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04-5076 (DSF)T4hf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . r04-0000507.6.: Date 6/22/04 Property Address 46 41 5 JEFFERSON ST APN: 649-071-012-21 -2190 - Application description . . . DEMO - SINGLE FAMILY Property Zoning . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 0. Owner Contractor ------------------------ ------------------------ CITY OF LA QUINTA EMERY LAND CLEARING & GRAD INC 78-495 CALLE TAMPICO P.O. BOX 1009 LA QUINTA CA 92253 THERMAL CA 92274 (760) 391-5840 WCC: STATE FUND WC: 0460011653 04/12/05 CSLB: 600283 11/30/05 CCC: C21 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 Qty Unit Charge Per Extension BASE FEE 45.00 ---------------------------------------------------------------------------- Special Notes and Comments DEMOLISH,REMOVE AND, -DISPOSE OF ONE HOUSE Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 45.00 .00 .00 45.00- Plan 5.00Plan Check Total .00 .00 .00 .00 .Grand Total 45.00 .0*0 .00 45.00 FJUN 2 3 `u CITY Op LA QUINTA ,,,,,A,,E DEPT. P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Address: 44 Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals C and my License in 11 fryce and effect. icense Class_ ( icense No. C /Date oiC ntractor OWNER-BUILDM DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a pen -nit 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 (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 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 1, 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. , B.& P.C. for this reason Date Owner 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 i ued. y worke compensation i rance carrier and Policy �number,ajQ t� ,,darrier _a olicy Number ey-(10 00 I f s::3 certify in the performance of the work for ich 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 t t, if I shoul eco a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. _,A!rate plicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS 4LAWFUL, 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 IABOR 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 f� 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 Quinta, 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 canction. I certify that I have read this application and state that the above info tion is correct. I agree to comply with all city and county ordinances and state laws relating to building constructio and hereby authorize representatives of t ' county t ter up�n a above-mentioned property for inspection purposes. mare Signature (Applicant or Agent): // k LL, ►QM>D:r SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQ MD. ASBESTOS NOTIFICATIONS- FII F it _xLWi Inc AM(=I =c re oM7A rAA4 —71 r -C k *,. sa - 1 s. { ,, •v r ,fy Z3.r 4 _ f, �y 3i.r .Y ,� :T ..:.. ... .. AQMD USE.ONLY, '; SCREEN BY , RECENED' S , r POSTMARK ` ENTERED BYk `` NOTIFICATION # - r i•H`"•HI`l is 2.41.:l, hiY'_ti ..!f.