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0208-151 (DEMO)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed 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 aa� I3J�?t}a C_1% 513/04ate' `'+'� 7. Signature of Contractor --r" 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date Signature of Owner 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. SI have and will maintain workers' compensation insurance, as required by on 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: Cartier STAAiF p1 TN.1Policy No. _ 946_R' 0131 (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, I shall forthwith comply with -those provisions. Date: "r' 1 A v r e,4> Applicant— Warning: pplicant 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 commehced 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) t';;,��?`M� Date5'=�`... 'y BU WING PERMIT DATE VALUATION &W LOT PERMIT # M591 TRACT JOB SITE�i ti. APN ADDRESS 78414 A�..;-,�i�e. DALA. P0,10 -*D, A i OWNER CONTRACTOR/DESIGNER/EN (NEER `WE-JIS1 SR'iliS� A iWWRES EXC'AMING R M"A1 x' O. BOX 1036 USE OF PERMIT MAMMON IDEMO OF Z,&. 'Att't'MYNT f3U1L0,WM;.A1Q) I -SI. UIX STRUCTURE $:IM` ATM COST Or, CONSFRUC1101f 0.00 DR,IAOUTION 0-19 ? O3.OW-423 000 $411,00 ..t . __ST -r6 --TJ AL fKRUMQN AM PLA14 c�k� 45K s Q1=0 PRE -PAM nun AUG i 2 2002 CITY OF LAQUINTA RECEIPT DATE BY 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 O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & 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 I I 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Aug -12-02 06:42 J&H ENVIRONMENTAL, INC. 41-800 Washington. Street B-1059 #201 Bermuda Dunes, CA 92201 FAX TRANSMITTAL COVER SHEET IMMEDIATE DELIVERY REQUIRED TO: Brian Monroe FROM: Thomas Sullivan COMPANY: Marvin Investments FAX NUMBER: (760) 771-5057 Date: August 12, 2002 MESSAI3E FAX NUMBER: ( P_OL PHONE NUMBER: ( # OF Pages 4 (INCLUDING FAX COVER SHEET) This message is intended only for the use of the individual or entity to which it's addressed and may contain information that is privileged, confidential or exempt from disclosure under applicable federal or state law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you received this communication in error, please.notify the above immediately by telephone and return the original message to the address above by U.S. mail. J&H Environmental, Inc. Air Samples' Results CLIENT NAME: (.Inion Environmental LABORATORY REF. it: M982112 JOB NAME: 5 1 -1 I I Desert Club Drive CLIENT JOB NUMBER: N/A JUH ADDRESS: La Quinta, CA CLIENT P.O. NUMBER: N/A Apartments 3, 2, 6 and 7 ANALYTICAL DATA DATE : August 4, 2002. PAGE:I LABORATORY "PAT" 1D #: 11067 ANALYTICAL METHOD NIOSH 7400 "A" .3ampte 1. D. rump No. plow (I/min.) Cassette T e Sample Date Runnin Start Time Slop(Min.) Duration Volume (Liters) Pump Calibration Before After Field /Fiber F/Sq.mm Det. Lim Fiber/cc Results Fiber/cc I J&H 01 10.0 1 25 8/4/02 16:15 18:15 1 120 1200 10.0 10.0 100 2.0 2.55 0.0022 B.D.L. 2 J&H 02 10.0 25 8/4/02 16:15 18:15 1 120 1200 10.0 10.0 100 1.0 1.27 0.0022 B.D.L. 3 J&1103 10.0 25 8/4/02 16:18 18:18 120 1200 10.0 10.0 100 3.0 3.82 0.0022 B.D.L. 4 J&H 04 10.0 25 8/4/02 16:18 18:18 120 1200 10.0 10.0 100 1.0 1.27 0.0022 B.D.L. 5 J&H 05 10.0 25 8/4/02 1 16:20 18:20 120 1200 10.0 10.0 100 2.0 2.55 0.0022 B.D.L. 6 0.0 25 8/4!02 0:00 0:00 0 0 0.0 0.0 100 0.0 0 - N.D. DESCRIPTIVE INFORMATION Sample Sample Resp. I.D. Type Sample Location Type Remarks U.C.L. 1 Area Inside Work Area - Unit 3 H/M Post Asbestos