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324 N Race St - Building
f ,ORT ~ l~O~ ,. 'L ~ ~ "l.tii:1C~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number property Address ASSESSOR PARCEL NUMBER: Application description Subdivis~on Name Property Use Property Zoning . . . Application valuation 04-00001161 Date .738483 324 N RACE ST 06-30-00-5-1-3700-0000- DEMOLITION 12/15/04 COMMERCIAL OFFICE 2000 P~l~[Ey-peEO b/f4!O? Owner Contractor CLALLAM CO PUB HOSPITAL DIST 2 PRIMO CONSTRUCTION 939 CAROLINE ST PO BOX 296 PORT ANGELES WA 98362 CARLSBORG,WA ( 36) 417-7000 SEQUIM WA 98382 (360) 683-5447 Structure Information RESIDENTIAL STUCTURE Construction Type . . .. TYPE V NON-RATED Occupancy Type . . . .. SINGLE FAM & CONGREGATES Permit Additional desc Permit Fee Issue Date Expiration Date DEMOLITION DEMOLITION OF 47.00 12/15/04 6/14/05 RESIDENCE Plan Check Fee Valuation .00 o Qty Unit Charge Per BASE FEE Extension 47.00 ~ ~ -:2:.. Fee summary 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 "";::0- -- .. ?0 ~ ~ 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 authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 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 and 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 pr me to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of co st cUon. Signature of Owner (if owner is builder) nPLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY Date Rec. I If- -I ~-<9 ~ Pelmlt #. OJ.{ -/ f ~ I Date Approved Date Issued. Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. Uyou have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 c~ ..Jc., ~+ Phone: Phone: 5&:,(),4t1.,{f..{g p~+ .L)~ Zip: d1e,?'< ApplIcant or Agent: Owner: O\'1""'?'C ~LI u( Address: q3 'i Ccu-~ City: Architect/Engineer: Contractor -p ~<<) Phone: State License #: Exp: Phone: City: Zip: s+ ZONING: Block: SubdivisIOn: Address: PROJECT ADDRESS: 324 l2..o~ LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing Address: Credit Card Type VISA MC # TYPE OF WORK: o ResidentIal 0 New Constr. 0 Re-roof o MultI-fannly 0 Adchtion 0 Move o Commercial 0 Remodel 0 Demolition o RepaIr 0 Sign BRIEF DESCRIPTION OF THE PROJECT: j).P1M " City: Exp. Date: o Stove o Garage o Deck o Other SIZEN ALUATION: SF. @ $ /SF. = $ SF. @ $ /SF. = $ SF. @ $ /SF. = $ TOTAL VALUATION $ ~ ..~ COMMERCIAL/RESIDENTIAL: Occupancy Group: No. of Stories: Lot SIZe: Existing Sq. Ft. Total lot coverage Occupant Load: & Proposed Sq. Ft. Construction Type: = TOTAL Sq. Ft. % ESAIW etland( s): 0 Yes 0 No SEP A Checklist required? 0 Yes 0 No Other: APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: BUll-DING PERMIT APPLICATION SUBMITTAL: The Building DiVIsion can provide you with informatlOn on the application and plan submittal reqUIrements If you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Buddmg Division to comply with current fee schedules. Contact the PermIt Coordinator at 417-4815 for aSSIstance. PLAN CHECK FEE: IF a plan check fee is due It must be subrmtted at the time the buildmg permIt applIcation and constructlOn plans are submitted. All other perrmt fees are due.ai-the time of permIt Issuance. EXPIRATION OF PLAN REVIEW: Ifno permIt is Issued WIthin 180 days of the date of application, the application will expire. The Budding Official can extend the time for action by the applIcant up to 180 days upon written'request by the applicant (see SectionRI05.3.2 of the InternatIOnal Building/Residential Code, 2003). No applicatIon can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true nd correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, a d t t I mu ain uch permits prior to work. Date: / 2~/t(..or Applicant: T:\RVESS\BLDG- forms-brochures\2003-Buildmgpermit wpd ~ORTANGELES WAS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT August 26, 2004 Olympic Medical Center 939 Caroline Street Scott Bower, Facilities Manager Port Angeles, \V A 98362 RE: Port Angeles Landfill Waste Disposal Application, WDA 04-19 Building demolition at 918 Caroline and 324 Race 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, ~~fi:::f?tv City Engineer Deputy Director of Engineering Services GWK if Encl WDA 04-19 Copy Ken Loghry ZenoYlc & Assoc N'\PWKSIENGINEER\WDAPPUc\04-19 WPD FILE. Landfill Solid Waste Disposal Apphcabons 321 EAST FIFTH STREET · P. 0 BOX 1150 · PORT ANGELES, WA 98362-0217 PHONE: 360-417-4805. FAX. 360-417-4542. TTY 360-417-4645 E-MAIL.publlcworks@cltyofpa.us ,.....- . w \)A--- 04- 20 PORTANGELESLANDBLL WASTE DISPOSAL APPLICATION To: City or 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: t'Jl/7MIJJC ~lCA L t!Md4/Z.. ~ U4~t",.v~ 5"'1. ~Il."i 4N0'i~~ 1 wA 98 Z 6 Z ~ urt'"1' g(J~) N-vJl-I--t)~ tl1AN ,t/6.{,R, . Contact: Phone: Project Name: /Jo1.1fi ~ljut-tIO".J Project Location: 7&') tV, S "t!11)-( J ~{;'111../\" 2. Other Contacts (if applicable): Consulting Firm: Zvvo \J I C- d I:) (JOG, 'JNG Contact: ~y ~J(){,"~(.. Phone: 4/7....050 t Contractor Name: UrV~6wN Contact: - Phone: - laboratory: NVL I.... VJ&Yt4-:;1'l:7.IV~J .:I- v..J C f\J, cl . Contact: /)-( Phone: tJD6 -S'f 7"0 J 00 t - - --------------- . --- - - - ------. --- - - .