Notification #

NOTIFICATION OF DEMOLITION Southwest Clean Air Agency

11815 NE 99th Street, Suite 1294 Vancouver, WA 98682

Voice: (360) 574-3058 Fax: (360) 576-0925 www.swcleanair.org

(10 day waiting period from date submitted)

Must include fee

See Consolidated Fee Schedule (Table 11) http ://www.swcleanair.org/fees/index .asp

1. TYPE OF NOTIFICATION (jjl"briginal D Revised D Cancelled):

2. TYPE OF OPERATION D Partial Demolition Ji!( Complete Demolition D Ordered Demolition

D Emergency Demolition D Fire Training

3. FACILITY DESCRIPTION (Example: Residence, Barn, Carport)

Commercial Name or Description: 'R ~ ~ l . -(_"' C.. .e_

Address: Lt O 9. oo.. J City: State: W

Present use: V ~ ~ 4. FACILITY INFORMATION

Date Received

SOUTl-1V0:En CL'.::AI /1, 1Ft AG r:: NC'

County: ( L ow

VV'\.O

Owner Name: 1:. Mailing Address: Q c~\ ~ u 0 ~

City: - Le-~v,e.U State : ~~ ZipCode: qfG".5Z. --'~~~~~~-'-~~~~~~~~~~~~~~~~~~~-t-~~~~~~~~~~----1

Contact: ~C>,_v' V"'~.\- \~' '-=\...._-e Phone=-uo _ J.10 -9BB~ 5. NAME AND AHERA CERTIFICATION NUMBER OF ASBESTOS INSPECTOR: r

' 19""'-6. ATTACH A COPY OF THE ASBESTOS INSPECTION REPORT Report must include laboratory name, analyst, sample type, location sample was taken and analytical method used to detect the presence of asbestos materials.

7. ASBESTOS REMOVAL CONTRACTOR IF APPLICABLE: D No asbestos resent, see attached AHERA Re ort

Name: \ -t"-t.. Address: 4 ri

State: Zip Code: q BG t.{. L

Contact: \ . Kt1r-- Phone:)bo - 667-0868

8. DATES ASBESTOS REMOVAL OCCURRED (mm/dd/yy) Complete: lo · Z.c...r , 1 ~ Asbestos Case Number: I~ Ei.. 'f 1.tJ ,ZJJ

9. DATES DEMOLITION WILL OCCUR (mm/dd/yy) Start:

10. DEMOLITION CONTRACTOR or FIRE DEPARTMENT: P.R. Wod<T (-\--

Name:

Address : v-.

City: State: l...,,i ()_ County: LC ~L '-' Contact and Phone#

SWCAA FORM N0.23 REVISED 07/13/2018

11. DESCRIPTION OF PLANNED DEC WORK, METHOD(S) TO BE USED:

D e... c... ~ s..\- "' \,\. t-- - L c:; ~L vc.. , .Q_

12. FUGITIVE EMISSIONS/DUST FROM DEMOLITION ACTIVITIES MUST BE CONTROLLED/PREVENTED DURING ALL PHASES OF THE PROJECT.

Yes 13. IF UNEXPECTED ASBESTOS CONTAINING MATERIAL (ACM) IS FOUND DURING DEMOLITION, STOP WORK, NOTIFY SWCAA AND CONSULT/HIRE A CERTIFIED ASBESTOS ABATEMENT CONTRACTOR.

ye.S

14. IF DEMOLITION IS ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY BELOW:

Name: ~ \<; I Title:

Agency:

Date of Order (mm/dd/yy): I

Date Ordered to Begin ( mm/dd/yy ):

15. FOR EMERGENCY DEMOLITIONS: (Contact SWCAA prior to work) \/\. \ C\ Date and Hour of Emergency (mm/dd/yy) (hh/mm):

Description of the Sudden, Unexpected Event:

EXPLANATION OF HOW THE EVENT CAUSED UNSAFE CONDITIONS OR WOULD CAUSE EQUIPMENT DAMAGE OR AN UNREASONABLE BURDEN: (ATIACH ADDITIONAL PAGE IF NECESSARY)

16. I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT.

0, ~ Woc<Tl-\- <v.~.w~~ f\:) - 'bQ-f'5 (Type or Print Name) (Signature of Owner/Operator) (Date)

HAVE YOU PERFORMED A HAZARDOUS MATERIALS ASSESSMENT ON THE STRUCTURE?~ ONO

The Washington State Dangerous Waste Regulations (WAC 173-303) require that demolition debris be evaluated to determine if it is dangerous. The evaluation should be completed before demolition to ensure that hazardous constituents are not released to the environment and do not present a risk to human health during or after demolition. These requirements apply to all buildings being demolished and are the responsibility of the property owner. The Washington Department of Ecology's website, https://ecology.wa.gov/Regulations-Permits/Guidance­technical-assistance/Dangerous-waste-guidance/Common-dangerous-waste/Construction-and-demolition , provides more information about the requirements and about sampling and testing construction materials to determine if they present a risk. For more information please contact a Hazardous Waste Inspector at the Washington Department of Ecology Southwest Regional Office: 360-407-6300.

