HomeMy WebLinkAboutBLD2023-00079 Final Mobile Home with Carport - BLD Inspections - 6/1/2023 INSPECTION CARD
Mason County
615 W. Alder St.
Building 8, Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
PERMIT# BLD2023-00079 PROJECT ADDRESS 395 W OLD OLYMPIC HWY SHELTON, WA 98584
PARCEL# 319324200030 PROJECT DESCRIPTION MOBILE HOME WITH CARPORT(1981)
OWNER LAWSON RONALD L&JACQUELINE M ADDRESS 391 W OLD OLYMPIC HWY PHONE 1.360.789.4941
CONTRACTOR ADDRESS PHONE
CONTRACTOR LICENSE LENDER
INSPECTION INSP DATE Comments INSPECTION INSP DATE Comments
as Demolition Final Inspection
v
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
B DD2023-00079 DEMO
PROJECT DESCRIPTION: MOBILE HOME WITH CARPORT (1981) ISSUED: 01/23/2023
SITE ADDRESS: 395 W OLD OLYMPIC HWY SHELTON
EXPIRES: 07/22/2023
PARCEL: 319324200030
APPLICANT: LAWSON RONALD L&JACQUELINE M OWNER: LAWSON RONALD L&JACQUELINE M
391 W OLD OLYMPIC HWY 391 W OLD OLYMPIC HWY
OLYMPIA,WA 98502 OLYMPIA,WA98502
1.360.789.4941
FEES: Paid Due
Demolition Fee $120.00 $0.00
State Fee-Residential $6.50 $0.00
Technology Flat Convenience $5.00 $0.00
Fee
Totals : $131.50 $0.00
REQUIRED INSPECTIONS
Connection has been verified by Health or Utilities Demolition Final Inspection
CONDITIONS
" The demolition and disposal of demolition debris must meet requirements as per Mason County regulations. it is unlawful
for any person to cause or allow the demolition (or major renovation)of any structure unless all asbestos containing
materials have been removed from the area to be demolished.work shall not commence on an asbestos project or
demolition unless the owner or operator has obtained written approval from ORCAA @ 2490 B Limited Lane NW, Olympia
WA 98502, 360-586-1044, 800-422-5623, www.orcaa.org
The Washington State Clean Air Act prohibits the burning of any construction or demolition debris in an outdoor fire.
Printed by:Genie Mcfarland on:06/01/2023 01:17 PM
Page 1 of 2
1 ,
Mason County
Mason County - Division of Community Development
615 W. Alder St.
imp Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
DEMO BLD2023-00079
* OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit
revocation.Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or
contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained
permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County
access to the above described property and structure(s)for review and inspection. This permit/application becomes null &
void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
* All building permits shall have a final inspection performed and approved by Mason County Building Department prior to
permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property
records on file with Mason County as being non-compliant with Mason County ordinances and building regulations.
* All construction and demolition debris must be removed from the beach after project completion. Proper disposal of
construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State
waters.
* For public safety, it is the responsibility of the applicant to confirm through written verification all utility services (electric,
gas, water, sewer,...) have been terminated prior to demolishing a structure.
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 presume to give authority to violate or cancel
the provisions of any other state/local law regulating construction or the performance of construction.
Issued By:
Contractor or Authorized A at:, ' i-�t� ��� � Date: Z' 2.3-2_�'
Printed by:Genie Mcfarland on:01/23/2023 10:35 AM
Page 2 of 2
♦ � coc,�rA MASON COUNTY PERMIT NO. �ICE ZD Z OOQ 1 el-
COMMUNITY SERVICES DEPARTMENT
BUILDING•PLANNING•FIR EMARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg.fib,615 W.Alder St (360)2754467 Belfair ext. 352
Shelton,WA 98M4 (360)482.5269 Elma ext 352
DEMOLITION PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Ronald L Lawson AME:Owner is doing demo work
MAILING ADDRESS:391 W Old Olympic Hwy MAILING ADDRESS:
CITY:Olympia STATE:WA ZIP:98502 CITY: STATE: ZIP:
PHONE:360-789-4941 CELL:360-789-4941 PHONE: CELL:
EMAIL:jacquielawson@livecom EMAIL:
L&I REG# EXP.
