04-4945 (DSF)I
Tdf 1 4 4Q"
P--O�Box 1504
�795 CALLE TAMPICO
L
flINTA, CALIFORNIA 92253
JUN 2 5 2004
'ITY OF LA QW41A A
FfNANGE DEPT.
Application Number
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation .
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
- FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
f_04-00004945 - Date 6/23/04
. . . 46055 JEFFERSON ST
649-071-009-19 -2190 -
. . . DEMO - SINGLE FAMILY
. . . LOW DENSITY RESIDENTIAL
0
Owner `
Contractor
------------------------
CITY OF LA-QUINTA
------------------------
TRESIERRAS CONSTRUCTION, INC.
78495 CALLE TAMPICO
2235 N. LAKE AVENUE,
#107
LA QUINTA
CA 92253 ALTADENA
CA 91001
(626) 794-3333
WCC: STATE FUND
WC: 1454302
07/01/05.
CSLB: 725996
02/28/05
CCC: B -C21
--------------------------
Structure Information -------------------------
Construction Type .
. . . . TYPE V.- NON RATED
Occupancy Type . .
. . . . DWELLG/LODGING/CONG <=10
Flood Zone . . . .
. . . . NON -AO FLOOD ZONE
Other struct info .
. . . . NUMBER OF UNITS
1.00
-------=------------------------------------------
Permit . .. . . . .
--------------------------
DEMO PERMIT
Additional desc
Permit Fee . . . .
.45.00 Plan Check Fee
.00
Issue Date . .
Valuation . . . .
0
.Expiration Date
12/23/04
Qty Unit Charge
Per
Extension
-----------------------------------------------------'-----------------------
BASE FEE
45.00
Special Notes and Comments'
COMPLETE DEMOLITION
OF EXISTING HOUSE
AND ALL IMPROVEMENTS
Y.
Fee summary
-----------------
Charged Paid Credited, r
Due
Permit Fee Total
-----------------=----------'"------------
45.00. .00 .00 4•
45.00
Plan Check Total
.00 .00 .00
.00
Grand Total
45.00 .00 .00
45.00
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Oq'21 q 24-
Applicant: I Architect or Engineer: Date: % ^ .2s- O
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed unde provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
C:ede and my License is in full force a effect.
License Class --C—Z l License No. 7 Z S_ 11 �o
r OWN"UILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractdrrs' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 (Sep. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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' compensatio rance carrier and policy number are:
artier g l PtTE (11-1) _3:KJe M Policy Number _ (4 5 eo Z — Z-00
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 thosp_rovlsloRs.
-- z5
WARNING: FAILURE TO SECURE WORKEAV COMPENSATIO(J COVERA S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 aboveuzfefrrmtiG0 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 my to enter up n the above -me ne roperty for inspection purposes.
�ate ,-nature (Applicant or Agent):
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
MAIL FORM AND FEE TO: SCAQMD. ASBESTOS NOTIFICATIONS. FILE # 55641. LOS ANGELES CA 90074-5641
AQM6WE-ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION #
COMPLETED BY JASON COMPANY BRICKLEY CONST. CO., INC. dba PHONE 909.888.2010
BRICKLEY ENVIRONMENTAL
DATE 5-25.04 CHECK # 2647 FEE $ 57.69 PROJECT # 6848
NOTIFICATION TYPE
ORIGINAL
PROJECT TYPE
EMERGENCY REMOVAL
SITE INFORMATION
SITE NAME SFR
SITE ADDRESS ----e"46055 JEFFERSON AVE:' CROSS STREET FIESTA DR.
CITY LA QUINTA STATE CA ZIP 92201 COUNTY RIVERSIDE
DESCRIBE WORK AND LOCATION ASB REMOVAL FROM FLOORING
BUILDING SIZE (SQ FT) 1200 ' NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 30 NUMBER OF DWELLING UNITS 1
BLDG PRIOR I PRESENT USE
HOUSE
SITE OWNER CITY OF LA QUINTA REDEVELOPMENT ADDRESS P.O. BOX 1504
CITY LA QUINTA STATE CA ZIP 92253 CONTACT TOM HARTUNG PHONE 760-777-7013
REQUIRED BUILDING
INFORMATION
ASBESTOS YES
PRESENT?
ASBESTOS YES
SURVEY!*
ASBESTOS NO
REMOVED?
BUILDING TO BE NO
DEMOLISHED?
PROJECT DATES
START 5-27-04 END 5-27-04 WORK SHIFT 0800.1630
ASBESTOS AMOUNT TO BE.
REMOVED (in square feet)
FRIABLE
50
CLASS I
120
CLASS II
TOTAL AMOUNT (ADD ROW) .
170
ASBESTOS REMOVAL FROM
SURFACES
AMOUNT OF EACH TYPE OF
ASBESTOS (in square feet)
ACOUSTIC CEILING
LINOLEUM
50
INSULATION
FIRE PROOFING
DUCTING
STUCCO
MASTIC
60
FLOOR TILES (VAT)
60
DRY WALL
i
PLASTER
TRANSITE' .
ROOFING
OTHER (DESCRIBE)
CONTRACTOR INFORMATION
CSLB LICENSE # 610414 OSHA REG # 49 AQMD ID # 76397
NAME BRICKLEY CONST. CO., INC, dba BRICKLEY ENVIRONMENTAL ADDRESS 957 WEST REECE STREET
CITY SAN BERNARDINO STATE CA ZIP 92411 SITE SUPVR SNYDER 1 LIEDER I MOORE I GOMEZ PHONE 909-888-2010
LARGENTICRUZ IGORDON IBOYTIWOOD '
WASTE TRANSPORTER #1 BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL
LANDFILL AZUSA LAND RECLAMATION CO.
ADDRESS 957 WEST REECE STREET
ADDRESS 201 GLADSTONE AVENUE
CITY SAN BERNARDINO
STATE CA
ZIP 92411
CITY AZUSA
STATE CA
ZIP 91702
Asbestos Demolition / Renovation Notification Form 080403 Page 1 of 2
SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
MAIL ORIGINAL TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074.5641
WASTE TRANSPORTER #2 E. C. T. I.
WASTE STORAGE SITE BRICKLEY CONST. CO., INC. dba
BRICKLEY ENVIRONMENTAL
ADDRESS P. 0. BOX 7318
ADDRESS 957 WEST REECE STREET
CITY SAN BERNARDINO. STATE CA ZIP 92411
CITY SAN BERNARDINO STATE CA ZIP 92411
CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure #, 2,N4, 5 or Other.
For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. 1,3
ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING:
Inspection, PLM, Bulk Sampling, Survey, PCM, TEM, Assumed as Asbestos-PACM, Describe Other:
FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL:
FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE #
AUTHORIZING PERSON: TITLE
DATE OF ORDER: DATE ORDERED TO BEGIN:
FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY, DATE AND HOUR OF
EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT:
EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN:
PLEASE SEE EMERGENCY LETTER
CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME
DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. REVISED NOTIFICATION LETTERS WILL BE SENT IF / WHEN APPROPRIATE. REMOVAL WILL BE DONE
WITHIN STATE, FEDERAL, CALIOSHA, and EPA RULES & REGULATIONS.
TRAINING CERTIFICATION: I certify that an individual trained in the provisions of regulatio AQMD Rule 1403 and NESHAP will be on site during the removal and
evidence that the required training has been accomplished by this person will be availabi or nspection during normal business hours.
BRICKLEY CONST. CO., INC.
dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 5-25.04
Company Name Print name of owner/operator S. ature o Operator Tittle of Operator Date
INFORMATION CERTIFICATION: I certify that the above information is correct and I have losed any required attachments.
BRICKLEY CONST. CO., INC.
dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 5-25.04
Company Name Print name of owner/operator Si ture of Operator . Tittle of Operator Date
Notifications cannot be accepted without the required fee (AQMD Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees.
Please make checks payable to "SCAQMD'. Fees are per notification, not refundable, and vary according to the project size. Fees are as follows:
DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $ 331.21
FROM 100 TO 1,000 SQUARE FEET $ 29.52 SPECIAL HANDLING FEE $ 28.17
FROM 1,001 TO 5,000 SQUARE FEET $ 90.24 REVISION OF NOTIFICATION $ 11.94
FROM 5,001 TO 10,000 SQUARE FEET $ 211.22 RETURNED CHECK CHARGE $ 29.28
MORE THAN 10,000 SQUARE FEET $ 331.21 CANCELLATION OF NOTIFICATION $ 0.00
DEMOLITION OF LESS THAN 100 SQ FT. $ 29.52 ASBESTOS REMOVAL AT owner- $ 29.52
occu ied, sin le�nit dwellin
ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a
demolition permit. For questions call 909-396-2336. For your convenience please mail the form and fee and do not hand carry to AQMD.
MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074.5641
TELEPHONE: (909) 396-2336 FAX: (909) 396.3342 WEB SITE: HTTP:/~.AQMD.GOV
Asbestos Demolition / Renovation Notification Form 080403 Page 2 of 2
`����',,.��
o J` <�OE�A •
6
ENV/RONMQVTAL P.O. B 318
it a s w L+ONfRACT0/48 San Bernardino, CA'19'
2411
RANSPORTATfON, Phone (909) 884-7424
Fax (909) 884-3744
I - - "' � ORIdINAL-RETURN TO GENERATOR
NON -HAZARDOUS
1. Generator's US EPA ID No.
Manifest Doe..
