4-LL
/)\J'1 &.> I uo ,...,) 6 S. ~k~ JJA~ ~ -1'0 TALL Y .5-?,o(..l,At~~ "70 ,~~ ~
S"-rv6$. of\) ~</l,1 ~11... ND I~/U"J'\.. I1...1J S 1-/<< .
1
4. Waste Material Composition: (check all that apply and Include percent of total)
Soil % Foundry Slag _%
Concrete! Asphalt % Dredge Sediments _%
Preserved Wood % 'tC Debris 100%
Coal Ash % Other (list)
Wood Ash % _%
_%
NOTE: Total must equal 100%.
5. Waste Material Contaminants: (check all that apply)
Gasoline
Metals
Heating Oil
Used Motor Oil/Waste Oil
Other Petroleum Product
PCBs
Diesel
Solvents
Unused Motor Oil
Other '1'-<<1"<0 ru'L -tc..LP (1'41
)(
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:
zS-
Cubic yards I
Drums I
'in
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:
~
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
I & number of discrete samples per composite .r
Number of DISCRETE samples .5'
()L..r326A -' ~Jbs,-t'4. )*....v'~ ~~ 1)( C<~ S'(),...IC Uw"-. 4~) '2 ~('1~....st
Ix. ~l,,^- ( Ok &LvlL.) I 1 \'- '?-1ft~4 I I~ ~ ';Irr' -7oz....- (WI4J Y-t)
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 conlain a minimum of three/maximum of five discrete
samples,
City of Port Angeles - Landfill Waste Disposal Application
Pago . 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, QAlQC 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:
fiP"'31 \/7I:loc.~
b) Provide a narrative as to why the above analytical methods were selected:
Dv/.a. -to 4C.{. 01'- ST'~,..()-<<. -1'~ '5 l.Jbtl...'Y U4(J -6.v"'-O
A4..,,.J--( c:!)N ~ "'''..Alert 1,)41(,(..
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 2
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)
I
JG 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 Waste Disposal Application
PaQo - 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 0 r abilities.
-7~"'(' t[(/06-<<..
Printed Name
~D\lt" j ~ IJcM'f<< J ~...,.I(..
Company
ID-f1..6<{
Date
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N\PQUCY _P\1000_SWl1009_01'wPD
City of Port Angelos - Landfill Waste Disposal Application
Page,S
OCT~05-2004 09:14
NVL LABS
2066341936
P.02/03
, . .
NVL Laboratories, Inc. :
4708 Aurora Ave. N., Seattle, WA 98103
Tel: 206.547.0100, Fax: 206.634.1936
www.nvllabs.com
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L .O~OIW
Analysis Report
AIHA - IH
#101861
Toxicity Characteristic Leaching Procedure - Lead (Pb)
Client Sample #
04326A
RL
mg/l
0.5
Batch #:241~11.
. MatrIX: 8u
Method: EPA 1311/7000
Client :~Qject #:0432.
Samples Received: .
Total SamPles Anatyzed:
Results
in mgll
<0.5
Client: Zenovic & Associates, Inc.
Address: 519 South Peabody Street, Suite 22
Port Angeles, WA 98362
Attention: Mr. Tracy Gudgel
Project location: Lot 3, Blk 270, Port Angeles
Lab ID
24082035
Results in
. ppin . -J-
< 0.5
Sampled by: Client
Analyzed by: Holly Tuttle
Date Analyzed: 10/05/2004
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RL = ReporORg limitl
'<' = Below the reportfng unfit
f
Page 1 ~
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DRAFT
mg/ L =Milligrams per liter
ppm = parts per million
Note: Method QC results are acceptable unless stated otherwise.
Bench Run No: 24-1004-6
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SMtpled br 1~~Cui\JGu I~ ~,v.'1 I-? .,. ~'4rc..k I"....... Y .L.!~ }
f-~nquishedbr ~~'t.: L'. ,h~ . i-- . /'..J ~v. (/ I~~L ~~~ 9-.~. liA:.....~,.,... .t~
1-. ReceIved by I,HOO"'" ~ ~ l)./:--~ ~ l ~-".. . ."'7...... r;,.;:].
AnafyZedbV."._~~.i I'~ ~:2:..c:H --T~-.---~ .9'..'~: U~~
~CalledbJl.__.. "'_ . i 1 J' :
"-uIta Fued bJ' .,J-I---,... . :. !
. .1....... .,- _ _,.I...___........_.j; .. -L .Jj --!!fll t
Special Instructions: Unless requested In writing. all samples win be disposed of two (2) weeks after analysis.
OCT:-05-2004 09:14
NVL LABS
2066341936
, .'
NVl Laboratories, Inc.
4708 Aurora Ave N, SeaIIIe. WA Sl81o:t
Tel: 206.547.0100 Emetg. Pager: 206.344.1878
1.888.NVL.lABS (685.5227)
Client Zenovic & Associates. ;Inc.
Street 519 $c)uth Peabody Street. Suite 4
CHAIN of CUSTODY
SAMPLE LOG
BATCHlO
2414411 .QO
NVL aatch Number
CIIent.lab ........ ~2..L.
To&II."", I
Tcm Around Time 0 1-Hr a 244irs 04; 08ys
o 2-Hrs B2 Days 06)_.
04-Hrs CJ~ o.Js' O,"<tDi10 oavs
PIIwe alfOrTATIii...._ .
Emil iiddnMIa ~. -'-----.A4'1-'. . .
Port Angeles
ProjectManllger ~~ 6'(/Or~(. .
PrqectLoeallon T' Tile. 70,. /be~ A,..y;.wr.s
Phone; (360) 417-0501
Fu: (360) 417-0514
o Mbestos Air o PCM (NIOSH 7400) . 0 TEM (NIOSH 7402) (J TEM (AHERA) 0 TEM (EPA Level 11) O.QIhtr
o MtJestoa Bulle o PlM (EPAI6OOtR-93It16) 0 PLM (EPA Point Count) 0 PLM (EPA GrMimeIII:n 0 TEM Ik*
METALS Dot. LimIt Matrix. RCRA..... 0 AI 8 ~........
U
o T olaI Metals !!wm (MS) [l Air Filter 0 Paint Chips o Arsenic (As) 0 Lead (Pb) ,Nfl
fj.. TClP o ppb (GFM) o Orinting water 0 Paint Chips (Area) o Barium (BJ) a Mera.y (Hg) o Copper (Cu)
U Dustfwipe 0 Waste Water o Cadmium (Cd) 0 Setenium eSe) o NicIaII (N)
o Soil o Chrumiuin-(CI) 0 Silwer (Ao) o .lJnC (Zn)
o OIlIer Types OFibeIgIus o ~ Oust o RoIometer CaIibtatIon 0 Other ~
of Analy$is 0 SiliQ o ReepirabIe Oust 0 MoIdIFungus
Condition of Package: 0 Good 0 Damaged (no &pillage) 0 s~ d~ (~)
Seer.'
1
Lab II)
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TOTAL P.03
P.03/03
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From:
To:
Subject:
Becky
Kathy Emery
Becky Horton
JE FOR Building Permit
Please do a JE for Building Permit{Raymond Gruver) #04-965 in the amount of $260.00. I have made the
necessary changes on BP side and given Barb a request for a refund.
Debit cash 001.0000.111.1000
Credit 001.0000.239.9000
Per Linda
Thanks
Kathy
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