PARCEL INFORMATION•
PARCEL NUMBER(12 DIGIT NUMBER)31932-42-OOM FIRE DISTRICT#4
LEGAL DESCRIPTION (ABBREVIATED) TR3 of NW SES 8/163 PCL 1 of BLA#98-67
SITE ADDRESS 395 W Old Olympic HWY(this is in MASON Co) CITY Olympia
DIRECTIONS TO SITE ADDRESS:From Shelton: take Hwy 101 South toward Olympia. Just South of
NVNep GJaL-hmm P R.P, —t'v(Zn/i2t4tit Ong o,., oe.ym,4ta.ho-y—-Zv a�omF!�<<t. ���vet vat c,, r2r5 h f "InAAVC—0
IS PROPERTY WITHIN 200 FT: 1315-go k-pI fw" t_eFi oz Weta -St racFwc tGHr �+ e �
SALTWATER LAKE RIVER/CREEK[] POND WETLAND SEASONAL RUNOFF STREAM
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[]NO 0
IF YOUR PROJECT IS LOCATED ADJACENT TO OR WITHIN AN AREA THAT IS LISTED ABOVE,PLEASE
CONTACT THE PLANNING DIVISION OF COMMUNITY DEVELOPMENT PRIOR TO DEMOLITION TO
ENSURE REDEVELOPMENT.
USE OF STRUCTURE BEING DEMOLISHED(RESIDENCE,GARAGE ETC.)
RESIDENCE
HOW WILL THE DEBRIS BE DISPOSED OF?:
TAKEN TO LANDFILL FOR DISPOSAL
PROVIDE A PLOT PLAN INDICATING LOCATION OF STRUCTURE TO BE DEMOLISHED
0 0� rnPi� few
OWNER/CONTRACTOR acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative, or contractor_ I further
declare that I am entitled to receive this permit and to do the work as proposed_ I have obtained permission from all the necessary
parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for
review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSPEC�TIO INACTVIIT/Y�F TH PERMPYWPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
Signature of Applicant to
XRONALD L LAWSON RJOWNER r]REPRESENTATIVE/OCONTRACTOR
Print Name
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
QlC SBG1oN C(,E Olympic Region Dean Air Agency
dip 2940 Limited Lane NW
Olympia,WA 98502
(360) 539-7610•FAX(360)491-6308 Demolition Permit
South Bend Office (360)942-2137
ti6 O RCAA Port Townsend Office (360) 338-6419
,'�y •rkFna•w�"'��`,�•� www.ORCAA.org
Demolition and renovation projects within Clallam,Grays Harbor,Jefferson,Mason,Pacific,and Thurston
counties REQUIRE A PERMIT and require that the following conditions be met prior to the demolition.
Olympic Region Clean Air Agency(ORCAA)regulations define a demolition project as the wrecking, razing,
leveling, dismantling, or burning(by a fire department for training purposes) of a structure,malting the structure
permanently uninhabitable or unusable. Renovations include the removing of load bearing structural members,
but not to the extent to make the structure uninhabitable.
The following information is merely a reference guide and not a substitute for agency regulations.
1. A good faith asbestos survey is required for any demolition.The survey must be conducted by a certified Asbestos
Hazardous Emergency Response Act(AHERA)building inspector.Qualified contractors and inspectors may be
found in your local Yellow Pages,through the Washington State Department of Labor and Industries,or on
ORCAA's website.
2. Asbestos samples must be sent to a NVLAP Laboratory (National Voluntary Laboratory Accreditation Program) per
40 CFR 763.87.A list of labs can be found on ORCAA's website.
3. The start date on other structure demolitions must be at least 10 working days from the submission date of the
complete application and payment.
4. It is the responsibility of the property owner and/or demolition contractor to ensure there is no asbestos-containing
material present in the structure to be demolished.
5. Any and all structures on the same parcel of property that are not proposed to be demolished must be identified as
such.
6. A copy of the asbestos survey and approved Demolition Permit must be kept on site and be available for review by
Agency inspection personnel.
7. The original demolition permit will expire 1 year from start date.If the pernbit expires and the project is not complete,
you must submit and pay for another demolition permit. Under no circumstances will a project be extended beyond 1
year from original submission date.
ADDITIONAL REQUIREMENTS:
In addition to Agency requirements,most building departments require a demolition permit(separate from ORCAA's
Demolition Permit).The Washington State Department of Labor&Industries and the local fire authorities may also require
notification for asbestos removal projects.
"Owner Occupied Residential Dwelling"means any single family housing unit which is permanently or seasonally
occupied by the owner of the unit both prior to and after the proposed project.This term includes houses,mobile homes,
trailers,houseboats,and houses with`mother-in-law apartment'or a`guest room.'This term does not include structures that
are demolished or renovated as part of a commercial or public project;nor does this term include any mixed-use building,
structure,or installation that contains a residential unit,or any building that is leased or used as a rental,or for commercial
purposes.
FIVE GUYS
EXCAVATING
Environmental Testing& Consulting
r
GOOD FAITH ASBESTOS SURVEY
Ran Lawson
3"Old Olympic HWY.
Olympia,Wa"502
Attn: Ron Lawson
PROJECT#LaN:4on- Demo
Date- 09/13/222
FIVE GUYS EXCAVATING
Environmental Testing& Consulting
Date:09,13122
Good Faith Asbestos Survey
Ann: Ron Lawson
395 Old Olympic HWY
Olympia,Wa 98502
Project#Lawson Demo-Demo
Dear Ron Lawson.
