DEMO (0208-280)57325 Madison St
0208-280
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licens„ d under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
471328 C21 A. {}3/,37/.7,{
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, Business & Professionals Code).
(w ) 1, as owner of the property, am exclusively contracting with licensed
-'contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exem t under Section B&P.C. for this reason
n
sDate P 11 c'+i Signature of Owner ft_. . 1Q"• 0
WORKER'S COMPENSATION DECLARATION
I hereby affirm under''penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
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 workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier uI'.c' `,'I: i?LIND Policy No. G 169t121t)1
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, Irshal shallforthwith
j,5 ith comply with those p ovisio s. . „,
Date `O I 19 t App licant h
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
.& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMITp
DATE , VALUATIONS LOT TRACT
y
JOB -SITE
ADDRESS r f 1n2 } % S'r ON rX=J 1
APN
. !
OWNER
CONTRACTOR / DESIGNER / EN (NEER
KT'S.£ .1A..AVJL PAPTI"5 ,` U4
DEMO Y3a'.11..TW*0. INC.
17 -7 G C► Off' UPPERIA00NEMSY MY RD
W7 NO ,AV's- 50
PC:"lc i:LIA1 `D OR 411224
TN.101:7 'C"A #12C.I
USE OF PERMIT
AMMAN= CO, r, CONSTRUCTION
OX0
i"kwai..l: 1.,Krw 19 Li.LYJ.1,vJAR
DEMOLITION 'EEC,
D
vr, 2, MR
CITY OF LA QUINTA
1 'FINANCEDEPT_
r
F[Jai-;t'UM, CON'wMMM01' AADD PLAN CHECK =
T45.00
LESS PUF-PAW Mill
SUCK►
TOTAIV. PKR.i'4 111 14TIE, SS DUI, NOW
MM
RECEIPT
DATE ,
BYE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
08/01/2014 FRI 06:08 FAX 1002
. t
08/21/02 WED 17:15 FAX 5036701604 OAC LAND MGNT 001
QPACIFIC
SAMA FE
August 21, 2002
Greg Butler
Building and Safety Department
City of is Quinta
78-495 Calle Tampico •^.
La Quinta, CA 92253-1504
RE- Puerta Azul — Tract No. 30096-1• -
Demo Unlimited contract
Dear Greg
This letter is to notify the City of La Quinta that we have reviewed and signed the =
contract for Dema Unlimited to complete the Puerta Azul•Demolition. Demo Unlimited
will work on site until the demolition is finished.
If you have any questions please contact Deborah Masterson at 503-670-5437 or email
her at deborahm@pacifiesantafe.com
Sincerely,
PUERTA AZUL PARTNERS, LLC
Pacific Santa Fe Corporation, Manager and Member
Mark P. Rockwell
President
NM. -d
17700 SW Upper Boones Ferry Road, Suite 100 Portland, Oregon 41224-7010
503.610-9300 Facsimile. 503-670-9400
•
= M E T R O S CANN P R O P E R T Y
P R O F I L E
.
Riverside' (CA)
*
*
*
<<< OWNERSHIP .INFORMATION >>>
*
*
*
Parcel Number .:762 240 003 S,:21 T:06S
R:07E Q:SE
*
Ref Parcel # :000 000 000 Pos Interest:
*
Owner Name :Puerta Azul Ptnrs
*
CoOwner
*
Site Address :57325 Madison St La Quinta 92253
*
Mail Address :17700 SW Upper Boones Ferry Rd Portland
Or 97224
*
Telephone :Owner: Tenant:.
*
<<< SALES AND LOAN INFORMATION
»>
*
Transferred :07/.07/2000 Loan Amount
:$750,000
*
Document # :264755 Lender
:Private
*
Sale Price :Non -Disc'- Loan Type
:Aitd
*.
