S:° r CCB# 221268 • OR DEQ ABATEMENT# FSC791 WA L&I REGISTRATION# GDSl***828MO • WA L&I ABATEMENT# ABNC00001672 ABESTOS INSPECTION Neil Kelly Project 2106 NW 88th St., …OR

- I AGENCY usE o·_N_L_Y_~ - ' I j ,

1 I JI DEC - 3 2018 ~ i SJU- C _f:./' '1

·v

NOTICE OF INTENT TO REMOVE ASBESTOS

Southwest Clean Air Agency 11815 NE 99th Street, Suite 1294

Vancouver, WA 98682 Voice: (360) 574-3058 Fax: (360) 576-0925

1wN1.swcleanair.org

This notification must be present at all times at the asbestos project site

AGENCY USE ONL'f .

Date Paid: f2ji//L(:6 Fee: $ :J. 7S: Receipt#: 5 17 d. I'-/" &

~ Date Notification Recei.v.,.....---~ Date of Submittal: ____ _

PROJECT CATEGORY (Check only one) See Consolidated Fee Schedule (Table 11) http.//www.swcleana1r.org/fees/ index.asp

Must include fee

D Residential (any amount-owner occupant performed)

D Less than 10 linear feet, Less than 48 square feet

D 10 to 259 linear feet, 48 to 159 square feet

ii 260 to 999 linear feet, 160 to 4999 square feet

D 1000 linear feet or more, 5000 square feet or more

D Emergency (Call SWCAA immediately for notification period waiver)

Quantity to be removed: _2_4_8_2 ___ square ft . ____ _ linear ft.

Advance Notification Period

Prior Notification

exempt per structure per year

10 days

10 days

10 days

(Double fee)

Workshift days: Ii M Ii T Ii w Ii TH ii F D SA D SU

Project starting date:_1_2_11_7_11_8 ____ Completion date 12/20/18 Works hi ft hours: _7_:3_0_a_m_- 4_p_m ________ _

Site address: 2106 NW 88th St. City Vancouver Zip _9_8_6_65 ____ county Clark

Location of asbestos: Garage -----------------~

Demolition of structure? _n_la _________________ If yes, Notification of Demolition required

Asbestos survey conducted? Ii YES D NO If yes, Include results summary page. If no, reason:-------------

AH ERA Inspector: Bob Farace Certification#: _1_7_0_3_11 ________________ _

Material to be Removed: D Fireproofing D Popcorn Ceiling DCAB D Sheet Vinyl D Boiler Insulation D Duct Tape

D Duct Paper D Mag. Pipe Insulation D Air Ceil D CA Pipe DVAT o Other Sheetrock

Control Methods: ii N.P Enclosure D Glove Bag D Mini Enclosure D Wrap & Cut Ii Water

l!!I HEPAVac D Other _______ _ _ __ _

Asbestos contractor: Willamette Construction Services inc.dba GDSI Asbestos Certification # ABCN00001620

Mailing address: 8823 N Harborgate St. Portland, OR 97203

Owner/CEO: _B_o_n_it_a_L_a_ne ____ ________ _

Onsite Supervisor: _J_o_rg_e_C_a_m_a_c_h_o ______ ___ _

Phone: 503-236-4299

Certificate #: ABAS00026452

Property owner: _R_u_th_M_o_u.::..ge....:y _______________ _ Phone: 502-682-7171

Mailing address: 2106 NW 88th St

City Vancouver State: Washington ZIP: 98665

Phone: 503-758-8001

Asbestos disposal site and landfill address: Hillsboro Landfill - 3205 SE Minter Bridge Rd, Hillsboro, OR 97123

I DO HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS NOTIFICATION IS, TO THE BEST o~y KNOWLEDGE, ACCURATE AND COMPLETE.

I# ±-~~ / z._/3 /Id ?~"'!J..,.~y G b ''S:°_r

Title Representing

AGENCY USE ONLY

Case No.

Reviewed by

SWCAA FORM NO. 20 REVISED 07/1 3/2018

OSI A Division of Willamette Construction Services Inc.