FGE is pleased to present our limited Good Faith Asbestos Survey for a Double wide mobile home.
Sincerely,
Five Guys Excavating
DBA
Bill McTumal Enterprises,LLC
Lisa Demmon
Al IFRA Building lnslwcux
Wertilicatc Number:011422-01)
FGF
P.O.Its,. 129
Shelton.Washington 98584
Phune:(360)432-0971
Fax: 1360)462-3272
11
TABLE OF CONTENTS
1.0INTRODUCTION «...................................................................................«.......«..........».».................1
1.1 SUMMARY............................................................................--------..........................------..........1
1.2 SAMPLE LOG.........................................................................................................................1
2.0 LIMITATIONS OF THE ASSESSMENT..........»..............«............».».».......»....... -----,..........2
2.1 OBJECTIVE..........................................................._..................................... ....................._...2
2.2 SCOPE OF WORK ..................................................................................................................2
2.3 LIMITING CONDITIONS ..........................................................................................----........2
2.4 LIMITATIONS OF THE ASSESSMENT ...............................................................................2
2.5 WARRANTIES ................................................................................................................_.......3
3.0 PROJECT SUMMARY .«................«.......,......................».......«.«....«................................,.........3
3.1 ASBESTOS SURVEY METHODOLOGY .....................................................................................3
4.0 CONCLUSIONS AND RECOMMENDATIONS «.».».«....«.«.«....«.«...........................««..,«.«.........»..4
TABLE
Table-Summary of Asbestos Sampling and Results
APPENDICES
Appendix A -iATL Asbestos Analytical Reports and Chain-of-Custody
1.INTRODUCTION/SUMMARY
On the 2nd of Sept,2022 Five Guys Excavating was contracted by Ron Lawson to collect samples from
structure located at address:395 Old Olympic HWY.Olympia Wa. Project#Lawson.-Demo.
Samples were taken for the purpose of determining asbestos containing materials within a single family
structure with intent to demolish. The home is a 1981 Double wide manufactured home..The structure is
approx. 1440 sq R and has 2 bedrooms and 2 bath.
The structure has Wood siding and vinyl windows,Insulation in wall and ceiling of home were fiberglass bat.
There is sheet laminate flooring in the kitchen,bathrooms and laundry.There is carpet in the remaining areas
of the structure with wood subfloor throughout house.The home has wood paneling walls with the exception
of 1 wall in Living room that has sheetrock. The whole house has pressboard ceiling. The roof of the home is
composition. Five Guys Excavating conducted an asbestos survey to identify possible ACM's(Asbestos
Containing Materials)A total of(3)samples were taken from the structure as shown in the chart below and(0)
of the(3)samples were found to contain a regulated level of asbestos.
1.2 SUMMARY
Five Guys Excavating conducted an asbestos survey to identify possible ACM's(Asbestos Containing
Materials). Sampling was conducted in accordance with sampling and analytical procedures required by
Asbestos Hazard Emergency Response Act(AHERA),Olympic Region Clean Air Agency(ORCAA),and the
Asbestos Survey Requirements of the State of Washington Department of Labor and Industries(L&I)WAC
296-62-077.
1.2 SAMPLE LOG
SEE ATTACHED
The owner should also use caution when performing demolition activities within the project areas.
Concealed materials may be encountered during the demolition project.ACBMs may be located between
walls.above ceilings,underneath floor,in pipe chases,or other inaccessible areas.A copy of the asbestos
survey document should be on site during all demolition activities.
2.0 LIMITATIONS OF THE ASSESSMENT
As addressed under 2.4 Limitations of the assessment in Project survey#Lawson-Demo The conclusions of
the report are professional opinions based solely upon visual site observations and interpretations of analyses
as described in our report.Common construction techniques render portions of the building inaccessible.
The opinions presented herein apply to the site conditions existing at the time of our investigation,and
interpretation of current regulations pertaining to asbestos.Therefore.our opinions and recommendations
may not apply to future conditions that may exist at the site. Future regulations pertaining to asbestos
material may impose stricter restrictions on demolition work.
2.1 OBJECTIVE
The objective of Five Guys Excavating's assessment work was to evaluate the presence of asbestos materials
from this residential home prior to a demolition project.
2.2 SCOPE OF WORK
The scope of services for the asbestos materials assessment included,and was limited to,the following
tasks:
• Perform an asbestos inspection to identify asbestos-containing building materials(ACBM)
present from this residential home. Sampling was conducted in accordance with AHERA
sampling requirements and analyzed by a NVLAP accredited laboratory for the presence of
asbestos using Polarized Light Microscopy(PLM).
