Notification #
IP>-lo ~::J
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 dav waitina oeriod from date submitted)
Must include fee
See Consolidated Fee Schedule (Table 11) httQ://www.swcleanair.org/fees/index.asQ
1f3L[Sl(p I
Kd/Y.f)f)) 19'>7 1. TYPE OF NOTIFICATION (ii Original D Revised D Cancelled):
2. TYPE OF OPERATION D Partial Demolition ii Complete Demolition D Ordered Demolition
D Emergency Demolition D Fire Training
~}~ f~,,~ -~I~ Liu\ DEC 1 2 2018 \
SOUTHWES I CLE rN NR ~G[]\J0)'
1=1.~ SWCAA Reviewed fr " /
\ ' 3. FACILITY DESCRIPTION (Example: Residence, Barn, carport) 1 house, 1 mobile home, 1 shop, 1 detached garageV
Commercial Name or Description:
Address:6300 NE 119th St
city: Vancouver State:WA County: c I ark
Present use: Al I Va cant Prioruse:Residency, storage
4. FACILITY INFORMATION
ownerName:StoneRidge Capital, LLC. Mailing Address:2552 NW 12th
City: Camas I State:WA Zip Code:98607
contact:Luke Jolma Phone:360-635-2627
5. NAME AND AHERA CERTIFICATION NUMBER OF ASBESTOS INSPECTOR: Tom Levitt IR -18 - 44278
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 present, see attached AHERA Report
Name:Rose City Contracting Address: 2 g 7 91 SW Kinsman Rd
City:Wilsonville I State:QR Zip Code:97070
contact:Cheryl Rice Phone: 503-685-9505
I
8. DATES ASBESTOS REMOVAL OCCURRED (mm/dd/yy) Start: 11 /13/18 Complete: 11/13/18 Asbestos Case Number: 18- W 00 .
9. DATES DEMOLITION WILL OCCUR (mm/dd/yy) Start: 12/27/18 Complete: 12/30/18
10. DEMOLITION CONTRACTOR or FIRE DEPARTMENT:
Name:StoneRidge Excavating
AddressA 707 NE Minnehaha St #C305
c ity: Vancouver I State:WA County: c I ark
Contact and Phone# J OS h Bishop 360-450-1642
SWCAA FORM N0.23 REVISED 07/13/2018
11. DESCRIPTION OF PLANNED DEMOLITION WORK, METHOD(S) TO BE USED:
Knock down with Excavator. Load into boxes and dump. 12. FUGITIVE EMISSIONS/DUST FROM DEMOLITION ACTIVITIES MUST BE CONTROLLED/PREVENTED DURING ALL PHASES OF THE PROJECT.
13. IF UNEXPECTED ASBESTOS CONTAINING MATERIAL (ACM) IS FOUND DURING DEMOLITION, STOP WORK, NOTIFY SWCAA AND CONSULT/HIRE A CERTIFIED ASBESTOS ABATEMENT CONTRACTOR.
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)
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.
~ (J,;.,t_-t(l,<;GrJ =A~ {l -(l ~fb --- (Type or Print Name) '- (Date)
HAVE YOU PERFORMED A HAZARDOUS MATERIALS ASSESSMENT ON THE STRUCTURE? DYES 0 NO
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
AS(J.8S10S lSAD MOLD
Phone (503) 685-9505 I Fax (503) 685-9190
www.rosecitycontracting.com 29791 SW Kinsman Rd.• Wilsonville, OR 97070
ontractina Inc. v
November 16, 2018
Stone Ridge Homes
RE: 621 O and 6300 NE 119th Street Vancouver WA 98686 RCCI Job No. 18-736
Dear Farzan,
Rose City Contracting, Inc. completed the asbestos abatement November 13, 2018 per the estimate# 18-1047 provided dated 10/11/18.
All abatement projects employed by Rose City Contracting, Inc. meet or exceed federal, state and local regulatory requirements. All waste was disposed at a state approved landfil l. Such records are not required for exempt material such as mastic.
Thank you for the opportunity to serve you. If you have any questions, please do not hesitate to call us.