- - -- - . - -..- - - -- --- ------ CI/y or Por1 Ange/os - land/ill Wdslo DI~;po:;al Apphcuhon Pa{JO 1 r . . - 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). CERCLNMTCA Remediation Agency Contact: Independent Remedial Action - UST Removal Unused Chemical Product Spill )( Other Source: 6;tVJ~ (i'tt/s7'l.-v6 1!IovVz- f ~ ~ ~ LJ~DUS4~ 4. Waste Material Composition: . (check all that apply and Include percent of total) Soil % Foundry Slag _% Concretel Asphalt % Dredge Sediments _% Preserved Wood % VJ Debris ~Io Coal Ash % O'ther (list) Wood Ash % _% _% NOTE: Total must eQual 100%. 5. Waste Material Contaminants: (check all that apply) Gasoline Solvents Unused Motor Oil Other LIIJ46 - "1'[ ~f> Metals Heating Oil Used Motor OillWaste Oil Other Petroleum Product PCBs Diesel -L Unknown ------ ._.._-------~-----~- - ----- - --- - . ------- ----. --- - .- NOTE: Supply any MSDS informalion with application, if available City or Port Alive/os - landfill Wasto Qisposal Appflcnholl Pugo - 2 . Ii ..-- 6. Estimated Quantity o( Waste (or Disposal: . 'J~) Cubic yards I Drums I 62:> 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. ( 2- S- Number of COMPOSITE samples & number of discrete samples per composite ~ Number of DISCRETE samples 10 t)<..I2~t-~ .; c'A"PDSI'1'1 S4~ Put ~~ ~ cY ~....v(j I ~ ;ti,~, al.U6 - Z t?6Ul"-'. 2 ~ A-t 4tA--\, I .....>~ c> l/Z2h 13 ... ~/)6/7l<. ~14~P~ tfA{j~ ~ o~ S"'~)tV 4 .[7. lo(4?1> t ny-4. 7M-. t;w'1J :2~ r./l ..a ~ 1'"0 c; ) ) ) NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 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 t NOTE 2: One composite sample shall conlaln a minimum of three/maximum of five discrete samples. 0-25 25 - 100 1 01 - 500 501 - 1000 1001 - 2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards = = = = = = City or Port Angelos - Lundr,ll Waste Disposal Appllctlllon P aoo . 3 9. Waste Analysis: . The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to deteimlne 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: (i!0A 7/')00 ~ b) Provide a narrative as to why the above analytical methods were selected: b~ io A41i (),L: - Llk,{,l..V ~'1 ~46-'1.~ 9.wc't'~ ~ J 44/U10 AaJ.~ LJ6-<<J ~ to/)~ b...u 711< . NOTE: Additional sheets attached: -k YES NO 10. Soil Classification: C''''FOR PETROLEUM CONTAMINATED SOilS ONly....) Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check one) Class 1 Class 2 Calculated Haiard Index Class 3 Class 4 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: t Exlremely Hazardous Waste (EHW) and Waste Code: -~--- ~-"-. .. n ~________~_ - ~-- ._---~- - --- City of POIt AIl!Jell)S Landfill Waslo [).isposlIl AppfJcalloll Pogo - 4 - : . . I 12. Certification: We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All information provided is corr and the enclosed analytical results represent the proposed waste material to the best 0 0 bilities. %~Y 6VC4i?L Printed Name 21AJt' V I c- J Company ~t>CJ 11Vf, 8-2--tt 0/0'1 Date . . ;':~l't.. .' ~~ "': . ,/:...:, ./J.i.;.;~:{.;~j;;~1:i~!~~0i:: ;~ ;':~\~:.il~~?:~';;'~;~~i~~tf[:, N V"'OllCY_P\1000_SW\l009_01.WPD CIty or Port Angelos - Landfill Waste Disposal Application Pago - 5 NVL Laboratories, Inc. . 4708 Aurora Ave. N., Seattle, WA 98103 AI.... AIHA - IH --1'"-4 Tel: 206.547.0100, Fax: 206.634.1936 _d -MnII- Analysis Report #101861 ACCREDITED www.nvllabs.com LABORATORY Toxicity Characteristic Leaching Procedure - Lead (Pb) Client: Zenovic & Associates, Inc. Address: 519 South Peabody Street, Suite 22 Port Angeles, WA 98362 Attention: Mr. Tracy Gudgel Project Location: 780 N. 5th St., Sequim, WA Batch #: 2410855.00 Matrix: Bulk Method: EPA 7000B Client Project #:04266 Samples Received: 2 Total Samples Analyzed:2 Lab 10 24060614 24060615 Client Sample # 04266A 042668 RL mgl L 0.5 0.5 Results in mg/L 0.6 0.7 Results in ppm 0.6 0.7 Sampled by: Client Analyzed by: Holly Tuttle Reviewed by: Nick Ly Date Analyzed: 08/11/2004 Date Issued: 08/11/2004 or mg/ L =Milligrams per liter ppm = parts per million Note : Method QC results are acceptable unless stated otherwise. Bench Run No: 24-0810-15 RL = Reporting Limit '<' = 8elow the reporting Limit Page 1 of 1 '" 'NVllaboratories. Inc. 4708 AUr()(9 Ave N. Seattle, WA 98103.. Tel: 206.547.0100 Emerg. Pager: 206 344.1878 t.888.NVUABS (685.5227) Client Zenovic & Associates, Inc. Street 519 South Peabody Street, Suite 4 BATCH \0 2410855.00 '\ _.. ,. . .. CHAIN of CUSTOD SAMPLE LOG s Port Angeles Project Manager -. 1'Mt.,'I 6 tJ~<J-<<" Project location -.2Ba.-,U. os' c. S~, 5~lJl""'" , ~ NVl Batch Number Client Job Number ~'f '2t.~ T olal Samples :2- Turn Around Time 0 1-Hr 024-Hrs 04 Days o 2-Hrs 02 Days a5 Days o 4-Hrs 03 Days. 06 to 10 Days Please can for TAT Ie$S lhan 24 Hrs Eri\ail address ~Q. ~,~. 47' . Phone: (360) 417-0501 Fax: (360) 417-0514 10 Asbestos ~ 0 PCM (NIOSH 7400) 0 TEM (NIOSH 7402) U TEM (AHEM) 0 TEM (EPA level II) 0 Other 10 Asbestos Bulk 10 PLM (EPA/6001R-93/116) 0 PLM (EPA Point Count) 0 PLM (EPA Gravimetry) 0 TEM Bulk rtoETAlS Det. Umlt Matrix ReRA Metals o ,... 