Page 1
n
WASTE MANIFEST
11 77 3 e. 5f
o
0 /�71/L
N O T R E U I R E D
1
3. Generator's Name and Mailing Address
CITY OF LA QUINTA REDEVELOPMENT
P.O. BOX 1504
LA QUINTA, CA 92253
4. Generator's Phone ( 760 ) 777-7013
5. Transporter 1 Company Name 6. US EPA ID Number
A. Transporter's Phone
BRICKLEY ENVIRONMENTAL IC A R 0 0 0 0 5 3 1 7 3
(909)888-2010
7. Transporter 2 Company Name 8. US EPA ID Number
B. Transporter's Phone
E C T I C A R 0 0 0 0 4 9 0 6 4
(909) 884-7424
9. Designated Facility Name and Site Address 10. US EPA ID Number
C. Facility's Phone
AZUSA LAND RECLAMATION
1211 W. GLADSTONE
AZUSA, CA 91702 IC A D 0 0 9 0 0 7 6 2 6
(626)334-0719
Description11. Waste Shipping Name and
No.
Type
0
a. NON FRIABLE ASBESTOS WASTE
b.
C.
d.
D. Additional Description for Materials Listed Above
E. Handling Codes for Wastes Listed Above
15. Special Handling Instructions and Additional Information
EMERGENCY CONTACT PHONE # (800) 535-5053
EPA REGION.IX (415) 744-1089 75 HAWTHORNE ST., SAN FRANCISCO, CA 94105
SCAQMD (909) 396-2336 21865 E. COPLEY DR., DIAMOND BAR, CA 91765
16. GENERATOR'S CERTIFICATION: I c�rtity the materials described above on this manifest are not subject to federal regulations for reporting properdisposal of Hazardous Waste.
Printed/Typed Name Signature c/+ MaN Day rear
17. Transporter 1 Acknowledgm Receipt
ent of of Materials
Printed Name • » Signature MaiM Day rear
18. Transporter i Ackrowledgment of Receipt oT Materials
Printeed Name Signature Atonm Day Year
os04.0- (, aD Ar
. G O,'`0`l
19. Discrepancy Indication Space
r Facility Owner or •. d by this manifest except as noted
nntedlryped Name Signature Moats Day Y.
.. s o e\kc
I - - "' � ORIdINAL-RETURN TO GENERATOR
State of Cal ifornia—Envi ran mental ftAgenc e
I' Form Approved OMB No. 2050-0039 (Expiies 9.30.99] See Instructions on back of page 6.
ti Department of Toxic Substances Control
l •. Please print or type. Form designed for use on elite''12-pitch) typewriter. Sacramento, California 1w
DO NOT WRITE BELOW THIS LINE.
Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state,
EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)
- UNIFORM HAZARDOUS
Generator's US EPA ID No. Manifest Document No.
2. Page 1
Information in the shaded areas `
LAID1918111410101511181
is not required by Federal law.
WASTE MANIFEST
of
0
3. Generator's Name and Mailing Address
A. State Manifest Document Number
CITY OF L-A4UINTA REDEVELOPMgNT
23535722
P.O. BOY 1504
B. State Generator's ID
.
4A QUINTAone � A 92253
760 77747413
5. Transporter ),Company Nome 6. US EPA ID Number
C. State Transporter's ID [Reserved.]
D. Transporter's Phone
BRICKLEY ENVIRONMENTAL ICIAIRIOIOIO101513111713
(909)888-2010
7. Transporter 2 Company Name 8. US EPA ID Number
E. State Transporter's ID [Reserved.]
E C T I ICIAIRIOIOIO10141910161 4
F. Transporter's Phone —7 424
9. Designated Facility Name and Site Address 10. US EPA ID Number
G. State Facility's ID
AZUSA LAND REC `ON
c1k -1
1211 «. GL.ADSTONNEL
H. Facility's Phone
AZUSA, CA,91702 ICIAIDIO1019101017161216
(626)334-0719
•
11. US DOT Description (including Proper Shipping Name, Hazard Class, ID Number)
12. Containers
13. Total
14. Unit
No.
Type
and
Quantity
Wt/Vol
I. Waste Number
a' R. Q. ASBESTOS, 9, NA2212, PG III (ERG#17
State 6W111
151
G
�
JD
PooQ,
Y
EPA/Other
Nb
State "
E
)
EPA/Other
R�
A
T
C.
State
O
EPA/Other
R
d.
State
EPA/Other
J. Additional Descriptions for Materials Listed Above
K. Handling Codes for Wastes Listed Above
a) ,Ab,1 1;S )S CONTAINING COUSTRUCTION• MATERIALS--- `"`
a. b
.. ., t 4
g' ��
C.
d.
15. Special Handling Instructions and Additional Information \
`
EMERGENCY CONTACT. PHONE # (800) 535-5053
EPA REGION IX (415) 744-1089 75 HA14THORNE ST., SAN FRANCISCO, CA 94105
SCAQMD (909) 396-2336 21865 E. COPLEY DR., DIAMOND BAR, CA 91'765
16. GENERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified, packed,
labeled,
marked, and and are in all respects in proper condition for transport by highway according to applicable international 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 l 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 present and future threat to human health
and the environment; OR, if I am a small quantity generator, I have 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 can afford.
Printed/Typed Name
Signature Ct{J�.�s r
Month Day Year
T17.
R
Transporter 1 Acknowled ement of Receipt of Materials
A
Printed/Typed Name
SignatureMonth
Day Year
N
P
0
18. Transporter 2 Acknowledgement of Receipt of Materials
TPrinted/Typed
Name
Signature
Month Day Year
EXa
-(: L �/t4
U6 O 8 d Y
19. Discrepancy Indication Space
F
A
C
I
L
1
20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in -11 em 19.
T
Y
Printed/Typed Name
E
Signature
-Month + Day Year
lCl vv -)"AU
C._) I (ClO aL
DO NOT WRITE BELOW THIS LINE.
Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state,
EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)
�f ri o�
Project/Case LQT-002-46055-000
and VACANCY WALKTUROUGU
Any and all personal property left on the project premises located at 46055 Jefferson Street,
La Quinta, CA 92253, is to be considered abandoned as of March 31, 2004.
AS EVIDENCE BY SIGNATURE AND DELIVERY OF KEYS I HEREBY AGREE THAT OCCUPANCY OF THE LISTED
ADDRESS HAS BEEN ABANDONED AND THATNO FURTHER ENTRANCE TO THE ABOVE ADDRESS WILL BE MADE.
xx x 3 3 0
laimant(s) Name Claimant(s) Signature Date
REPLACEMENT ADDRESS: (
NEW PHONE
ON THIS DATE I PERSONALLY INSPECTED THE DISPLACEMENT AT THE ABOVE ADDRESS AFTER
THE OCCUPANT, HAD MOVED AND FOUND THE PREMISES TO BE IN SATISFACTORY CONDITION
AND THAT ALL PERSONAL PROPERTY, EXCEPT FOR TRASH OR DEBRIS PLACED FOR REMOVAL,
HAD BEEN REMOVED FROM THE ACQUISITION AREA EXCEPT FOR THE FOLLOWING:
t
35/G
ocation Representative Dfite
0 There are tenants remaining on this property. )(This property is now vacant.JAbandoned property remains
• \ on site
-PROPERTY MANAGEMENT
Keys given to: notes:
Date:
Received by
Overland,Pacific & Gjtler, Inc. 07/03
01/03/1994 21:15 6267943339 TRESIERRAS INC PAGE 03
TRESIERRASCONST 52C. 289 ZIQA�, P,01
Ai
'r ' ' '1�4ts[srraa Construction IIIc.
General Co4tractors
2235 North Lake Avenue, Suitt 107, Altadena. (:A 91001
. < Tel: (62f) 794-3;$33 Fnx: (626) 7?4-3339 • Stat a L.cenae 725996
f.. zy.
�' k, � ,�, ° �•- Tt�mt}I�utr$s ice � '
CIO.
IO or J.IaQaixlo`Rode%*1,gpmcrtt
0,0...#3tni 1504 ± °
T.
` 1.� P Yv raqueyt, Trs.Conzirtrion Inc is pleased to submit for your nviow a lump sum bid propos,I
._fgr;the" llowi► of
� 1 1
^a ^ (:
WORK:
„E. I lNililoval 040. Disposal Oasbtstgs waterials dcsigna(ed in your;survcy provi,dcd tm May Ss 2004
N K 64 71�1?rZ6, F
syten, Ngtieairsk
steto remain runt ling clC2;PtardnCkis
-. � s {:��'? j!'+tovWed %�Nitdustalal Hyaicnist.
- ,- . � � . . �� �7,o�(I�ian to a11• n+gn�ted a�emies, Cal-OY11n, s �AQM[y and Ci' Y pe k-mittinr�. 2 ±
A J?ispo§al oL,li,,11.}Igxnrdvus vYesta �atcr lals at I.iCi nso Land fill Azu:a Lind kectanlation.
.i... • i; `x'rovi�e f"itt�er i l,iabiliiy'lrtsurs�ncd and Workman <.ornpcnsation Certification.
,i
6 Tbya project performed under Frevailing wages se�doled for Red,:vel'optne.nt ngcYrcr-
-pntrac'tor will providiiis ar 4n� power to project 1 ation,
dpa not ir+c)ude Third lndt��ttlat Hygie►iist Setvicut. :
........ ...................... .......... $17,aa§.00
�: S.. ;SCV�Qtdgn • ih u od ,)~Q� • Ftun¢red, Vighty • nine .......................... Dollars
's411kd yoti ha pny Quvoltona I+Cg>;td-Ing this proposal please do riot h-,41ale to call nae at following listed �
44 626494-3333. t'Ir'e'626.794-3333. 4
-.T s ►ali ramA�tl�V ipn .fo.t Thirty (3p) days from the first writik n, pit wl1ich.timc it shall become dull
.i ;' ; W Void yvitit, any fluter notice'
r�:; • :: ;: ' - .ia�es<peb�fLliy �brrtitted, _ • y: a
4-7
T
P.O. Box 55329
Riverside, CA 92517
(909)624-1665
SCOTT MORRISON & ASSOCIATES
ASBESTOS SURVEY REPORT (Addendum)
Completed On
May 24, 2004
PLM0427#1226add
Client: Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
Project: 46-055 Jefferson Ave.