Abatement Activities (Finals) 2 Area Inside Work Area - Unit 3 H/M Post Asbestos Abatement Activities (Finals) 3 Area Inside Work Area - Unit 2 H/M Post Asbestos Abatement Activities (Finals) 4 Area Inside Work Area- Unit 2 H/M Post Asbestos Abatement Activities (Finals) 5 Area Outside Work Area H/M Post Asbestos Abatement Activities (Finals) 6 Blank Field Blank Field Quality Control Blank COMMENTS: KEY TO ABBREVIATIONS SAMPLE TYPE: PRS: Personal, PRM: Perimeter, ENV: Environmental, BGD: Background, FC: Final Clearance, HEX: I II;PA Exhaust, AR: Area. RESPIRATOR TYPE: HM: Half Face Negative Pressure, FF: Full Face Negative Pressure, PAPR: Power Air Purified Respirator, SAC: Supplied Air Continuous, SAPD: Supplied Air Pressure Demand, SCBA: Self Contained Breathing Apparatus. Analyzed by: Brad Sullivan m� SULL Dc 9 - t DATE : August 4, 2002. PAGE:2 LABORATORY "PAT" ID 11067 ANALYTICAL METHOD NIOSH 7400 "A" Sample I.D. J&H Environmental, Inc. Flow (1/min.) Air Samples' Results CLIENT NAME: Union Environmental LABORATORY REF. !i : M982112 JOB NAME: 5 1 -1 11 Desert Club Drive CLIENT JOB NUMBER: N!A JOB ADDRESS: La Quinta, CA. 'CLIENT" P.O. NUMBER: NIA Apartments 3, 2, 6 and 7 F/Sq.mm Det. Lim Fiber/cc Results Fiber/cc ANALYTICAL DATA DATE : August 4, 2002. PAGE:2 LABORATORY "PAT" ID 11067 ANALYTICAL METHOD NIOSH 7400 "A" Sample I.D. Pump No. Flow (1/min.) Cassette Type Sample Date RunningTime Start Stop(Min.) Duration Volume (Liters) Pum Calibration Before After Field i Fiber F/Sq.mm Det. Lim Fiber/cc Results Fiber/cc 1 J&H 06 10.0 25 8/4/02 16:30 18:30 120 1200 10.0 10.0 100 3.0 3.82 0.0022 B.D.L. 2 J&H 07 10.0 25 .8/4/02 16:30 18:30 120 1200 10.0 10.0 100 2.5 3.18 0.0022 B.D.L. 3 J&H 08 10.0 25" 8/4/02 16:32 18:32 120 1"_'00 10.0 10.0 100 1.5 1.91 0.0022 B.D.L. 4 J&H 09 10.0 25 8/4/02 16:33 18:33 120 1200 10.0 10.0 100 2.0 2.55 0.0022 B.D.L. 5 J&H 10 10.0 25 8/4/02 16:35 18:35 120 1200 10.0 1 10.0 100 3.0 3.82 0.0022 I B.D.L. 6 j 0.0 25 8/4/02 1 0:00 0:00 _0 I 0 0.0 0.0 1 100 0.0 0 - N.D. DESCRIPTIVE INFORMATION Sample I.D. Sample -Type Sample Location Resp. Type Remarks U.C.L. I Area Inside Work Area - Unit 6 H/M Post Asbestos Abatement Activities (Finals) 2 Area inside Work Area - Unit 6 FI/M Post Asbestos Abatement Activities (Finals) 3 Area Inside Work Area - Unit 7 HIM Post Asbestos Abatement Activities (Finals) 4 Area Inside Work Area - Unit 7 H/M Post Asbestos Abatement Activities (Finals) . 5 Area Outside Work Area H/M Post Asbestos Abatement Activities (Finals) 6 Blank Field Blank Field Quality Control Blank COMMENTS: KEY TO ABBREVIATIONS SAMI'LE TYPE: PRS: Personal, PRM: Perimeter, ENV: Environmental, BGD: Background, FC: Final Clearance, HEX: 1 TEPA Exhaust, AR: Area, RESPIRATOR TYPE..: HM: Half Face Negative Pressure, FF: Full Face Negative Pressure, PAPR: Power Air Purified Respirator, SAC: Supplied Air Continuous, SAPD: Supplied Air Pressure Demand, SOBA: Self Contained Breathing Apparatus. Analyzed by : Brad Sullivan J&H Environmental, Inc. Air Samples' Results CLIENT NAME : Union Environmental LABORATORY REF. #: N/A JOB NAME: 78-040 Ave. La Fonda (Video Store) CLIENT JOB NUMBER: N/A JOB ADDRESS: La Quinta, CA_ CLIENT P.O. NUMBER: N/A ANALYTICAL DATA DATE: August 6, 2002. PAGE:I LABORATORY "PAT" ID #: 11067 ANALYTICAL METHOD NIOSH 7400 "A" Sample I.D. Pump No Flow (Umin.) Cassette T e SampleERunnin�Time Date art Sto Duration (Min,) Volume (Caters) Post Asbestos Abatement Activities (Finals) / Fiber F/Sq.mm Det. Lim Fiber/cc Results Fiber/cc H/M J&H 001 10.0 25 