8 Qther MetaIa o Total Metals ~pm (MS) [l Air Filter o Paint Chips o An.enic (As) o lead (Pb) UAII3 ~TClP o ppb (GFM) o Drinking water o Paint Chips (Area) o Barium (Ba) o Mercury (l-tg) o Copper (Cu) U Dustlwipe o Waste Water o Cadmium (Cd) o Selenium (Se) o Nickel (Ni) o Soil o Chromium (Cr) 0 Silver (Ag) o Zinc (Zn) o Other Types o Fiberglass o Nuisance Dust o Rotometer earlbration o Other '(Specify) of Analysis 0 Silica o Respirable Dust 0 MoldlFungus Concf':"Jon of Package: 0 Good 0 Damaged (no spDlage) 0 Severe darna~ (spillage) - - - - - _..~ .. ... Seq.' lab .0 Client Sample Number Comments AIR 1 C) l.fZ,hb A I~ 2 l'C) 1./".1- L 8 A4h.> 3 4 . 6 6 7 8 9 10 11 12 13 14 .-- 15 Sampled by Relinquished by Received by Analyzed by Results Called b~l Results Faxed by [=~-- Special Instructions: Unless reques1ed in writing. all samples will be disposed of two (2) weeks after aMlysis. fUv4J~ IA1" ~~Ul~5 . I . ' Date: lOb Loj:ation: Owner: Contact: Subject: Inspector: Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360..385-0584 northwestasbestosconsultants@cablespeed.com 7/28/04 324 Race St. Port Angeles, WA 98362 Olympic Medical Center 939 Caroline St. Port Angeles, WA 98362 Scott Bower, Facilities Manager Demolition Bob Witheridge EP A-AHERA-Building Inspector Management Planner WAMOA - 0042-03 Expires - 10/28/04 c/~ iL to;~'\i (J\^ /7 ~ (G(Q)~W Scope of work 1) Inspect for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect materials. 3) Copies for Scott Bower, Facilities Manager, City of Port Angeles Permit Center, City of Sequim Permit Center, Olympic Region Clean Air Agency and on site for demolition. Inspection Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). The suspect materials were: Samole #1: Living room ceiling tile. White Sample #2: Bathroom hot water tank room. Top layer sheet vinyl with mastic. Pink speckled pattern. Sample #3: Bathroom vinyl with mastic. Top layer. Pink speckled pattern. Sapl'ple #4: Bathroom hot water tank room. Bottom layer sheet vinyl with mastic. Tan and cream. Sample #5: Bathroom vinyl with mastic. Bottom layer. Gray Samole #6: Kitchen floor vinyl with mastic. Pink, tan and sparkles. Sample #7: Laundry room sheet vinyl with mastic. Pinkish tan with sparkles. Sample #8: Second floor hallway and bathroom. 9"x9" floor tiles with mastic. Tan with red and green. Sample #9: Second floor north bedroom. Floor vinyl with mastic. Brick pattern. Sample #10: Second floor south bedroom. Floor vinyl with mastic. Off white and gray. Sample #11: Second floor ceiling tile. White All samples were sent to lab. See results. ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed 8t. Port Townsend, W A 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com To Clayton Services Date: JQ..Q Location: Owner: Contact Sample #1: Sample #2: Saml)le #3: Sample #4: Sample #5: SamJ)le #6: Sample #7: Sample #8: Sample #9: 7/19/04 324 Race St. Port Angeles, WA 98362 Olympic Medical Center 939 Caroline St. Port Angeles, WA 98362 Scott Bower, Facilities Manager Living room ceiling tile. White Bathroom hot water tank room. Top layer sheet vinyl with mastic. Pink spetkled pattern. Bathroom vinyl with mastic. Top layer. Pink speckled pattern. Bathroom hot water tank room. Bottom layer sheet vinyl with mastic. Tan and cream. Bathroom vinyl with mastic. Bottom layer. Gray Kitchen floor vinyl with mastic. Pink, tan and sparkles. Laundry room sheet vinyl with mastic. Pinkish tan with sparkles. Second floor hallway and bathroom. 9"x9" floor tiles with mastic. Tan with red and green. Second floor north bedroom. Floor vinyl with mastic. Brick pattern. Sample #10: Second floor south bedroom. Floor vinyl with mastic. Off white and gray. Sample #11: Second floor ceiling tile. White Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-03 Expires - 10/28/04 Please call with test results when completed. Thank you, B~~ Bob Witheridge, EFM JUL-27-2004 17:03 CLAYTON GROUP SERVICES '~~:' C1lnrtnnQ!) ASBESTOS BULK SAMPLE DATA .,": , J.p.J"' NVLAP LAB CODE #101106-0 ~ . C . 0 1-' P S ER V ICE S A.....1ted ....._'" ~ a MqiaIII Wq.$<< SWUl:II 5 s-Jo. WA 98134 {)OJ!) '63-7360 2067634189 P.08 Log #: Priority: Projed #: Number or Samples~ 36698 Regular B ZOO.77 11 ClieI,1t Name; ~orthwest Asbestos Consultants J.ob LOcation: 3,24 Race Street... Port Angeles, W A 98362 Contact: Bob Witheridge PO/Jl)b#: " ~ ! S~MPLE #= ~ :- ~ ) RESULTS: OTHER mImS % '. '70 r Layers Homogeniz.td for Analysis Cenulose 1.Ai!1t 36698.1 SOURCE: CeJ;ing Tile No Asbestos Detedet! ASBESTOS TYPE PERCENT . ~0CA TION: L'~'ng Room OTHER MATERIAbS ~ : : Fitle:r & Binder 10 . I : Paint 20 MA TERLu. DESCRlPTION: LA. YER.E:D ' , (J/j.Hillit<< pdiftt With gr4D1 04 silHr fleeRs Dft I ~m.". fl/Iro,,$ c,lIIpr6sd lIIt1lDi"E , , NOtel . " , ,. . : OrnER was % .' S~LB #: (2 : ) RESULTS: , Layers Homogenized for Analysis Cellulose 20 .1.lIli.!i ~669ll.2 I S ': , No Asbestos DetectlUl Synthellc SOURCE: Sh~tVinyl/Mntic , 1QQb. nON: Bathroom, aot Water Tank Room - ASBESTOS TflJE PERCENT . , QTIIER. MA TBlUALS % ! TOp La.yer 5 l '. Aggrep1e Filler & Binder '3Q. MATERIAL DEstRIPTION; LA YEllED Vinyl FIller and Binder ~ : i~~~~~~4ri~~<<U~~"ri~ , "Ii totl.'1lII4 tnty -"brtiflj 6"ddng with ta ltUlstir: mUllIff' Notd: rlmzMB is !Js[lllTllh IIIBStitllY!5iJIIB fi1r inJi",jJ.J rllfwyt>is. .. . . r. , ; 11 S~LE #: (3 . ) RESULTS: OTHER. FIBERS % ~ Layers Homogenized for Analysis Cellulose 20 ~ 36698.3 SynlbetiC 5 I S?URCE: Sh~tViDyl/Mastle No Asbestos Detected ~ , j:1.9CATION: B~hroom - Top Layer ASBESTOS TYPE PERCENT , OTHER MATERIALS % " A,sgrcplc 5 Filler & Binder 35 ,/ M:A. TBR.lM.. J;l5St:RJJ>110N: LAYERED .r Vutyl Filler and Bindel" 35 TGIr. gold. pUtt d,.d sihJer spt-ekle-patterndl'inyl 'f 08.taa "". IJ'IlY ,pbrous IxJcklflg IVitk brow" f ."I-bNtk IlUl$tlc N(J~t UMble t8lllJNlraM IlltAStkftir indi,iIlIlIllIlBaI}'Sir. , , , SA,MPLEl> B~ COMPANY~ I ~IVED BY~ Bob Witheridge DATE: 7/1912004 Northwest Asbestos Consul1xn1s ANALYZED BY; Rachel Melgoza DATE: 7/27/2004 l'racv 'Pcd:IM or ~r NVLAP A , Cl_1J teetcdi'''''h1iNlSTINVlAP. Act=IiIozian by 1'<"VL.A.I'00cI nl'4 fn4l~__1 brNVlJlll..,."'\l' _~"IImq', All bul~ ~DT;lJI1,l~iIllll:m.o<<MdI mcdloC 'BA.'6OOIM4-U-tl20 (~19I2) AJWyaef ~ ~ """"th iDIoT;md iIItrlllabaf=<)' qwdity lIHlIRll"" pmallIlfti to- .",'f,udOll, Tho ~ Y/l1_ t'l!pMod ..00... ""' booed... awinl..h;.uoI , ~ by~ uDIRw vmtlCIIIOl\ tIy I'lilIlI C<l1mIiaJ io ladiasIal. Ts rnul!:l n:pancd ~1111; Q111y to '* _l~ !uIlfnrtlDd by 1ho clionllD O")'IDD. TnI<.e 1IIlUIIII1" or mboslClll CQIIld ~bly be miI8llCI by I'L"'" ~_~1_hi "'''''''hI~ 'Ibior'parulo11I1..",benptadl'<<4 ex_1ol i.....lInrty. ,..;!baol CbQ<ma am"" SorvU:a.permismon. BrrarbmJ ~Ic. ^nootiICWlC'oo;\101i~_ QliAlIllll~..OJ, QuinIiWlv....12' 'I'Rmdne. J.etintJliIe ;rwj ....n\ll~II;I. .lSbtSUIl. Qu!lILali.....02, QlIIII>!ilA1iw...Ol A. IW!e IIIIIalmt ~ II$~ .. ~~!II OI\C ro fIII6 nbci& fc\rilllln Itrit Ilidt IIlIlIIIII&. AaI>ml/It ,f?un~rn llIi...",,,,,,,I....lI bo~m -~.. Gmnie Psachos DATE~ 7/'J,2/2004 DRAFT LAYERED s.A1\IPLE; NESHAP aDd AHERA regulations require layers be analyzed and reported separately. SAMPLE#: (s' :) LAYER! RESULTS: OTHER FIBERS ~ "- CellulQ&e I..Aiut 36698.SA ' S0URCE: Sh~ VinyllMastic LOCA nON: Ba~hroem - Bottom Layer , . JUL-27-2004 17:04 CLAYTON GROUP SERVICES e';'" 1'li",,7fnn~ ASBESTOS BULK SAMPLE DATA ~~:,' "'10 J' IA.1. NVLAP LAB CODE fll0UOlHt ~~ 'G I{ o~ P 5 E R. V ICE S AureOJted Lllboratory 4oS!6 Ii IofMJiluJ WlI}' 80. Sumo 11 S $etIII~, VIA, 9tjJ4 (106) 7li3.7~64 I Client Name: Northwest Asbestos Consultants . ' ...' " . lob ,Location: ~24 Race Street - Port Angeles, W A 98362 SAMPLE #: ~ : ) ~ 36698.4 S~URCE: Sheet VinyllMasdc LOCATION: Ib,throom, Hot Water Tank Room- ~om Layer RESULTS: Layers Homogenized for Analysi$ No Asbestos Detected ASBESTOS TYPE PERCENT MATERIAL D~!;:RIPTIQN: LAYERED ..' '" 1.. 4lI4 cretI. vIII)'f 011 ~A1u jlbt014 4a4 black , aj,A,zldcjlbtous btlckhtg JP/IIr. 1M semi-brlttle ""'J!Ic ' N_~ Onable'~ IqHIrtml "..J;tk for UullvI4f1t1l tutttlysfs. , " r No Asbestos Detected ASBESTOS TYPE PERCENT MATERIAL DES~R1PTION: T.,; pirJyl tllIlighl-b,olfllf )II(l1'a jib,oul mll~ wlrA lfd""' brlit~ IIItJStic !(l)te: On4bU t(I uplRiI~ nunl/c f'" ltt4MJiHtl a_(y.ti$. , , SAMPLE #; ~ ;, ~ 36698.sa . ,. ' St:?t1Jlm Not Noted L9cA nON: Ibharoom - Bottom Layer " -) LAYER 2 RESULTS: No Asbestos Detected ASBESTOS TYPE PJj;RC:ENT , MA;TBRlALDESC8.tP1'JON: , ,~y jilmJ,1I1t JHl~ lJUItuial Note: . 206763415'9 Log #: Priority: Projed #: Number or Sampler. 36698 P.09 " %. I, i 3S S , , , % ' , .30 ~ I 10 i '20 ." , I .. : . , % ; ,25 t , , l % 2S SO' I , ., J. .' , :~ , % SO .1S " . I , % " .~S " < \ '" sAMPLEO BY: Bob Witheridge DATE: 1/1912004 '. : COMPANY~ Northwest Asbestos Consultants . RECEIVlID BY'! Ginnie Psachos Regular B 200.77 11 Contact; Bob Witherldge PO/Job#: OTHER FmERS Cellulose Symbetic OTHER. MA1:ERIALS Asphalt Fillet & Bindet' Fmer & Binder Vinyl Filla lllld. Bindl'f OTHER MATERIALS filler" Binder Vinyl Filler and Binder 011IER. FIBERS Cellulose S}'nthetie OTHER MATERIALS Filler & Binder ANALYZED BY: Rachel Melgoza DAlE: 7/2712004 DRAFT Trnev Pcdim AI> A Si &torv ClI')WIII ~)Illl b)' toIISTINVLAP ""'-<J<4i~ ~ NVLAI' &eo naf mdillllll> -........ by JoIVLAP Or iDlY 0IiKlr so""""""'" "i"'"'Y. All bulk _Jell _ ..,.lYm! in 1ICCanlon.. willi mcdrGd $I;'.t,IJOOIM.I-\lUl20 (~1~1) AIIaI~ ~ CIW~d thnnlah inter IlIld j.,." ~1Qf)' (lI*Iil>' Us""""",, pro;jI1II1lS far ....!6<lR!on ~ ~ .....lum npmted obo.e "'" based 011 caI"""""'J,,;,uu Cfll~ by -oJ"",o unI... vorilic.moa by p~ Covl1lint II Indiom.... T"'t 1'<SI1lu ~ rd9lC tnli;' 10 lh. sompI~ ~ by <he cllCln 10 CIIb'tcn. Tr.u;" III'Ilcunts of asbeszoJ eQllld pQSll~ ~ ~ Il1I'LM. ~ 4CaMl~ TRuIm, oomnat bo __~ 'ThIs I'qlOrt &ba1l_ be ~ CXecpl' III III ctIIitoly, ..itlunJl. a..ytm Gmop.$cr>io;t llCrmifiion. !!nor ltailS: CluyIOlil.. Amosltc &lid Cr<lCMblllv ~ Q\IIllllli>v-,03, Qu.oo1Dli...-.i2 I TmoIolilC, Minlllll<: :md ADtbcIpb).lIile ",'-<II: Q~IIi\i1!..,. 