R spectfully Submitted,
~
OR CCB# i0293.2 WA# ROSECC!° 0 63.J9
Abate Tek LLC 37LI SW Stephenson St. Portland Or. 97219 971-275-6423
ABATE TEK LLC
ASBESTOS ASSESMENT AND SURVEY
Prepared for: Ryan Christensen- StoneRidge Homes
Property Address: 6300 NE 119th St. Vancouver WA. 98686
Residence
1.0 INTRODUCTION:
On Monday, September 24th, 2018 Abate Tek LLC of Portland, completed an asbestos inspection and survey of a home slated for demolition located at: 6300 NE l l 9th St. Vancouver WA. 98686. This survey was conducted by Tom Levitt (Certification# IR-18-44278), an accredited AH ERA Asbestos Inspector under 40 CFR, Part 763, Subpart E, and Appendix C. This report presents the asbestos survey methods, findings, and conclusion.
2.0 PURPOSES AND SCOPE:
This survey & assessment is to be done on home slated for demolition.
6300 NE l 19th St. Vancouver WA. 98686
Various local, state, and federal regulations govern the use and management of Asbestos Containing Materials (ACM). The codes are generally focused on preventing airborne emissions of asbestos fibers and addressing public and worker health concerns for exposure to asbestos during demolition or renovation projects. The Environmental Protection Agency (EPA) requires that any material that contains greater than 1% asbestos be handled as an asbestos containing material.
3.0 SUSPECT MATERIALS TESTED FOR ASBESTOS CONTENT:
The number of samples taken for any surfacing, TSI or miscellaneous material is determined by CFR Part 763.86.
In some cases, the inspector can use discretion and take fewer samples of factory manufactured materials such as VCT, ceiling tile, and roofing.
- - - . - ---------- ---
4.0 SUBJECT SITE DESCRIPTION: The subject property site is a family home with basement (Dwell ing). Approx. 2300 Sq. Ft. The structure was (unoccupied) at time of survey.
5.0 SURVEY METHODOLOGY: The scope of services included identification of any suspected ACM within the specific areas that could be impacted by upcoming activities, to bulk sample and analyze those suspect materials and to provide a report of findings. A general walkover examination was initially completed to plan the asbestos survey, identify functional spaces (spatially distinct areas within the work area), and to develop a sampling scheme for homogeneous areas of suspected ACM. The interior finishes were visually inspected for suspect ACM. Bulk
samples were collected in a representative manner by the Inspector based on suspected material contents, as defined by Regulatory codes or guidance's for sampling methods and as applicable to the planned activities .
The samples were placed into airtight plastic bags and hand delivered to LabCor in Portland, Oregon. LabCor Portland, Inc. is a NVLAP accredited laboratory for the analysis of bulk materials using Polarized Light Microscopy (PLM).
6.0 IDENTIFIED ASBESTOS CONTAINING SAMPLES - FINDINGS: A total of twelve (12) samples were taken from interior/exterior of the home. (See Chain of Custody).
The following represents a tabulation of bulk samples, which were found (if any) to contain above 1% asbestos content during the preparation of this survey and the results of their analysis.
Samples that were tested as (Negative) for asbestos are listed as *NAO (No Asbestos Detected).
NR = < 1% Non-Regulated. NR - Non-Regulated materials (<1%} or trace amounts of any asbestos contaminant should be handled using OSHA approved guidelines for wet removal. This is for your safety and the safety of your contractors.
~~~
Sample 001 Plaster Material Living Room No Asbestos Detected
Sample 002 Plaster Material Bedroom East No Asbestos Detected
Sample 003 Plaster Material Bedroom West No Asbestos Detected Sample 004 Insulation Material Attic Area No Asbestos Detected
Sample 005 Ceiling Texture Dining Room No Asbestos Detected
Sample 006 Ceiling Texture Hallway No Asbestos Detected
Sample 007 Ceiling Texture Living Room No Asbestos Detected
Sample 008 Vinyl Flooring Kitchen No Asbestos Detected
Sample 009 Roofing Material Comp. Roof, Front No Asbestos Detected
Sample 010 Ceiling Tiles - Adhesive (Dots) Kitchen Area No Asbestos Detected
Sample 011 Vinyl Flooring Utility Room Next To kitchen 45% (Backing) 90 Sq. Ft. Sample 012 Vinyl Flooring Hall Bathroom 35% (Backing) 42 Sq. Ft.