Prepare a summary report documenting the findings of the assessment and providing tables
summarizing materials,analytical results,comments and recommendations.
2.3 LIMITING CONDITIONS
*Five Guys Excavating's site inspection included a physical inspection of accessible areas_
2.4 LIMITATIONS OF THE ASSESSMENT
•The conclusions of the report are professional opinions based solely upon visual site observations
and interpretations of analyses as described in our report.Common construction techniques render
portions of the building inaccessible.As a result,additional ACBM may be present in inaccessible
areas(e.g.,crawl spaces,above ceiling,and behind walls)at the site.
•The opinions presented herein apply to the site conditions existing at the time of our investigation,
and interpretation of current regulations pertaining to asbestos.Therefore,our opinions and
recommendations may not apply to future conditions that may exist at the site.Future regulations
pertaining to asbestos material may impose stricter restrictions on demolition work.
2.5 WARRANTIES
*There are NO warranties written,expressed or implied.
3.0 PROJECT SUMMARY
Information concerning the subject property was obtained from site inspections conducted by Lisa Demmon of
Five Guys Excavating.This section provides a sampling methodology and a brief discussion of Five Guys
Excavating's assessment results.Supporting documentation provided within the survey report includes
material summary tables and the Appendices section that includes the staff certification and laboratory
analysis reports with chain-of-custody documentation.
3.1 ASBESTOS SURVEY METHODOLOGY
Five Guys Excavating's asbestos survey was performed following the sampling protocol for the
renovation/demolition areas as outlined under AHERA,40 CFR 763,the Olympic Region Clean Air Agency
(ORCAA)and the State of Washington Department of Labor and Industries WAC 296-62-077.Sample
locations were chosen in a random fashion,with emphasis being placed on obtaining samples of each tvpe of
accessible suspect material_Five Guys Enterprise's survey was conducted by Asbestos Hazard Emergency
Response Act(AHERA)accredited building inspector,an accreditation through training AHERA,29 CFR
Part 763,Lisa Demmon(Certificate Number:011422-04)during the asbestos inspection.Copy of the building
inspector certificate is provided in Appendix A.
Samples were collected in a non-abrasive manner by carefully removing small portions of the suspect
material with a sharp knife or other hand tool suitable to the material being sampled. Each sample was
placed in a pre-labeled plastic container immediately after collection.Sample containers were then
placed in a large re-sealable plastic bag for transportation to the laboratory.The sampling instrument was
subsequently wiped with a clean moist cloth to decontaminate the tool and prevent the potential release of
asbestos fibers or contamination of subsequent samples. Data pertinent to each sample(e.g.,date,sample
number,material description,and material condition)were recorded on a sample log sheet.The sample log
forms are kept on file at the Five Guys Excavating's office.
Asbestos bulk samples,copies of the sample log and chain-of-custody submittal sheets were
delivered to International Asbestos Testing Laboratories(iATL)in Mt. Laurel,New Jersey. iATL
participates in the National Voluntary Laboratory Accreditation Program(NVLAP)for quality control
procedures.As specified in 40 CFR Chapter I(1-1-87 edition)Part 763,Subpart F,Appendix A,each
sample was analyzed using polarized light microscopy(PLM)/dispersion staining techniques,in
accordance with U.S.EPA Method 600/M4-82-020.Detection limits for this type of analysis are
approximately one half percent(by volume). Materials containing at least one percent asbestos are considered
to be regulated asbestos-containing building materials(ACBM).
4.0 CONCLUSIONS AND RECOMMENDATIONS
Five Guys Excavating collected a total of three(3)bulk samples from this residential home and zero(0)of the
three(3)samples collected were found to contain a regulated level of asbestos.Asbestos abatement is not
required for these items shown in the Certificate of Analysis.
The owner should also use caution when performing demolition activities within the project areas.
Concealed materials may be encountered during the demolition project.ACBMs may be located between
walls,above ceilings,underneath floor,in pipe chases,or other inaccessible areas.A copy of the asbestos
survey document should be on site during all demolition activities.
Supporting documentation for the asbestos samples, including a copy of the laboratory analysis reports
with the chain-of-custody documents are provided in Appendix B.
