10040141 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21914 HERMOSA AVE CONTRACTOR:JULIO MEJIA PERMIT NO: 10040141
CONS'RUCTION
0' T'S NAME: JAMES R&PAMELA L COURTRIGHT 361 W VIRGINIA ST DATE ISSUED:05/06/2010
O R'S PHONE: 4082554147 SAN JOSE,CA 95125 PHONE NO:(408)529-3634
❑ LICENSED CONTRACTOR'S DECLARATION BUIL DING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# r
MECH r RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION:DEMO ONE-STORY HOUSE&DETACHED GARAGE
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
(909SOFT)
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.F Floor Area: Valuation:$5000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN slumber:35716048.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter FERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, `JVITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 80 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section G � /
9.18. Issued byi-- 4—�� Date:—ST --
2%
S re Date
•
[�( OWNER-BUILDER DECLARATION RE-ROOFS:
✓ \ All n,ofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of insta led without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,asowner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I ha"e read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Cali'ornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. coin aliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Hea th&Safety Code,Sections 23505,25533,and-25534.
not employ any person in any manner so as to become subject to the Worker's /
Compensation laws of California. If,after making this certificate of exemption,I weer oraho d •' t: /
become subject to the Worker's Compensation provisions of the Labor Code,I must i�� -, .,ALA Date: C v /' '
forthwith comply with such provisions or this permit shall be deemed revoked.
il
CON " 'UCTION LENDING AGENCY
APPLICANT CERTIFICATION I he:eby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for`,ihich this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to' ''ding construction,and hereby authorize representatives of this city to enter
t to above mentioned property for inspection purposes.(We)agree to save Lender's Address
mnify and keep harmless the City of Cupertino against liabilities,judgments,
.s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all ,.n-point source regulations per the Cuperti••Municipal Co ,Section I un ierstand my plans shall be used as public records.
9.18. �� �j�
Signature
A /��� �"G'4 / ate b J D Licensed Professional
it
PIP
CITY OF atBuilding Department
? ,,, 10300 Tone Avenue
��/ Cupertino, CA 95014
•
%' Phone (408)777-3228
/��.,: Fax (408)777-3333 •
•
CUPERTINO
PROCEDURE FOR DEMOLITION PERMITS
The demolition application should be applied for before or at the same time as the new
construction permit application (these are separate permit applications &fees). Plan check
fees are due at the time of application/plan submittal. The new construction permit will not
be issued until the demolition permit is issued.
BEFORE DEMOLITION PERMITS CAN BE ISSUED,THE FOLLOWING STEPS MUST BE COMPLETED:
SIGNATURE/DATE
ZZW 1. A demolition/plot plan will be required showing any trees 10 inches in diameter at 3 feet
e2-3_ above grade on the subject property,and what means will be taken to protect same. Three
copies of this plan are required for review by the Planning Department. These need to be
submitted at the time of permit application,to the Building Department.
dl.?✓3 10 2. P.G.&E. must be contacted AS EARLY AS POSSIBLE prior to demolition to schedule the
,,-----r--2------abandonment. Contact P.G.&E. at(408) 725-3325. A letter from P.G.&E. shall be provided
to the City,stating that all gas and electric has been disconnected. (This step can be time
consuming,so it is important to begin the process immediately)
\ / /
MO /3. Plovide.a"current preliminary title report,which shows ownership of property,open deeds
of trust,any liens,taxes,and a legal description. All taxes must be current and paid in full.
\\ : Any liens (This excludes mortgages) must be taken care of. This report is to be issued within
`
/thirty(30) days prior to issuance of the demolition permit. Allow 5 working days for review.
\\ / \ 4. Fill out the Demolition Request Form(s)with the names and addresses (correspondence address)
V of any lending institutions,banks,lease holders, partnerships,lines of equity, or any other
/ persons having entitlement to the property. We will send the form(s) advising interested
parties that there is a request for demolition,and they have 15 business days to respond to
our office if they object to the demolition.
e(,22—t• 5. Provide a letter of inspection,tests, and abatement of any Hazardous Materials. Letter to be
initiated by person(s)certified in asbestos, mercury and/or hazardous material examination.
6. Check to see if the building is considered an historical landmark. Obtain clearance from the
Community Development Planning Department. Allow 10 working days.