7.0 RECOMMENDATION: Abate Tek LLC findings after this inspection showed that the samples listed above (011, 012) were tested and found to be (Positive) or greater than >1% asbestos content. Therefore, Abate Tek LLC recommends this material be removed by a licensed abatement contractor.
HV AC tape - wrap was not detected during initial survey but may reside in walls and registers.
This report represents Abate Tek LLC's findings and conclusions based on the scope of services agreed to by the client and within the client's schedule and budget. All findings are based on readily available and reasonably ascertainable information on site conditions at the time of the survey and for the known regulations in affect at that time.
The services provided include professional opinions and judgments based on readily available information, field observations and measurements. This includes analytical reports by an independent laboratory. The specific conditions and limitations of the AH ERA Asbestos Inspector Certification have influenced these results. The bulk samples collected influencing this survey only indicate the presence or absence of the investigated contaminant within the discrete sample units.
Each sample was collected from an area most likely to be affected by the asbestos contaminant and accessible to the inspector. However, affected areas may exist in areas not sampled for potential contaminants and may not be selected for analysis and characterization. Any analytical results included in this report should be considered only as indicators of possible site conditions. Specific statistical significance is influenced by sampling technique and laboratory methodology. Abate Tek LLC recommends that any impact to the identified areas if any in this report be conducted using approved asbestos abatement procedures. These include wet removal methods and engineering controls to capture any asbestos fibers during removal. We further recommend the use of a licensed Asbestos Abatement Contractor.
8.0 LIMITATIONS OF THIS REPORT:
We have prepared this Survey Report to aid in the renovation of this property and reference for potential future remodeling/demolition projects. This report was created for the exclusive use of Ryan Christensen -StoneRidge Homes and Abate Tek LLC. This report applies only to the subject detailed above and shall not be relied upon by any other party without the prior written consent of the inspector that prepared the report.
Abate Tek LLC work is performed in a professional manner with the best interests of our client in mind .
Abate Tek LLC objective is to perform our work with care, exercising the customary thoroughness and competence of professionals in the relevant disciplines; in accordance with the standard for these services at the time and location those services are rendered.
It is important to recognize that even the most comprehensive scope of services may fail to detect environmental liability on a given site.
Therefore, Abate Tek LLC cannot act as insurers and cannot "certify or underwrite" that a site is free of environmental contamination. No expressed or implied representation or warranty is included or intended in our reports. Our work was performed within the limits prescribed by our client, with the customary thoroughness and competence of our profession.
ABATE TEK LLC 3711 SW Stephenson St. Portland OR. 97219 Ph. 971-275-6423
Inspector: Tom Levitt Date: 9 - 27 - 2018
AHERA Inspector# IR-18-4427B
Lat>e9r Lab!Cor Portland Inc Portland ' . In ,, , l) i 4321 SW Corbett Ave,, Ste A
BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http://www,labcorpdx,net
,, : : ' Portland OR 97239 .. : ! ,
..... t Asbestos and Environmental Analysis
Client: Abate Tek LLC
3711 SW Stephenson St Portland , OR 97219
Job Number: 187155
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA
Project Notes:
Client Sample ID: 001
Client Sample Description:
Sample ID: S1
Plaster Material ; Living Room
Asbestos Mineral Fibers
Layer 01
fine compact powder, tan
Layer 02
cementitious material , gray
Layer Percent: Chrysotile Amosite
10 %
90%
Other Fibers Fibrous Mineral
Layer 01 Layer 02
Glass Cellulose Wool Synthetic
Crocidolite
Client Sample ID: 002 Sample ID: S2
Client Sample Description: Plaster Material ; E. Bedroom
Asbestos Mineral Fibers Layer Percent: Chrysotile Amosite Crocidolite
Layer 01
fine compact powder, tan
Layer 02
cementitious material , gray
10%
90%
Other Fibers Fibrous Mineral
Layer 01
Layer 02
Glass Cellulose Wool Synthetic
Page 1of7
Other
Other
Report Number: 187155R01 Report Date: 09/2712018
P.O. No: 6300
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden Percent
Asbestos:
Matrix 100%
100%
NAO
NAO
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden
Percent Asbestos:
Matrix 100%
100%
NAO
NAO
NVLA.p WJ.? !AB CCY-0 2007.;1.<:1
La&Je9r Lab/Cor Portland Inc Portland ' .
BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http ://www.labcorpdx. net
1· · ·· i) i 4321 SW Corbett Ave ., Ste A J; ' Portland, OR 97239
Asbestos and Environmental Analysis
Client: Abate Tek LLC 3711 SW Stephenson St Portland, OR 97219
Job Number: 187155
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA Project Notes:
Client Sample ID: 003
Client Sample Description :
Sample ID: S3
Plaster Material; W. Bedroom
Asbestos Mineral Fibers
Layer 01
fine compact powder, tan
Layer 02
cementitious material, gray
Layer Percent: Chrysotile Amosite
10 %
90 %
Other Fibers Fibrous Mineral
Layer 01
Layer 02
Glass Cellulose Wool Synthetic
Crocidolite
Client Sample ID: 004
Client Sample Description:
Sample ID: S4
Insulation ; Attic Area Asbestos Mineral Fibers
Homogeneous
fibrous material, dark brown
Layer Percent: Chrysotile Amosite
100 %
Other Fibers Fibrous Mineral Glass Cellulose Wool Synthetic
100%
Crocidolite
Page 2 of 7
Other
Other
Report Number: 187155R01 Report Date: 09/27/2018
P.O. No: 6300
Date Analyzed: 09/27/2018
Analyst:
Date Analyzed:
Analyst:
Stephanie Golden
Percent Asbestos:
Matrix 100 %
100 %
09/27/2018
Stephanie Golden
NAO
NAO
Percent Asbestos:
Matrix 0 %
NAO
NVLA.p ~ J.? LJ.B cc:-E ::o:maJJ
==~ Lab/Cor Portland, Inc. BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http://www.labcorpdx.net
I · · :n 4321 sw Corbett Ave ., Ste A • ~:; · Portland , OR 97239
,.. : ., "' ~ Asbestos and En vironmental Analysis
Client: Abate Tek LLC
371 1 SW Stephenson St Portland, OR 97219
Job Number: 187155
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA Project Notes:
Client Sample ID: 005
Client Sample Description:
Sample ID: S5
Ceiling Texture; Dining Room
Asbestos Mineral Fibers
Layer 01
fine compact powder, offwhite/tan
Layer 02
cementitious material , gray
Layer Percent: Chrysotile Amosite
10 %
90 %
Other Fibers Fibrous Mineral
Layer 01
Layer 02
Glass Cellulose Wool Synthetic
Crocidolite
Client Sample ID: 006
Client Sample Description:
Sample ID: S6
Ceiling Texture ; Hallway Asbestos Mineral Fibers
Layer 01
fine compact powder, offwhite/tan
Layer 02
cementitious material , gray
Layer Percent: Chrysotile Amosite
10 %
90 %
Other Fibers Fibrous Mineral
Layer 01
Layer 02
Glass Cellulose Wool Synthetic
Crocidolite
Page 3 of 7
Other
Other
Report Number: 187155R01 Report Date: 09/27/2018
P.O. No: 6300
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden
Percent Asbestos:
Matrix 100 %
100 %
NAO
NAO
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden
Percent Asbestos:
Matrix 100 % 100 %
NAO
NAO
NVlAJ WJ.P UE CCJE ?00'/'.;tJJ
~~d Lab!Cor Portland, Inc. BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http://www. labcorpdx. net
In -~ ~ \ 4321 SW Corbett Ave., Ste A · ."!; ' Portland, OR 97239
: ~- t : Asbestos and Environmental Analysis
Client: Abate Tek LLC 3711 SW Stephenson St Portland, OR 97219
Job Number: 187155
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA Project Notes:
Client Sample ID: 007 Client Sample Description:
Sample ID: S7 Ceiling Texture; Living Room
Asbestos Mineral Fibers
Layer 01
fine compact powder, offwhite/tan
Layer 02 cementitious material , gray
Layer Percent: Chrysotile Amosite
10%
90%
Other Fibers Fibrous Mineral
Layer 01
Layer 02
Glass Cellulose Wool Synthetic
Crocidolite
Client Sample ID: 008
Client Sample Description:
Sample ID: SB
Vinyl Flooring; Kitchen Asbestos Mineral Fibers Layer
Layer 01
vinyl , blue/black
Layer 02
mastic, colorless
Other Fibers
Layer 01
Layer 02
Percent: Chrysolile Amosite
90 %
10 %
Fibrous Mineral Glass Cellulose Wool Synthetic
Crocidolite
Page 4 of 7
Other
Other
Report Number: 187155R01
Report Date: 09/27/2018
P.O. No: 6300
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden Percent
Asbestos:
Matrix 100% 100 %
NAO
NAO
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden
Percent Asbestos:
Matrix 100 % 100%
NAO
NAO
NVLAJ ~-pill cc:e: :.rom~
=~~ Lab!Cor Portland, Inc. BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http://www.labcorpdx. net
I: ·· · ~n 4321 sw Corbett Ave. , Ste A · • ; · Portland, OR 97239
:. ... : : Asbestos and En vironmental Analysis
Client: Abate Tek LLC
3711 SW Stephenson St Portland, OR 97219
Job Number: 187155
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA Project Notes:
Client Sample ID: 009
Client Sample Description:
Sample ID: S9
Roofing - Comp; Roof, Front
Asbestos Mineral Fibers
Layer 01
rocky fibrous tar, black
Layer 02
rocky fibrous tar, black
Layer Percent: Chrysotile Amosite Crocidolite
50 %
50 %
Other Fibers Fibrous Mineral Glass Cellulose Wool Synthetic.
Layer 01
Layer 02
Client Sample ID: 010
Client Sample Description:
Asbestos Mineral Fibers
Layer 01
compressed fibrous material , tan with paint, off-whi te
Layer 02
brittle mastic, green
35 %
35 %
Sample ID: S10 Ceiling Tile - Dots ; Dining - Kitchen
Layer Percent: Chrysotile Amosite Crocidolite
90 %
10 %
Other Fibers Fibrous Mineral Wool
Layer 01
Layer 02
Glass Cellulose
98 %
Synthetic
Other
Other
Report Number: 187155R01 Report Date: 09/27/2018
Date Analyzed:
Analyst:
P.O. No: 6300
09/27/2018
Stephanie Golden
Percent Asbestos:
Matrix 65 %
65 %
NAO
NAO
Date Analyzed: 09/27/2018
Analyst: Stephanie Golden
Percent Asbestos:
Matrix 2 %
100 %
NAO
NAO
----------------------------- --- - -- -
Page 5 of 7 NVLAJ .WJ..." ue o.::£ L©7.;1.c
=:~ Lab!Cor Portland, Inc. BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http://www.labcorpdx.net
1 . ~h 4321 SW Corbett Ave., Ste A · • : ; · Portland, OR 97239
... ; ' ~ Asbestos and En vironmental Analysis
Client: Abate Tek LLC
3711 SW Stephenson St Portland , OR 97219
Job Number: 187155
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA Project Notes:
Client Sample ID: 011
Client Sample Description:
Asbestos Mineral Fibers
Sample ID: S11
Vinyl Flooring ; Nook Off Kitchen Layer
Percent : Chrysotile Amosite Crocidolite
Layer 01
vinyl , off-white/brown 25 %
Layer 02
fibrous backing, gray 25 % 45 %
Layer 03
fibrous backing , brown 15 %
Layer 04
foam material, black 35%
Other Fibers Fibrous Mineral Glass Cellulose Wool Synthetic
Layer 01
Layer 02
Layer 03 100 %
Layer 04
Client Sample ID: 012
Client Sample Description:
Sample ID: S12
Vinyl Flooring ; Bathroom
Asbestos Mineral Fibers Layer Percent: Chrysotile Amosite
Layer 01
vinyl , tan
Layer 02
fibrous backing , gray with mastic, orange
Other Fibers
50 %
50 %
Fibrous Glass Cellulose
35 %
Mineral Wool Synthetic
Crocidolite
Other
Other
Report Number: 187155R01 Report Date: 09/27/2018
Date Analyzed:
Analyst:
Date Analyzed:
Analyst:
P.O. No: 6300
09/27/2018
Stephanie Golden
Percent Asbestos:
Matrix 100 %
55 %
0 %
100 %
09/27/2018
Stephanie Golden
NAO
45%
NAO
NAO
Percent Asbestos:
NAO
35%
Matrix
Layer 01 100 %
Layer 02 65 %
Page 6 of 7 NVLAI 'ji{.J..-::. ill cc:JE x"m.c
==~ Lab!Cor Portland, Inc. 1 .... :p 4321 SW Corbett Ave., Ste A
: ~ ~ 1 Portland, OR 97239 ~ ... f
BULK SAMPLE ASBESTOS ANALYSIS
Asbestos and Environmental Analysis
Phone: (503) 224-5055 http://www.labcorpdx.net
Client: Abate Tek LLC
3711 SW Stephenson St Portland , OR 97219
Report Number: 187155R01 Report Date: 09/27/2018
Job Number: 187155 P.O. No: 6300
Project Name: Stone Ridge Homes
Project Number: 6300 NE 119th St Vancouver WA Project Notes:
This laboratory participates in the National Voluntary Laboratory Accreditation Program (NVLAP) . Testing method is per 40 CFR 763 Subpart E, Appendix E, PLM. This report and the data contained therein cannot be used to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the U.S. Government.