La Quinta, CA
(2nd layer of exterior wall only)
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(760)323-7743
On May 12, 2004 an asbestos reinspection and bulk sampling was conducted at the above project
address. Bulk samples were.taken of the exterior wall plaster only at the request of the client named
above. A total of (03) bulk samples were submitted to Carolina Environmental, Inc. located at: 107 New
Edition Court in Cary, NC (NVLAP Code 101.768-0 and Cal. Environ. Lab. Cert. #2483) to determine the
precise percentage of asbestos by using the EPA approved 1,000 total point count method.
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. Bulk
samples are analyzed by PLM (Polarized Light Microscopy) using EPA procedure 600/R-93/116.
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. Scott Morrison & Associates conducts asbestos
inspection surveys following the A.H.E.R.A. inspection protocol.
ASBESTOS INSPECTION BY: Scott Morrison, DOSH #92-0248
BULK SAMPLES ANALYZED BY; Carolina Environmental, Inc., NVLAP #101768-0
.;
(1)
P.O. Box 55329
Riverside, CA 92517
(909)624.1665
PLM0427#1226add
SCOTT MORRISON & ASSOCIATES
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(760)323-7743
Sample #QT -60a
Type of material: exterior wall plaster/ grey (2nd layer)
Location: exterior N. wall
Area:throughout exterior walls
Friable:no
Results: 0.80% Chrysotile asbestos (8 pts./1000)
Sample #QT -60b
Type of material: exterior wall plaster/ grey (2nd layer)
Location: exterior E. wall
Area:throughout exterior walls
Friable:no
Results: 1.16/o Chrysotile asbestos (11 pts./1000)
Sample #QT -60c
Type of material: exterior wall plaster/ grey (2nd layer)
Location: exterior S. wall
Area:throughout exterior walls
Friable:no
Results: 0.60% Chrysotile asbestos (6 pts./1000)
Inspector 71A—),�—
Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
(2)
May -18-04 11:39am From -CAROLINA ENVIRONMENTAL
CAROLINAEWRONMENTAL, INC
107 New Edition Court Cary, NC 27511
Phone: (919), 481-1413 Fax: (919) 481.1442
Client: Scott Morrison & Associates
31855 Date Palm Dr, Suite 3-507
Cathedral City, CA 92234.
Project: PLM0427#1 226 cidal
+4811442 7-427 P.02/04 F7939
LABORATORY REPORT
ASBESTOS BULK ANALYSIS
CEI Lab Code:
A04-3576
Received:
05-17-04
Analyzed:
05.18-04
Reported:
05-18-04
Analyst:
Gary A. Swanson
CLIENT ID CEI %
LAB ID HOMOGENEITY. DESCRIPTION ASBESTOS
QT -60a A262759 WALL PLASTER CHRY 0.80%
Homogeneous, Grey, Fibrous, Bound
CHRY 0.80% BIND 99.20%
0.80%CHRY = (8 CHRY points
1000 TOTAL points) x 100
QT -60b A262760
Homogeneous,
1 A%CHRY = (11 CHRY points
1000 TOTAL points) x 100
QT -60c A262761
Homogeneous,
0,60%CHRY = (6 CHRY points /
1000 TOTAL points) x 100
WALL PLASTER
Grey,fibrous, Bound.
CHRY 1.1% BINC 98.9 °10
WALL PLASTER.
Grey, Fibrous, Bound
CHRY. 0.60% BIND 99.40%
CHRY 1.1 %
CHRY 0.60 %
Page 1
Mar -18-04 11:40am From -CAROLINA ENVIRONMENTAL +4811442
T-427 P.03/04 F-939
The following definitions apply to
the abbreviations used in the ASBESTOS BULK
ANALYSIS REPORT:
CHRY = Chrysotlle
CELL = Cellulose
DEBR = Debris
AMOS = Amosite
FBGL = Fibrous Glass
BIND = Hinder
CROC = Crocidolite
ORGN = Organ.es
SILI = Silicates
TREM = Tremolite
SYNT = Synthetics
GRAY = Gravel
ANTH = Anthophyllite
WOLL = Wollaston ite
MAST = Mastic
ACTN = Actinolite
CERWL = Ceramic Wool
PLAS =Plaster
N D = None Detected
NTREM = Non-Asbestiform
PERL = Perlite
NANTH = Non-Asbestiform
Tremolite
Anthophyllite
RUBR =Rubber
CLIENT: Scott Morrison & Associates
PROJECT: PLM0427#1226
CES LAS CODE: A04-3576
Stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical technique used
`or sample identification. The percentage of each component is visually estimated by volume. These results pertain only
:o the samples analyzed. The samples were analyzed as submitted by the client and may not be representative of the larger
tlaterial in question. Unless notified in writing to return samples, Carolina Environmental, Inc. will discard all bulk samples
after 30 days.
Utany vinyl floor tiles have been manufactured using greater than 1 % asbestos. Often the asbestos was milled to a fiber
;ize below the detection limit of polarized light microscopy. Therefore, a "None Detected" (ND) reading on vinyl floor tile
foes not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive
orm of analysis for vinyl floor tiles.
t is certified by the signature below that Carolina Environmental, Inc. is accredited by the National Voluntary Accreditation
grogram (NVLAP) for the analysis of asbestos in bulk materials, The accredited test method is EPA / 600 / M4-821020 for
he analysis of asbestos in building materials. Procedures described in EPA / 600 / R-93 / 116 have been incorporated
vhere applicable. The detection limit for the method is 0.1 % (trace amount). Carcllna Environmental, Inc.'s NVLAP
ieereditation number is #101768-0. This report is not to be used to claim product endorsement by NVLAP or any agency
)f the U. S, Government. This report and its contents are only valid when reproduced in full. Oust .and soil analyses for
ast:>estos using PLM are not covered under NVLAP accreditation.
ANALYST
REVIEWED BY
Tianbao Rai, Ph.D.
Laboratory Director
End of Report
May -18-04 11 :40am
V
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From -CAROLINA ENVIRONMENTAL
+4811442 T-427 P.04/04 F-939
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SCOTT MORRISON &ASSOCIATES
P.O. Box 55329
Riverside, California 92517 DOSH 92-0248
ASBESTOS SURVEY REPORT
Completed On
May 08th, 2004
PLM0427#1226
Client: Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
Project: 46055 Jefferson Avenue
La Quinta, CA
(3 bedroom single family home with attached garage)
(909)624-1665
(800) 824-3353
On April 27th, 2004 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 (12) bulk samples were submitted to Carolina
Environmental, Inc. located at: 107 New Edition Court in Cary, NC (NVLAP Code 101768-0 and Cal.
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. Bulk
samples are analyzed by PLM (Polarized Light Microscopy). 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. 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. Scott Morrison & Associates conducts asbestos inspection
surveys following -the A.H.E.R.A. inspection protocol.
I ilr•
ASBESTOS INSPECTION BY: Timothy Morrison, DOSH #02-3142
BULK SAMPLES ANALYZED BY: Carolina Environmental, Inc., NVLAP #101768-0
(1)
BRICK LIx ENvIRO1V MENTAL
Environmental Remediation Contractor
INVOICE
BILL TO
CITY OF LA QUINTA
P.O. BOX 1504
LA QUINTA, CA 92253
ATTN. TOM HARTUNG
INVOICE # BID`# TERMS.
6848AA 10894A DUE UPON RECEIPT
INVOICE DATE
61112004
JOB - SITE
SFR - VACANT
46055 JEFFERSON AVENUE
LA QUINTA, CA 92201
P.O. NUMBER
CONTRACT
DUE DATE CONTRACT AMT REP
6/1/2004 1,655.00 IFG
DESCRIPTION OF WORK PROVIDED
PER ATTACHED PROPOSAL AND CONTRACT., 1,655.00.
REMOVEAND DISPOSE OFASBESTOS FLOORING MATERIALS.
APPROVED FOR PAYMENT
BY
=—�
By
ACCOUNT NO. a 1-1 ss 0
DESCRIPTION
AMT. TO PAY' S S
Interest.at the rate.of 1 %% per morith will.be charged on all past due accounts
Ind: a/5BALANCE DUE
El Proposal/Contract/Work order $1,655.00
❑ Purchase Order
❑ Certificate of Insurance
❑ Copies of Notification Letters
❑ Supervisor's Log
❑ Dump Manifest
❑ Progress Payment/Releases .
957 West Reece Street, San Bernardino, CA 92411, Lic. No. 610414 CAUOSHA No. 49
909-888-2010 800-530-3366 FAX 909-381-3433
JB,'j1K11C1K1L1EY1ENV I[ IRSO)IN NUENT'A\1L
Environmental Remediation Contractor
Date: June 1, 2004
To: Tom Hartung From: Ian Gordon
Please find enclosed a copy of our billing for the recent
abatement project we performed, along with supporting
documentation for the work completed.
We appreciate the opportunity to bid and perform this
project for you.
Please call if you have any questions.
Thank you,
Ian Gordon
Project Manager / Estimator
bir
Enclosures
AUGO
v1t 0EY/21/2004 14:04• 7607777''.� LA QUINTA PAGE 02
FROM "!&I CKLEY ErW I RONMENTAL FAX 'NO. :909 391 3433 rla y, 21 2004 02: 34PM P2
Environmental Remediation Cautractor
PROPOSAL & CONTRACT
May 21, 2004.