02, Qullllliclri",,_03 A"~ _Ill of asbnIlllO i. dofined as Dn. ID twD llbi;r$ _d In Ih~ ,i1de m_. MbooIm fCIllld m tha _.um: ""II be ~ III "T_~. DATE: 7/2212004 J UL - t!: (- ~\::Il!l4 1. ( ; \::14 .....LH T J UI'I L:Il'<(UUr- :::It:.t'<(v l'..A:::::l ~'" I 'lin~rl-nn~ ASBESTOS BULK SAMPLE DATA ~{,. \.1111)' LlLI. NVLAPLABCODE#10110i-0 ~ ~ R 0 ~u P 5 E R V I C 12 S AeuecUted t.aboratory 4636 s. MmJinaI Way ~ $IUUl %IS S6lllk. VIA 1IS134 (2.06) 1&10'~64 Cli~t Name: rilorthwest Asbestos Consultants Job t.ocati.on: 3-14 Rate Street. Port Angeles, W A 98362 ~ ,. SAMPLE #: (6 1 1..AM; 36693.6 S,OURCE: VioyllMastie LOCATION: Kitchen ) RESULTS: Layers Homogenized for Analysis No Asbestos Detected ASBESTOS TYPE PERCENT , ~'T'ERJAL Df!SpqPTfQN: LAYERED TA goltl, pink. ,.4,/hrel- rpedde-JI(ltt",," "/1IJll on 1#" tuJtI fMl jpr,us bRaing kllth "'OPiVn brittle ",,:*;' Nq<<: U".J,I.e fq rePff'"q IIfQ6tit: fpr Ift4ivil/llf,lIl~ir. . . SAMPLE II: (7 : ~ 36696.7 SOURCE~ V~astie LOCATION: L(un<lry R.om ) RESULTS: Layers Homogenized for Analysis No Asbestos Detected ASBESTOS TYPE PERCENT MATERIAL DEStRwnON: LAYbEU ,i,a ~Jff. with gdu IUI~ pinkJlu:b 011 b'(let ~tic fibrous ~lU:kiaK with /tin mastic rt!Sitlue Notr. Unaole.rs IStrplI.rGt6 "'flStiC ,mira jtlr indi.,iduaJ IIftfllyds. " SAMPLE #: (8 . ) ~ 36698-1 . SOUllCE: 9"X9" Floor TUeslMastlc. , i u;>cATION: 2nd F1.&Ol".lhIlway and Bathroom RESULTS: Layers. Homogenized for Analysis No Ashestos Detected ASBESTOS TYPE PERCENT . MATERrAL D~lPTION: LAYJmED T~ Wi!y1.wItJI m, "fSIlgrenl stnNlks on hld .~i! Jlhr/IUS~ckilfg ,.,idlretltJisll-hNlWII upii-soft 1fUIstU: ~ Nlltel UIIIIhli: III IfttpfUfl1B IlUUlic 1M' lIIdlvldlUll. tlfUllysts, Lt:JorOJ"t.LoJ r.J.\3 Log #: Priority: Project #: Number or $llmples: 36698 Re&uJar B 100.77 11 . . Contact: Bob Witheridge PO/Job#: , OTHER FffiERS % " Cellulose (& Synth~c 7, > , , OTHER MATERIALS % ~. Aggregate- S , FilIQ'& aind~ 30 I Vinyl fill<< and Bind~ 4(} . 'I i OTHER FIBERS ~lbJlQ6e Synthetic OTHER MATERIALS Asphalt Filler &, Binder Filler &:. Binder Viayl Filler and Binder OTHER FIBERS Cellulose Synthetic O~ MAT~ts Aspbalt Filler &: Binder F'iI1cr &: 8indcr Vinyl Filter lIIJfj Binder SAMPLED BY: Q)MP.ANY~ RECEIVED BYi Bob Witheridge DATE: 7/19/2004- NOJ:tbwest Asbestos Consultants ANALYZED BY: Rachel Melgoza , Perkin8 or other NVLAP A ~ C1I,'1Mn it ac.milod b.J~T.oNVlAl' ~;on b.J NVLAP doo&.l1od~ C'ldor9cmolll br JI/VUJI "uny oUt... ~l ~.:y. All balklll1l1lpll1u'''IDl..Jy.:ood III ~ ...I!,_had llPA/6'OO/M<I..B2.cno (DOoorablr 19\12). ...~ _ atJS>oCbocbd mv.llllg- ilDd. illlra iIIbanIIrlIy qLlllll1:Y ""'~_ ~ (or vcriliar1ion. The pcrwn "01_ RPOttCt-.... buod "" oaIi_.... SbnImlIbrwl_IUIIc:a octil'iCali"b)-l'lIi1lICamnmIW IlId~, r_rmullII~~QIl\l' 10 lh~Hmpl....ubl'DlttMby"'e .h~",C1l1Ylon, Tm<c ..,oWlll gf..b<m>s COl1Id P'lllllllly b::mIucd II)' PLM, 1lIcod'~ ncaulvelClllulfll _ be ~ Tbl~ l'tt>OR dholI nol: be r<p1><luud e<cqX I. il.i onlrral)' wUhow: CIay\<ln Croup s.:.-..ICo;f pennilloioa. Ilmrr RIll"" CluymDI<o, Anw6l\C 1114 Cr6tldDlim_bostaI: QIIIIIull.....OJ Q-UbIU.... 12/ T_91I~ Mtilllllilllllfld AnIbophyUIle ~1 QlI81i1&l_.Q:l. QumimJiv,," m .. \1101: Imounl ofUboltat IS dIl1ined .. ""0 mlwo 1l~ fOOnd ill lln'ool ilicle IIIlIUIl5. AlIboIom tlSIlDd ill IhiJ ..-un: wil!, be rq>QfWf M '7tBQr- Ginnie Psachos DATE: 7/2212004 DATE: 7/2712004 DRAFT JUL-~'(-~11l::l4 1(;1::14 LLHYIUN 11I'<UUt-' ~c.I'<VIU::~ .011~" .11o,Ttnn- ASBESTOS BULK SAMPLE DATA .- .. '" ~J IAI. NVLAP LAD CODE #101106-0 Q C' R O~ P ~ E R V ICE 5 Acendlted Laboratory , ~E.~W",~.Sq~~lS .' s..tls. W A 91134 (2116) '~-1U4 Client Name; Northwest Asbestos Consultants , , '. , JOb,l.:-ocation; ~24 Race Street - Port Angeles, W A 98362 ~l1b' (b.:S41l::l':::l P.ll 36698 Log #: PrlOrltyl Project #~ Number of SampJe$: Regular B 100.77 11 Contact: Bob Witheridge PO/10M; ~ SAMPLE #. (9 I l..AiVt 36698.9 , , t SOURCE: VbiyllMastic: ~. . LOCATION: 21l~ Floor, North Bedroom OTHER FmERS ) RESULTS = Layers Hom~enized for Analysis No Asbestos Detected ASBESTOSTYFE PERCENT Cel/ulo&e Synthetic OTHER MATERIALS Asphalt Filler cIt Binder Filler &: Binder Vinyl Filler end BiTldQl' . ~LreR141 D~GRIP110N: LA YEaED :R;iP'pJUl CJ'f4Ift-i,l,rttll1iny( WI 6l<<ck rapll"ltic pr'IlS INIckbtg ~!tlt rtt4'llh-brownlrUlStic residue . ,. N~ UtIofI6k UJ $BJTIU'I* lrlric raMIIII fin" llllliItJdruJ _iII{ysior" L SAMPLE #: (l~ .r...Mut 36698.10 SOURCE: VJ~astie ., ' LOcAnoN: :!n~ Floor. Sollth Bedroom OTHER FIBERS ) RESULTS: Layers Homogenized for Analysis No Asbestos Detected ASBESTOS mE PERCENT Cellulose Synthetic . MATERIf'\L DESCRlPTION: LAYERED . T. rtoJ'I-,,, ~ Ilsphabic fi"'t'1lS bactiag ~ith b~)fI" 'etrll-brittl~ mastic " . OrnER MATERIALS Asphalt Filler & Binder Faller & Binder Vinyl Fillcnlnd Binder Note UnllltU to Sepll.Tlltt!lllllJ1ltk fIN' i1f4iPbhulI (III1l1,yJis. . S~LE #: (ni ~36698.l1 ; . , , . S~URCE: Ce~g Tile WCATION: lD~ Floor ) RESULTS: OTHER FIBERS l...ayers Homogenized for Analysis Cellulose No Asbestos Detected ASBESTOS TYPE PERCENT OTHER MATERIALS Filler & Binda . I ~M M!ATERI<\t- DES€RIPTION: l.AYERED ;Jft,itipalRt Oil JJiht-IJro",,, jib",," C9111prt!MmJ miIterW . . . N<<e: t, ':' . t ~LED BY:~ :Sob Witbetidge DATE: 7/1912004 ANALYZED BY: Rachel Melgoza DA TE~ 7/27/2004 1 ",C?MPANY~ Northwest AsbeStOs CQ~tants DRAFT ~ BY~, Ginnie Psaohos DATE: 712212004 T Ptrkm or other ved SI ~ ., IIemdIIcd b>- FINVLAP. A<orcdIIClO<lIly NVLAP dos Dct iDd/caIe OIldol'acfttcol! bjr NVLAl' CIC 1m)' cIM- ~lJ1atlll&CCCy, All btdk osapIo:s III'C .....J)'2<d ., lCOOI'd&ncc..tth lnIllbod e:r AIfiOOiM.4..B2.0.20 ~ T9~), MalYI....." cnmod\oohd tIwou8l> ho", GlWI mln.1abaml<DY quoliJr ~ PI'Qllramt far vcrirlCllUDIL The pscml ....1_ ~ tt>tw. ...., ImotI Em tzlibnmi VIIUIII catl_ IlyWllUllll! IIDI_ .m/lCl\iOll 1:,)' P<l1Q\ Caualiaa it indicawJ, "rat.