G(22--tri 7. Provide a letter of clearance of all vermin from a licensed pest control contractor.
LL f� /� 8. Important: Priordo the issuance of the demolition permit, the applicant must call the Public
7 Works Department at(408) 777-3104 and arrange a"habitable dwelling" inspection.
q-4 3--P0 9. Debris bin and Recycling sheet: read,sign and date. The sheet will remain in the project's
/l/L�building permit file for the duration of the project.
nAlc, 10. Prior to issuance of the demolition permit(commercial only), the Fire Department must review
/ the plans for fire suppression/alarm systems that shall remain in service or be modified during
1. Demolition or that shall be replaced with the new construction.
Revised 06/10/09
City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
(408)777-3354
Debris Bins
Debris from a project in Cupertino can be collected and disposed of in either:
1. a Los Altos Garbage Co. bin (call 725-4020 to order), OR
2. a bin owned by the project's general contractor or demolition contractor, and hauled by a vehicle
owned and registered to that contractor(contractor should be prepared to prove ownership), OR
3. a private truck with a bed, but no bin
The Los Altos Garbage Company is the only debris bin service provider
franchised to do business in Cupertino.
Bins from other leasing.companies may not be used in Cupertino.
Please check all that apply:
❑ I will use a Los Altos Garbage Company bin •
❑ I will use a bin and truck owned by the general contractor or the demolition contractor.
,l' I will use a private truck, and not drop a bin.
Recyclable Materials . .
Recyclable materials may be collected in private debris bins or containers-leas-61W
from ANY company, as long as the materials are both: G�'y
1. separated by type of material into separate containers, AND APR 2
97°
2. are not contaminated by garbage.
Separated recyclable materials are materials that are separated into individualecontainers
, each
containing just one type of recyclable material. Typical examples.of recyclable materials
include: metal, wood, concrete, steel-reinforced concrete, asphalt, tree trimmings, white goods,
toilets (hardware removed), rocks and clean fill dirt. Separated recyclables must ultimately be
recycled or otherwise reused, and not disposed of in a landfill.
Contractor should be prepared to provide the name and phone number of any recycling companies being
used on the project. A list of local recycling companies can be found at: www.recyclestuff.org.
Signature: 4/✓1 £ Date: T 21/D
/ w
Name (printed): v --jig/it/LC Oierk
Title: O(.)Nit Of Horn £
Phone: 2s-s- gni.? (I, ortg- '7 2.77 I Lle )
Project address: / 9 iltranosif 4VE
This form to remain in the project's building perntit file for the duration of the project
Revised 1/03
AP1. L). CVIV 0:' MIVI faCI IC 11a5 an0 t leftrlc L0. NO. / I/V r.
•
• Pacific Gas and
•
Electric Company'
' 10900 No.Blaney Avenue
Cupenino,CA 85014
•
•
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City of Cupertino
10300 Torre Avenue
Cupertino, Ca. 95014
To Whon1 It May Concern:
SUBJECT REMOVAL OF GAS AND/ OR ELECTRIC FACILITIES
The gas and electric facilities have been removed and/or abandoned at:
a-1aty Roc'Nino 5(,.1/4, on Y/�2/(0
If you have any further questions, please contact me at (4080725-3325
Sincerely,
C2) . C5JRv
•
Service.Planning •
•
•
cEj �
• By. R 237010
I 004 al Li I
emu') CITY OF CUPERTINO
11 DEMO
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
0:5r7leo O '{$ 17_11- l0
Building Address: 9/1/
� N�. � Iz'loSA AVS. ,
Mailing Addres (if different from building address):
(sRmc.)
Owner's Name: Phone:
JAincs .R r PArn q L Cd(lRia216w 4dg S - 'F/W7
Contractor: Phone : 'LOW 97 3 91 JL5
3UL-/o Mg-164 CD/JT)o7a) siaV, ldC Fax: 408 `l93 9/01k
Contractor License #: R4 C2G/L # '918781
Cupertino Business License#: z.7 2SL
Contact: Phone: Syyy,
Fax:
Residential ' Sq Footage 90 Commercial ❑ Sq Footage
Job Description: �m o a. 5702_11 H p u5� £ DI/A c €ID 6-472/16t
Valuation: !7f
3790d
Project Size: Express ❑ Standard Large❑ Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
IDEMORES Demo-Residential B ISFDWL-DEM
1 DEMOPRES Pool Demo Residential B ISFPOOL-DEM
1BCBSC Cal Bldg Standards B ALL PERMIT
Commission Fee TYPES
IBSEISMICRE Seismic Residential B
Revised 01/07/09
PEST CONTROL
•
February 11 , 2010
To Whom It May Concern:
The property at 21914 Hermosa Ave., Cupertino, California, 95014, was
inspected today for any infestation of rodents. No active infestation was
found.