Deed Type :Grant Deed Interest Rate
:Fixed
*
% Owned :100 Vesting Type
*
*
*
*
*
<<< ASSESSMENT AND TAX INFORMATION
>>>
*
Land :$685,000 Exempt Type
*
Structure :$304,000 Exempt.Amount
*
Other Tax Rate'-Area
:20-073
*
Total :$989,000 Taxes
:$10,925.92
*
% Improved :31
*
*
*
«< PROPERTY DESCRIPTION >>>
*
*
*
Map Grid :
*
Census :Tract: Block:
*
Land Use :RO1 Res,Single Family Residences
*
Legal :19.64 ACRES M/L IN POR SE 1/4 OF
*
:SEC 21 T6S R7E FOR TOTAL
*
:DESCRIPTION SEE ASSESSORS MAPS
*
Sub/Plat '
*
Book Page:
*
<<< PROPERTY CHARACTERISTICS >>>
*
Bedrooms Stories YearBuilt":
AgPreserve
*
BathFull Units :1 MiscImprv:No
*
Bath3Qtr Bldg SgFt: Street
ADDITIONAL
*
BathHalf Gar SgFt Waterfrnt:
*
Fireplce :No Gar Type Elect Svc:
RmAddtns :No
*
Cntrl Ht :No Lot Acres:19.64 Gas Svc
RmAddSF
*
CntrlA/C :No Lot SgFt :855,518 WaterSrce:_
AddGarType
*
Pool :No Roof Type: SewerType':
OthrPkng
Information compiled from various sources. Real Estate Solutions makes no representations
or warranties as to the accuracy or completeness of information contained in this report.
y
SIM
/
t.
Locating / Opening Fe (per flour)
,.'
r
t.
Locating / Opening Fe (per flour)
,.'
Slze System P ; f •r 3
'1 .s v-;
• .,
P- a
t r
SER VICE CHAR04,0F:S20 WILL
GE DUE.
,ONALL'RETURNED. CHECKS'
18%,PER YEAK:W;LL':BE
l
• `
HOURS-
CHARGED
PAST' DUE'ACCOU,NTS.'OVER;3:O.DAYS. :;:• ' >f'
•
r. LABOR+:._ _ t
AMOUNT
MECHANICS ` ® TOTAL
MATERIALS
'
HELPERS ` TOTAL` 4.
LABOR .
hereby acknowledge the. 9lisfactory
'tSIGNATUR
com lev
f e ab a escribed work: TOTAL LABOR '
•::
i J TAX
COMPLETED +
. r
//-DATE
! l (' f O TOTAL d ,•- rF
• T
nV
SCOTT MORRISON & ASSOCIATES y
P.O. Box 55329 1130 E. Fuerte Circle
Riverside, CA 92517 Palm Springs, CA 92262
(909) 624-1665 r DOSH 92-0248{ (800) 824-3353
ASBESTOS SURVEY REPORT
Completed On
August 7, 2002
PLM0802#2901-
Client: Elder Construction
2144 Knollwood Avenue
Fallbrook, CA 92028
-Project: 57-325 Madison
La Quinta, CA
(Art Sculpture Park)
On August 2nd, 2002 an asbestos inspection and bulk'.sampling was conducted at the above project
address. Bulk samples were taken of all suspect asbestos containing building materials (ACBM) at the
request of the client' named above. A total of (28) bulk samples were submitted to Carolina
Environmental; Inc. in Cary, NC (NVLAP Code 101768-0 and Cala Environ. Lab. Cert. #2483) to estimate
the percentage of asbestos by volume and determine the type(s) present.
Carolina Environmental, Inc. determines percentages and type of asbestos by using EPA approved
method 600/M4-82-020: interim Method for the Determination of Asbestos'in Bulk Samples. Asbestos is'
quantified by using the visual arena estimation technique and can only determine the' approximate
percentage of asbestos present. ,
After a thorough search is conducted and no asbestos is detected "none detected" will be noted in the-
report.
hereport. The essence.of polarized light microscopy is not to emphatically determine that no asbestos is
present, merely that none was detected or,, if it was, it was likely to be less than 1.0% of the sample.