816/02 16:30 18:30 120 1200 I Field Blank "CalilraloionField 100 3.0 3.82 0.0022 B.D.L. 2 1&H 002 100 25 R/6/02 16:30 18:30 120 1200 100 1.5 1.91 0.0022 B.D.L. 3 J&Fi 0031 120 1200 100 2.0 2.55 0.0022 B.D.L. 4 1 0.0 25 8/6/02 1 0:00 1 0:00 0 1 0 0.0 0.0 100 0.0 0 - I N. 67 DESCRIPTIVE INFORMATION sample I.D. Sample —Type Sample Location Resp. Type Remarks U.C.L. I Area Inside Work Area H/M Post Asbestos Abatement Activities (Finals) 2 Area Inside Work Area H/M Post Asbestos Abatement Activities (Finals) 3 Area jOutside Work Area H/M Post Asbestos Abatement Activities (Finals) 4 Blank I Field Blank IField 2uality Control Blank COMMENTS: KEY TO ABBREVIATIONS F E TYPE: PRS: Personal, PRM: Perimeter, ENV: Environmental, BGD; Background, FC: Final Clearance, HEX: I]EPA Exhaust, AR: Area. R TYPE: HM: Half Face Negative Pressure, FF: Full Face Negative Pressure, PAPR: Power Air Purified Respirator, SAC: Supplied Air Continuous, SAPD: Supplied Air Pressure Demand, SCBA: Self Contained Breathine Apparatus. Analyzed by : Brad Sullivan Form Approved OMB No. Z050-0039 (Expires 9-30 99) See IFlstructlon; on back ofP 9 a e 6. Please print or type. Form designed for use on elite ( I2 -pitch) typewriter. Department of Toxic Substances Control 00-- 00.< 0_00 CSj W � ImLL C r4a Z 2 F- 3 a Z 0 c w J_ Q U J_ n. W 0 U Z w f LU LL. 0 LU sn Q U PW DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) EPA 8700-22 UNIFORM HAZARDOUS 1 • Generator's US EPA ID No. Manifest Document No. 2. Page 1 Sacramento, California Informolion in the shaded areas WASTE MANIFEST C 0 0 2. 5 5 4 8 , is not required by Federal low. < of 3. Generator's Norhe and Mailing Address Marvin Ilirvf-s SIM s A. Stale Manifest Document Number � 1.867288 L 78-080 Ca.11e 13ti3���i �t2Dl�. •%08©4 Calle I,�; ro>ada La ptti nt.iCA. /��I B. State Generator's ID t ,T1.1�, CA r. a I l.�enpo For 5 hong ��� •) t 5. Transporter 1 Company Name 6. US EPA ID Number C. Slate Transporter's ID IReserved.) r D. Transporter's Phone 7. Transporter 2 Company ame 8. US EPA ID Number p 1714) E. Slate Transporter's ID [Reserve .1 F. Transporter', Phone 9. Designated Facility Nr e anjS'1 . , d ess g ty a.,1i. Le�A jF41ti{.lity 10. US EPA ID Number G. Stat Fat.i ID, r�1 y 9 1 7 1 1 16999 1-.�ag�l way 95 Mile � est 128. H. Facility's Phone 1 t 3q�t /! :j t` g .' is £ , :3 1 1. 1 �6 R' 911-'1.x'y:i j 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number] 12. Containers 13. Total W. Unit No. T pe o. Quantity Wl/Vol I. Waste Number State E -R-0. Wast1r Asbestos 9d I� A 22121 .1'6' til � Q � . � EPA/Other � E b. stale RR EPA/Other T C. �, Stale R EPA/Other d. i Stale EPA/Other ' J. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Above �_�_, BRP OW t 10d aW 1ai+�lfaCl a. b. ADEQ Air gaatity V4* 3033 N. Cental Ave, C. d. ftotvb4 A7 85012 A#f: Jobs Mat4ing 15. Special Handling Instructions and Additional Information 1f;VVVft1A Waht. IO axil I.1sMA hsal�; int (-,Ivk l &VA. ATvid Rrcalhbi; (I' d-, ISA -w- rRM y cosdad.. ??m?'Ir :1x -_y aur 1)01'P 5B? 5 06de 171, Flt{)11�I..1�• NJ. 1,.Vf')6 I0477j r y E—C4—'V-k'yDive,I)Iamcmd 02'.L. 01 t -N 1 76 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and nalional government regulations. If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic 11 practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which fiinimizes the present and Future threat to human health and the environment; OR, if I am o smaquantity generator, I have made a good foith effort to minimize my waste generaji(n and select the best waste