�..i � .t � COMPLETED BY COMPANY EMERY LANDCLEARING PHONE 760/391-5840 LORI EMERY V.P. AND GRADING, INC. DATE JUNE 21, 2004 CHECK# FEE$ 118.41 PROJECT# NOTIFICATION TYPE ORIGINAL REVISION DATES REVISION OMER (h*fight) CANCELLATION DEMOLITION ORDERED E uiU DoN ' RENOVATION (rernovaq EMERGENCY REMOVAL PLmNED RENO (annual) PROJECT TYPE SITE INFORMATION SITE NAME SITE ADDRESS 46145 JEFFERSON STREET, CROSS STREET WESTWARD HO CITY LA QUINTA STATE CA ZIP 92253 COUNTY RIVERSIDE DESCRIBE WORK AND LOCATION DEMOLISH REMOVE AND DISPOSE OF ONE HOUSE BUILDING SIZE (SQ Fr) 2212 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 43 NUMBER OF DWELLING UNITS 1 BLDG PRIOR I PRESENT USE CO MERCuL Hosmm INDusmw Other OMCE PUBLIC BLDG FIOUSE ` SCHOOL SHP . UNMCOIlEGE SITE OWNER CITY OF LA QUINTA ADDRESS 78-495 CALLE TAMPICO CITY LA QUINTA STATE:, CALIF. ZIP 92253 CONTACT MR. TOM HARTUNG PHONE 760!177-7013 REQUIRED BUILDING INFORMATION ASBESTOS YES f%0 PRESENT? ASBESTOS - YES . NO SURVEY?* ASBESTOS YES NO REMOVED? BUILDING TO BE YES ' NO DEMOLISHED? PROJECT DATES START JUNE 22, 2004 END JUNE 30,26M WORK SRIF day, ng, night) ASBESTOS AMOUNT TO BE REMOVED (n square feet) FRIABLE CLASS I CLASS II TOTAL AMOUNT (add row) ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS AMOUNT OF EACH TYPE OF ASBESTOS (n square feet) ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) DRY WALL PLASTER TRANSITS ROOFING OTHER () CONTRACTOR INFORMATION CSLBLICENSE# 600283 OSHA REG# AQMDID# 100435 NAME EMERY LANDCLEARING AND GRADING, INC. ADDRESS P.O. BOX 1009 CITY THERMAL STATE CA ZIP 92274 SITE SUPVR JAMES C. EMERY PHONE 760/774-9493 WASTE TRANSPORTER #1 LANDFILL ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP ' Asbestos surveys are required prior to Demolition and Renovation 'y' `. 4 .1 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074,5641 WASTE TRANSPORTER #2 WASTE STORAGE SITE ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure # 1.2, 3, 4, 5 or Other. For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING Survey, Bulk Sampling, Inspection, PLM, PCM, TEM, Assumed as Asbeslos-PACM, Describe Other: FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: BRICKLEY ENVIRONMENTAL 6/5/O4 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME A PHONE # AUTHORIZING PERSON: MR. TOM HARTUNG TITLE' BUILDING AND SAFETY DIRECTOR DATE OF ORDER JUNE 11, 2004 DATE ORDERED TO BEGIN: JUNE 22.2004 FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE {AMBER 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: 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. STOP PROJECT HAVE CERTIFIED ASBESTOS REMOVAL CONTRACTOR REMOVE AND DISPOSE OF. TRAINING CERTIFICATION: I certify that an Individual trained in the provisions tion AQMD Rule 1403 and NESHAP vnl1 be on site during the removal and evidence that the required training has been a=mplished by this person will aIai>abfe for hispectim during nomial business houra Tittle of o m/olerathr Date Coagw.y Name EMERY Prig tt name of wowplape;at Sim Mm(; e � LANDCLEARING AND LORI EMERY / i 07 GRADING, INC. VICE PRESIDENT • 1 INFORMATION CERTIFICATION: I certthat the above infWnaf}om iS otqnd 1 have "required attachments. I CorNa-me-meE'EMERY Print IV of l:r/tea: " ' LANDsiCLEARING AND LORI EMERY -"" VICE PRESIDENT lGRADING, INC. "sc: fee A�'A1IT? t"�iii� s"�r`1 ��tua iaiu�tc� r �:r�'.i c`�v sqj=rf; f---1 c3`t exfrorm WutiC3iion ani tees. E 1 N>;us L can Tse, be ao .ed iii utit theregi (Q t s � ). �~fJ' � •a , '� Please make checks payable to *SCAQMD. Fees are per notification, not refundable, and vary acc&dft to the project size. Fees are as folium.' fiEMOLTON OR AaZ EST03 WMOVAL 1, PROCEffURE 4 OR 5 PIS °: A Edi 4L!u :A^L.