CLIENT: CITY OF LA QUINTA REDEVELOPMENT PROPOSAL IiUMBER: 10594A
ATTN: TOM HARTUNG' JOB NAME: . VACANT SFR
ADDRESS: P_ O, BOX 1304 SITE ADORE S$: 46055 JEFFERSON AVENUE
CITY: LA QUINTA. CA ZIP: 92293 CITY: LA QUINTA, CA ZIP; 92201
PHONE: 780"777.7013 PROPERTY OWNER:
FAX: 780-7777011 CONTRACT AMOUNT: $1,655.00
'REMOVE AND DISPOSE OF ASBESTOS CONTAINING MATERIALS (ACM) PER SITE INSPECTION ON
5/12104 AND SCOTT MORRISON & ASSOCIATES SURVEY #1226, IN QUANTITIES AND LOCATIONS AS`:
OUTLINED DELOW;
APPROX. 50 SQ, FT. OF VINYL FLOOR COVERING - SOUTH CENTRAL BATHROOM.
AI'PROX 60 SQ. FT. OF 12" X 12" FLOOR TILE AND MASTIC - NORTH EAST LAUNDRY ROOM..
COST $1,620.00
SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJECT: COST $35.00
CLIENT/OWNER TO PAY ALL RE -NOTIFICATION FEES
(MINIMUM $26.00 EACH) AND TO BE RESPONSIBLE FOR
ALL FEES IF THE PROJECT IS CANCELLED,
THIS PROPOSAL IS BASED ON PREVAILING WAGE DETERMINATION SC -102-682-1-2003-1. ISSUE DATE
FEBRUARY 22, 2003 AT THE RATE OF $28.90 PER HOUR.
BRICKLEY ENVIRONMENTAL WILL PROVIDE ALL OSHA REQUIRED PERSONAL AIR MONITORING AND
HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIEC LABORATORY.
AT THE COMPLETION OF THIS PROJECT, OR AS REQUIRED, BRICKLEY ENVIRONMENTAL WILL
-- PROVIDE. COMPLETE DOCUMENTATION Le. NOTIFICATION LETTERS, WASTE MANIFEST,
CERTIFICATE OF INSURANCE, SUPERVISORS DAILY LOGS, ETC.
ALL'RE;GULATED WASTE GENERATED FROM THIS PROJECT WILL BE PROPERLY DISPOSED OF AT AN
EPA, STATE OR LOCAL REGULATORY AGENCY APPROVED DISPOSAL FACILITY, UTILIZING THE
APPROPRIATE WASTE DISPOSAL MANIFEST.
OWNER TO PROVIDE WATER AND ELECTRIC AT JOB SITE, BRICKLEY ENVIRONMENTAL WILL PROVIDE
NECESSARY CONNECTIONS.
957 Raece Street, San Semardino, CA 92411, LIc, No. 610414 CALIOSHA No, 48 Page, w2
909.888.2010 800-530-3366 PAX 909481.3433
0521/2004 14:04 7607777E LA QUINTA PAGE 03
FROM 'BRICKLEY ENUIRONMENTAL FAX NO. :909 381 3433 May. 21 2004 02:34PM P3
WORK SHALL. BE PERFORMED IN ACCORDANCE WITHIN OSHA, EPA, AND STATE REGULATIONS.
THE ABOVE WORK TO BE COMPLETED IN A SUBSTANTIAL AND W aRKMANLIKE MANNER ACCORDING
TO STANDARD PRACTICES FOR THE SUM OF:
ONE THOUSAND.51X HUNDRED FIFTY-FIVE ........ a.`*********DOLLARS
***w** w• ***DOLLARS ($1,655.00)
A. TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED
B. THIS PROPOSAL MAY BE WITHDRAWN BY BRICKLEY ENVIRONMENTAL IF NOT ACCEPTED WITHIN 30 DAYS,
C. CONTRACTOR WILL, MAINTAIN INSURANCE IN THE AMOUNT OF $1,000,)00.00 OR AS REQUIRED BY
SPECIFICATIONS.
D. CONDITIONS: THE TERMS AND CONDITIONSA,S F@kCpWTRE'E.XPRESSLY INCORPORATED INTO THIS
CONTRACT,
BY: / ` _
AN GO N PROJECT MANAGER / ESTIMATOR K2H
ACCEPTANCE OF PROPOSAL
THE ABOVE PRICES, SPECIFICATIONS, AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU
ARE AUTHORIZED TO DO THE WORK SPECIFIED, PAYMENT WILL BE MADE AS OUTLINED ABOVE,
CLIENT
CITY OF LA QUINTA REDEVELOPMENT AUTHORIZED 51GI RE
#10894A
OATE_�//Q Y " TITLE � �L/ /L�O/+yG "Y
ADDITIONAL TERMS & CONDITIONS OF CONTRACT
TERMS: DUI= UPON RECEIPT UNLESS OTHERWISE ARRANGED, INTERE18T AT THE RATE OF 1 Y2% PER MONTH WILL
BE CHARGED ON ALL PAST DUE ACCOUNTS. IN THE EVENT OF FAILUF.E TO PAY ANY OF THE.AMOUNTS DUE ON
THIS INVOICE, ALL COLLECTION COSTS, ANDIOR ATTORNEY'S FEES IN THE COLLECTION OF ANY SUCH AMOUNT,
WILL BE PAID BY THE CLIENT,
UNLESS OTHERWISE STATED IN THIS PROPOSAL, BRICKLEY ENVIRONMENTAL WILL PROVIDE ONLY THE OSHA
REQUIRED PERSONAL AIR MONITORING. THE OWNER SHALL PROVIDE, AT THEIR COST, ALL ADDITIONAL
TESTING AND ALL FINAL CLEARANCE TESTING OR RETESTING ON THIS 'RWECT.
THIS BID OFFER IS BASED ON REMOVAL OF CERTAIN TYPES AND QUANTITIES OF HAZARDOUS AND NON-
HAZARDOUS MATERIALS AS LISTED IN THE PROPOSAL, IF ADDITIONAL OR CONCEALED HAZARDOUS MATERIALS
ARE FOUND AND THE OWNER CHOOSES ABATEMENT, A CHANGE OF DER WILL BE REQUIRED TO ALLOW THE
ADDITIONAL COSTS AND TIME TO COMPLETE THE ADDITIONAL WORK,
PLEASE BE ADVISED THAT THE OWNER OF THE PROPERTY AND GENSRATOR OF ANY HAZARDOUS MATERIALS
MAY BE SUBJECT TO MANIFEST / EPA NUMBER FEES ISSUED BY TlIE DEPARTMENT OF TOXIC SUBSTANCES
CONTROL (DTSC). ALL FEES ISSUED BY DT8C ARE THE RESPONSIBIL TY OF THE OWNER / GENERATOR. FEES
ARE BILLED DIRECTLY FROM DTSC AND ARE NOT INCLUDED IN THE CONTRACT AMOUNT,
ALTHOUGH BRICKLEY ENVIRONMENTAL TAKES PRECAUTIONS TO AVOID DAMAGE TO FINISHED SURFACES, SOME
DAMAGE MAY OCCUR, BRICKLEY ENVIRONMENTAL SHALL NOT BE RESPONSIBLE FOR ANY SUCH REASONABLE
COSMETIC DAMAGES NOR SHALL PAYMENTS TO BRICKLEY ENVIRONPIENTAL BE REDUCED OR WITHHELD AS A
RESULT THEREOF. im. DAMAGES STEMMING FROM PLACEMENT OR REMOVAL OF POLYETHYLENE AND
WOOD/DRYWALL BARRIERS AND FASTE=NING MATERIALS WHICH ARE REQUIRED TO HOLD BARRICADES IN PLACE
DURING ABATEMENT. ALL REPAIR& OR REFINISHING WILL BE PERFORMED ONLY UNDER SEPARATE WRITTEN
AGREEMENT OR CHANGE ORDER BETWEEN BRICKLEY ENVIRONMENTAL AND OWNER.
THE OWNER, BY ACCEPTANCE OF BRICKLEY ENVIRONMENTAL BID OFFER, HEREBY AGREES TO ABSOLVE
BRICKLEY ENVIRONMENTAL OF ANY AND ALL RESPONSIBILITY FOR ITEMS OR OBJECTS WHICH MAY BE
REPORTED DAMAGED, DESTROYED OR MISSING, UNLESS OWNER CAu PROVE BEYOND A REASONABLE DOUBT
THAT AN EMPLOYEE OR SUB CONTRACTOR OF BRICKLEY ENVIRONMENTAL IS THE RESPONSIBLE PARTY.
CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REOULATED BY THE CONTRACTORS' STATE
LICENSE BOARD. ANY QUESTIONS CONCERNING A CONTRACTOR MAY BB REFERRED TO THE REGISTRAR,
CONTRACTORS' STATE LICENSE BOARD, P.O. Box 26000, 5ACRAMENTC. CALIFORNIA 95628.
Page 7 of 2
03/21/2004 14:04
7607777011
LA GU NTA
PAGE 04
P.O. Box 1504
78495 CALM TAMP160 (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101
May 21, 2004
SOUTH COAST AIR QUALITY MANAGEMENT DIVISION
21865 East Copley Drive
Diamond Bar, CA 91765-4185
ATTN: Mr. Mohan Nagavedu
BUILDING DEMOLITIONS — ASBESTOS ABATEMENT
Project Address: 46480, 46-055, 46-145 Jefferson and
80-020 Vista. Grande
. La Quinta, CA
We are requesting that SCAQMD waive the usual 14 -day notification waiting
...period -for the project listed -above:
The subject buildings must be abated to make: room for a road expansion.