OR CCB# 221268 •OR DEQ ABATEMENT# FSC791 WA L&I REGISTRATION# GDSl***828MO • WA L&I ABATEMENT# ABNC00001672

Pre-Renovation Limited Hazardous Building Materials Survey Report 2106 NW 881

h St. Vancouver, Wa.98665

Prepared for:

Neil Kelly Company

General Information Laboratory Asbestos Data Inspector Certifications

'8823 N. HARBORGATE STREET, PORTLAND, OR 97203 P (503) 236-4299 • F (503) 961-1183


OR CCB# 221268 • OR DEQ ABATEMENT# FSC791 WA L&I REGISTRATION# GDSl***828MO • WA L&I ABATEMENT# ABNC00001672

ABESTOS INSPECTION Neil Kelly Project

2106 NW 88th St., Vancouver, WA 98665 1.0 INTRODUCTION

Green Deconstruction Services, Inc. (GDSI) has completed a Limited Hazardous Building Materials Survey prior to renovation for Neil Kelly Company, at a site located at 2106 NW 881

h St., in Vancouver, WA. The site was occupied at the time of this survey. The survey for asbestos containing building materials was completed September 27, 20 I 8 at the request of Holly Burtchael by Bob Farace (Certificate# I 64 I 45), an accredited AHERA Building 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

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 I% asbestos be handled as an asbestos containing material.



OR CCB# 221268 •OR DEQ ABATEMENT# FSC791 WA L&I REGISTRATION# GDSl***828MO • WA L&I ABATEMENT# ABNC00001672

3.0 SUSPECT MATERIALS TESTED FOR ASBESTOS CONTENT

The number of samples taken for any surfacing material is determined by 40CFR Part 763.86, which requires:

- 3 samples for each material that is present in quantities of 1,000 SF or less. - 5 samples for each material that is present in qualities of 1,000 - 5,000 SF. - 7 samples for each material that is present in qualities of greater than 5,000 SF.

In some cases, the inspector is allowed to use discretion and take fewer samples of factory manufactured (not site mixed) materials such as VCT, ceiling tile, and roofing. The following materials were tested for asbestos content and returned results of greater than 1 % asbestos, we have also listed materials that contained trace amounts or <I% of asbestos :

SAMPLE NUMBER

lA

IB

IC

2A

2B

2C

MATERIAL LOCATION RESULT

fine compact powder, Garage 51Yo tan/off-white, with coating, off-white fine compact powder, off- Garage 6% white, ' 'vith fibrous backing, brown compact chalky material Garage NAO with paper, off-white fine compact powder, off- Upstairs Bedroom; 4% white, with coating, white Entry, Upstairs

Hall, Bedroom 2 flexible material , off- Upstairs Bedroom; NAO

Entry, Upstairs Hall , Bedroom 2

compact chalky material Upstairs Bedroom; NAO with paper, off-white Entry, Upstairs Hall,

Bedroom 2


CONDITION

Fair

Fair

Fair

Fair

Fair

Fair

OSI A Division of Wi flamette Construction Services Inc.


4.0 SUBJECT SITE DESCRIPTION

The subject site is a single story wood frame building used as residential space. Selected areas of this building are targeted for renovation.

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 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 RECOMMENDATION

This report represents GDSI'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, and analytical reports by an independent laboratory.

The materials identified in this report as Asbestos Containing should be monitored semiannually and any changes to their condition noted . If, over time, any of these materials are removed from the structure, notes should be made and the quantities should be subtracted from the Asbestos Inventory. All activities impacting these materials should be conducted by a Licensed Asbestos Abatement Contractor using Certified Asbestos Workers under the direction of a Certified Asbestos Supervisor.

The specific conditions and limitations of the AHERA Building Inspector Certification have influenced these results. The bulk samples collected in connection with this survey only indicate the presence or absence of the investigated contaminant within the discrete sample units. Although each sample was collected from an area most likely to be affected by the contaminant and accessible to the inspector, affected areas may exist in areas not sampled or for potential contaminants not selected for analysis and characterization. Any analytical results included in this report should be considered only as indicators of possible site conditions with specific statistical significance and influenced by sampling technique and laboratory methodology.