-1b ropartod ...1.1e ordy I. die HllIplcslwbm,!lod bf Ihe 01.... '" Clo.yf<X1. .r~ _Ii or""""",,,,, could pauibl) be .....K4 II,< f!.M. ~ aepIvt~l)o juinDl...... TIllS r<poIt IIUlI ~ II< ropl'Oliuc:ed """q><m i~ ~Ii~. I'rilblloll c~ <lraup ~ pennl;..OO, El'tOt!!.a1al Chr)<sOOle. AJoome _Cr.,.,J<lyt11e ~, Qa,oli__1l3. Q\IomIllIlivc~ 12 r T nIClOlml, A.aiooIIIIO - AddIOIlhyllil<' .be"", Q...w..._lX2. QNtlI;\Oli",,- 03 A....... IIIIlIJIIIU r:tI' Aibcaw .. dt:IiDod .. anolo twD fibe<s fbuad 10 tIwcc slilie _D. Ame>loS lOud... 1hIa_IMlI~~.. "J'raoe". " n, " .',' " , : f.. . ~ % : : 25 1 5 > % ZS 5 ~ 40 \ , ' . . '.' r- " I ! , " . , ~.;: 20 : 7 . . I . % , . ..i' ~ l 15 ! 35 , .: " ! i" , . ; " % " , < 80 '. % i 12 . & . " < " " .,. , . " Summary of Inspection This survey includes all areas of inspection with the report results from Clayton Environmental Testing Labs. Sample results are as follows: Samole #1: Living room ceiling tile. White No asbestos detected. Sam,ple #2: Bathroom hot water tank room. Top layer sheet vinyl with mastic. Pink speckled pattern. No asbestos detected. Sample #3: Bathroom vinyl with mastic. Top layer. Pink speckled pattern. No asbestos detected. Samole #4: Bathroom hot water tank room. Bottom layer sheet vinyl with mastic. Tan and cream. No asbestos detected. Sample #5: Bathroom vinyl with mastic. Bottom layer. Gray No asbestos detected. Sample #6: Kitchen floor vinyl with mastic. Pink, tan and sparkles. No asbestos detected. Sample #7: Laundry room sheet vinyl with mastic. Pinkish tan with sparkles. No asbestos detected. Sample #8: Second floor hallway and bathroom. 9"x9" floor tiles with mastic. Tan with red and green. No asbestos detected. Sample #9: Second floor north bedroom. Floor vinyl with mastic. Brick pattern. No asbestos detected. Sample #10: Second floor south bedroom. Floor vinyl with mastic. Off white and gray. No asbestos detected. Sample #11: Second floor ceiling tile. White No asbestos detected. All suspect materials sampled had a reading of no asbestos detected according to the testing lab. All asbestos containing building material with a reading of 1% or greater is to be removed by a certified abatement contractor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency. This report is not a guarantee that all suspect of AC.B.M. were found. The possibility of concealed material exist and may be found during demolition. Please contact NW AC for further inspection if needed. After the facility is completely cleaned out a walk through and inspection is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by Scott Bower, Facilities Manager, City of Port Angeles Permit Center, City of Sequim Permit Center. and Olympic Region Clean Air Agency. Thank you, (3~w~ Bob Witheridge, E.F.M. .>-(j^ , :BORT,AN-GELES WAS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT , August 26, 2004 Olympic Medical Center aroEne-=8trrel Scott Bower, Facilities Manager Port Angeles, W A 98362 RE: Port Angeles Landfill Waste Disposal Application, WDA 04-19 Building demolition at 918 Caroline and 324 Race Street, Port Angeles, Washington We have received your application for disposal ofbuilding 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 tOJe 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. ~ '? .J:.. Please call if you have questions. , "\ ~ ~ ~ Very truly yours, J/UAU~ Gary W. Kenworthy, P.E. r City Engineer Deputy Director of Engineering Services GWK-tf Encl- WDA 04-19 Copy_ Ken Loghry ZenoVlc & Assoc. N-\PWKSIENGINEERIWDAPPLlCI04-19 WPD FILE: Landfill Sohd Waste DIsposal Apphcal10ns 321 EAST F1 FTH STREET · POBOX 1 150 · PORT ANGELES, WA 98362-0217 PHON E 360-417-4805. FAX- 360-417-4542 · TTY 360-417-4645 ;"1 E-MAIL publlcworks@cltyofpa us r--. J." (' -' ~ . WPA-- 04-\l 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 NOTE: Phone: (360) 417-4803 FAX: (360) 417-4709 All questions must be answered for waste to be approved. ,. Generator Information: Company Name: Mailing Address: . Contact: Phone: Project Name: Project Location: O/)1MPJL M~Jet4L ~;&e q~ q CA~OLM)~ 5'7; (bR..-/ 4f06,z,{fi-Sj t-UA CfB30z · ~D-t'"7' ~lA..I~) ,c.4c.,1U ~/-S~ !U'1-'V44'Vf..- Jl004- ~1U 7). ON ~ /)Hiu.. "'(~ /),m,oQtT1o-J qJ{3 C4~6vvlz S-t 4' 'S'kL{ ~CJi 5 I p~.., d".;~Vt~ 2. Other Contacts (if applicable): Consulting Firm: Contact: Phone: Contractor Name: . Contact: Phone: Laboratory: Contact: Phone: t -~ -------------- ~ItJOUIG .I k~CL'J 1iNG "/44 C Y t\u<)64G 4/7-()~O ) u~koWIV - AJ VL L./.J,6(j1,<J7u!Gt1-5 I :tArc.. Iv J~~ L ,L( , "Db -.. 