TABLE
SUMMARY OF ASBESTOS SAMPLING AND ANALYTICAL RESULTS
90M Commerce Parkway,Suite B•Mount Laurel,N! 09054
.iATLPhone:877-429-4295/856-231-9449•Fax.8i6.�t-9818
INTERNATIONAL
AsnEsros Trts-n>W,LABORATORIES
Chain of Custody
—Bulls Asbestos --
Contact Infairmation
Client Company: Five Guys Excavating Inc. Project Number: 395 Old Olympic HWY
Office Address: 721 W Kamilche In. Project Name: Lawson
City,State,Zip: Shelton,Wa 98584 Primary Contact: Lisa Demmon
Fax Number: 360-462-3272 Office Phone: 360432-0971
Email Address: fiyeguysentetpriseChotmad.com Cep Phone: 360-463-2396
PLM Instructions:
®PLM:Bulk Asbestos Building Materials EPA 600 R-93/116, 1993
❑PLM:Bulls Asbestos Building Materials EPA 600 M-4/82-020, 1982
❑PLM:Bulk Asbestos Building Materials NIOSH 9002, 1985
0 PLM:Bulk Asbestos Building Materials NYSDOH-FLAP 198.1,2002
❑PLM:Bulk Asbestos Building Materials NYSDOH-FLAP 198.6,2010
0 TEM:Bulk Asbestos Building Materials NYSDOH-FLAP 198.4,2009
❑PLM:Point Counting ❑PLM:Analyze Until Positive(Positive Slop)
❑PC:via FLAP 198.1 0 AUP:by Homogcnous Area as Noted
❑PC:400 Points 0 AUP:by Material Type as Noted
❑PC:800 Points• ❑PLM:NOB via 198.6
❑PC: 1600 Points* 0 PLM:Friable via EPA 600 2.3
❑If<1%by PLM,to TEM via 198.4•
❑PLM.Instructions for Multi-Layered Samples 0 If<1%by PLM,Hold for Instructions
❑Analyze and Report All Separable Layers per EPA 600
0 Report Composite for 1 Systems NFSHAP •••
�^� y P� El Non-Building Material ' (Dust,Wipe,Tape)
❑Report All Layers and Composite Where Applicable ❑Soil or Vermiculite Analysis
❑Only Analyze and Report Specifically Noted Layer 0 CARB 435
Special Instructions:
•.4dditimral cha ge and turnaround mm.be rrqukvd •'.4hernative Me had(ex:EPA 60"_0*tiat)may hr rernmmeude+d by ta8nr�ton
Turnaround Time
Preliminary Results Requested Date: "1014M []Verbal ®Email ❑Fax
IfK datC t time
❑to Day N 5 Day t3 Day ❑2 Day ❑1 Day* ❑12 Hour-- ❑6 Flaw• 0 RUSH-
-End of next business day unless otherwise specified.•*Matrix Dependent.***Plean notify the lab before sbipplag—
!.:—hain of Custody -
Relin Relinquished rri.ow. uc. �-'
q (Name/Organization): Date. ,a oo.m
Received(Name/iATL}: Time:
_ Date: Time:
Sample Login(Name/iAT .fo L L D Time:
Ana tysis(Name(s)1 iATL}_ f Date ► Time: C r -
QA/QC Review(Name/iA ): Date: Time:
Archived/Released: QA/QC Intcr AB Use: Date. Time:
moo
�elebiating?a lears...osr saatplc x:a time
H�1:.aaet.cane
-1 -
1ATL9000 COnun"'Ce Parkway,Suite 13•Mount Laurel,M O8o54
Phone:877-428-4285i855-231-9449• Fax:856-231-9s 18
INTERNATIONAL
Nsffsws TFSnxG LAHORA'IrWES
Sample Log
—Bulk Asbestos —
Ct;cnt:Five Guys Enterprise Project:Lawson
sa>p�g Date ri=:08/24/22 10:00 am
Bulk Asbestos Samose Log
Client Sample# iATL# Location/Description Notes
1 7 4 s 9'G 7 Whole house ceiling Ceiling board
2 s'43926 Living room wall Wall Texture
3 7 4 8 9 z 41iLiving room wall Wall sheetrock
MAM
Ccle[�ratini 25 ycarc,..on�.an�psc<t a time
Sfi-!n1!Fw.:
9000 Commerce Parkway State B
ML LaurcL New Jersey 08054
.iA"rLTelephone:856-231-9449
INTERNATIONALEmail:customerservice(o miaU.co
A�,t3L .crs 7 ESrtAsC,LARt:RA 0RIE-S
CERTIFICATE OF ANALYSIS
Client: Five Guys Enterprise LLC Report Date: 9..12/2022
721 Kamilche In.W Report No.: 668289-PLM
Shelton WA 98584 Project: Lawson;395 Old Olympic Hwy
Client: FW721 Project No.:
PLM BULK SAMPLE ANALYSIS SUMMARY
Lab No.:7489267 Analyst Observation:Beige Ceiling Board Location:Whole House Ceiling
Client No.: 1 Client Description:Ceiling Board Facility:
Pcn=t Asbestos: Percent Non-Asbestos Fibrous Material Percent Non-Fibrous Mat 'al:
None Detected 99 Cellulose 1
--------------------
Lab No.: 7489268 Analyst Observation:White Wall Texture - _-� Location:Living Room Wall
Client No.: 2 Client Description:Wall Texture Facility:
Percent Asbestos: Percent Non-Asbestos Fibrous Material: Percent Non-Fibrous Material:
None Detected None Detected 100
Lab No.:7489269 Analyst Observation:Lt Tan Drywall ----~ Location:Living Room Wall ---_-Y-
Client No.:3 Client Description:Wall Shcetrock Facility:
Percent Asbestos: Percent Non-Asbestos Fibrous Material: Percent NQn-Fibrous Material:
None Detected 10 Cellulose 90
Note:Joint Compound not prasent.