There is also concern for the unsafe condition of these buildings and the
potential for unlawful trespassing and illegal activities on these sites.
Please feel free to contact me' at (760) 7777019, if you have any questions
or concerns.
Thank you for your attention to this matter,
Sincerely, t
h '
Tom Hartung
Building & Safety Director
w
CAL/OSHA ASBESTOS NOTIFICATION
BRICKLEY CONST. CO., INC. dba
BRICKLEY ENVIRONMENTAL
957 WEST REECE STREET
SAN BERNARDINO, CA 92411
TEL: (909) 888-2010 FAX: (909) 381-3433
CAL/OSHA LICENSE NO. 610414
DEPT. OF INDUSTRIAL RELATIONS ASBESTOS CERT. A-6005
ADDRESS: SAN BERNARDINO DIST. OFFICE DOSH REGISTRATION #49
464 WEST 4TH ST., # 332
SAN BERNARDINO, CA 92401
DATE: 5-25-04 JOB # 6848
NAME / ADDRESS OF EMPLOYER: CITY OF LA QUINTA REDEVELOPMENT
P.O. BOX 1504
LA QUINTA, CA. 92253
ADDRESS OF JOB SITE: SFR JOB LOCATION: FLOOR
46055 JEFFERSON AVE.
LA QUINTA, CA. 92201
NEAREST CROSS STREET: FIESTA DR.
NAME OF CERTIFIED SUPERVISOR: WOOD
NAME OF, QUALIFIED PERSON IN CHARGE OF AIR MONITORING, LAB WORK AND
RESPIRATORS: AS ABOVE AND GEM SERVICES OR CONTRACTED C.A.C. / I.H.
JOB START DATE: 5-27-04 JOB COMPLETION DATE: 5-27-04
DESCRIBE SCOPE OF JOB AND WORK PRACTICES (Inc. sq. ft.): SCRAPE AND REMOVE WET IN
SECTIONS AND DISPOSE OF 50 SQ. FT. OF LINOLEUM, 60 SQ. FT. OF MASTIC, 60 SQ. FT. OF FLOOR
TILE.
ESTIMATED NUMBER OF EMPLOYEES ON JOB: S+1
EVALUATION OF POTENTIAL FOR EXPOSURE: MINIMAL EXPOSURE - RESPIRATORS AND
PROTECTIVE CLOTHING WORN THROUGHOUT PROJECT.
TRANSPORTED BY: BRICKLEY CONST. CO., INC. dba
BRICKLEY ENVIRONMENTAL
U. S. E. P. A. # CAR 000053173
STATE HAULER #2599
' AND/OR
ECTI
P.O. BOX 7318
SAN BERNARDINO, CA 92411
STATE HAULER # 3731
DUMP SITE: AZUSA LAND RECLAMATION CO.
1201 W. GLADSTONE STREET
AZUSA, CA 91702
CAD009007626
CAL OSHA 042503
i
r
CAL/OSHA ASBESTOS NOTIFICATION
BRICKLEY CONST. CO., INC. dba
BRICKLEY ENVIRONMENTAL
957 WEST REECE STREET
SAN BERNARDINO, CA 92411
TEL: (909) 888-2010 FAX: (909) 381-3433
CAL/OSHA LICENSE NO. 610414
DEPT. OF INDUSTRIAL RELATIONS ASBESTOS CERT. A-6005
ADDRESS: SAN BERNARDINO DIST. OFFICE DOSH REGISTRATION #49
464 WEST 4TH ST., # 332
SAN BERNARDINO, CA 92401
DATE: 5-25-04 JOB # 6848
NAME / ADDRESS OF EMPLOYER: CITY OF LA QUINTA REDEVELOPMENT
P.O. BOX 1504
LA QUINTA, CA. 92253
ADDRESS OF JOB SITE: SFR JOB LOCATION: FLOOR
46055 JEFFERSON AVE.
LA QUINTA, CA. 92201
NEAREST CROSS STREET: FIESTA DR.
NAME OF CERTIFIED SUPERVISOR: WOOD
NAME OF, QUALIFIED PERSON IN CHARGE OF AIR MONITORING, LAB WORK AND
RESPIRATORS: AS ABOVE AND GEM SERVICES OR CONTRACTED C.A.C. / I.H.
JOB START DATE: 5-27-04 JOB COMPLETION DATE: 5-27-04
DESCRIBE SCOPE OF JOB AND WORK PRACTICES (Inc. sq. ft.): SCRAPE AND REMOVE WET IN
SECTIONS AND DISPOSE OF 50 SQ. FT. OF LINOLEUM, 60 SQ. FT. OF MASTIC, 60 SQ. FT. OF FLOOR
TILE.
ESTIMATED NUMBER OF EMPLOYEES ON JOB: S+1
EVALUATION OF POTENTIAL FOR EXPOSURE: MINIMAL EXPOSURE - RESPIRATORS AND
PROTECTIVE CLOTHING WORN THROUGHOUT PROJECT.
TRANSPORTED BY: BRICKLEY CONST. CO., INC. dba
BRICKLEY ENVIRONMENTAL
U. S. E. P. A. # CAR 000053173
STATE HAULER #2599
' AND/OR
ECTI
P.O. BOX 7318
SAN BERNARDINO, CA 92411
STATE HAULER # 3731
DUMP SITE: AZUSA LAND RECLAMATION CO.
1201 W. GLADSTONE STREET
AZUSA, CA 91702
CAD009007626
CAL OSHA 042503
1
BRICKLEY ENVIRONMENTAL
...
SUPERVISOR DAILY LOG SHEET
7
DATE: SUPERVISOR NAME:-
AME:
JOB
JOB NUMBER (0$10S JOB NAME:
JOB LOCATION: �'bflS-S`y tF{,�rsol�l
PRE JOB SAFETY MEETING NOTES & ATTENDANCE: 4-- l
CREC..K. ::::.:::::::::::::::::::::::::.;:<.::
:.......................::.......::....::.......:::::::::::::::::::::::::::::::....:.........................................::::...::::::.:::::::::::.::::.::.................::::::::.......:::::::::..:::::.:::.
:........................................::::::::::::::::::::::::::::::::::::.:::::.::::::..............
:...: .......
Yom:....... .......:...
::.:..:;; .;;:.;:.: ;:.:
1. ENTRY/EXIT LOGS, DECONTAMINATION PROCEDURES, EMERGENCY PLAN POSTED.
• ✓'
2. JOB/EMPLOYEE FILES,• EMERGENCY KIT, FIRE EXTINGUISHER ON SITE.-.
3. RESPIRATOR BOARD UP, PROPER RESPIRATOR SELECTED/ USED.'
►� '
4. WARNING SIGNS / CRITICAL BARRIERS POSTED. -
5. AIR MONITOR.ON SITE & READY."I✓
6. WORK AREA PRE CLEANED. . �� �✓/�
_
y
7. POLLY CONTAINMENT ENCLOSURE INSTALLED.
8. DECONTAMINATION SYSTEM INSTALLED AND FUNCTIONING.
9. WATER. FILTRATION SYSTEM INSTALLED.
10. NEGATIVE PRESSURE ESTABLISHED.
GAil'iHEK,tT.:::::::::::::::.:::::::::::::::::::::::::::::::::...
:.::::::::::...5....:::lO.:.......N
...............................:::::::::::.::::::::::::::::::::::::::::::::::;::::.:;>::.;:...........:.::::..::::::::::::::::::.:::::::::::::::::::::::::::.:::::::::.................
.....
t ....
1. RESPIRATORS & SUITS WORN BY ALL PERSONNEL IN CONTAINMENT.
-�
2. WET REMOVAL/ PROPERLY BAGGED ACM.
✓_
3: NO SMOKING, EATING, DRINKING IN CONTAINMENT.
4. HEPA VACUUM USED.
5. CONTAINMENT BARRIER WORKING PROPERLY.
6. NEGATIVE AIR PRESSURE OPERATIONAL.
7. PERSONAL
/
UTILIZING DECONTAMINATION SYSTEM PROPERLY.
c:lmscffice%vA mvordVcrms%sdls.ds
....A ...:.......... K ElST.:::.:::....:.::::::::::.::::::::::.:::<:::.::.:::..:.::.:.:::.:::::::::.:.:.:.:::::::.::.<.::<::::::::::::.::::::. .
::::.............................. E
ACM DEFINED IN SCOPE OF WORK REMOVED
1. ALL ACM WASTE PROPERLY PACKAGED, LABELED & MANIFESTED.y
2. INSPECTION FOR RESIDUAL DEBRIS: A. HORIZONTAL SURFACES - I.E. - FLOORS, PIPES, VENTILATION DUCTING, ETC.
B. VERTICAL SURFACES - I.E. - WALL, REGISTERS, WINDOWS, LIGHTS, ETC.
3. WORK'AREA ACHIEVE VISUAL CLEARANCE.
4. ENCAPSULATION OF WORK SURFACES.
5. CLEARANCE AIR SAMPLES COLLECTED.
0
ARRIVAL TIME: OaOa DEPARTURE TIME: //oz)
GOREQF:.:WORKIFI »::::>:::::>:<::::::::......::::::::>:.........:;:>::;.;:.;:.>:.;:.;:.;;:.;:.:;.::.;:.;;:.;.;:.;:::.;>;:.;:;;:<:::.>.>;;:«:;:.;:.;:.;:.;:.;::.:.::::::.:::::.::..:::::::::;....:..::.:..:..
ELD NOTES.:.:...::::::::::::::::.::::..:::::::::....:::::::.::.......:.:::.<::::::::::::::.:::::.::::::::.:::::..:::.::.:.:::::.::::::..:::::::.:::::.::.::.,.......,
....................................................