`. = w sell T.7 ! SD=[II.TL UAKIn; NG LM F 226 .117 I i tOLa90 iLJ Iv I,:31ri u:dVTV i:.. a ii "-'-,J•L� � ::�• 1 1 FROM 1,001 TO 5,000 StIUARE FEET $ 90.24 REVISION OF NOTiFiCAT ION $11.94 FROM 5,001 To 10,000 SQUARE FEET $211.22 ! RETURNED CHECK CHARGE $ 29.28 .s.� gty:�cylATRI-M :!-"niu'`':i;.M Tn'n 1 _/i1 1i V'li! tVyFiIV SJ�YVTV�i4Lc! M+� '�"` e � • I DEMOLITION OF LESS vHAN 100 SQ FT $ 29-52 1 ASBESTOS REMOVAL AT ownff $ 2.5.52 ,sin& -unit dwelling MAIL FOR6° AND FEE TO: SCACIMID, ASBESTOS NOTIFICATIONS, RILE # 55641, LOS ANGELES CA SWI i P-ap 2 of 2 TELEPHONE: (909) 396-2336 FAX: (909) 3963342 Fort REV 20030527 - El'AP'KFTi in inwnFbi ..:')4iii.`i+ G- ('nnioae -T imm t uorrnn� Q— PA Gi PF, A49-, iGA01 `3tiw" lwj-k i BILL TO 10LI)RI[C LEY ENVIRONMENTAL CITY OF LA QUINTA P.O. BOX 1504 LA QUINTA, CA 92253 ATTN: TOM HARTUNG Environmental Remediation Contractor INVOICE JOB SITE SFR - VACANT 145 46JEFFERSON AVENUE LA QUINTA; CA 92253 . INVOICE DATE. 611612004 P.O. NUMBER CONTRACT INVOICE # BID # TERMS DUE DATE CONTRACT AMT REP ,e;. 6882AA .10936B DUE UPON RECEIPT 6116/2004 3,365.00 IFG DESCRIPTION 0MORK PROVIDED PER ATTACHED PROPOSAL AND CONTRACT: 3,365.00 ' REMOVE AND DISPOSE OF ASBESTOS CONTAINING MATERIALS.. w Interest at the rate of 1 '/2% per month will be Incl: a/s ❑ Proposal/Contract/Work order ❑ Purchase Order ❑ Certificate of Insurance ❑ Copies of Notification Letters. ❑ Supervisor's Log ❑ Dump Manifest ❑ Progress Payment/Releases APPROVED FOR PAYMENT ACCOM 00...�lQ.1-hl to -SS t • 3 a- �� Esc �2 � e�oc��• AMtr TO F%V due accounts BALANCE DUE $3,365.00 957 West Reece Street, San Bernardino, CA 92411, Lic. No. 610414 CAUOSHA No. 49 909-888-2010 800-530-3366 FAX 909-381-3433 I3ID\\_RC _' _j'EY ENV1R0NME,"__7AL I Environmental Remediation Contractor PROPOSAL & CONTRACT June 3, •2004 CLIENT: CITY OF LA QUINTA PROPOSAL. NUMBER: 10936B ATTN: TOM HARTUNG JOB NAME: VACANT SFR'S ADDRESS: P. O. BOX 1504 SITE ADDRESS: JEFFERSON AVENUE (SEE BELOW) CITY: LA QUINTA, CA ZIP: 92253 _ CITY: LA QUINTA, CA ZIP: 92253 PHONE: 760-777-7013 PROPERTY OWNER: FAX: 760-777-7011 CONTRACT AMOUNT: $3,365.00 - REMOVE AND DISPOSE OF ASBESTOS CONTAINING MATERIALS (ACM) PER SITE INSPECTION ON 5/24/04, IN QUANTITIES AND LOCATIONS AS OUTLINED BELOW: • ti ' 46145 JEFFERSON AVENUE • APPROX. 1,400 SQ. FT. OF,ACOUSTIC CEILING SPRAY—THROUGHOUT. • APPROX. 185 SQ. FT. OF 9" X 9" FLOOR TILE AND MASTIC. COST $3,265.00 SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJECT: COST $100.00 CLIENT/OWNER TO PAY ALL RE -NOTIFICATION FEES (MINIMUM $25.00 EACH) AND TO BE RESPONSIBLE FOR ALL FEES IF THE PROJECT IS CANCELLED. 46170 JEFFERSON AVENUE • APPROX. 