SWCAA FORM N0.23 REVISED 07/13/2018

'·

KEYSTONE CONTRACTING 417 N w 26981 Street, Rictgehelct WA 98642 . (360) 887-0868 . office (360) 887-8157 fax

· To: Preston Worth PR Worth Excavation

Re: Asbestos Abatement 409 S Dubois Road Ariel, WA. 98603

Preston,

WA Registration #k'.Ey§'f'Cfi32N§ Oregon CCB #64144 keystone4 l 7@tds.net

This letter is to confirm that Keystone .Contracting, Inc. removed all asbestos per survey provided by Compliance En\rironmental Services, LLC. Martin Ortiz was the supervisor on the project. WA Certification ABAS00032366. Asbestos waste will be disposed of at the Wasco County Landfill in The Dalles, OR.

Thank.you,

Kerry Holtmann Keystone Contracting, Inc. .

KEYSTONE CONTRACTING, I NC. 417 N.W . 209TH STREET RIDGEFIELD, WA 9864 2

CCB#64144 UBI#6010324 11 KEYSTCI132NS Voice: 360.88 7.0868 Fax: 360.887.8157

Sold To: PR WORTH EXCAVATION 517 19TH AVE LONGVIEW, WA 98632

Ship To: PR WORTH EXCAVATION 409 S DUBOIS ROAD ARIEL, WA 98603

• nvoice Invoice Number:

KEY 1 8 - 282

Invoice Date: Oct 29, 2 01 8

Page: 1

Customer ID Customer PO Payment Tenns PR IDRTH

Sales Rep ID Shipping Method Hand Deliver

Quantity Item Description 1.0C Bid iLUMP SUM BID PRICE

Thank You For Your Business

Net 15 Days

Ship Date

Unit Price 750 . 00

Subtotal Sales Tax

Total Invoice Amount Payment Received

TOTAL

I I

Due Date 11/13/18

Extension 750 . 00

750 . 00

58 . 50

808 . 50

808 . 50

KEYSTONE

CONTRACTING

. INC. FIELD JOB WEEKLY RECORD

417 N.W. 209th Street Ridgefield, WA 98642 (360) 887-0868

lJS"'A

CUSTOMER j>Xl ~ Week Ending \ Q l&B l \ ~ LOCATION \ka '\ ~ t)~ CLO P.O.# Job# ~ \ i · ~ ~ d-.. ~ ------- "

DESCRIPTIONOFWORK ~K. '>\J....tn::n.M--vQ .._h b~

1.

2.

3.

4.

5.

6.

8.

II TOTALS (Office Use Only) I I II II Signed: KCI Authorized Representative Signed: Customer Authorized Representative

Daily Project Log

Project Name: £ ~ ~1 ·. Job#: l'O · j._ i J..... Date: \ 0 I ;>4 j \$5 Onsite Contact Name & Phone Number: ~ 9] \ · J-')~ · q 4 ~lp

Exact Location of Project:

Total Quantity/Type of Asbestos Removed:

Name of Air Monitoring Onsite: Time on site:

Keystone arrival at job site: ... JaJ..;.o;_..(}'-/{}~---- Departure from job site: ~I <20 Crew On Site:

~L/"O;t i

Equipment Rented and from Whom:

Unusual Events That Happened Today:

Supervisor S ignature:

ASBESTOS WASTE SHIPMENT REPORT FORM

PLEASE PRINT OR TYPE. If you have ques:iODS. ::ont2ct your local DEQ ~ Offiee in Portland 503-229-5364, Salem S03-37S.S086, MedfmdS41-776-6107, Coos Bay 541-269-2721m.222. Bmd541-633-2019, or Pendleton 541-278-4626.

S=-t CcyJb:e Ca=y Gp

- . Wasts disposal site: Wuco County Landfill Pbone:54_1_·29§..4082_· --=-------2550 Steele RQad Tne Dalles, OR Wasco 97058

Mrlress: 417 NW 209th Street Ridgefield, WA. 9882

TRA.~SPORTER(S): 8 T~#l:(~oi=-ipio!~)

Ager.t: ________________ ccmipay: Keene in~

Ad.dress: 417 NW 209th Street ~d, WA. 98642 PhoD« 360-887-oae8 Si~e: ____________________ nme: _________ _

9 7~rter #2: (~ of:llCCipi ofms=i&ls) A.gc.:t: Coz::lpany: ____________ _

Addre$$: 417 NW 209t:h Street~· WA. 9882 ~=-----------s:p=e: Date: _________ _

DISPOSAL: (~of receipt cf "°'8ZDS~ cavce:1 ay this~ exClpt as ::o:ied t:. =z: l l below.)