Mike Stadmiller444-0,-ild Field Representative
408-866-6609RECEIVED
APR 2 2 2010
BY:
2432 Denevi Drive, San Jose, CA 95130-2104, (408) 866-6609 '
Z-CON Specialty Services, Inc.
Environmental Abatement Contractor
1645 Old Bayshore Hwy
San Jose, CA 95112
408-451-9512
Contractor's License 803805
CERTIFICATE OF WORK COMPLETION
DATE: APRIL 14,2010
ATTENTION: JIM COURTRIGHT
408-727-1483 - WORK
408-255-4147—HOME
408-727-1949- FAX
RE: 21914 HERMOSA AVE
CUPERTINO, CA
Z-CON SPECIALTY SERVICES, INC. REMOVED,TRANSPORTED AND DISPOSED OF
APPROXIMATEY 520 SQUARE FEET OF CARPET, LINOLEUM AND ASBESTOS CONTAINING 9"x9"
FLOOR TILE LOCATED THROUGHOUT RESIDENCE.
WORK TO BE PERFORMED TO EPA AND OSHA REGULATIONS. FULLY CERTIFIED AND PROTECTED
WORK FORCE. CONTAINED WORK AREA. WET REMOVAL METHODS USED. ALL WASTE
DISPOSED AT AN APPROVED LANDFILL.
(David Zanotti
Signature A,�
President RE
Title CEI APR 2 2 2010
By:
abatement analytics
ASBESTOS SURVEY REPORT
FOR THE RESIDENCE
LOCATED AT
21914 HERMOSA AVENUE
CUPERTINO, CALIFORNIA
MARCH 2010
RECEIVED
APR 2 2 2010
PREPARED FOR
JIM COURTRIGHT
21914 HERMOSA AVENUE
CUPERTINO, CALIFORNIA
BY
ABATEMENT ANALYTICS
P.O. BOX 1392
CAMPBELL, CALIFORNIA 95009
p.o. box 1392, campbell, ca 95009 phone/fax 408-264-1230
1.0 SCOPE OF WORK
The scope of this Asbestos Survey included visual and tactile inspection to identify
friable and non-friable asbestos containing material (ACM) in the subject building, the
collection of samples of suspect ACM and submittal to an EPA certified analytical
laboratory and preparation of a report describing the results of the survey. This
information may then be utilized by an asbestos abatement contractor for proper
removal/handling of identified ACM during demolition activities. This asbestos survey
consisted of examination of all accessible interior and exterior areas.
Regulations regarding ACM which may apply prior to renovation/demolition activities
those of the Environmental Protection Agency's (EPA) Part 61 of Title 40 of the Code of
Federal Regulations National Emission Standard for Hazardous Air Pollutants
(NESHAP). Bay Area Air Quality Management District (BAAQMD) is the EPA's
delegated agency for the enforcement of the NESHAP regulation. Sampling protocols
pertaining to the NESHAP were utilized during this survey.
2.0 BUILDING DESCRIPTION- 21914 Hermosa Avenue, Cupertino
The subject structure on this property is an approximately 850 square foot single family
dwelling with a detached garage. This wood framed house has a wood exterior and a
composition shingle roof over felt. The house sits on a raised foundation with a crawl
space. Windows in the house are wood framed with putty securing the glass in place and
aluminum with rubber strips holding the glass. The interior of the house is finished with
wood walls and ceilings and sheetrock in the addition area.
Most of the floors of the house are covered with 9"X 9" floor tiles under carpet and sheet
flooring. The mastic is homogenous. Sheet flooring is present in the kitchen and back
room.
1-Ieat is supplied by a wall heater located in the living room. The metal flue for the heater
exhibited no suspect materials. The water heater in the kitchen closet also has a metal
flue with no suspect materials.