25 SQ. FT. OF ROLLED GREEN LINOLEUM FLOORING (1ST LAYER). COST NO CHARGE 46425 JEFFERSON AVENUE • APPROX. 20 SQ. FT. OF ROLLED GREY FLOORING (1ST LAYER). COST NO CHARGE 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 REQUIRED PERSONAL AIR MONITORING AND. HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIED LABORATORY. AT THE COMPLETION OF THIS PROJECT, OR AS REQUIRED, BRICKLEY ENVIRONMENTAL WILL PROVIDE, COMPLETE DOCUMENTATION i.e. 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 Bernardino, CA 92411, Lic. No. 610414 CAUOSHA No. 49 Page f oft 909-888-2010 800-530-3366 FAX 909-381-3433 06/03/2004 15:'09 76077770" LA QUINTA PAGE 03 .FROM :BRICKLEY ENVIRONMENTAL FAX NO. :909 381 3433 02 2004 02:MPM P3 WORK SHALL BE PERFORMED 1N ACCOR13ANCE WITHIN OSHA, HPA, AND STATE REGULATIONS. THE ABOVF, WORK TO BE COMPLETED IN A SUBSTANTIAL AND WORIMIANLIKE MANNER ACCORDING TO STANDARD PRACTICES FOR THE SUM OF: THREE THOUSAND THREE HUNDRED SIXTY-FIVE DOLLARS {$3,365.00) A. TLaRlmg: DUE UPON RECEIPT UNLESO OTHERWISE ARRANGED e. THIS PROPOSAL. MAY BE WITHDRAWN BY BRICKLEY ENVIRONMENTAI. IF NOT ACCEPTED WITHIN 30 DAYS, C. CONTRACTOR WILL MAINTAIN INSURANCE IN THE AMOUNT OF $1,000,000.00 OR AS REQUIRED BY SPECIFICATIONS, D, CONDITIONS. THE TERMS AND CONDITIONS AS FOLLOW ARE EXPRESSLY INCORPORATED INTO THIS CONTRACT, IAN GORDtW_ _ PRO&CT MANAGER 1 ESTIMATOR ,,. ACCEPTANCE OF PROPOSAL, - THE ABOVE PRICES, SPECIFICATIONS, AND CONDITIONS ARE SATISFAC rORY AND ARE HEREBY ACCEPTED. YOU ARE AU-THH+O�R+IZED TO DOpTHE WORK SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABO CLIEeiu& re,SE CITY OF IA QUINTA 1093E1At AUT` RIZFD SIGMATURE DATE -6L Io L( L T*, m.4 d_.�,q ly E -Q TITLE: ADDITIONAL, TERMS & CONDITIONS OF CONTRACT TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED. INTEREST AT THE RATE OF I %OA PER MONTH WILL BE CHARGED ON ALL PAST DUE ACCOUNTS. IN THE EVENT OF FAILURE: TO PAY ANY OF THE AMOUNTS DUE ON THIS INVOICE, ALL COLLECTION COSTS, ANO/OR ATTORNEY'S FEES IN THE COLLECTION OF ANY SUCH AMOUNT, WILL BE PAID BY THE CLIENT, UNLESS OTHERWISE STATED IN THIS PROPOSAL, 13RICKLEEY ENVIRONIAENTAL WILL PROVIDE; ONLY THE OSHA REQUIRED PERSONAL AIR MONITORING. THE OWNER SHALL PRO'/IDE, AT THEIR COST, ALL ADOMONAL TESTING AND ALL FINAL CLEARANCE TESTING OR RETESTING ON THIS PROJECT. THIS BID OFFER IS BASED ON REMOVAL OF CERTAIN TYPES AND QUANTITIES OF HAZARDOUS AND NOW 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 A00I11`10NAL COSTS AND TIME TO COMPLETE THE AbDITIONAL WORK, PLEASE; BE ADVISED THAT THE OWNER OF THE PROPERTY AND GENERATOR OF ANY HAZARDOUS MATERIALS MAY BE SUBJECT TO MANIFEST 1 EPA NUMBER FEES ISSUED BY THE DEPARTMENT OF TOXIC SUBSTANCES CONTROL, (DTSC), ALL FEES ISSUED BY DTSC ARE THE RESPONSIBILITY OF THE OWNER / GENERATOR. FEIES ARE BILLED DIRECTLY FROM DTSC AND ARE NOT INCLUDED N THE CONTRACT AMOUNT. ALTHOUGH BRICKLEY ENVIRONMENTAL TAKES PRECAUTIONS TO AVOID DAMAGE: TO FINISHED SURFACES. SOME DAMAGE: MAY OCCUR, CIMCKLEY ENVIRONMENTAL SHALL NOT BE RES50NSIGLE FOR ANY SUCH REASONABLE COSMETIC DAMAGES NOR SHALL PAYMENTS TO BRICKLEY ENVIRONMENTAL BE REDUCED OR