: c Waste Disl:>osal Siu· Wasco County Landfill . . ~a..~e a:ici Title: __________________ Daza: _________ _

Sig:iati!.~ : ____________________ Photle: ________ _

. ' DISCREPANCY SPACE: (Add.amc'mnentl as=edad>--------------------

Preston Worth

From: Sent: To: Subject: Attachments:

Preston

Compensol@gmail.com Brian Thompson <compensol@gmail.com>

Friday, October 19, 2018 5:44 PM

Preston Worth

Re: Asbestos Inspection Reports -18-5832 - AHERA - PR WORTH - 409 S DUBIOS RD ARIEL, WA.pdf; LAB RESULTS #1 -

PR WORTH.PDF; LAB RESULTS #2 - PR WORTH.pdf; INVOICE - 18-5832 - PR WORTH -

AHERA - 409 S DUBIOS RD ARIEL, WA.pdf

Attached are your Inspection reports for this project I will send a copy to Steve also

There is asbestos flooring in the bathroom that will need remediation

Please give me a call if you have any questions

Report is on file with Keystone Contracting 360-887-0868

Thank you

Brian ICES compensol@gmail .com

Enviroomentol Services

1

PIXIS Labs (~ A Tentamus Company

P.R. Worth 2690 Coweemen Park Dr. Kelso Washington 98626 United States

Dear Steve Wagner,

12423 NE Whitaker Way Portland, OR 97230

503-254-1794

111111111111111~ Ill~ ~11111111111111~1111111111

Job Number:

Report Date:

ORELAP#:

Purchase Order:

18-008975

10/15/2018

OR100028

Project Name: 409 S. Dubois Rd.

Project No:

Enclosed please find Pixis Labs analytical report for samples received as order number 18-008975 on 10/10/2018 at 07:35 AM . Should you have any questions about this report or any other matter, please do not hesitate to contact us. We are here to help you.

The samples listed below were received in good condition at 21 °C.

Laboratory Sample ID

18-008975-0001

Field Identification

Roofing

Matrix

Other

Collection Date

10/08/2018

Collection Time

03:00 PM

Test results relate only to the parameters tested and to the samples as received by the laboratory. Test results meet all requirements of NELAP unless otherwise noted. This report shall not be reproduced, except in full, without the written consent of this laboratory. Samples will be kept a maximum of 15 days from the report date unless prior arrangements have been made.

NOTE: This analysis was subcontracted to EMSL Analytical in San Leandro, CA. EMSL Analytical San Leandro is an NVLAP accredited laboratory.

Thank you for allowing Pixis to be of service to you, we appreciate your business.

Sincerely, Reviewed and Signed

~~ ' ( ()L_____ Derrick Tanner General Manager

Order 18-008975-0001

Co lumbia Food Laboratories Pixis Labs Member of Tentamus Group

info@columbia food lab.com www.columbiafoodlab.com customerservice@pixislabs.com

Company registered in the United States of America Tax ID: 93- 1227941

Page 1 of 4

PIXIS Labs (~ A Tentamus Company

+ EMSL Analytical, Inc. 44 McConnlck Slrocit 6M Loan~o. CA 94577

Tol!Fax: (!"110) 896-3()75 / (510) 895·3680

hnp:llwww.EMSL.com I &1nlr!,11nctrdAh{!:P.r11sl.coo1

Attent ion: Mark Leed

Pixis Laboratories

12423 Northeast Whitaker Way

Portland . OR 97230

Project: 18.008975

12423 NE Whitaker Way Portland, OR 97230

503-254-1794

1111111111 ~11111111 ~11111111111111~11111111

EMSLOrder.

Customer 10:

Customer PO:

Project ID:

Phone :

Fax:

Received Date:

Analysis Date:

CoUected Date:

Job Number:

Report Date:

ORE LAP#:

Purchase Order:

Project Name:

Project No:

091822344

PYXS78

18.008975

(503) 254-1794

(503) 254 -1452

10/1212018 11 :30 AM

1011212018

Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy

........ Dncrtplion

RoofincJ

Sl~111Q Hcissor (1}

Appi1119n1nco

Bl1td1/Grccn Fibrous l ·km~

Non-Asbestos

% Fibrous

~C'.cllulosc

% Non·Abrous

8% Q.mrtz

,~~ Matrix

16% Ncr.·tihrC115 (Other)

Mallh f!NJ Datongbac.al or Ob:r Ac1pr0Yed Si!JnHICr -y

Nooe Octccicd

EMSL !"fieci :ttn!. tabf1!y l rnt.t!c b 001.: o r a'1llly~s Irv above ar a lyses wtJl'll ucr'ofmtd .., ~:ul C0'11c;i 111ra: -w1~ A:ipt:no'u. E !<> So.Jb:)n•: E o ! .tO Cl'"R (::irevo.u.Jy EPA OOO!f.~ ·62-020 i n1t:rm