GDSI recommends that any impact to the Materials > 1 % listed as asbestos containing in this report be conducted using approved asbestos abatement methods including notification to the local air pollution authority (DEQ), wet removal methods, Engineering controls to capture any asbestos fibers during removal. We further recommend the use of a licensed Asbestos Abatement Contractor. For materials listed as < I% ACM we recommend that a Negative Exposure Assessment (NEA) be produced prior to extensive Renovation by the client, to provide for OSHA Compliance with this material during the project.


OSI A Division of Wilfamette Construction Services Inc.


7.0 LIMITATIONS OF THIS REPORT

We have prepared this Survey Report to aid in maintaining this property and reference for potential future Remodeling/ Demolition projects. This report is for the exclusive use of Neil Kelly, the structure owner, and GDSI. 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.

GDSI ' s work is performed in a professional manner with the best interests of our client in mind. GDSI ' s 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 particular site. Therefore, GDSI cannot act as insurers and cannot "certify or underwrite" that a site is free of environmental contamination and no expressed or implied representation or warranty is included or intended in our reports except that our work was performed within the limits prescribed by our client, with the customary thoroughness and competence of our profession.

Within the limitations of scope, schedule and budget, our services have been executed in accordance with generally accepted practices in this area at the time this report was prepared. No other conditions, expressed or implied, should be understood . Nothing in this report should be interpreted as legal advice; the information contained here is for information only.

Bob Farace AHERA Building Inspector Certification No. I 64 I 45




8.0 SAMPLE LIST OF MATERIALS THAT MAY CONTAIN ASBESTOS AND MAY BE PRESENT AND HIDDEN ON ANY CONSTRUCTION, RENOVATION OR DEMOLITION SITE

• Window glazing • Ductwork flexible connections • Stucco • Acoustical ceiling texture "popcorn" • Cement pipes • Electrical cloth • Cement board/transite • Electrical wiring insulation • Duct tape/paper • Roofing shingles • Furnace insulation • Built-up roofing • Vinyl sheet flooring/mastic • Base flashing • Vinyl floor tile/mastic • Rolled roofing • Poured flooring • Caulking/putties • Pipe insulation/fittings • Incandescent light fixture backing • Plaster/ wall joints • Brick mortar • Textured paints/coatings • Vinyl wall coverings • Ceiling tiles/panels/mastic • Vapor barrier • Spray-applied insulation • Cement roofing shingles • Blown-in insulation • Gray roofing paint • Fireproofing • Nicolet (white) roofing paper • Sink insulation • Sub flooring slip-sheet • Packing materials • Mudded pipe elbow insulation • High temperature gaskets • HY AC duct insulation • Lab hoods/table tops • Boiler/tank insulation • Elevator brake shoes • Breaching insulation • Asphalt flooring • Paper firebox in walls • Paper on backside of fiberglass • Fire doors

insulation • Fire blankets • Erkot roofing material • Fire curtains/hose • Laboratory fume hoods • Electrical panel partitions • Construction mastics • Chalkboards

• Joint compound/wallboard

Note: This list does not include every product that may contain asbestos. It is intended as a general guide to show which types of materials may contain asbestos.




9.0 SUGGESTED PROCEDURE FOR COMMUNICATING SURVEY FINDINGS TO AFFECTED PARTIES

The results of this survey should be posted on site for ALL CONTRACTORS AND SERVICE PERSONNEL to see. A copy of this report should be provided to all persons who may come in contact with materials that are known to contain asbestos. The following is a signed acknowledgment to be collected and signed by anyone who is provided a copy of this report.

I acknowledge that I have read and understand the report titled:

Pre-Renovation Limited Hazardous Building Materials Survey Report

6012 NW 88th St., Vancouver, WA 98665 I further acknowledge that hidden asbestos materials (refer to list contained in section 8.0 of this report) may exist in concealed areas that may be exposed during demolition. If suspect materials (refer to list contained in section 8.0 of report) are discovered that have not been tested, I will treat these materials as asbestos until additional testing proves otherwise.