available to me and Thal I can afford. management method that is tinted/Type Name •+. - / Signature' !. Month Day Year T R 17. Transporter 1 Acknowled ement of Recei 1 of Materials '1 H S Prjpted/Typed Name t igna� e. i y( on h f Day Year, 0 18. Transporter 2 Acknowledgement of Receipt of Materials C (' R Printed/Typed Name Signature E R --Month Day Year 19. Discrepancy Indication Space F A C I ' L I T ity Owner or Operator Certification of receipt of hazardous molerials covered by this manifest except as noted in Item 19. Printed/Typed Name Y Signature rMan�th­7Doy Year DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) EPA 8700-22 Form Approved OMB No. 2050-0039 Ex' fres 9.3099 i. PP ( P I I See Instmction"n back of page 6. Department of Toxic Substances Control Please print or type. Form designed for use on elite (12 -aitch) tvoewriter. C SA I` C c c c c CM_ c� N W M c =1 t:�r s t - c c o C C C C 0 a F A U L U 0 0 C LL I t - a L a V. ae C } z ll: �i aG W W LL C W sn Q U DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Jacramento, California Information in the shaded areas WASTE MANIFEST C A. 0 0 0 2 5 5 4 8 1 3 6 % 2 8 1 1 is not required by Federal law. 9 of 3. Generator's Name and Mailing Address Marvin Homes SITE: A. State Manifest Document nt N umber+ 21867289 78-080 Calle Estado #201 51111 Desert Club .Dr. B. S4ateGenerotor's ID H t t � a CA 2)53 Ta Ouinta, CA enbfalor k1t ( 9 s `„ 760 771 v I ' 5. Transporter 1 Cofipany Name 6. US EPA ID Number C. Slate Transporter's ID [Reserved.) 3296 tCt ' , .,��5 7�L, D S W ))11. D. Transporter's Phone 1.4 375-7748 i 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID [Reserved.] r t F. Transporter's Phone 9. DlIS(gnated Facility Na aspn 2cyrgu„_t T __ IU 10. US EPA ID Number JJtI�l� t u. �VVl1U Y 1.i3>GKJI G.. Stat Fa I A g'� D9 5 U 8 2 3 I 1 1 ' 26999 kfilhvvey 95 Mile Pmt 128. H. Faeilltl/s Phone (928) 916-1253 i Pad=, AZ 85344 l j 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total ]A. Unit No. Type a. Quantity Wt/Vol I. Waste Number State 151 G R.Q. Waste Asbestm, 9, NA 2212, PG III � EPA/01har l E t b. E State i R EPA/01her t T t c. State R EPA/Other State i EPA/Other J. Additional Descriptions for Materials Listed Above l� K. Handling Codes for Wastes Listed Above BW tie m W 1aNIA a. b - ADEQ Air Quak D"t 3033 N. *A Ave, Ca . P>i & AZ 83012" Aden: Jodi Mufi�g d 15. Special Handling Inslr#ion_ s cyd gd�dili�ongl Infgr�tofinon� WA or MW Avid BmIf � , Ql ��1 Avoid F y comiga. wy no. DOT P 58W.S Guide 171 PR.0FnZ PTO. LP66W4771. E.P.A. Region 1X 21865 F- ' Dtivo, Di=oud E[a, Ca 9.1755 16. GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to international applicable and national government regulations. If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the presenl and future threat to human health and the environment; OR, if I am a smaquantity generator, I have made a good faith effort to minimize my waste generation the best waste management method that is available to me and that I can afford. ltd se Printed/Typ d Na e Signature i C �,�-..,..� � �,`.•!�- :_, � !'� ��` Month Day Year R17. Trans Transporter 1 Ackn led em nt of Receipt of Materials A R P Ppge /Typed Na Sign of o L - ,Day , Year A6Af 0 7 (�..� 18. Transporter 2 Acknowledgement of Receipt of Materials 12 TPrinted/Typed E _ Name Signature R Month Day Year 19. Discrepancy Indication S pace F A C 1 L Iity T Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Printed/Typed Name Y Signature FM�onlh—Day Year L -t I DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 �! ,. .. rniinniiiui,.u.....uu..... Unui.y Form Approved OMD No. 2050-0039 (Expires 9-30.99) See Instructions on back of Page 6. Department of Toxic Substances Control Please print or type. Form designed for use on elite 02 -pitch) typewriter. �. .