Mof1a.l"). l>..i l •\JUrYt..<1 1t:C w- ll.., P'uuxh1roswb"ll:tl 111!J)C1993 ("lr1a\j~"ll™°'l or1riert e'=100 Tn1s ru1X1"!re '1t'l:s m tr 11.1 t"lll ~tmples lt()Or!t!(l fll.oi.:Nu , rtfltl !Tiffy 1~! b: rephx_lau.'<l. fl•U:P'. 111 l.J ll . w1:tl0.ll

w·1"~1!1url tt lXl!'VY1tf Loy E M Sl. . EhtSL t.;h rt> no re~ionsSill !y ltY Miil :>llJ 1..'dlt.-clD"'lttCh ·1t11ts. CT t1/'\/llyl1Ct11 me t'l()(l l• 111 lHuons ln lli rf""la llOll m 'Cl u~ O' .-.:s.: rus.ul ls K!t:I u .. respo·1t.1Ui'1:,0 o t ltltl c lu ll A ll

aamPti !lo r«.i.;m:.<l Jl DCU:Pbb:t:ro1d11Xrr un~s.so tt'll ~ rRbO no:.:<J l m:>rc::urt must ro! lll usod try tncld ll!nt to d orm prtKf .K.."!ccrll'OtOOn. r1PQfm.'DI. a erdor!.Clroonl l.oy N\ILAP, N S T er aflY UQ0rl(..)' o•

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(Initial n.."'Pal lrorn : 1G'12fl018 17:42:37

458 PLM 0008 0001 • 1 78 Prinlcd: 1G'12!201 8 2:4:2 PM

Order 18-008975-0001

Co lumbia Food Laborator ies Pixis Labs Member of Tentamus Group

info@columbiafoodlab.com www.columbiafoodlab.com customerservice@pixislabs.com

Company registered in the United States of America Tax ID: 93- 1227941

Pagc 1 of1

18-008975

10/15/2018

OR100028

409 S. Dubois Rd.

Page 2 of 4

PIXIS Labs (~ A Tentamus Company

12423 NE Whitaker Way Portland, OR 97230

503-254-1794

Job Number:

Report Date:

ORELAP#:

Purchase Order:

18-008975

10/15/2018

OR100028

I ~1111 11111111111 1~ llll l~ll 1~11 1111111 ~II Project Name: 409 S. Dubois Rd .

Project No:

derT 09 1822344

• Asbestos Bulk Building Material Chain of Custody

EMSL A>;;, · -,_, \•, 200 R<Jul ( 130 N "

C ~.tJAt/:rJ<\' ~ .. !~J fi8Q7 EMSL Order Number (Lab use Only) PHv:.E 1800· 220-36 5

F"-< [856J 78'3 597-'

I EMSL·Bill to: U Same ~ D1tteren1 Comp.!!!)' : P1x1s Labs _ I , a• 10 • '""' "°'' '"'"""'°"' m Conmen!$"

Street: 12423 NE VJhitaker Way - Thlf'd Partv B1/11na rrouires wntten authonzarion from third oarrv

C'!y: Portland _ I State/Province : OR Zip/Postal Code : 97230 J _£.ountry: U~A Report To (Name): Marl! Leed and Melissa Hubbard __ ~hone# : 503-254- . ~

Email Address: mleed@pixoslabs com. mhubbard@pi.islabs co nf u #: 503-254-1452 l Purchase Order:

Prolect Name/Number: 1 '(, oo /3 6,\ ') - Please Provide Results: fl Fax l'l Email U.S. Sblte Samples Taken: CT Samples : l Commerc ial/Taxable I I ResldentiallTax Exemot

Turnaround Time (TAT) Options· - Please Check [ J 3 Hour I [ ] 6 Hour I ~ 24 Hour I [l 48 Hour I [ l 72 Hour I [ l 96 Hour I [J 1 Week I lJ 2 Week •for TEM A.Jr .l nr rnrougti 6 flt , f)leaseca/J aheoo to sehedufe "There is a prem1Um cnarpe tot 3 Hour TEM AHERA or EPA Level II TAT You wi/I be asked to 519n

an authonla!JOn lofm lor thrs seMCe AnalVS1s completed m accordance wrtn EMSL s Te.rms and Corldtt1ons IOCatea 111 the Allatvtaf Pnce Gulde

PLM · Bulk !repot1ing lim ltl TEM - Bulk

~ PLM EPA 600/R-93/116 (<1%) - 0 TEM EPA NOB - EPA-6001~931 1 16 Section 2 5 5 t

0 PLM EPA NOB (<1%) 0 NY ELAP Melhod 198 4 (TEM)

Po1n1 Counl 0 400 (<O 25%) 0 1000 (<O 1%) 0 Cha1field Protocol (sem1-quan 11ta11ve)