WITHHELD AS A RESULT , 1.0. DAGESAND WOODIDRYWALLOBARRIERS AND FASTEN NGI NG MATERIALS WHICH ARE RE 6U RED TO HOLD BARRICA ESPROM PLACEMENT o:j REMOVAL OF POLYETHYLFI•NN PLACE DURING ABATEMENT, ALL REPAIRS OR REFINISHING WILL BE PERFORMED ONLY UNDER SEPARATE WRITTEN AGREEMENT OR CHANGE ORDER BETWEEN BRICKLEY ENVIRONMENTAL ANO OWNER. THE OWNER. BY ACCEPTANCE OF BRICKLEY ENVIRONMENTAL BID OFFER. HERESY AGREES TO ABSOLVE BRICKLEY ENVIRONMENTAL OF ANY AND ALL RESPONSIBILITY FOR ITEMS OR OBJECTS WHICH MAY BE REPORTED DAMAGE=D, DESTROYED OR MISSING, UNLESS OWNER CAN PROVE BEYOND A REASONAESLE DOUBT THAT AN EMPLOYEE OR SUB CONTRACTOR OF BRICKLEY ENVIRONMENTW- 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, SACRAMENTO, CALIFORNIA 96828. P890 2 of 2 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE Y0: 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 6.4.04 CHECK # 2655 FEE $ 57.69 PROJECT # 6882 NOTIFICATION TYPE ORIGINAL PROJECT TYPE EMERGENCY REMOVAL SITE INFORMATION SITE NAME SFR SITE ADDRESS 46145 JEFFERSON AVE. CROSS STREET FIESTA DR. CITY LA QUINTA STATE CA ZIP 92253 COUNTY RIVERSIDE DESCRIBE WORK AND LOCATION ASB REMOVAL FROM CEILING BUILDING SIZE (SQ FT) 2,000 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 35 NUMBER OF DWELLING UNITS 1 BLDG PRIOR I PRESENT USE HOUSE SITE OWNER CITY OF LA QUINTA 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 6.10-04 END 6-10.04 WORK SHIFT 0800.1630 ASBESTOS AMOUNT TO BE REMOVED (in square feet) FRIABLE 1400 CLASS I 370 CLASS II TOTAL AMOUNT (ADD ROW) 1770 ASBESTOS REMOVAL FROM SURFACES AMOUNT OF EACH TYPE OF ASBESTOS (in square feet) ACOUSTIC CEILING 1400 LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC 185 FLOOR TILES (VAT) 185 DRYWALL 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 1 MOORE I GOMEZ PHONE 909.888.2010 ' LARGENT I CRUZ I GORDON I BOYT I WOOD 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 I 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 y 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 #D 2, 3�4, 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 I 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 regulation 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 inspection during normal business hours. BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 6.4-04 Company Name Print name of owner/operator Si Otur of Operator Tittle of Operator Date INFORMATION CERTIFICATION: I certify that the above information is correct and I h^enclosed any required attachments. BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 6.4-04 Company Name Print name of owner/operator SignatuTe 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:/NMW.AQMD.GOV Asbestos Demolition / Renovation Notification Form 080403 Page 2 of 2 :l 05/21/2004 14:04 7607777011 LA QUINTA PAGE 04 agwo P.O. Box 1504 78-495 CALLS TAmplco (760) 7 77-70 00 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: 46=480, 46-055, 46-145 Jefferson and. 80-020 Vista. Grande La Quinta, CA . We are requesting that SCAQMD waive the usual 1.4 -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) 