When findings reveal less than or close to 1.0% asbestos contained in a sample, further analysis may be
called for on additional samples to confirm or denounce the initial findings. The California Code of
Regulations (CCR 1529) requires bulk sampling be conducted according to the-A.H'E.R.A. protocol
provisions of 40 CFR Part 763.86. The A.H.E.R.A. protocol recommends three (3) or more friable
surfacing samples from a homogeneous area be collected and analyzed before any building material is
determined -to be non -asbestos containing.
ASBESTOS INSPECTION BY: Scott Morrison, DOSH #92-0248
BULK SAMPLES ANALYZED BY: Carolina Environmental, Inc., NVLAP #101768-0
The results on the, following page(s) indicate that asbestos was detected in 02 of the 28 samples
analyzed.
SCOTT MORRISON & ASSOCIATES . r
P.O. Box 55329
R 1130 E. Fuerte Circle
Riverside, CA 92517
Palm Springs, CA 92262
(909) 6241665
DOSH 92-0248 (800) 8243353
r
PLM0802#2901 '
Sample #EC -01
Type of material:`roof felt,
t Location: roof of southeast gazebo, under clay tiles
- Area: throughout roof above gazebo
Friable:no
'Results: none detected
Sample #EC -02
Type of material: roof felt
Location: roof of soutti-central gazebo, under Gay tiles
Area: throughout roof above gazebo
Friable: no
Results: none detected
Samples #EC -03 thru #EC -16 and #EC -19 thru #EC -23 were taken from the main building. y
Sample #EC -03
Type of material: exterior stucco- cream (1 rst layer)
Location: exterior northwest wall of main bldg-
Area: ti ►roughout•exterior walls of main bldg..
Friable:no
Results: none detected
Sample #EC -04
Type of material: plaster- grey (2nd layer) _
Location:behind sample #EC -03
Area: throughout exterior walls of main bldg.
Friable:no
Results: none detected
Sample #EC -05
Type of material: troweled on plaster- white (1 rst layer)
Location: interior walls and ceiling of garage
Area: throughout interior of garage - -
Friable:no
s
Results: none detected`
Sample OEC -06
Type of material: drywall 4
Location:. behind sample #EC -05
Area: throughout interior_ of garage
Friable:no
Results: none detected
Sample #EC -07
Type of material: drywall mud
Location: interior ceiling of garage skylight
Area: unable to determine
Friable:no
Results:, none detected
Sample #EC -08
Type of material: mudded drywall tape
Location: interior east wall of kitchen ,
Area: unable to determine
Friable:no
Results: none detected `
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329
1130 E. Fuerte Circle
Riverside, CA 92517
'Palm Springs, CA 92262
(909) 624-1665
DOSH 92-0248 (800) 824-3353
}
PLM0802#2901
Sample #EC -09
Type of material: wall mastic- black '
Location: northeast bathroom behind mirrors k >
Area: less than 100 total sq. ft.
(various bathroom walls throughout main building)
Friable: no
Results: 20°% Chrysotile asbestos
Sample #EC -10
Type of material: interior wall stucco (1 rst layer)
Location: interior east wall of northeast room
Area: throughout interior walls
Friable:no
Results: none detected
Sample #EC -11
Type of material: drywall (2nd layer)
Location: behind sample #EC -10
Area: tr roughout interior walls
Friable:no
Results: none detected
Sample #EC -12
Type of material: insulation- yellow
s Location: above interior ceilings.
Area: throughout area just above interior ceilings
Friable:yes
Results: none detected
Sample #EC -13
Type of material: wall mastic- black
Location: interior north wall of central bath
•
Area: less than 100 total sq. ft.
(various bathroom walls throughout main building)
Friable:no
Results: 20"/o Chrysotile asbestos
Sample #EC -14
Type of material, troweled on plaster- white
Location: interior ceiling of large southeast room
Area: throughout interior ceilings 7 '.
Friable:no
Results: none detected
Sample #EC -15
Type of material: stucco. plaster core
Location: exterior south wall
Area: throughout exterior walls of main bldg.