• "NAO" is No Asbestos Detected. • Asbestos consists of the following minerals : chrysotile, amosite, crocidolite, tremolite, actinol ite, anthophyllite. • Material binders, such as those found in vinyl floor tiles , may prevent the detection of small diameter asbestos fibers . A gravimetric preparation and point-count is recommended for such samples. • Quantitative analysis by PLM point count or TEM may be recommended for samples testing at <or = to 1 % asbestos. ·The following estimate of error for this method by visual estimation of asbestos percent are as follows: 1 % asbestos: 0-3% error, 5% asbestos : 1-9% error, 10% asbestos: 5-15% error, 20% asbestos : 10-30% error. • This report pertains only to the samples listed on the report. Report considered valid only when signed by analyst.
Reviewed by:
.. ·~ Stephanie Golden Technical Manager
------------------------------ - - - - ----
Page 7 of 7 NVLAJ YN'J.? L4E c.c_"'.E 'm7~~Jj
Chain of Custody Record \S~ lSS r 1/2 Abate Tek LLC
Analytical Protocol: Turnaround: ...,L3Days __ ZDoys 3711 SW Stephenson St.
Info @abatetekllc.com Portland OR. 97219 Contact: Tom Levitt [email protected] Phone - 971-275-6423
_L' · PLM - Visual estimate PLM - Gravimetric PLM - 400 Pt. Count 24Hours
Date: 9-.lc/= / f: Sample No.
Lab Cor Portland 4321 SW Corbett SUite A Portland, OR. ~7239
Job No. ~-ic:c>
Sample Description:
Relinquishe~ Date: 9-...J~. d RecewedB~ _ · Date:Gj-7,4.-JfJ
Internal Lab Use Only:
Location
Time: / · · /0
Time: l i l 0 ff\q
o Final Results Released ------ Invoice Emailed ---------0 By: Email Verbal Reviewed By:
Sq. Ft.
Chain of Custody Record \ 'O"T l SS , ?fl Abate Tek LLC 3711 SW Stephenson St. Info @abatetekllc.com Portland OR. 97219 Contact: Tom Levitt [email protected] Phone - 971-275-6423
Project Address: C:::::.$<=2<' of£
Analytical Protocol: / PLM - Visual estimate
PLM - Gravimetric PLM -400 Pt. Count
Lab Cor Portland 4321 SW Corbett Suite A Portland~ OR. 97239
Tumarou~ _,-_33Days __ 2Days
24Hours
JobNo. 4too
Date: 9 ·«IV·/~ Sample No. Sample Description:
I~_,,.,, ~/, A/v t: ~Ld"""L'-~
ReHnqufflhe~ ReceJVedBy: .... ~ .... ~ ............ ~""""""--......... ~ .... -~--=--
1nternal Lab Use Only:
o Final Results Released ------0 By: Email Verbal
Location
~~-~~ _ ... _, .... -
Date: 9 ... -1o/. /F
Date:q-z4-L&
Invoice Emailed
Time: / -' /6
Time: l < \.0 Ph
------Reviewed By: _____ _
Sq. Ft.