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p- W-lmwn
SUPEft OR'S SIGNATURE
c:lmscffice%wnwordVormslsdls. ds
;4QMQ
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS. FILE # 55641. LOS ANGELES CA 90074.5641
AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION #
COMPLETED BY JASON COMPANY BRICKLEY CONST. CO., INC. dba PHONE 909-888-2010
BRICKLEY ENVIRONMENTAL
DATE 5.25.04 CHECK # 2647 FEE $ 57.69 PROJECT # 6848
NOTIFICATION TYPE
ORIGINAL
PROJECT TYPE
EMERGENCY REMOVAL
SITE INFORMATION
SITE NAME SFR
SITE ADDRESS 46055 JEFFERSON AVE. CROSS STREET FIESTA DR.
CITY - LA QUINTA STATE CA ZIP 92201 COUNTY RIVERSIDE
DESCRIBE WORK AND LOCATION ASB REMOVAL FROM FLOORING
BUILDING SIZE (SQ FT) 1200 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 30 NUMBER OF DWELLING UNITS 1
BLDG PRIOR I PRESENT USE
HOUSE
SITE OWNER CITY OF LA QUINTA REDEVELOPMENT ADDRESS P.O. BOX 1504
CITY LA QUINTA STATE CA ZIP 92253 CONTACT TOM HARTUNG PHONE 760-777-7013
REQUIRED BUILDING
INFORMATION
ASBESTOS ' YES
PRESENT?
ASBESTOS YES
SURVEY?*
ASBESTOS NO
REMOVED?
BUILDING TO BE NO
DEMOLISHED?
PROJECT DATES
START 5-27.04 END 5-27-04 WORK SHIFT 0800-1630
ASBESTOS AMOUNT TO BE
REMOVED (in square feet)
FRIABLE
50
CLASS I
120
CLASS II
TOTAL AMOUNT (ADD ROW)
170
ASBESTOS REMOVAL FROM
SURFACES
AMOUNT OF EACH TYPE OF
ASBESTOS (in square feet)
ACOUSTIC CEILING
LINOLEUM
50
INSULATION
FIRE PROOFING
DUCTING
STUCCO
MASTIC
60
FLOOR TILES (VAT)
60
DRY WALL
PLASTER
TRANSITE
ROOFING
OTHER (DESCRIBE)
CONTRACTOR INFORMATION
CSLB LICENSE # 610414 OSHA REG # 49 AQMD ID # 76397
NAME BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL ADDRESS 957 WEST REECE STREET
CITY SAN BERNARDINO STATE CA ZIP 92411 SITE SUPVR SNYDER I LIEDER I MOORE I GOMEZ PHONE 909.888.2010
LARGENTICRUZ IGORDON IBOYTIWOOD
WASTE TRANSPORTER #1 BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL
LANDFILL AZUSA LAND RECLAMATION CO.
ADDRESS 957 WEST REECE STREET
ADDRESS 201 GLADSTONE AVENUE
CITY SAN BERNARDIN0
STATE CA
ZIP 92411
CITY AZUSA —f
STATE CA
ZIP 91702
Asbestos Demolition / Renovation Notification Form 080403 Page 1 of 2
SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
MAIL ORIGINAL TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641
WASTE TRANSPORTER #2 E. C. T. I.
WASTE STORAGE SITE BRICKLEY CONST. CO., INC. dba
BRICKLEY ENVIRONMENTAL
ADDRESS P. 0. BOX 7318
ADDRESS 957 WEST REECE STREET
CITY SAN BERNARDINO STATE CA ZIP 92411
CITY SAN BERNARDINO STATE CA ZIP 92411
CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure #N2,04,5 or Other.
For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. 1,3
ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING:
Inspection, PLM, Bulk Sampling, Survey, PCM, TEM, Assumed as Asbestos-PACM, Describe Other:
FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL:
FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE #
AUTHORIZING PERSON: TITLE
DATE OF ORDER: DATE ORDERED TO BEGIN:
FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY, DATE AND HOUR OF
EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT:
EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN:
PLEASE SEE EMERGENCY LETTER
CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME
DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. REVISED NOTIFICATION LETTERS WILL BE SENT IF / WHEN APPROPRIATE. REMOVAL WILL BE DONE
WITHIN STATE, FEDERAL, CALIOSHA, and EPA RULES & REGULATIONS.
TRAINING CERTIFICATION: I certify that an individual trained in the provisions of regulatio AQMD Rule 1403 and NESHAP will be on site during the removal and
evidence that the required training has been accomplished by this person will be availabl or nspection during normal business hours.
BRICKLEY CONST. CO., INC.
dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 5.25.04
Company Name Print name of owner/operator S' ature o Operator Tittle of Operator Date
INFORMATION CERTIFICATION: I certify that the above information is correct and I have losed any required attachments.
BRICKLEY CONST. CO., INC.
dba BRICKLEY ENVIRONMENTAL JASON BERGERONPROJECT ADMINISTRATOR 5.25.04
Company Name Print name of owner/operator Si ture of Operator Tittle of Operator Date
Notifications cannot be accepted without the required fee (AQMD Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees.
Please make checks payable to "SCAQMD". Fees are per notification, not refundable, and vary according to the project size. Fees are as follows:
DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $ 331.21
FROM 100 TO 1,000 SQUARE FEET $ 29.52 SPECIAL HANDLING FEE $ 28.17
FROM 1,001 TO 5,000 SQUARE FEET $ 90.24 REVISION OF NOTIFICATION $ 11.94
FROM 5,001 TO 10,000 SQUARE FEET $ 211.22 RETURNED CHECK CHARGE $ 29.28
MORE THAN 10,000 SQUARE FEET $ 331.21 CANCELLATION OF NOTIFICATION $ 0.00
DEMOLITION OF LESS THAN 100 SQ FT $ 29.52 ASBESTOS REMOVAL AT owner- $ 29.52
occupied, single -unit dwelling
ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a
demolition permit. For questions call 909-396-2336. For your convenience please mail the form and fee and do not hand carry to AQMD.
MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641
TELEPHONE: (909) 396.2336 FAX: (909) 396-3342 WEB SITE: HTTP:/~.AQMD.GOV
Asbestos Demolition / Renovation Notification Form 080403 Page 2 of 2
May 12 04 12:46p Timothy S. Morrison 7608634919 p.2
SCOTT MORRMSON & ASSOCIATES (909) 624-1665
P.O. Box 55329 (800) 824-3353
ROSH 92-0248
Riverside, California 92517
ASBESTOS SURVEY REPORT
Completed On
May 08th, 2004
PLM0427#1226
Client: Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
Project: 46055 Jefferson Avenue
La Quinta, CA
(3 bedroom single family home with attached garage)
ed at the above
a ' April. 27th, 2004 an asbestos keninspection of all suspect asbestosbulk m containing taining bui dingt materials (ACBM)project
o the
address. Bulk samples were a
request of the client named
eat: 107 New Edition Couof above.(rt?n Cary, NC (NVLAP Code ) bull, samples were x101768-0 and Cal.
Environmental, Inc. located
Environ. Lab. Cert. #2483) to estimate the percentage of asbe:;tos by volume and determine the types
present.
y using EPA
oved
Carolina Environmental, Inc. determines ethod forctheaDetermfiat on of Asbestos ges and type of asbestos bin Bulk Samples. r Bulk
method 600IM4-82-020: Interim asbestos is quantified by using the visual
samples are analyzed by PLM (Polarized Light Microscoprox mate ercen quantified
of asbestos present.
arena estimation technique and can only determine the app P
After a thorough search is conducted and no asbestos i detocted emphatically determine ill be noted i asbestos report. The essence of polarized light microscopy snot to
present; merely that none was detected or, if it was, it was likely to be less than 1.0% of the sample.
close to 1.0% asbestos
i
may be
When findings reveal less than r to onfirmor denounce th�al initial further
al f ndngs`T eCaliforiniasCode of
called for on additional samples
Regulations (CCR 1529) requires bulk sampling be conducted according to the A.H.E.R.A. protocolor more
povisions of 40 from a homogeneous aa beco a tedoar d analyzed beforeranyrotc:)l recommends thee(building material is
surfacing samples
determined to be non -asbestos containing. Scott Morrison &Associates conducts asbestos inspection
surveys following the A.H.E.R.A. inspection protocol.
ASBESTOS INSPECTION BY: Timothy Morrison, DOSH #02-3142
BULK SAMPLES ANALYZED BY: Carolina Environmental, Ir c., NVLAP #101768-0
(1)
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329 (909) 624-1665
Riverside, California 92517 DOSH 92-0248 (800) 824-3353
The results on the following page(s) indicate that asbestos was detected in 04 of the 12 samples
analyzed.
PLM0427#1226
Sample #QT -50
Type of material: acoustic ceiling- white
Sample #QT -56
Location: interior ceiling of east diningroom
Area: approx. 1700 total sq. ft. throughout
Friable:yes
Results: none detected
Sample#QT-51
Type of material: acoustical ceiling- white
Sample #QT -57
Location: interior ceiling of west livingroom and hallway
Area: approx. 1700 total sq. ft. throughout
Friable:yes
Results: none detected
Sample #QT -52
Type of material: rolled vinyl floor- white
Location: floor of east -central bathroom
Area: approx. 40 sq. ft.
Friable:no
Results: none detected
Sample #QT -53 Type of material: rolled vinyl floor- grey/gold
Location: floor of south-central bathroom
Area: approx. 50 sq. ft.