Point Counl w/Grav1metnc 0 400 [<O 25%) 0 1000 (<O 1%) 0 TEM % by Mass - EPA 600/R-93/116 Sec on 2 5 5 2

O NIOSH 9002 \<1%) 0 TEM Oual11at1ve via F1ltrat1on Prep Technique

0 NY ELAP Method 198 1 (fnable 1n NY) 0 TEM Ouahlatrve via Drop Mount Prep Technique 0 NY ELAP Method 198.6 NOB (non-fnable-NY) ,__ _ - - - Q the_r _ - _ -~ --0 OSHA ID-191 Mod1f1ed

0 Standard Addttion Method 0

n Check For Pooitive StoD - Clearlv Identify Homooenous GrouD I Date Samnled:

Samplers Name: I s amplers Signature:

Sample I HA # Sample Location Material Descriotlon

l~C~lie~n~t~S~a~m~•o~ll e~#!i'•~•l~: 7~/'1-f---ir----:;;:=;::;::~=------ _ Total # of Sa'!!_P_!!s:

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Order 18-008975-0001

Columbia Food Laboratories Phds La bs Member of Tentamus Group

Page 1 ol -I- pages

Pel.Q t l Of

info@columbiafoodlab.com www.columbiafoodlab.com customerservice@pixislabs.com

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Company registered in the United States of America Tax ID: 93-1227941

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Page 3 of 4

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PIXIS a s ~~A lcntamu~ Comp:m·1

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Order 18-008975-0001

Columbia Food Laboratories Company registered

Job Number:

Report Date:

ORELAP#:

Purchase Order:

18-008975

10/15/2018

OR100028

Project Name: 409 S. Dubois Rd.

Project No:

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Page 4 of 4

Pixis Labs Member of Tentamus Group

info@columbiafoodlab.com www.columbiafoodlab.com customerservice@pixislabs.com

in the United States of America Tax ID: 93-1227941

Compliance Environmental Services, LLC. PO Box 87277 Vancouver, WA. 98687

Biii To

PR Worth 51719thAve Longview, WA 98632

Quantity Description

I Clearance Sampling and Analysis by PCM

Phone: 360-834-3031

Project Description

Asbestos Inspection @ 409 S Dubois Rd Ariel, WA

Date

10119/2018

P.O. Number

Preston

Price Each

345.00

I Total

Invoice Invoice#

18-5832

Terms

NET IO

Amount

345.00

$345.00

ENS~ Laboratories·

Environmental Hazards Services, L.L.C.

7469 Whitepine Rd

Richmond , VA 23237

Telephone: 800.347.4010

Client: Compliance Env. Services

P.O. Box 87277 Vancouver, WA 98687

Asbestos Bulk Analysis Report

· Report Number: 18-10-03060

Received Date: 10/18/2018

Analyzed Date: 10/18/2018 Reported Date: 10/19/2018

Project/Test Address: 18-5832; PR Worth; 409 S Dubois Rd ; Ariel , WA

Client Number:

49-1 467 Laboratory Results Lab Sample

Number Client Sample

Number

18-10-03060-001 F-1

18-10-03060-002A F-2

Chrysotile present in fibrous backing.

18-10-03060-002B F-2

Layer Type

Linoleum

Mastic

Possible contamination from fibrous backing.

18-10-03060-003 HW-1

Lab Gross Description Asbestos

White Vinyl ; Beige NAO Fibrous; Inhomogeneous

Red-Brown Vinyl; Gray 18% Chrysotile Fibrous; Inhomogeneous

Total Asbestos: 18%

Yellow Adhesive ; 2% Chrysotile Homogeneous

Total Asbestos: 2%

Black Tar-Like Fibrous; NAO Homogeneous

Page 1 of 2

Fax Number:

3603142411

Other Materials

20% Cellulose 80% Non-Fibrous

5% Cellulose 77% Non-Fibrous

98% Non-Fibrous

55% Cellulose 45% Non-Fibrous

Environmental Hazards Services, L.L.C Client Number: 49-1467

Project/Test Address: 18-5832; PR Worth; 409 S Dubois Rd; Ariel, WA

Lab Sample Number

QC Sample:

QC Blank:

Client Sample Number

21-M12011-4

Layer Type

SRM 1866 Fiberglass

Lab Gross Description

Reporting Limit: 1 % Asbestos

Method:

Analyst:

EPA Method 600/R-93/116, EPA Method 600/M4-82-020

Michelle Swift

Report Number:

Asbestos

Reviewed By Authorized Signatory:

Missy Kanode QA/QC Clerk

18-10-03060

Other Materials

The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report. Each distinct component in an inhomogeneous sample was analyzed separately and reported as a composite. Results represent the analysis of samples submitted by the client. Sample location, description, area, volume, etc. , was provided by the client. This report cannot be used by the client to claim product endorsement by NVLAP or any agency of the U.S. Government. This report shall not be reproduced except in full , without the written consent of the Environmental Hazards Service, L.L.C. California Certification #2319 NY ELAP #11714 NVLAP #101882-0 VELAP 460172. All information concerning sampling location, date, and time can be found on Chain-of-Custody. Environmental Hazards Services, L.L.C. does not perform any sample collection.