:;:~:~d Lab!Cor Portland, Inc. BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http ://www.labcorpdx.net

Inc • , ; . 4321 SW Corbett Ave., Ste A f ! ~ Portland, OR 97239

.;. :: : . Asbestos and Environmental Analysis

Client: Green Deconstruction 23331 NE Halsey St. Wood Village, OR 97067

Job Number: 187267

Project Name: Neil Kelly - Mougey

Project Number: 2106 NW 88th St Vancouver WA 98665

Project Notes:

Client Sample ID: Sample ID: S1

Client Sample Description: Sheetrock w/c Tape , Tex, Mud; Garage

Asbestos Mineral Fibers Layer Percent: Chrysotile Amosite Crocidolite

Layer 01

fine compact powder, tan/off-white, with coating , off-white

Layer02

fine compact powder, offwhite, with fibrous backing, brown

Layer 03

compact chalky material with paper, off-white

Other Fibers Fibrous Glass

Layer 01

Layer 02

Layer 03 Trace

5 % 5 %

5 % 6 %

90 %

Mineral Cellulose Wool Synthetic

2 %

4 %

5 %

Page 1of3

Other

Report Number: 187267R01 Report Date: 10/02/2018

P.O. No: n/a

Date Analyzed: 1 0/02/2018

Analyst: Travis Long

Percent Asbestos:

Matrix 93 %

90 %

95 %

5%

6%

NAO

NVLA.p·

:;:~;~d Lab/Cor Portland, Inc. BULK SAMPLE ASBESTOS ANALYSIS Phone: (503) 224-5055 http://www.labcorpdx.net

Inc , , ; , 4321 SW Corbett Ave., Ste A -/fl Portland, OR 97239

Asbestos and Environmental Analysis

Client: Green Deconstruction

23331 NE Halsey St. Wood Village, OR 97067

Job Number: 187267


Project Number: 2106 NW 88th St Vancouver WA 98665 Project Notes:

Client Sample ID: 2 Sample ID: S2

Client Sample Description: Sheetrock w/c; Upstairs Bedroom ; Entry, Upstairs Hall , Bedroom 2

Asbestos Mineral Fibers Layer Percent: Chrysotile Amosite

Layer 01

fine compact powder, offwhite, with coating , white

Layer02

flexible material, off

Layer 03

compact chalky material with paper, off-white

Other Fibers Fibrous Glass

Layer 01

Layer 02

Layer 03 Trace

20 % 4 %

30 %

50 %

Mineral Cellulose Wool Synthetic

Trace

6 %

Crocidolite

Other

Page 2 of 3

Report Number: 187267R01 Report Date: 10/0212018

P.O. No: n/a

Date Analyzed: 10/0212018

Analyst: Travis Long

Percent Asbestos:

Matrix 96 %

100 %

94 %

4%

NAO

NAO

NVlA.p

~~:~d Lab!Cor Portland, Inc. Inc _,, ; 4321 SW Corbett Ave., Ste A

Jn - Portland, OR 97239

BULK SAMPLE ASBESTOS ANALYSIS

Asbestos and Environmental Analysis

Phone: (503) 224-5055 http :l/www.labcorpdx.net

Client: Green Deconstruction 23331 NE Halsey St. Wood Village, OR 97067

Report Number: 187267R01 Report Date: 10/02/2018

Job Number: 187267 P.O. No: n/a


Project Number: 2106 NW 88th St Vancouver WA 98665 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, actinolite , 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:

~ra~ tr--Analyst

Page 3 of 3 NVlA4J'

Documents

S:° r CCB# 221268 • OR DEQ ABATEMENT# FSC791 WA L&I REGISTRATION# GDSl***828MO • WA L&I ABATEMENT# ABNC00001672 ABESTOS INSPECTION Neil Kelly Project 2106 NW 88th St., …OR