Friable:no Results: 25% Chrysotile asbestos
Sample #QT -54 Type of material: acoustic ceiling- white
Location: interior ceiling of southeast bedroom
Area: approx. 1700 total sq. ft.
Friable:yes Results: none detected
Sample #QT -55
Friable:no
Type of material: smooth coat- white (1 rst layer)
Location: interior south wall of southwest bedr000m
Area: throughout interior walls
Results: none detected
Sample #QT -56
Type of material: grey coat (2nd layer)
Location: behind sample #QT -55
Area: throughout interior walls
Friable:no
Results: none detected
Sample #QT -57
Type of material: 12" floor tile- grey (1 rst layer)
Location: floor of northeast laundryroom
Area: approx. 60 total sq. ft.
Friable:no
Results: 5% Chrysotile asbestos
(2)
P.O. Box 55329
Riverside, California 92517
PLM0427#1226
SCOTT MORRISON & ASSOCIATES
DOSH 92-0248
(909)624-1665
(800) 824-3353
Sample #QT -58
Type of material: floor tile mastic- black (2nd layer)
Location: under sample #QT -57
Area: approx. 60 sq. ft.
Friable:no
Results: 10% Chrysotile asbestos
Sample #QT -59
Type of material: stucco- biege (1rst layer)
Location: exterior north wall
Area: throughout exterior walls
Friable:no
Results: none detected
Sample #QT -60
Type of material: plaster- grey (2nd layer)
Location: behind sample #QT -59
Area: throughout exterior walls
Friable:no
Results: 211/6 Chrysotile asbestos
Sample #QT -61
Type of material: roof felt- black
Location: exterior roof under wood shingles
Area: approx. 2500 sq. ft.
Friable:no
Results: none detected
Note: The two (2) transite pipes located above the east -central roof are presumed asbestos containing
material (PACM).
Note: All asbestos containing building material(s) containing greater than 1.0% asbestos by volume or
weight, must be removed by a state certified asbestos abatement contractor prior to any demolition or
renovation of the property.
Inspector Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
I
(3)
May -03-04 04:02vm From -CAROLINA ENVIRONMENTAL
CAROLINA ENMONMFNTAAIL 1W.
107 NsW Edffion'Cwr% Cary, NC 71511.
Phow. (919) A81-1413 Fac (919)481.1442
Client: Scott Morrison & Associates
31855 Date Palm Dr. Suite 3-507
Cathedral City, CA 92234
Project: PLM0427#1226
+4811442 T-020 P. 02/05 F-441
LABORATORY REPORT
ASBESTOS BULK ANALYSIS
CEI Lab Code:
A04-3153
Received:
04-30-04
Analyzed:
05-03.04
Reported:
05-03-04
Analyst:
Gary A. Swanson
CLIENT 1D CEI HOMOGENEITY DESCRIPTION
LABID ASBESTOS
QT -50 A257280 ACOUSTIC CEILING ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QT -51 A257281 ACOUSTIC CEILING ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QT -52 A257282 ROLLED VINYL FLOOR ND
Homogeneous, White, Non-fibrous, Bound
VINYL 50%
BIND 50%
QT -53 A257283 ROLLED VINYL FLOOR CHRY 25%
Homogeneous, Grey, Gold, Fibrous, Bound
CHRY 25% VINYL 50% CELL 5%
BIND 20%
QT -54 A257284 ACOUSTIC CEILING ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QT -55 A257285 SMOOTH COAT ND
Homogeneous, White, Non-fibrous, Bound
SIND 100%
Page 1
4;
.May -03-04 04:03pm
From -CAROLINA ENVIRONMENTAL +4811442
7-020 P.03/05 F-441
CAROLINAENVRONMENTAL, WC.
Project: PLM0427#1226
101 Now Edition Court;
09* NC 27511
Phone: 9196481-1413
Fax: 919481-1442
Lab Code: A04-3153
CLIENT ID
CEI LAB ID
HOMOGENEITY DESCRIPTION
'ASBESTOS
QT -56
A257286
GREY COAT
NO
Homogeneous,
Brown, Fibrous, Bound
BIND 97% CELL
3%
QT -57
FLOOR TILE
CHRY 5%
A257287
Homogeneous,
Beige, Fibrous, Tightly Bound
CHRY 5% VINYL 95%
QT -58 A257288 MASTIC CHRY 10%
Homogeneous, Black, Fibrous, Bound
CHRY 10% MAST 90%
QT -59 A257289 STUCCO NO
Homogeneous, Beige, Non-fibrous, Bound
BIND 100%
QT -60 A257290 PLASTER
Homogeneous, Grey, Fibrous, Bound
CHRY 2% BIND
QT -61 A257291 ROOFING
Homogeneous, Black, Fibrous, Bound
TAR 50% CELL 40%
SYNT 10%
CHRY 2%
NO
Page 2
May -03-04 04:03pm From -CAROLINA ENV I ROMENTAL +4611442 T-020 P-04/05 F-441
The following definitions apply to the abbreviations used in the ASBESTOS BULK
ANALYSIS REPORT:
CHRY _= Chrysotile
CELL = Cellulose
DEBR = Debris .
AMOS = Amosite
FBGL Fibrous Glass
BIND = Binder '
CROC = Crocidolite
ORGN ; Organics
SILI - Silicates
TREM = Tremolite
SYNT = Synthetics
GRAV =Gravel
ANTH = Anthophyllite
WOLL = Wollaston ite
MAST = Mastic
ACTN = Actinolite
CERWL = Ceramic Wool
PLAS = Plaster
N D = None Detected
NTREM = Non-Asbestiform
PERIL = Perlite
NAN7H = Non-Asbestiform
Tremolite
RUBR =Rubber
Anthophyllite
CLIENT: Scott Morrison & Associates
PROJECT: PLM0427#1226
CEI LAS CODE: A04-3153
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 return samples, Carolina Environmental, Inc. will discard all bulk samples
after 30 days.
Many vinyl floor tiles have been manufactured using greater than I % asbestos. Often the asbestos was milled to a fiber
size below the detection limit of polarized light microscopy. Therefore, a "None Detected" (ND) reading on vinyl floor tile
does not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive
form of analysis for vinyl floor tiles.
It is certified by the signature below that Carolina Environmental, Inc. is accredited by the National Voluntary Accreditation
Program (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA / 600 / M4-82 / 020 for
the analysis of asbestos in building materials. Procedures described in EPA / 600 / R-93 1116 have been incorporated
where applicable, The detection limit for the method is 0.1 % (trace amount). Carolina Environmental, 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. Government. 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.
J
AREVIEWED BY &
ianbao 8ai, Ph.D.
Laboratory Director End of Report
11
PO Box 1504
La Quinta, CA 92253
Phone: 760-777-7013
Fax: 760-777-7011
Fcvc
To: Ian Gordon
City of La Quinta
From: Tom Hartung
Fam 909-381-3433 Date: May 21, 2004
Phone: 909-533-7016 Pages: 4
Re: Asbestos Removal CC: File
r
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
Ian,
Here is the approval for 46-055 Jefferson as well as the AQMD letter. The Temp EPA # is.
CAC002576767. I will fax the OK for the other house on Monday as it needs the City Manager's
signature.
FROM.:BRICKLEY ENVIRONMENTAL FAX NO. :909 381 3433 May. 21 2004 02:34PM P2
Environmental Reniedlatinn Contractor
0
PROPOSAL & CONTF:ACT
May 21, 2004
CLIENT: CITY OF LA QUINTA REDEVELOPMENT PROPOSAL IJUMBER: .10894A
ATTN: TOM HARTUNG JOB NAME: VACANT SFR
"ADDRESS: P. O. BOX 1504 SITE ADDRE 3S: 46055 JEFFERSON AVENUE
CITY: LA QUINTA, CA 27P: 92253 CITY: LA QUINTA, CA ZIP: 82201
PHONE: 760.777-7013 PROPERTY OWNER:
FAX: 760.777-7011 CONTRACT AMOUNT: $1,655.00
REMOVE AND DISPOSE OF ASBESTOS CONTAINING MATERIAI-S ,(ACM) PER SITE INSPECTION ON
5112/04 AND SCOTT MORRISON & ASSOCIATES SURVEY #1226, IN QUANTITIES AND LOCATIONS AS
OUTLINED BELOW:
APPROX. 50 SQ. FT, OF VINYL FLOOR COVERING - SOUTH CENTRAL BATHROOM.
• APPROX. 60 SQ. FT. OF 12"X 12" FLOOR TILE AND MASTIC: - NORTH EAST LAUNDRY ROOM.
COST $1,620.00
SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJECT: COST $35.00
CLIENT/OWNER TO PAY ALL RE -NOTIFICATION FEES
(MINIMUM $25.00 EACH) AND TO BE RESPONSIBLE FOR
ALI_ FEES IF THE PROJECT IS CANCELLED,
THIS PROPOSAL IS BASED ON PREVAILING WAGE DETERMINATION SC -102-882-1-2003-1, ISSUE DATE
FEBRUARY 22, 2003 AT THE RATE OF $29,90 PER HOUR,
BRICKLEY ENVIRONMENTAL WILL PROVIDE ALL OSHA REQUIRI=D PERSONAL AIR MONITORING AND
HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIEC .LABORATORY.
AT THE COMPLETION. OF THIS PROJECT, OR AS REQUIRED, BRICKLEY ENVIRONMENTAL WILL .
PROVIDE, COMPLETE DOCUMENTATION Le, NOTIFICATION LETTERS, WASTE MANIFEST,
CERTIFICATE OF INSURANCE, SUPERVISORS DAILY LOGS, ETC,
ALL REGULATED WASTE GENERATED FROM THIS PROJECT WILL BE PROPERLY DISPOSED OF AT AN
EPA, STATE OR LOCAL REGULATORY AGENCY APPROVED DISPOSAL FACILITY, UTILIZING THE
APPROPRIATE WASTE DISPOSAL MANIFEST.