Environmental Hazards Services, L.L.C. recommends reanalysis by point count (for more accurate quantification) or Transmission Electron Microscopy (TEM), (for enhanced detection capabilities) for materials regulated by EPA NESHAP (National Emission Standards for Hazardous Air Pollutants) and found to contain less than ten percent (<10%) asbestos by polarized light microscopy (PLM). Both services are available for an additional fee .

400 Point Count Analysis, where noted, performed per EPA Method 600/R-93/116 with a Reporting Limit of 0.25%.

*All California samples analyzed by Polarized Light Microscopy, EPA Method 600/M4-82-020, Dec. 1982.

LEGEND: NAD = no asbestos detected

Page 2 of 2

Compliance Environmental Services LLC. PO Box 87277 Vancouver, WA 98687 Phone (360) 834-3031 Fax (360) 314-2411

-t SatYlpu LO ~ r.MA of AJk Chain of Custody FrovYt sa.rnp~ ixMj ~ 1 8 compensol@gmail.com

Wo Project: { '3- 5 cg" 3 2 State: WA P.O. # NA

Company CES, Inc. Report Attention: Phone # 360-834-3031 Fax# 360-314-2411

Samples Collected By: BT Date (s) Collected: //tJ-/7 - 1'6 Samples Chilled to 4° C?NA Tum Around Time:

Comments: ASBESTOS Name of Lab Samples Sent: ~ S

Sample ID# Media Container Volume Description Location Analysis Required

.,; -) Pi11/J::. f(4#f1c N~ .VlQlt"'° ~,.J ,.. s;:--...-t ,r.J ~~~fz;-f-Z. I I I --Fl 00,... r.z -fl / I L.A:3I -

~ .{-\ Vl-3 I ' I ~ti~ ( J} ..-caMl ~~ k,;,-1 o..- l • ,

I "

18-10-03060

111111111 ~111111111~111111~1 llllll~l l~ll 11111 Due Date :

10/19/2018 (Friday)

~~ AE

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I

Date/Time: · .... / ~ Received By: ----r_ ;(,,.,, Date/Time: tO /1 g J 1

Date/Time: Date/Time: Remarks: Air Ex USPS Courier

Continued On Next Page? Yes ___ No X (if yes see following pages)

Asbestos Inspection Of The

House on Property

at

409 S Dubios Rd

in

Ariel, WA

October 17th, 2018

#18-5832

presented to:

PR Worth Excavation Preston Worth 517 191

h Ave Longview, WA,

preston@prworth.com

prepared by:

Compliance Environmental Services, LLC. PO Box 87277

Vancouver, WA. 98687 (360) 834-3031

compensol@gmail.com

Asbestos Management • Mold Inspections • Industrial Hygiene • Indoor Air Quality • Laboratory Services

ID# F-1

F-2M

F-2M

HW-1

RF-1

Compliance Environmental Services LLC. PO Box 87277 Vancouver, WA 98687 Phone (360) 834-3031 e:mail: compensol@gmail.com

EPA/AHERA ASBESTOS INSPECTION CES: 18-5832

Date: 11-17-18 Time: 11:00 Client Name: Preston Worth I PR Worth Excavation

Inspection Address: House @ 409 S Dubios Rd Ariel, WA

Client Address: PR Worth/ 517191h Ave Longview, WA,

Phone#: 1-503-209-8737 e-mail I preston@prworth.com

Inspector: Brian Thompson #1628775

Purpose: Locate, Identify & Quantify ACM Prior To Demolition

Building Description : Type of structures Foundation Walls Roof

1960s D #1 Story x #2 Story D Concrete D DWJC D 3-Tab

D Basement D Trailer x Block x Wood D Flat

D Outbuildings D Wood D Plaster x Shake

Total # Samples Including sub-Layers: l#s

1#1 Total # Samples Containing 1 % or More Asbestos:

Remediation Required Yes [D No D RESULTS

Flooring D Concrete

x Wood

D Both

Samples were collected from selected homogeneous materials in order to evaluate the presence or absence of asbestos in each material. Determination of homogeneous materials included material type, texture, pattern, color, and size.

s amp es ana 1yze db AHERAP >y 1 P "f M t . 1 . R d /M rotoco . - OSI Ive a ena s are m e ore th 1% an 0

Description I Location Floors Wall Ceilings Exterior Total Sq/ft % Asbestos FLOORING I BACK ENTRY x None Detected