The 200 square foot garage is wood framed and wood sided with a rolled composition
roofing material. The structure sits on a concrete slab. There were no interior
improvements.
At the time of the visual reconnaissance, the structures were occupied.
The purpose of the survey is to prepare for demolition.
1
Material having <I% asbestos content may I ellId111 uut iitg uwitniLluss, taw _ ...
demolition contractor is a Cal-OSHA registered asbestos abatement contractor, uses
mechanical methods, ie., wrecking ball, bulldozer, excavator, etc., utilizes wet methods
nnrl nriherec to reonlntinns.nertnininn_inwnrker safet.v._ _
e
3.0 INVESTIGATIVE METHODS
3.1 Sampling Protocols
In accordance with your request, I performed an asbestos survey at the subject
address, 21914 Hermosa Avenue, Cupertino CA, March 11, 2010. Thirteen
samples were necessary to evaluate all suspect ACM.
Material sampled and its location is documented on the Bulk Sample Log:
Representative samples of each suspect material were taken according to
NEST-IAP protocol guidelines.
3.2 Laboratory Analytical Methods
Analysis was performed using polarized light microscopy.(PLM) method for
determination of asbestos in bulk building materials (EPA 600 method). The
samples were mounted on slides and analyzed for asbestos content (chrysotile,
amosite, crocidolite, anthophyllite and actinolite/tremolite), fibrous non-asbestos
constituents (mineral wool, paper, fiberglass, etc.) and non-fiberous constituents.
Asbestos was identified by refractive indices, morphology, color, pleochroism,
birefringence, extinction characteristics and signs of elongation. The same
characteristics were used to identify non-asbestos constituents. Quantification of
the amount of constituents in proportion to the total volume of the material
sampled was performed.
Suspect samples were documented and submitted to Scientific Analytical Institute,
Inc., an EPA certified analytical laboratory in Greensboro, North Carolina for
laboratory analysis.
It should be noted that the definition of ACM in the state of California is material
that contains greater than 0.1% asbestos. EPA'S definition of an ACM is material
that contains greater than 1.0% asbestos.
4M RESULTS OF INVESTIGATION
Five samples tested positive for asbestos content. These materials and their
locations are documented on the bulk sample log and the laboratory analytical
report
36-1 Southwest bedroom sheetrock taping mud <1% Chrysotile
36-3 Southeast bedroom sheetrock taping mud <1% Chrysotile
36-5 Hall 9"X 9" floor tile 5% Chrysotile
36-7 Living room 9"X 9" floor tile 3% Chrysotile
36-8 Southeast bedroom 9"X 9" floor tile 5% Chrysotile
All floor tile in the house shall be considered positive, approx. 520 sq. ft. total
2
6.1 Inspector Certification
6.2 Sample Chain-of-Custody and Analytical Results
6.3 EPA's Sample List Of Suspect Materials
4
. STATE OF CALIFORNIA Arnold Schwarzenegger,Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF OCCUPATIONAL SAFETY AND HEALTH
ASBESTOS CONSULTANT and TRAINER APPROVAL UNIT
2211 Park Towne Circle, Suite 1 •"rv/
Sacramento, CA 95825
Tel: (916) 574-2993 Fax: (916) 483-0572
•
009052811C 208
Abatement Analytics June 30, 2009
James Scott Bryan
PO Box 1392
Campbell ' CA 95009
Dear Certified Asbestos Consultant or Technician:
Enclosed is your certification card. To maintain your certification, please abide
by the rules printed on the back of the certification card.
Your certification is valid for a period of one year. If you wish to renew your
certification, you must apply for renewal at least 60 days before the expiration
date shown on your card. [8 CCR 341 .15(h)(1 )].
Please hold and do not send copies of your required AHERA refresher renewal
certificates to our office until you apply for renewal of your certification.
Certificates must be kept current if you are actively working as a CAC or CSST.
The grace period is only for those who are not actively working as a CAC or
CSST.
Please inform our office at the above address, fax number or actuna dir.ca.gov of
any changes in your contact/mailing information within 15 days of the change.
Sincerely, a,/
State of California
Division of Occupational Safety and Health
Jeff Ferrell Certified Asbestos Consultant
Senior Industrial Hygienist •
James Scott Bryan
ak4 - Nama
J F/ms Certification No.