Friable:no
Results: none detected ..
Sample #EC -16
Type of material: roof felt
Location: ground debris south of bldg. under clay tiles
Area: throughout exterior roof above main bldg.
• Friable:yes
Results: none detected
(3) T
P.O. Box 55329
Riverside, CA 92517
(909) 624-1665
PLM0802#2901
ZIP
SCOTT MORRISON- & ASSOCIATES
1130 E. Fuerte Circle
' Palm Spiings CA 92262
DOSH 92-0248 (800) 8243353
Sample #EC -17
Type of material: exterior stucco (Irst layer) °+
Location: exterior wall'of dog house
Area: throughout exterior walls of dog house
Friable:no
Results:, none detected
Sample #EC -18
Type of material: exterior. wall plaster (2nd layer)
Location: behind sample #EC -17 _
' Area: throughout exterior walls of dog house
Friable:noResults:
none detected '
Sample #EC -19
Type.of material: interior plaster, raked finish
Location: interior west wall of southwest room
Area: throughout interior walls of southwest'room
Friable:no
Results' none detected
Sample #EC -20
Type of material: penetration roof mastic black
-
Location: exterior roof penetrations
Area: approx. 20+ total sq. ft.
Friable:no
Results: none detected
Sample #EC -21
Type of material: tar & gravel (1 rst layer)
Location: exterior northwest roof area
Area: approx. 1650 total sq. ft. `
Friable:no
Results: none detected
' Sample #EC -22
Type of material: roof felt (2nd layer)
Location: under sample #EC -21
Area: approx. 1650 total sq. ft.
Friable:no
Results: none detected
Sample #EC -23
Type of material: tar & gravel'
Location: exterior southeast roof area
` Area: approx. 1650 total sq_ ft. ;a
Friable:no
Results: none detected.
Samples #EC -24 thru #EC -28 were taken from the mobile home south of main bldg.
Sample #EC -24
Type of material: rolled vinyl flooring- yellow/grey
Location: floor of east room and bathroom ,
Area: approx. 200 total sq. ft.
Friable:no
Results: none detected .
;..,
(4)
SCOTT MORRISON & ASSOCIATES
• P.O. Box 55329 1130 E. Fuerte Circle
Riverside, CA 92517 ; Palm Springs, CA 92262
(909) 624-1665 DOSH 92-0248 (800) 824-3353
PLM0802#2901
Sample #EC 25 Type of material: floor linoleum- white
Location: floor of south-central bedroom
Area: approx. 70 sq. ft.
Friable:no Results: none detected
Sample #EC-26 Type of material: floor linoleum (2nd layer)
Location: floor of bathroom
Area: approx. 30 sq. ft.
Friable:no --Results: none detected
Sample #EC-27 Type of material: floor mastic (3rd layer)
Location: under sample #EC-26 in bathroom
Area: approx. 30 sq. ft.
Friable:no Results:= none detected
Sample #EC-28 Type of material: floor linoleum- greenlyellow
Location: floor of southwest bedroom closet
Area: approx. 15 sq. ft.
Friable:no Results:' none detected
Note: All asbestos containing building material(s) containing greater than 1.04 asbestos .01, .;e ar
weiy~t, must be removed by a state caftiffied asbestos abatement contractor prior to any demolitivr'i or
renovation-of the property.
Inspector G/G'
Scott C. Morrison -
Certified Asbestos Consultant
DOSH#92-0248
CA-HOUti k, :ENVIRONMENTAL, INC.
LABORATORY REPORT
,.i lew<r?EdCtion Court, Cary, NC 27511
ASBESTOS BULK 1e1NAI,Y3I3'
Pl or (9191,181.1413 Fix (919) 481.1442
Client: Scott Morrison & Associates
CEI Lab Code:
A02-4991
1130 Fuerte Circle
Palm Springs.
C A 92262
Received:
08-05-02
'
Analyzed:
08-06-02
Reported:.