FLOORING I MASTIC x +!- 60 sq/ft 2% Chrysotile

MASTIC x None Detected

HOUSE WRAP x None Detected

ROOFING FELT x None Detected

* +/- 60 Sq/ft VINYL FLOORING I BATHROOM

-- PAGE 01 of 03 -

Asbestos Management • Mold Inspections • Industrial Hygiene • Indoor Air Quality • laborato1y Services

GOVERNING AGENCIES

Asbestos containing materials are regulated in the Ariel, Washington area by the following regulatory agencies;

(US-EPA Region 10)

(WISHA)

(SW CAA)

(L & I)

United States Environmental Protection Agency NESHAPS; Reference 40 CFR Part 61 Sub-Part M & AHERA; 40 CFR Part 763

Washington Industrial Safety & Health Administration Reference; 29 CFR 1926. I 101

Southwest Clean Air Agency Reference; SWCAA 476 Standards for Asbestos Control

State Washington Department of Labor and Industries Reference; General Occupational Health Standards Chapter 296-62-WAC

DISCUSSION & RECOMMENDATIONS

When demolition or renovation is to occur then all asbestos containing materials must be removed. The Occupational Safety and Health Administration (OSHA) & the Washington Industrial Safety and Health Administration (WISHA) classify the removal or disturbance of the above described asbestos containing materials as Class 11 asbestos abatement project. The removal or any disturbance of these materials must be undertaken by trained and qualified individuals. Furthermore, the Washington State Department of Labor and Industries (L&I) as well as the Southwest Washington Air Pollution Control Agency (SW APCA) requires 10 days notification and the appropriate fees prior to the beginning of an asbestos abatement project of this nature.

LABORATORY INFORMATION

Samples were analyzed by Environmental Hazards Services, Inc. using Polarized Light Microscopy (PLM) with dispersion staining to identify asbestos constituents as required by EPA regulation 40 CFR, Part 763 NESHAP. EHS Laboratory is accredited by the American Industrial Hygiene Association (AIHA) and the National Voluntary Laboratory Accreditation Program (NVLAP #1882). EHS #18-10-03060 (Analysis upon request)

DISCLAIMER

Conclusions reached as the result of analysis done on suspect materials are not 100% accurate. Error can occur in two forms: 1) sampling error; and 2) non-uniform distribution of asbestos in materials that otherwise appear homogeneous. CES conclusions are based on the results of the laboratory analysis and the site inspection. Compliance Environmental Services, Inc. is not responsible for any asbestos-containing material that might be behind walls, under floors, underground, or in any area that is generally inaccessible.

Asbestos Management • Mold Inspections • Industrial Hygiene • Indoor Air Quality • Laborato1y Services

DEMOLITION PERMIT

This report needs to be submitted to the following agency (SW CAA) for demolition approval.

(SWCAA) Southwest Clean Air Agency 11815 NE 99TH St. Suite #129A Vancouver, WA 98682 (360)-574-3058 Web: www.swcleanair.org

Report Prepared By:

~'15~ Brian Thompson EPA/ AHERA Building Inspector #168379

-- PAGE 3 of 03 - END OF REPORT

Asbestos Management • Mold Inspections • Industrial Hygiene • Indoor Air Quality • Laborato1y Services

House @ 409 S Dubios Rd Ariel, WA

AH ERA #168379

<!Certif irate of <!Completion This is to certify that

Brian Thompson has satisfactorily completed

4 hours of refresher training as an

AHERA Building Inspector

to comply with the training requirements of TSCA Title II, 40 CFR 763 (AHERA)

168739 Certificate Number

11BBCI~ -·~::!! H .. .tJNl .,.G • CONSul.T~G (')

~--~·

Jul 25, 2018 Expires ., 1 year Dale(•) ofTraini;;g---- -

Exam Score: rt l pptOP .... te.

Asbestos Management • Mold Inspections • Industrial Hygiene • Indoor Air Quality • Laborato1y Services

Cowlitz County Parcel Search

-·

O-ll), r, lUti"tf

Assesso r's Parcel Search

The Assessor's

Office 360-577-

3010

\:J!f.Lt:L~.r:..tl<ll.l!~! Search

Account Information

Accou nt

Parce l

Jurisdiction

Owner

Mail ing Address

Abbrevia ted Property Reference

Short Pla t/ Large Lot#

Situs

Tax Dist rict

Neighborhood

Levy

Current Year Levy Rate (2017 Assess 2018 Payable)

Property Details

Create Printable PDF

R002 585

EH2320044

Click account to view parcel map. {Flash Player 11.1.0 or greater required)

COWLITZ COUNTY

HICKEY THOMAS A/MARGARET

3 CHI NOOK CT

LONGVIEW, WA 98632

SUB : K INGS TRACTS UNRECORDED LOT : 44 DESC : \'il'.S T - 568 Pl'3.CE L EH 2 30 30 4 1 1974 & PRI OR YRS SECT , TWN , RNG : 2 3 - 6N - 2 E Pl'.RCE L : EH232 0 044