00-2811
. Expires on 09/20/10
Attachment: Certification Card L • the cendcatianvas issued M the Nista of
ssi I °Sorel` t end Haiti Am
as wnaM
d
cc: Ale ,, - . r seciorolsosiwasanessat
PwassonscaJo
(Renewal-Card Attached Revised W29/06)
•
•
51•0
Bulk Asbestos Analysis t M
thBy Polarized:60R-Light aMicroscopyd00/M H�7V /n n®
EPA Method:600/R-93/116 and 600/M4-82-020 W V�L=>�,J
NVLM lahco4:=Shia
Customer:Abatement Analytics Attn: Jim Bryan Lab Order ID: 1002447
PO Box 1392 Analysis II): I002447PLM
Campbell, CA 95009
Date Received: 3/12/2010
Project: 21914 Hermosa Ave Cupertino 10-36 Date Reported: 3/16/2010
Sample II) Description _ Asbestos Fibrous Non-Fibrous Attributes
tabSample ID Lab Nates Components Compone n is
Treatment
South west bedroom 1% 12%. Cellulose 88% Other Brown.White
36-I < Chrysotile
sheetruck taping mud Non Fibrous
Heterogeneous
sheetrock:none detect:join:
10024471•15,4_1 rewind:compnd:.3%chrysotile Crushed
36-2 Bathroom sheetrock taping 12% Cellulose 88% Other Brown,White
mud Non Fibrous
_ None Detected Heterogeneous
sheet rock only
10024171'IM 2 Crushed
36-3 Southeast bedroomsheetrock < 1% 12% Cellulose 88% Other Brown,White
taping mud Ch r)'SOI I IC
Non Fibrous
Heterogeneous
slree:rock:none detect:join:
1002-61711154_3 compnd:3%chrysolite Crushed
36-4 Bathroom sheet flooring 15% Fiber Class 85% Other White
Non Fibrous
None Detected Ilomogeneous
1002447PIM J Dissolved,Teased
36-5 Hall 9"s9"floor tile 5% Chrysotile 95% Other White
Non Fibrous
I homogeneous
1002447PtM 3 Dissolved
36-6 Mastic 100% Other Black
Non Fibrous
None Detected homogeneous
10024471'1M 6 Dissolved
36-7 Living room 9"x9"floor tile 3a/D Chrysotile 97% Other Tan
Non Fibrous
I lomogeneous
10024471'1M_7 Dissolved
36-8 Southeast bedroom 9"x9" 3% Chrysotile 97% Other Tan
floor tile Non Fibrous
Homogeneous
1002JJ7PLM 8 Dissolved
Ditehlmen Due to the nature of the EPA 600 method.osbeatm may not be detected in samples containing low levels of asbestos.We strongly recommended Mat analysis of Door aleanxmumlln,and/or
heterogeneous soil samples be conducted by TEM forcanarmation mrnon.Desertedby PIN.This re on relates only to the samples tested mad may nal be reproduced,except In fou,without the
written approval of SAI.This report may not be used by the client o claim product endorsement by SVLAP or may other gmry of stomal .h I.b 05%.
Ban Huber(13)
Analyst Nathaniel Durham,MS or Approved Signatory
Scientific Analytical Institute,Inc. 302-1.Pomona Dr.Greensboro,NC 27407 (336)292-3888 Page I of 2
•
•
`
Bulk Asbestos Analysis '�^�^�
Cji)
� By Polarized Light Microscopy ryry--�/�(� /� (�®
EPA Method: 600/R-93/116 and 600/M4-82-020 II\ V ISL=>�J
.NvLArlabcah::nan4.