08-06-02 '
Project: 57-325 Madison, La Quinta
Analyst:
Edwin J. Stager
Project # PLM 0802 # 2901
-
CLIENT ID CEI
LAB ID-
SAMPLE DESCRIPTION
ASBESTOS
EC -01 A63532
FELT
ND
Heterogeneous.
'Black, Fibrous,Tightly Bound,
TAR 15%
CELL 65%
EC -02 A63533
-EELT
ND
Heterogeneous,
Black, Fibrous,Tightly Bound
TAR 15%
CELL 85%
EC -03 A63534
STUCCO
ND
Heterogeneous,
-Off-white, Fibrous, Loose
BIND 25%
CELL <1 %
PAINT 15%
. _.- -... SILI 60%
EC=04 A63535
PLASTER
No
Heterogeneous.
Grey, Fibrous, Bound
PLAS 100 %
CELL c1
EC -05 A63536
PLAS.TF.B PAINT
N D
Heterogeneous,
Yeilow,White, Fibrous, Bound'
PLAS 90%
CELL 0 %
PAINT 10%
EC -06 A63537
DRYWALL
ND
Heterogeneous,
Brown,White, Fibrous, Bound
-
PLAS 50.%
CELL 45
FOGL 5%
Page 1.
CAROLINA ENVIRONMENTAL, INC.
. Project: 57.325
Madison, La Oulnta
101 New Edition Court, Cary, NC 27511 Project
# PLM 0802 # 2901
Phone: 819481.1413
Fax: 91Wt-t442
Lab Code: A02-4991
CLIENT ID
CEI
LAB 10
SAMPLE QESCRIPTIdN
ASBESTOS
EC -07
A63538
JOINT CQMPOUhlp &PAINT
N p
Heterogeneous,
Off-white, White, Fibrous,Bound
CELL
<1 %
FBGL
' 100
EC -08
A63539
PAPER & Jo1NT COMPOUNC
ND
Heterogeneous,
Off-white,White, Fibrous,Bound
PLAS 50 %
CELL
35
MICA 15%
EC -09
A63540 •
MASTIC
'CHRY 2 0%
Heterogeneous,
Black, Fibrous,Tigh tLy Bound
CHRY 20 % TAR 80%
CELL
<1 %
' EC -10
A63541
B= 0 -
NO
Heterogeneous,
Off-white, Pink, Fibrous, Bound
PLAS 90%
CELL
c1 %
PAINT 10 %
EC -11
A63542
D13-YWALL
N 0
Heterogeneous,
Brown,White, Fibrous,Bound
PLAS 501%
CELL
45.%
F8GL
5 %
EC -12
A63543
INSULATION
NO
Heterogeneous,
Yellow, Fibrous, Loose
PLAS 50%
CE=LL
45%
F8GL
5% '
EC -13
A63544
MASTIC
-
-
CHRY 2 0 %
Heterogeneous,
. Black, Fibrous, Tightly Boland
CHRY 20. °% TAR 80%
CELL
<1 %
EC -14
A63545
PLASTF.R A PAINT
ND
Heterogeneous,
Off-white, White, Fibrous, Bound
PLAS 90%
CELL
<1 %
PAINT 10%
.. t
CAROLINA ENVIRONMENTAL,
INC.
Project:' 57-32$
Madison, La Quinta
107 New Edition Court, Cary, NC 27511 Proiect
# PLM 0802 # 2901
Phone: 919481.1413
Fax: 919.481.1442
Lab Codec A02-4991
- CLIENT ID
CEI
L'AB'ID
SAMPLE DESCRIPTION
°E
'
AS6E$T05
EC -15
A63546
STUCQO
ND
Heterogeneous,
Off-white, White, Fibrous,Bound`
PLAS 95%
CELL
<1
PAINT 5%
EC -16
A63547
FELT
µ
ND _
Heterogeneous,
Black, Fibrous,Tightly Bound
TAR 15%
CELL
85%
EC -17
A63548
STUCCO
ND
Heterogeneous,
Off-white,White, Fibmus,Bound
PLAS .95%
CELL
c1.%
PAINT 5
' EC -18
A63549
PIASTER
N O ,
Heterogeneous,
Grey, Fibrous, Bound
PLAS 100%
CELL
<1 orb
EC -19
A63550
DRYWALL PAINI &JOINT COMPOUQ
NO
Heterogeneous,,
Off-white,White, Fibrous, Bound
PLAS 55%
CELL
35 %
.