Lab No.:7489269(L2) Analvst Observation:White Wall Texture Locaeon:Lining Room Wall
Client No.: 3 Client Description:Wall Sheetrock Facility:
PP=.cnt Asbestos: Percent Non-Asbestos Fibrous Material: Percent Non-Fibrous Material.
None Detected None Detected 100
Pkxc refer to dK Appendix of this i cM for further inftmeation regarding yaar matysis.
Date Received: 9/2/2022 Approved By:
Date Analyzed: 09/12/2022
Frank E.Ehrenfeld III
Signature: Laboratory Director
Analyst: Ellen Smith
Dated:9/12/2022 4:51:45 Page I of 4
9000 Commerce Parkway Suite B
Mt.Laurel,New Jersey 08054
Telephone:856-231-9449
ILA Email:customerservicxGiad.cotn
INTERNATIONAL
�►4$E_`i'l"Ca'STF4Tp!�(�LAHI?R.\"IfzfillS
CERTIFICATE OF ANALYSIS
Client: Five Guys Enterprise LLC Report Date: 9/12/2022
721 Kamilche In.W Report No_: 668289-PLM
Shelton WA 98584 Project: Lawson,395 Old Olympic Hwy
Client: FIV721 Project No.:
Appendix to Analytical Report
Customer Contact_Lisa Demmon
Methed:40 CFR Appendix F to Subpart E of Pan 763,interim method for the Determination of Asbestos in Bulk Insulation Samples,US6PA 600,R93-116 and
NYSDOH FLAP 198.1 as necdod.
This appendix seeks to pmnuate grater understanding of any observations,exceptions.special instructions,or circumstances that the laboratory
the client concerningthe above es.The information below is used to het r y needs to r oust tr icis.o
samples. P lx�e Y�ability to make the trtosl informed decisions for you and your customers.
Please note the following points of contact for any questions yet may have.
IATL Ciastow Service:customersemceand.com
iATL OltkY Manager:wchampkv0_ivM.tom
iATL Acesi nt Representative House Account
Sample Levin Notes. See Batch Shot Attached
Sample Matrix:Bulk Building Materials
Exeeptioss Noted:See Following Pages
General Terms,Warrants,Limits,Qualifiers:
General information about iATL capabilities and client/laboratory relationships and responsibilities are spelled out in iATL policies duet arc listed at www.iATL.com and a
our Quality Assatance Manual per iSO 17025 standard tegmrentents.The information therein is a representation of An definitions and policies for turnaround tithes,
sample sutbmitud,wlkx tion media,blank detintuons,quantification issues and limit of detection,analytical methods and procedures,sub-contracting policies,results
reporting options.fees,terms.and discomxs.confidentiality,sample archival and dispacal,and data interpretation.
iATI.wanarats the lest results to be of a precision normal for the type and methodology employed for each sample submitted.WTI.disclaims any other warrants.
expressed or implied,including warranty of fitness for a particular purpose and warranty of merchantability.iATL accepts to ki d responsibility for the purpuse for which
the client uses test results.Any analytical work performed must be governed by our Standard Terms and Conditions_Prices.methods and detection limits may be Banged
without notification.Please contact your Customer Service Representative for the most current information.
This confidential report relates only to those itcm(s)tested and does not mpresent an endorsement by MIST-M LAP,AIHA LAP LLC,or any agency of focal,state or
province governments awn of any agency of the U.S.governmenL
This mutt stall not be reproduced except in full,widxxa wriam approval of the latxxatory.
information Pertinent to this Report:
Analysis by US EPA 600 93-116:Determination of Asbestos in Bulk Building Materials by Polarized Light Microscopy(PLM).
Certifications:
• NIST-NNrLAP No. 101 165-0
NYSDOH-FLAP No. It 021
• AIHA-LAP,LLC No. 100188
Quantification at<0.25%by volume is pt>,siblc with this mediod.(i'C)Indicates Stratified Point Count Method performed.(PC-Trace)means that asbestos was daected
but is not quantifiable under the Point Counting regimen.PC Trace represents a<0.25%amount.Analysis includes all distinct separable layers in accordance with EPA
600 btethod.If not matted or otherwise noted,layer is either not preset or the client has specifically requested that it not be analyzed I eat.arudyie until positive
inamuetmos).Small asbnalua fibers may be missed by PLM due to resolution limitations of the optical microscope.Therefore,PLM is not consistently reliable in detecting
asbestos in non-friable organically bound(NOB)materials.Quantitative transmission electron microwupy('CF1t+f)is currently the only ru abod that an pronounce
materials as non-asbestos coniai�ring.