Customer:Abatement Analytics Attn: Jim Bryan Lab Order ID: 1002447
PO Box 1392 Analysis II): 1002447PLM
Campbell, CA 95009
Date Received: 3/12/2010
Project: 21914 Hermosa Ave Cupertino 10-36 Date Reported: 3/16/2010
Sample II) Description Asbestos Fibrous Non-Fibrous Attributes
Lab Sample 1D Lab Nolen, Components Components
Treatment
36-9 Kitchen window putty 1110% Other Tan
Non Fibrous
None Detected Homogeneous
—
100244719A1-9 Crushed
36-10 Living room window putty 100% Other Tan
Non Fibrous
None Detected Homogeneous
1002447P1A1 10 Crushed
36-11
Ilouse roof felt70% Cellulose 30% Other BlackNon Fibrous
None Detected Homogeneous
1002447P1A1 11 Dissolved
36-12 House composition shingle 20% Fiber Glass 80% Other Black
Non Fibrous
None Detected Homogeneous
10024471'1A1 12 Dissolved
36-13 Garage rolled roofing 30% Cellulose 70% Other Green,Black
Non Fibrous
None Detected Ilomogeneous
10024471941 13 Dissolved
lacldmen nue to the nature or the EPA 600 method,asbestos may not be detected in samples containing ton Inds or asbestos.We strongly recommended thatan.bsis or poor ales,vermiculite.nomor
heterogeneous sea'stapes be condoned by TEN for confirmation of•ione Wenner by Pl-N.This repon relates only to the samples tested and may not be reproduced.Brew in full.without the
sedum approval of SAt.TIM report may not be used by the client to claim product endorsement by NVIAP or any other agency pEmbus TI t1.1.05%.
Ban Huber(13)
Analyst Nathaniel Durham,MS or Approved Signatory
Scientific Analytical Institute.Inc. 302-1.Pomona Dr.Greensboro,NC 27407 (336)292-3888 Page 2 oft
• 9- aeg. ° Scientific Analytical Institute Lab Use Only
302-L Pomona Dr. Greensboro, NC 27407 Lab Order ID:
Phone: 336.292.3888 Fax: 336.292.3313 Client Code:
www.sailab.com lab@sailab.com
.__.-
SAI Fed Ex# 28003394-4
Company Contact Information Asbestos Test Types,,
Company: Abatement Analytics Contact:Jim Bryan PLM EPA 600/R-931116 I/�
Address: P.O. Box 1392 Phone❑: (408)264-1230 Positive stop ❑ F�
Campbell,CA 95009 Fax 0:(408)264-1230 PLM Point Count 0
Email J: aajsb223@yahoo.com PCM NIOSH 7400 0
TEM AHERA ❑
Billing/Invoice Information Turn Around Times TEM Level II 0
Company: 90 Min. 0 48 Hours 0 TEM NIOSH 7402 0
Contact: Cr 3 Hours 0 72 Hours n TEM Bulk Qualitative 0
Address: 6 Flours ❑ 96 Hours 0 TEM Bulk Chatfield 0
12 Hours 0 120 Hours 0 TEM Bulk Quantitative 0
. 24 Hours 0 144+Hours 0 TEM Wipe ASTM D6480-99 0
TEM Microvac ASTM D5755-02 ❑
PO Number:/0-36 TEM Water EPA 100.2 0
Project Name/Number: 2,/q/y/- , 4_ Ave Cvpaft,prio I O -3 ( Other: • 0
• Sample ID# Description/Location Volume/Area Comments
•36-/ ,t,/414)esr �ioAi«?Al She(12oc%Tapl1 4v1)
3L—Z Biwkew,K s,iipeeliecc.k`heti m°U
3G--3 Soo/LP-Yr &J,2 ,r,.Shee�/tcc/g fJrs,*?r>
3366—kt �-L/41�1-�i&ClOQ% SWdEloo2lj
310—S //J/ ! 4 qa /err T/ /e .
n---(a. aT4 ftC I �/
J� hlvaAit EOeM #I fr `
r`�aoiz 77/ta , .) Not- AM-it(
36-� S r•- c3ed/ of t 5 i0nuanrr/e . in- 1 7C
3&— 9 k>tr-4,- LJ«c-l/aw fDUT77
36 -(0 �rultui/e0041 �,4T�(0k/f a I
.3c —LI A z 'GO% r-e C
3(Q-( 7. Avis e (i,t,{+p t{-10,J cS�il, l?
. 3C- L3 C � e "ON-d. / c ona Y .