• O sry h N W) O O 00 J U U Q WC, �a "U Z_ _ 3 ad LU h - Z U.1 U w V) Z O ta: N L1.1 C' Q Z O Q Z IlJ N J Q U J J CL N W O } U Z w U.1 LU LL. O LU Q U Ii DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1 /99) EPA 8700-22 I!,, .. l I::.1 '• ' rl ; :, r, r: UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Sacramento, California Information in the shaded areas WASTE MANIFEST d is not required by Federal low. CACOO255'41 .Z of 3. Generator's Name and Mailing Address Marvin ?HOt[x?F� SITi: A. State Manifest Documinl Number d 21867291 78—O8 Calle E tad #201 51111 T�serL' Club Dr. h � B. State Generator's ID J_((��jj I� en9.'taor' Done (CA 92 '- . . La Quint.a , CN G 5. Transporter 1 Company Name 6. US EPA ID NumberC. Slots Tronsporter's ID (Reserved.] ` D. Transporter's Phone (714)313 -7749 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID [Reserved.] n F. Transporter's Phone 9. Designated Facility Nryn e n{ir5' e-q,d r ss 10. US EPA ID Num6er g b i..rf�..11..l�t(.. G. Slat Foa "t(`ID9 C fe Q y ` y r rr .3 ! i9 I V 1 z: t �Q� J��l ij�lt�l'q 9-5 Mild° .Brost 12,8. H. Facility's Phone Parke:�r, AZ: 85344 C1 ': 1 1 1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total 74 Unit No. Type Quantity Wt/Vol I. Waste Number a. • State lir G E ��..�e,�. Aslvstofi, 9 , NA 22 12., FO 111 � (� � 1 i! /i y�� EPA/Other N 6. L ll V E State R A EPA/Other T O c stare R EPA/01her d. State EPA/Other ' J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above Bap an &A -ed ad labofp& o b. ADEQ Air QvAy NO 303.3 N. CmW Ave, . C. d. 15. Special Handling InstrjcJZ a Additional Info ation (T�7 m V�ff3Rdsi. �o M$ bovak ta;W cK cwm &TL Avoisi RrriObh% ckmt. FJ=V ( fd'L: �.flfDes C•6ft v 111>. DOT P 58M.11 (411lido lit t'st.()clt,r TVE7..t.��f�t3(14"7;1 {{�y L's. s4°'. m IX 2 t&�iS 3�. C 'i l.Jf.,LV':, 1-hNj%4)nd 9:4aK Ca. 9170 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and nationol government regulations. If I am a large quantify generator, I certify that I hove a progrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and'hal I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am o small I have quantity generator, made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and That I con afford. Printed/Typed Name f�r i i•Y-tea � .!'''r:,,� �. Si nature "` ''' ,!r''� r Da Month Year T R ,�' 17. Trans orfer 1 Acknowled emanl of Receipt of Materials .'� _.�.--•- : r � _ ^� A N I Priattd/Typed NarlLe .. gnatu �� /2 T i Mont .:,pay Year 0 f .Trans oder 2 Ackriowled errant of Receipt of Materials -•f' T ASignature Printed/Typed Name Month Day Year F 19. Discrepancy Indication Space A C I L I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered 6 this manifest except as noted in Item 19. YPrinted/Typed Name Signature Month Doy Year DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1 /99) EPA 8700-22 I!,, .. l I::.1 '• ' rl ; :, r, r: EXCAVATING & GRADING, INC. POST OFFICE BOX 1036 / LA QUINTA, CALIFORNIA 92253 PHONE (760) 360-0255 / FAX (760) 771-9695 Lic. 610005 August 12, 2002 To Whom It May Concern: I, Albert Flores, authorize my wife, Brenda Flores, to sign for and receive demolition permits for job located at the corner of Avenida Tampico & Desert Club Drive, La Quinta. Sincer y Albert Flores