OWNER TO PROVIDE WATER AND ELECTRIC AT JOB SITE, BRICKLEY ENVIRONMENTAL WILL PROVIDE
NECESSARY CONNECTIONS,
957 Reece Street, San Bemardino, CA 92411, LIc. No. 610414 CAL/OSHA No. 49 Page i or 2
909-888.2010 800-530-3366 FAX 909-381-3433
FROM :BRICKLEY ENVIRONMENTAL FAX N0. :909 381 3433 May. 21.2004 02:34PM P3
WORK SHALT. BE PERFORMED IN ACCORDANCE WITHIN OSHA, EPA, AND STATE REGULATIONS.
THE ABOVE WORK TO SE COMPLETED IN A SUBSTANTIAL AND WORKMANLIKE MANNER ACCORDING
TO. STANDARD PRACTICES FOR THE SUM OF:
ONE THOUSAND.SIX HUNDRED FIFTY-FIVE***`—*—*******4"**""""**"*"**"*DOLLARS ($1,655.00)
A. TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED
B. THIS PROPOSAL MAY BE WITHDRAWN BY BRICKLEY ENVIRONMENTAL IF NOT ACCEPTED WITHIN 30 DAYS,
C. CONTRACTOR WILL MAINTAIN INSURANCE IN THE AMOUNT OF $1,000,00.00 OR AS REQUIRED BY
SPECIFICATIONS.
D, CONDITIONS: THE TERMS AND CONDITIONS AS FOLLOW ARE EXPRESSLY INCORPORATED INTO THIS
CONTRACT.
BY:
IAN GORDON PROJECT MANAGER / ESTIMATOR KEH
ACCEPTANCE OF PROPOSAL
THE ABOVE PRICES, SPECIFICATIONS, AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU
ARE AUTHORIZED TO DO THE WORK SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE,
CLIENT _
CITY OF LA OUINTA REDEVELOPMENT AUTHORIZED SIGI URE
#10894A
DATE / P/%L t�L rpty1C )9be /4,01.14 .f --A I� i7"Y
TITLE
ADDITIONAL TERMS & CONDITIONS OF CONTRACT
TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED. INTERE:3T AT THE RATE OF 1 %2% PER MONTH WILL
BE CHARGED ON ALL PAST DUE ACCOUNTS. IN THE EVENT OF FAILUF.E TO PAY ANY OF THE.AMOUNTS DUE ON
THIS INVOICE, ALL COLLECTION COSTS, AND/OR ATTORNEY'S FEES IN THE COLLECTION OF ANY SUCH AMOUNT,
WILL BE PAID BY THE CLIENT,
UNLESS OTHERWISE STATED IN THIS PROPOSAL, BRICKLEY ENVIRONMENTAL WILL PROVIDE ONLY THE OSHA
REQUIRED PERSONAL AIR MONITORING. THE OWNER SHALL PROVIDE, AT THEIR COST, ALL ADDITIONAL
TESTING AND ALL FINAL CLEARANCE TESTING OR RETESTING ON THIS 'ROJECT.
THIS BID OFFER IS BASED ON REMOVAL OF CERTAIN TYPES AND QUANTITIES OF HAZARDOUS AND NON-
HAZARDOUS MATERIALS AS LISTED IN THE PROPOSAL, IF ADDITIONAL OR CONCEALED HAZARDOUS MATERIALS
ARE FOUND AND THE OWNER CHOOSES ABATEMENT, A CHANGE ORDER WILL BE REQUIRED TO ALLOW THE
ADDITIONAL COSTS AND TIME TO COMPLETE THE ADDITIONAL WORK.
PLEASE BE ADVISED THAT THE OWNER OF THE PROPERTY AND GEN:RATOR OF ANY HAZARDOUS MATERIALS
MAY BE SUBJECT TO MANIFEST / EPA NUMBER FEES ISSUED BY THE DEPARTMENT OF TOXIC SUBSTANCES
CONTROL (DTSC). ALL FEES ISSUED BY DTSC ARE THE RESPONSIBIL TY OF THE OWNER / GENERATOR. FEES
ARE BILLED DIRECTLY FROM DTSC AND ARE NOT INCLUDED IN THE CONTRACT AMOUNT.
ALTHOUGH BRICKLEY ENVIRONMENTAL TAKES PRECAUTIONS TO AVOID DAMAGE TO FINISHED SURFACES, SOME
DAMAGE MAY OCCUR. BRICKLEY ENVIRONMENTAL SHALL NOT BE RESPONSIBLE FOR ANY SUCH REASONABLE
COSMETIC DAMAGES NOR SHALL PAYMENTS TO BRICKLEY ENVIRONMENTAL BE REDUCED OR WITHHELD AS A
RESULT THEREOF. i.e. DAMAGES STEMMING FROM PLACEMENT OR REMOVAL OF POLYETHYLENE AND
WOOD/DRYWALL BARRIERS AND FASTENING MATERIALS WHICH ARE REQUIRED TO HOLD BARRICADES IN PLACE
DURING ABATEMENT, ALL REPAIRS OR REFINISHING WILL BE PERFCRMED ONLY UNDER SEPARATE WRITTEN
AGREEMENT OR CHANGE ORDER BETWEEN BRICKLEY ENVIRONMENTAL AND OWNER.
THE OWNER, BY ACCEPTANCE OF BRICKLEY ENVIRONMENTAL BID OFFER, HEREBY AGREES TO ABSOLVE
BRICKLEY ENVIRONMENTAL OF ANY AND ALL RESPONSIBILITY FOR ITEMS OR OBJECTS WHICH MAY BE
REPORTED DAMAGED, DESTROYED OR MISSING, UNLESS OWNER CAN PROVE BEYOND A REASONABLE DOUBT
THAT AN EMPLOYEE OR SUB CONTRACTOR OF BRICKLEY ENVIRONMENTAL IS THE RESPONSIBLE PARTY,
CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE CONTRACTORS' STATE
LICENSE BOARD, ANY QUESTIONS CONCERNING A CONTRACTOR MAY BE REFERRED TO THE REGISTRAR,
CONTRACTORS' STATE LICENSE BOARD, P.O. BOX 26000, SACRAMENTC, CALIFORNIA 95826,
Pepe 2 of 2
P.O. Box 1504
78-495 CALLS TAMPICO' (7 60) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (7 60) 777-7101
May 21, 2004
SOUTH COAST AIR QUALITY MANAGEMENT DIVISION
21865 East Copley Drive
Diamond Bar, CA 91765-4185
'ATTN: Mr. Mohan Nagavedu
BUILDING DEMOLITIONS - ASBESTOS .ABATEMENT
Project Address: 46-480', 46-055, 46-145 Jefferson and
80-020 Vista Grande
La Quinta, CA
We are requesting that SCAQMD waive the usual 14 -day notification waiting
period for the project listed above.
The subject buildings must be abated to make roomfor a road expansion.
There is also concern for the unsafe condition of these buildings and the.
potential. for unlawful trespassing and illegal activities on these sites.
Please feel free to contact me at (760) 777-7019, if you have any questions
or concerns.
Thank you for your attention to this matter.
Sincerely,
Tom ,Hartung
Building & Safety Director .
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06/01/2004 13:32' 7603237743 SCOTT MOF:RISON & ASS PAGE 07
P-0. 86x SCOTT MORRISON & ASSOCIATES
Riverside, CA 92517
(909) 6241665 31655 Date pains Drive, Ste. #3-507
" � Cathedral C�
ity, CA 92234
(760)323-7743
INVOICE.
Client: Tom Hartung's Office .
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
Project:; 46-055 Jefferson Ave.
46-145 Jefferson Ave.
80-020 Vista Grande
Reinspection dates: May 12 and May 24, 2004
Date: June 0.1, 2004
Project/.P'.()#
File name: PLM0427#1226add
AM0510#1130add
PLM0510#1631 add
asbestos reinspection/ bulk sampling: 2 days @ $90,00 ea. _ $ 180.00
09 total bulk samples for 1,000 point -count analysis @ 8125.00 each*.= $1,125.00
# hours of travel time @ $ each = inGuded .
Total amount due @ $1,305.00
""Includes lab reports r
Please send payment to: 31855 Date Palm Drive, Up. #3-S07
Cathedral City, CA 92234
APPROVED FOR PAYN111 T
Terns: 'Net 15 days. By
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ACCOUNT No. �L �' Z .%LQ -551, 3,?-
Thank you.
DESCROTIMM
AMT. TO RAY �.. _ ...3 O
INVOICE
SCOTT MORMSON & ASSOCIATES
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(760)323-7743
Client: Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
H�.
Project: j;j �--055 Jefferson St.
76-235 Jefferson St.
76-3354 ' efferson St.
76-480 fferson St.
Inspection dates: April 27 and April 28, 2004
Date: May 10, 2004
Project/ P.O#
File name: PLM0427#1226
PLM0427#0927
PLM0428#0928
PLM0428#1529
asbestos inspection/ bulk sampling: 4.single-family homes @ $125.00 ea. = $500.00
45 total bulk samples for analysis (PLM) @ $20.00 each ='$900.00
# hours of travel time @ $ each = included
Total amount due = $1,400.00
Please send payment to: 31855 Date Palm Drive; Ste. #3-507
Cathedral City, CA 92234
Terms: Net .15 days APPROVED FOR PAYMENT
9Y
.Thank you. � / ?
ACCOUNT NO. /-- % l% — .�J� �. `� /0
DESCRIPTION
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AMT TO