Analytical Mcdwdoiogy Alictr ivts:Your initial request for analysis may not have accounkd for recent advances in regulatory requirements or adtanca in technology
that are routinely used in similar situations for other qualified projects.You may have the option to explore additional analysis for further information.Below are a few
options,listed as the matrix followed by the appropriate methodology.Also included are pinks to more information on our website.
Bulk Building Materials that are Non-Friable Organically Bound(NOB)by GraAmetric Reduction techniques employing PLM and TEM:FLAP 199.6(PLM-NO$).
FLAP 198.4(TESL-NOB)See additional information at the end of Ibis appendix.
Dated:9?12/2022 4:51:45 Page 2 of 4
P-rL 9000 Commerce Parkway State B
Mt.Laurel.New Jersey 08054
Telephone:856-231-9449
INTERNATIONALFtrtail:custotticrservicx(ajiatLcotn
CERTIFICATE OF ANALYSIS
Client: Five Guys Enterprise LLC Report Date: 9/12/2022
721 Kamilche In.W Report No.: 668289-PLM
Shelton WA 98584 Project: Lawson;395 Old Olympic Hwy
Client: FIti721 Pr
Loose Loose Fill Vermiculite Insulation.Attic Insulation,Zmolite(copyright),etc.:US EPA 600 R-41004(multi-tiered analytical process)
Sprayed On Insulation/Fireproofmg with Vermiculite(SOF-V):ELAP 198.8(PLM-SOF-V)
Soil,sludge,sediment,aggregate,and like materials analyzed for asbestos or other elongated mineral particles(ex.erionite,etc.):ASTM D7521,CARR 435.and other
options available
Asbestos in Surface Dust according to one of ASTM's Methods(very dependent on sampling collection technique_by TEM):ASTM D 5755,b5756,or D6480
Various other asbestos matrices(air.water,ek:_)and analytical methotds are availabk.
Disclaimers/Qualiflers:
There may be some samples in this project that have a"NOTE:"associated with a sample resulL We use added disclaimers or qualiters to inform the client about
something that requires Further explanation.Here is a list with highlighted disclaimers that may be perluictu to this project.For a full explanation of these and other
disdaimem please inquire at catkomerservieeCe irid con.
1)Note:No mastic provided for analysis.
2)Note:Insufficient mastic provided for analysis.
3)Note:Insufficient material provided for analysis.
4)Note:Insufficient sample provided for QC reanalysis.
5)Notc:Diffcrart material than indicated on Sample Log/Description.
6)Note:Sample not submitted.
7)Note:Attached to asbestos containing material.
8)Note:Received wet.
9)Note:Possible surface contamination_
10)Now.Not building material.1%threshold may not apply.
11)Note:Recommend TEM-NOB analysis as per EPA recommendations.
12)Note:Asbestos detected but not quantifiabdc.
13)Note:Multiple identical samples submitud,only one analyzed.
14)Note-Analynd by EPA 600fR-93/116.Point Canning detection limit at 0.080°/..
15)Note:Analyzed by EPA 6000L-931116.Point Counting detection limit at 0.l25'/..
16)Note:This sample contains>loo/.vermiculite mincral.See Appendix for Recommendatitms for Vermiculite Analysis.
Recommendations for Verudeulite Analysis:
Several analytical protocols exist for the analysis of asbestos m vermiculite.These analytical approaches vary depending upon the nature of the vermiculite mineral being
tested(c.g.un-processed gauge,homogeneous exfdiated books of mica,or mixed mineral composius).Please contact your client representative for pricing and mmatntatd
time options available_
iATL rosin rnerrds initial testing using the EPA 600/R-93/116 method.This method is specifically designed for the analysis of asbestos in bulk building materials.it
provides an acceptable starting point for primary screening of vermiculite for possible asbestos
Results from this testing may be inconclusive.EPA suggests proceeding to a multi-tiered analysis involving wet separation techniques in conjunction with PLM and TEM
gravimetric analysis(F.PA 600:R-04004).
For New York State automers.NNSDOII requires disclaimers and qualifiers for vanotts vermiculite containing samples that direct analysis via ELAP198.6 and
EL.AP 198.8 for samp"that contain>10°i vermiculite mineral where EIAPi 99_6 may be used to evaluate the asba*K content of the material.However,any test result
using El API 98.6 will be reported with the following disclaimer."ELAP198.6 method does not re nave vermiculite and may underestimate the level of asbestos present in
a sample containing>10%vermiculite."