TAR 5 %
FOGL'
<1 %
MICA 5%
'
EC -20
A63551
PENETRATIoN MASTIC
NO
Heterogeneous,
Black, Fibrous,Bound
TAR 75 %
,
CELL
25%
EC -21
A63552
TAB &GRAVEL
NO
Heterogeneous,
Black, Fibrous,Tightly Bound
`
- TAR '. " 100%
CELL
'<1 %
EC -22
A63553
FELT
_
NO
Heterogeneous,
Black, Fibrous, Tightly Bound
TAR 35%
CELL
<1 % -
FER L
65
Page '3
CAROLINA ENVIRONMENTAL, INC.
Project: 57.325
Madison,
La 00nta
107 New Edition Court, Cary, NC 27511
Proiect
# PLM 0802 # 2901
Phone: 919481.1413
Fax: 919481.1442
Lab Code: A02-4991
CLIENT 4D
CE!
LAB ID
$AMPLE DESCRIPTION
ASBESTOS.
EC -23
A63554
TAR a' GF:AVEL
• N D
Heterogeneous,
Black, Fibrous,Tightly Bound
TAR • 45 %
CELL
<t %
FBGL
55%
EC -24
A63555
SEAMLESS FLOORING &MASTIC
'
ND
Heterogeneous,
Off-white,Grey, Fibrous,Bound
VINYL 35%
CELL
35%
BIND 15%
F"i3GL
10%
EC -25
A63556
SEAMLESS FLOORING & MASTIC
N D
Heterogeneous,
Off-white,Grey, Fibibus,Bound
VINYL 45%
CELL
'35%
BIND15%
MAST 5%
EC -26
A63557
SFAMLESS FLOORING "
ND -
DHeterogeneous,
Heterogeneous,
Off-white,Grey, Fibrous,Bound
VINYL 30%
CELL
45%
BIND 15%
FBGL
10
EC -27,
A63558 -
MASTIC -
-
ND
- •,
Heterogeneous,
Tan, Fibrous, Bound
MAST 100%
CELL
<1 %
FBGL
<1 %
EC -28
A63559
SEAMLESS FLOORING
ND ,
Heterogeneous,
Green,Grey, Fibrous;Bound
VINYL 40 %
CELL
35%
BIND 15%
SYNT
10%-
0%`EC-29
EC-29.
SAMPLE MISSING
-
s
-
Page 4
The following definitions apply to the abbreviations used In the ASBESTOS
BULK ANALYSIS REPORT:
CHAY = Chrysotile CELL = Cellulose, DEER = Debris
AMOS = Amosite FBGL = Fibrous Glass BIND =Binder
CROC = Crocidolite OAGN = Organics SILI = Silicates .
TREM = Tremolite SYNT . = Synthetics GRAV = Gravel
ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic
ACTN = Actinolite CERWL T Ceramic Wool PLAS =Plaster
ND = None Detected NTREM = Non-Asbestdorm PERL = Perlite
NANTH = Non-Asbes6form Tremolite
RUBR =Rubber
Anthophyllite -
+ CLIENT: Scott Morrison & Associates r
PROJECT: 57-325 Madison, La Ouinta -
• Project # PLM 0802 # 2901.
CEI LAB CODE: A02-4991
Stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical technique used
for sample identification. The percentage of each component is visually estimated by volume. These results pertain only
to the samples analyzed. The samples were analyzed as submitted by the client and may not be representative of the larger
material in question. Unless notified in writing to_retum samples, Carolina Environmental, Inc.. will discard all bulk samples
after 30 days. .
f•
Many vinyl floor tiles have been manufactured using greater than I% asbestos. Often the asbestos wasmilled to a fiber
size below the detection limit of polarized light microscopy. Therefore, a "None Detected" (NO) reading Ion vinyl floor Us
does not necessarily exclude the presepce of asbestos. Transmission electron microscopy provides a more conclusive
form of analysis for vinyl floor tiles.