409 S DU80IS RD , ARI EL 98603

940 Couw

Click the underlined tax district to view summarized tax authorities

Click here to view md1v1dual tax authorities

10 - LEWIS RIVER RO

Map Data Chck t-le re For Interact ive Map t ns trucllons

R-404-W D- ::7-(2 -E 1-Yl

13. 706493

Model: SFR

FIRST 685

SEC_ VER_2 3 72

Model: XFOB

~~;~~;:,~~~~essment Click Here to View Historica l Values

Taxes Assessment Payable Actual Assessed Year Yea r Type Value Value Acres

2018 2019 IMPROVEMENTS 95710 95710

2018 20 19 LAND 125590 125590 .23

Notice of Valuation **

NOV for EH/320044

~.mUor I;H2 ~?_QQ11

Page 1 of 2

""'" This is the Notice of Valuation as it was originally mailed out. Any subsequent changes to values after the initial notice was produced are not reflected in this PDF.

Photographs

http://www.cowlitzinfo.net/applications/cowlitzassessorparcelsearch/(S(zmy 1 yhnv44cnds. .. 10116/2018

Cowlitz County Parcel Search Page 2of2 ·- ,.

The Treasure r's Office

360-577- 3060

The Aud itor's Office

3 6 0-577 - 3002

The Building and Planning Office 360 -577-3052

Current Transaction Information Click Here to View Historical Taxes

Assessment Year

2017

Tax Year 2018

Total Charges

$2,810.74

Pa id 1st Half

51,405.37

Paid 2nd Half

51,405.37

Paid Whole

Year Unpaid

Amount

50.00

Tax Bill*• Credit Card Payment Link (pdf) Point & Pay

R002585

•• This is the tax bill as it was mailed out in February. Subsequent changes to the tax bill are not reflected in this PDF.

Make Checks Payable to:

Cowlitz County Treasurer

207 4th Ave. N.

Kelso, WA 98626

Property Recordings

Reception

3596811

531151

931105132

Click on the !mks to view conveyance documenrs 3104957

3009524 While we make every a u empt to make dowmen ts available onlme, there may be some cases ~ ·1here documents are 011/y available Ill We Auditor 's Office.

Cowlitz County Permits

3023545

3093858

30482 59

Book Page Grantor

LIEN RICHARD l / SHERENE

661 128 LIEN JACK E ETUX

1161 279 LIEN JACK E/RUTH K TRUST ETAL

0

Click 011 th e !mks to v1 e111 perm it doc11me11ts Permit# Project Name Type Remark Filing Date Status

While we make eve1y attempt to make documencs available 011/me, there may be some cases where documents are unavailable 111 an elecuo111c fo11nat .

<:I ere Fo On1 nl? Plann no aps- {EP C)

Copyright © 20J.3 Cowlit z County . All Right s Res erved.

http: //www.cowlitzinfo.net/applications/cowlitzassessorparcelsearch/(S(zmylyhnv44cnds... 10/16/2018

Table 11 - SWCAA 476-050 Standards for Asbestos Control, Demolition and Renovation

Waiting Fee Effective Dates Fee Applicability Fee Categories

Period Current 1/1/2018 1/1/2019

~sbestos Removal and Demolition advance Notification Period and Fees:

Owner occupied single family Prior $25 $27 $30 !Per Removal Notice residence; occupant performed. Notification

All other removal projects: Less than 10 linear feet; and

None $0 $0 $0 No Notification less than 48 square feet.

10 to 259 linear feet; or 10 Days $100 $1 IO $120 Per Removal Notice 48 to 159 square feet.

260 to 999 linear feet; or IO Days $250 $275 $300 Per Removal Notice 160 to 4,999 square feet.

1,000 and more linear feet; or IO Days $500 $550 $600 Per Removal Notice 5,000 and more square feet.

Amendments to all projects Prior

$25 $27 $30 !Per Amendment after 2 Notification

Annual notification 10 Days $500 $550 $600 !Per Removal Notice

Renovation with asbestos IO Days Same as normal asbestos fees

Renovation without asbestos None $0 $0 $0 !No Notification

Demolition with asbestos 10 Days $50.00 + $55.@+ $60.00 + !Per Demolition Notice +

Normal asbestos fees !Per Removal Notice

Demolition without asbestos IO Days $50 $55 $60 Per Demolition Notice

Temporary asbestos storage Prior $50 $55 $60 Per Application

facility authorization Notification

Emergencies Prior All fees are doubled Per Request Notification

Table 12 - SWCAA 491-030 Gasoline Facilities Registration

Work Fee Effective Dates Fee Applicability Fee Categories

Hours Current 1/1/2018 1/1/2019

Registration Fee NA $90 $99 $108 Per Facility

Criteria Pollutant Fee NA $45 $50 $55 !Per Ton of Emissions

Toxic Pollutant Fee NA $25 $27 $30 !Per Ton of Emissions

10