5<11-0100 . - -- --- ~--- - Cfly of Port Angelos - Lon(jfill Wtlslo Dq)o:.,al Appllcalton PilOO 1 r i- t . Source of Waste: , 3. , , . 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: bhvvtDL-I'1II)"v . f2Y'~-II~ ~ 1-k1.M. f ty (fll" t3 u() {, 47' LDCJ4 ?'dN~ /V0't"'..ul oAJ f1Mulo~ 11h;~ ;6 ~7 (j~oust./~ 4. Waste Material Composition: (check all that apply and Include percent of total) . Soil % Foundry Slag _% Concrete/Asphalt % Dredge Sediments _% Preserved Wood % ~ Debris 1aJ:l. % Coal Ash % Other (list) Wood Ash % _% _% NOTE: Total must equal 100%. 5. Waste Materiat Contaminants: (check all that apply) Gasoline Metals Diesel Solvents Heating Oil PCBs Unused Motor Oil Used Motor Oil/Waste Oil -L Other LIrA~ - -feLP Other Petroleum Product Unknown -------- - -------------------- - NOTE: Supply any MSDS information with application, if availnble City of Port Anuelo~ . Landfill Wasto Disposal Application Pogo - 2 . . . t 6. Estimated Quantity of Waste for Disposal. ---- '25' Cubic yards I Drums I <1D 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: -tL One time Monthly Annual Otller 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 2. & number of discrete samples per composite ~ , - Number of D SCRETE samples / 0 ~2b c '.. <::tl a,q~LUv1..- ~lh<b'(1. 5A-Jt1. ._ ~ Sj~/..ve;) , Y-' -I/lit-V"\, 6q)~- 2 bJb4""'o-V~ , Z't ,.t.:1.4~IY\J~ Ol{1..~b (~) - 32-'-f ~Oi- S"-t. L;~.;b~,t'~ 7 1l.-1#'\.A. J I i\J"it J ~ -1" -t , ~1 ~t-<.tj)t/r. '0 ~ S-;.-a,"";C; l~ ) ') \f; ;4'3 vt....l.u ~ ~w<s J 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 Clly of Port Angeles - Landllll Waste Disposal Application Puoe - 3 . '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 resulls, QNQC data, and Cham 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: fiPA /ODD/5 b) Provide a narrative as to why the above analytical methods were selected: ~{)~ Uv.,.(J ~ 46" i!. oj:. 5"' ~'l.AI(;-ft.Y/h.S ~~ I S )osS'l~Y "g.d'(~ IJ4/.-I-t' &,-J H~ I NOTE: Additional sheets attached: ~ES 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 2 Class 3 Calculated Hazard Index Class 4 11. Dangerous Waste Affidavit: Based on a review of the analytical tcst results, site history, and the applicable regulations, this waste is classified as: (check one) L t Dangerous Waste (OW) Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW) and Wasto Code: Cxtremely Hazardous Waste (EHW) and Waste Code' ----------- ------- ------------ CIty of Port An!J\!iI'~ Landfill W<lsto Disposal AppllLdllOll Pego - 4 - . . . . 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 ur a ./ities. enerator Signeture ~ O&t'J6-cL Printed Name .Zr.NOV1c- J 4,socl Company B--2-1{,o t{ Date ')11.\.. ":~ ',. City of Port Angel~s Approval: <' ~....>.. ......~.. ::.....;..\'St..s~P1-~$.;.. ..:.. ....... .. .... ..... ~'::..... '<-::'...,," ...........' ~..~..,<y,.;-~..... ~"*"~...)...:,. .... .... ..-y:....... y........ 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( .... . .... ..... <5 ~ ..~.. ~>!..:::~~~tf.~"~~ry"'/....... ....~ .> '>" '" , ',.'~^' <J~ru:u >/.' , " .. .. .. ...... ../' ....~?'::;:......:: ......... \.. .. ..0;.... ..;:: .. '";.<}..$~,~~~~:.;.~~:,-:....... ~ 1'.""" .. .... . ......)'....::;.o;r1r~~......... ...... ..' ..< ../<;..~r,.............. ...., , , , ..:, .... ~ .. , .. .. ../ .... ~ , , ~"" .. . .. ;. .. I'...f.~~~::,<,?~, ....... " ", ">(l''f~'1f.'(/.'''/'>", , ." / .... :,<' ~)~~~..~~~~~l/::: f ...... > .. ~.. .... ....~ '~"};~m~t~;^//1.." ~ '.. ....,'Y.... .. .(:- .. ........ ..... :, .. ~ .. l , " .. ........ .. .......... .... :...... '. { Cily of Port Angelos - Londflll Waste Dlsposnl Appllcotlon Pogo - 5 NVL Laboratories, Inc. (1-) 4708 Aurora Ave N, Seattle, WA 98103 A I HI'.. AIHA - IH EnvlronrnMttal L..d Tel: 206.5470100, Fax: 206.634 1936 end Indu.tri.1 Hygiene Analysis Report ACCREDITED www.nvllabs com #101861 LABORATORY Toxicity Characteristic Leaching Procedure - Lead (Pb) Client. Zenovic & Associates, Inc Address 519 South Peabody Street, SUite 22 Port Angeles, WA 98362 Attention: Mr. Tracy Gudgel Project Location. 918 Caroline St., (04226 C) and 324 Race St. (042260), Port Angeles Batch #: 2410856.00 Matrix: Bulk Method: EPA 7000B Client Project #.04266 Samples Received: 2 Total Samples Analyzed.2 RL Results Results in Lab 10 Client Sample # mgl L in mg/L ppm 2-406~.6~-6 Q42-2-SC 0-:-5 < 0-:-5 < 0.5 24060617 042260 0.5 < 0.5 < 05 Sampled by: Client Analyzed by Holly Tuttle Reviewed by' Nick Ly Date Analyzed' 08/06/2004 Date Issued. 08/09/2004 ector mg/ L =Mllligrams per liter ppm = parts per million Note' Method QC results are acceptable unless stated otherwise. Bench Run No: 24-0805-5 RL = Reporting Limit '<' = Below the reporting limit Page 1 of 1 " . .NVL Laboratories, Inc. 4700 Auror8 Ave N, Seattle, WA 98103.. Tel. 206.547.0100 Emerg Pager: 206 344.1878 1.888 NVL LABS (685.5227) Client Zenovic & Associates, Inc Street 519 South Peabody Street, Suite 4 CHAIN of CUSTOD~ SAMPLE LOG ~ BATCH 10 ... 