'Wrs.ci:itdied by the signature below that Carolina. Environmental; Inc. is accredited by the National Voluntary Accreditation
s zl?. 4 a h (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA 1600 / M4-82 / 020 for
4r,'14a. alysis of asbestos in building materials. Procedures described in EPA / 600 / R-93 / 116 have been incorporated
Where applicable. The detection limit for the method is 0.1 % (trace amount). Carolina Environmentai, Inc.'s NVLAP
accreditation number is #101768.0. This report is not to be used to claim product endorsement by NVLAP or any agency
of the U. S.•Govemment. This report and its contents'are only valid when reproduced in full. Dust and soil analyses for
asbestos using PLM are not covered under NVLAP accreditation.
ANALYST
REVIEWED, BY x
Tianbao Bai, Ph.D.
Laboratory Director - - End of Report
From: Scott ;Morrison & Associates
1130 Fuerte Circle
Palm Springs, CA 92262
323--7743—
CHAIN OF CUSTODIA
To: Carolina Eavironmental, Inc.
0-4 b114Eti' too" (i,.Q—
(919) 481-1413
NVLAP Code 101768-0 CA FLAP #2483
ClienaELDM Cerin
t Lc-nol
Person Taking Samples::Scat:
hlorrison. CA0192-11248
Joh No. f LfA09 ,tYZ'*'2gp
Site Address:
53 —325 ALA
LA O utN'EA
Sample 9
Sample Date
Material & Description
I,M AA -Pb
Other Informalion
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Relinquished By: Datcaime: a -02 '2 PA& Received By:—Date/Time:_
Mai!!Fax To: Scott Morrison & Asoeiates,1130 Fuerte Circle, Paem Springs, CA 92262,(76(0)323-7743'
r 7r'!n
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CHAIN OF CUSTODY
'- Froln: Scott Morrison & Associates To: Carolina Environmental, Inc. o
1130 Fuerte Circle 07 . AjC----+ Ew-T'1 J:-.&Uor N
- Palm Springs, CA 92262 Cary, NC 27511 _
(919) 481-1413 N
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NVLAP Code 10176" CA FLAP 112483 a
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Client: Ns'j t?' 4 1
Sample Date
Person Taking Samples: Scott Morrison. CAC#92-0248
1 AA -Pb
Job Na.'" Ovm*,pI
Site Address:
5-4 327 jUAD I SMY (A_6L.,Ar*
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Sample #
Sample Date
Material & Description
1 AA -Pb
Other Information
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Relinquished By: Date/Time:10
-6 A- Received By: Date/Time:CY
S
NIALIFax To: Scott Morrison Asociate;, 1130 )Fuerte Circle, Paim dings, CA 92262, (760) 323-7743
CHAIN OF CUSTODY
from: Scott Morrison & Associates To: Carolina Environmental, Inc.
1130 Fuerte Circle D' ilii 0t; ourt
Palm Springs, CA 92262 _ Cary, NC 27511 _
-----(7"y323--1743—
(919) 481-14.13 -- --
NVLAP Code 201768-0 CA ELAP #12483
Client:
1 'iZ C_..QN
SYaJ->) bNJ
Person Taking Samples; Scott
Morrison.
CAC#92-8248
Job No.
9laVlp9p2 29bt
SiteAddreBs: '
- 328 AAi4 (,
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Sample #
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Swnple Date
Material & Description
-
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Relinquished Bj: __.. - jamj-- Date/Time: 'L
O-0 -o Received B . ALJ DatelTime: s -'
Mail!Fax To: Scott :Morrison & Asociates, 11.30 Fuerte Circle, Palm Springs, CA 92262. (760) 323-7743