Further information on this method and other vermiculite and asbestns issues can be fatrhd at the following:Agency for Toxic Substances said Disease Registry(ATSDR)
wwwAisdr,odc.gov,United States Geological Survey(USGS)www.minmis.usgs.got•/minerals•.US EPA www.epa.goviasbestos.The USEPA also has an informative
brochure"Current Best Practices for Vermiculite Attic Insulation"EPA 747FO3001 May 2003,that may assist the health and remediation professional.NYS customers
please follow current NYSDOH FLAP requirements per policy on subject of surfacing and vermiculite.May 6,2016,Testing Requirements for Surfacing Material
Containing Vermiculite(hugs:,/www.wadswonh.orglsites/defauWftlevVebDoc,4198_8 02_2.pdf)
The following is a summary of the analytical process outlines in the EPA 600/R404/004 Method:
I)Aaalyt"Step/Methed:Initial Screening by PLM,EPA 600R-93/116
Requirementa/CONSAMts:Minimum of 0.1 g of sample.-0.25%for rrwst samples.
Dated:9/12/2022 4:5 t:45 Page 3 of 4
4 9000 Commerce Parkway Suite B
Mt.Laurel,New Jersey 08054
Telephone:856-23 I-9449
INTERNATIONALrx Email:custortservir;.e@iatl.com
A413ts'sc :Trny-i-%c;LAB(�KATt KIF_.&
CERTIFICATE OF ANALYSIS
Client: Five Guys Enterprise LLC Report Date: 9/12/2022
721 Kamilche In.W Report No.: 668289-PLM
Shelton WA 98584 Project: Lawson;395 Old Olympic Hwy
Client: FIV721
Project No.:
2)Arasiytkal StepJMrtYsd:Wes Sqtuadon by PLM Gravimctric Technique.EPA R-04,004
Requiremeots/Ce mseents:Minimum 50e*of dry sample.Analysis of"Sinks"only.
3)Analytit:al Step/1Netkod:VVet Separation by PL%I Crravimetric Technique,IPA R-04.'004
Regtriremeab/CommesAs:Minimum 50g"of dry'sample.Analysis of"Floats`only.
4)Analytieal Step/Method-Wet Separation by TEM Gravimctric Technique,EPA R-041004
Regairetttt+ WCommews:Minimum 50g'•of dry sample.Analysis of"Sinks"only.
S1Analytial StqvMethei:Wa Scparatioo by TE%i(;ravimetric Technique,EPA R-04%4
Rcgeirewerats/Comments Minimum 5Ug'•of dry sample_Analysis of"Suspension"only.
'With advance notice and confirmation by the laboratory.
"Approximately t Liter of sample in double-bagged container 1-,9x6 inch bag of sample).
New Yurk State Department of Heakh requires that samples originating from NYS that they categorize as Non-friable Organically Bound materials can only be coafrnmed
as Konc Detected fur asbestos by method 198.4.See the table below for a list of those materials.(ENVIRONMENTAL LABORATORY APPROVAL PROGRAM
CERTIFICATION MANUAL-ITF.M No.198.1,Revision lire 5/6,116)
{Asphah Shingles,Caulking,Ceiling Tile%writh Cellulose,Duct Wrap,Glazing,Mastic,Paint Chips,Resilient Floor Tiles,Rubberized Asbestos Gaskets,Siding Shingles,
Vinyl Asbesim Tile,NOR materials(otha drat tiM-V)with<10%vermiculite,Any material(Friable or NOB other than SM-V)with>I WA vermiculite.
Swu;t tally derived uncertainty with any measure should be taken into consideration when reviewing and interpreting all reported data and remits.A more comprehensive
listing of accuracy,precision,and uncertainty as it impacts this method is available upon request.
Dated:9112/2022 4:51:45 Page 4 of 4
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2940 United Lam NW. Demolition
Olympla,WA 9MO2
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eaterthe property Tilted in tli s Notfrauwr at reasonabieu"m fior Quposes of hmpecmgtbe won#tha isthesubjed of the NotdKabm and to ensure couPlasm
with caedb mm,appirahie bwz,aid regetfabw�&t undestand this Nate does not authorize anyoneto vm"e fedaai,stab ex lueah!:ties or regulation pertaining
to actieies assoe- I atrTh this Now. 1 have read and wdh abide bythe conditions set forth in the Notification and any adder 1 thensm
t do certify under penalty of perjury under thelasa of the state of Washmgtan thaxthe information in this application and suppls-nentah data i3 to the best of rwy
Appticartt Name Date
Date Received Payment kdo_ Asbestos Notification
Received I cap, Assam
VI Check- # 1 Demolition!Notification
.'Ali 2 4 202 [ ]Credit Card # �.L- DEM00 L¢�!
Receive date--j
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