2410856.00 s NVL Batch Number Client Job Number C) I...f 2., fa Total Samples 2- Port Angeles ~ Tum Around rime 0 1-Hr 024-Hrs 04 Days Project Manager /Il..A(.'-I buD6'-( 02-Hrs 02 Days 815 Days Project Location Q'6 ~L~ ~-r., 052~ c) A.N6 04-Hrs 03 Days 06 to 10 Days 32<.( ~us.. Sf; (oY2z"6 bA.f A-v6~(.o(~ Please callrorTAT less tnan24 HIS . . Email address -r'..t.4a' R ~(.. AJ"'- '1' Phone: (360) 417-0501 Fax: (360) 417-0514 o Asbestos Air o PeN! (NIO~H 7400) 0 TEM (NIOSH 7402) U TEM (AHERA) D TEM (EPA Level II) D Other o Asbe$tos Bulk o PLM (EPAI600IR-93/116) D PLM (EPA Point Count) 0 PLM (EPA Gravimetry) 0 TEM Bulk "~ALS Dot. Umit Matrix RCRA Metals DAIIS Other Metals o Total Metals ~ppm (MS) [l Air Filter 0 Paint Chips o Arsenic (As) 0 Lead (Pb) U All 3 rit,TGlE -G-ppb-(GFM} UJ-Drinking-watef--Q-Paint-C-hips-(Area)- E1-BariurfllBa}-O"Mercury (Ai>> B-Copper(Cu) U Dusl/wipe 0 Waste Water D Cadmium (Cd) 0 Selenium (5e) o Nickel (Ni) o Soil o Chromium (Cr) 0 Silver (Ag) o Zinc (Zn) o Other Types o Fiberglass D Nuisance Dust o Rotometer Calibration 0 Other (Specify) of Analysis 0 Silica D Respirable Dust 0 MOldIFuogus Condition of Package: 0 Good 0 Damaged (no spUlage) 0 S~vere da~~J~'pHIa~e) Seq. , lab 10 Client Sample Number Comments 1 C]t 2 3 04 5 6 7 8 9 10 11 12 13 14 15 AIR _ Prin Below Sampled by ~ Relinquished by Received by I , --. j. Analyzed by Results Called b; ,-- Rnults Faxed ~ L_ ~=~~~--- Tme ..._~_. ---- - Speclallnstructions: Unless requested in wnling. all samples will be dlspo6ed of two (2) weeks after analysis. f LM-$'I\ ~~ Il~u,,-e~ ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 Application Number . . . . , 15- 00001569 Date 12/15/15 Application pin number . . . 752500 DITCH Property Address . . . . 324 N RACE ST ASSESSOR PARCEL NUMBER: 06-30-00-5-1-3700-0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . , . Property Use . . . . . . . . FINAL Property Z.oning , . . . . COMMERCIAL OFFICE Application valuation . . . . 0 --------------------------------------'---------------- Application desc -------------- - - - -__ . 200 amp service for sprinkler system Owner Contractor CLALLAM CO PUB HOSPITAL, pl87 2 OLYMPIC ELECTRIC CO INC 939 CAROLINE ST 4230 TUMWATER PORT ANGELES WA 98362 PORT ANGELES WA 98363 ( 36) 417 -7000 (360) 457 -5303 Permit , , . . , , ELECTRICAL NEW COMMERICAL Additional desc . . Permit Fee 137,00 Plan Check Fee ,00 Issue Bate 12/15/15 Valuation . . . . 0 Expiration Date 6/1.2/16 Qty Unit Charge Per Extension 1,00 5.0000 ECH EL- BRANCH CIRCUIT W /FEEDER 5.00 1100 132,0000 ECH EL -COM 0 -200 SRV FEEDER 132.00 Fee summary Charged Paid Credited Pile Permit Fee Total 137.00 137.00 00 00 Plan Check Total .00 .00 .00 .00 Grand Total, .137.00 137,00 .00 ,00 REPORT SALES TAX on your excise fax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN FINAL 1 l 1 COMMENTS: `— PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or EIectrical Contractor X Date: G:IEXCHAN GEIBUILDING Dec 15 2015 09:42AM HP Fax page 2 CITY OF PART ANGELES PERMIT APPLICATION Building DivislonlElectileal Inspections 321 ,East Filth Street— P.O. Box 1150 / fort ,Angeles Washington, 98362 Ph: (360) 417.4735 Fax: (360) 417 -4711 DOW l Q, Multi- Family or Commercial* Plan Review Ma lie f3equired, Please Complete Electrical Plan Review Information Sheet Jae Address: ceyg ae s - -- _, Building Square Footage; Description of above Owner Information Contractor Information Name, Name; d.rMPIcELECTRic Mal ling Address: Mailing Address: 4230 TumwArffR City: State'.. rp, ^��� G'i�; POR TPNOEL S State; WA 21p; 88963 Phone; Fax; Phone: 30-467430a Fax: —2-08 License #1 Exp. License #IExp OLYMPeeaasm em Unit Charne 91hi Total Multiplied it Charge! ServlcelFeeder 200 Amp. $ 132.00 - $ ServicalFeeder 201400 Amp. $160.00 $ Servioe/Feeder 401 -600 Amp $ 225.00 $ ServioelFeader 601 -1040 Amp. $ 288.00 $ SenricalFeeder over 1000 Amp. $ 410.00 $ Branch Circuit W! Service Feeder $ 5.00 Branch Circuit W10 Service Feeder $ 74.00 $ Each Additional Branch Circuit $ 5.00 $ Branch Circuits 1-4 $ 86,00 $ Temp, Servlcal Feeder 200 Amp, $102,00 $ Temp. ServicelFeedet 201 -400 Amp. $121,00 $ Tarr p. ServicelFeeder 401.600 Amp, $ 164.00 $ Temp. ServicelFeeder 601.1000 Amp . $185,00 $ Portal to Portal Hourly $ 96,00 SlgnlOulllne Lighting $ 88.00 $ Signal Cl Umited Energy - Multi- Family $ 64,00 $ Signal Circuit/ Limited Energy/ First 1500 sf _ Commercial $ 96,00 Note: $5.00 for each additional 1500 sf Renewable Electrical Energy - 5KVA System or Less $113-00 $ Thermostat $ 56.40 $ Note: $5.00 for each additional T-Stal c $.—: Total Owner as defined by RCW 19.28,261; (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner Is required to hire an electrical contractor If above said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation oralteration in compliance with the electrical laws, N,E,C , ROW, Chapter 19.28, WAC, Chapter 296-408, The Clty of fort Angeles Municipal Code, and Utility Specifications and PAMC 14,05,050 regarding Electrical P mit Applications. Signature of owner, electrical contractor or electrical administrator; Q cash © crack cram card4 _ - — f� /