Total # of Samples
cia Relin wished by Date/Time Received by Date/Time
No st-ifi
Page • of
Scientific Analytical Institute
APPENDIX G:
Sample List of Suspect Asbestos-Containing Materials
• Cement Pipes • Elevator Brake Shoes
• Cement Wallboard
• Cement Siding • HVAC Duct Insulation
• Asphalt Floor Tile • Boiler Insulation
• Vinyl Floor Tile • Breeching Insulation
• Vinyl Sheet Flooring • Ductwork Flexible Fabric Connections
• • Flooring Backing • Cooling Towers
• Construction Mastics(floor tile,carpet,ceiling tile,etc.) • Pipe Insulation(corrugated air-cell, block.etc.)
• Acoustical Plaster • Heating and Electrical Ducts
• Decorative Plaster • Electrical Panel Partitions
•
• Textured Paints/Coatings • Electrical Cloth
• Ceiling Tiles and Lay-in Panels • Electric Wiring Insulation
• Chalkboards
• Spray-Applied Insulation
• Blown-in Insulation • Roofing Fetingles
• Fireproofing Materials • Roofing sett
• Taping Compounds(thermal) • Base Flashing
• Packing Materials(for wall/floor •penetrations) • Thermal Paper Products
• Fire
• High Temperature Gaskets u Doors
• Ad
• Laboratory Hoods/Table Tops • Adhesives
• Laboratory Gloves ives •
• Fire Blankets • Wallboard
• Fire Curtains • Joint Compounds
• Elevator Equipment Panels •
Vinyl Wall Coverings
• Spackling Compounds
NOTE: This list does not include every product/material that may contain asbestos.It is intended as a general guide to show which types of
materials may contain asbestos.
APPENDIX H: •
•
References
USEPA. 1987. Asbestos Abatement Projects, Worker Protec-
USEPA. 1984. U.S. Environmental Protection Agency. Na- trop, Final Rule.40 CFR 763.February 1987.
tional Emission StandardsforHazardous Air Pollutants.40 USEPA 1987. US. Environmental Protection Agency As-
CFR 61.April 5, 1984. bestos-Containing Materials in Schools; Final Rule and
USEPA. 1985. US.Environmental Protection Agency.Meas-
uring Notice.40 CFR 763. Federal Register,October 30. 1987.
airborne asbestos following an abatement action. USEPA. 1988. EPA Study of Asbestos-Containing Materials
Washington DC:USEPA.EPA 600/4-85-049.("Silver Book") in Public Buildings:A Report to Congress. February; 1988.
USEPA. 1985. U.S. Environmental Protection Agency. As- USEPA. 1989. Asbestos Ban and Phaseout Rule. 40 CFR.
bestos in buildingsSimplhed sampling scheme for surfacing 763.160 to 763.179. Federal Register,July 12, 1989.
materials. Washington DC: USEPA. EPA 560/5.85-030A.
("Pink Book")
USEPA. 1989. Guidelines for Conducting the AHERA TEM
enc . Guid- Clearance Test to Determine Completion of an Asbestos
USEPA. 1985. U.S.Environmental Protection A
once for controlling asbestos-containing materials n build- Abatement Project. Washington DC: EPA 560/5-89-001.
ings. Washington DC: EPA 560/5-85-024. ("Purple Book") USEPA. 1989. Transmission Electron Microscopy Asbestos
Laboratories Quality Assurance Guidelines.Washington DC:
USEPA. 1985. US. Environmental EPA 560/5-90-002
Protection Agency. As-
bestos in buildings: Guidance for service and maintenance US. Department of Labor: OSHA Regulations. 29 CFR
personnel. Washington DC: EPA 560/5-85-018. ("Custodial 1910.1001-Genera//ndustryAsbestosStandardand29 CFR
Pamphlet")
1926.58- Construction Indus-try Asbestos Standard.June
USEPA.1986.U.S.Environmental Protection Agency.Abate- 1986;Amended,September, 1988.
ment of asbestos-containing pipe insulation Washington DC: U.S. Department of Labor. OSHA Regulations. 29 CFR
Technical Bulletin No. 1986-2.
1910.134 - Respiratory Protection Standard. June. 1974.
USEPA. 1986. U.S. Environmental Protection Agency A Keyes. Dale L. and Chesson. Jean. 1989:A Guide to
guide to respiratory protection Jrothe asbestos abatement Monitoring Airborne Asbestos in Buildings.Environmental
industry Washington DC: EPA 560/OPTS-86.001.
Sciences,Inc.,105 E.SpeedµayBlvd.,Tucson,Arizona 85705.
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