777-7019, if you have any questions or concerns. Thank you for your attention to this matter, Sincerely, Tom Hartung Building,& Safety Director I 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: 6-4-04 JOB # 6882 NAME / ADDRESS OF EMPLOYER: CITY OF LA QUINTA P.O. BOX 1504 LA QUINTA, CA. 92253 ADDRESS OF JOB SITE: SFR JOB LOCATION: THROUGHOUT 46145 JEFFERSON AVE. LA QUINTA, CA. 92253 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: 6-10-04 JOB COMPLETION DATE: 6-10-04 DESCRIBE SCOPE OF JOB AND WORK PRACTICES (Inc. sq. ft.): SCRAPE AND REMOVE WET IN SECTIONS AND DISPOSE OF 1400 SQ. FT. OF ACOUSTIC CEILING, 185 SQ. FT. OF FLOOR TILE, 185 SQ. FT. OF MASTIC ESTIMATED NUMBER OF EMPLOYEES ON JOB: S+3 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 B,RIC.KLEY ENVIRONMENTAL SUPERVISOR DAILY LOG SHEET E - SUPERVISOR NAME: S c o-rr 5,.r yD CF/? -- N UINIB E R:--6 AS Z JOB NANIE r- JOB'SAI. ETY i\-[.I__.'f_'TtNiG NOTES & ATTENDANCE X )KMS: SUPER` ISOR- DAILY LOG SHEET See Enn i Exit Log For Attendance -, ABATEMENT START UP'. Jit*4t CK.)Ll$T*:-- YES.- - NO N1_ 7-INTRY/EXITLOGS, DECONTAMINATION PROCEEDUPES, EMERGENCY PLAN POSTED OB/EMPLOYEE FILES, EMERGENCY KIT. FIRE EXTINGUISHER ON SITE ZESPIR.ATOR B('.)AR-D UP, PROPER RESPIRATOR SELECTED/ USED ✓ WARNING SIGNS/ CRITICAL BARRIERS POSTED kIR MON ITO R ON S ITE & READY N 0 RK. A Rf A PRE -CLEANED N21. 'OLLY C 0 N1 "FAIN NIEN T ENCLOSURE INSTILLED )ECONTANMNA]"ION SYSTEMINSTALLED AND FUNCTIONING k'ATER FILTRATION SYSTEM INSTALLED 4EGATIVE PRESSURE ESTABLISHED RING ABATENIENT'C11E.0K Ll*S'T"'* YES: NO NIA \,ESP[R.AT()RS & SUITS WORN BY ALL PERSONNEL IN CONTAINMENT VET REMOVikl- PROPERLY BAGGED ACfvl / rvtC[Vf 40 SMOKING. DRINKING IN CONTAINMENT iEPA V,--\CU(.!NI (JSF-D 'ON TIN iVl RRIIER, WORKING PROPERLY -jEGA'I_IVE.---\lR. PRESSURE- OPERATIONAL 'l-ASONAL (.lrlL.j7.[NG DEC'ONTANIFNATION SYSTEM PROPERLY )KMS: SUPER` ISOR- DAILY LOG SHEET POST ABATEINIENTCRE.CK.'LIST ..�'.....: YESNO NU ;!\,ICLVI DEFINED IN SCOPE OF WORK REMOVED I - ALL %,'ASTE PROPERLY PACKAGED, LABELED & MANIFESTED INSPECTED FOR RESIDUAL DEBRIS A. 14ORIZONT:\L SURFACES - I.E. :FLOORS, PIPES, HVAC DUCTING, ETC B. VERTICAL SURFACES - I.E. - WALL REGISTERS, WINDOWS, LIGHTS, ETC WORK Al�El--k ACHI.E'VES VISUAL CLEARANCE 4. ENCAPSUL.--kTION OF WORK AREA 5. CLEAP\,kNC.EAIR SAMPLES -COLLECTED kRRJVAL Tll\,tL:7: _ o 7c.,o - ;COPE OF WORJ\*"./ FIELD NOTES: DEPARTURE TIME: Gy -77 L.J. - L11-1-I'Ll'Tr- -r. (A/1- �t kf- I - A yll-e- zj 15; r-, 4,,vs 117-0 LlAk"� $,-Kci '4�,- - L .2 '* r-4 L%e-- e S� i Li P-. SUPERVISOR DIMLY LOG SHEET BRICKLEY ENVIRONMENTAL SUPERVISOR DAILY LOG SHEET DATE:- Jjq-�jo SUPERVISOR NAME: !N'L n JOB NUMBER:A66a7 JOB NAME LD a%) s , PRE JOB SAFETY iVIEETING NOTES & ATTENDANCE See Entry / Exit Log For Attendance E ABATE lYIEI.T.5 t7P.'.C�EG�'- ._._. 1. ENTRY/EXIT LOGS, DECONTAMINATION PROCEEDURES, EMERGENCY PLAN POSTED_ �. JOB/EMPLOYEE FILES; EMERGENCY KIT, FIRE EXTINGUISHER ON SITE J. RESPIRATOR BOARD UP, PROPER RESPIRATOR SELECTED/ USED 1. WARNING SIGNS/ CRITICAL BARRIERS POSTED 5. AIR MONITOR ONSITE &,READY t 6. WORK AREA PRE -CLEANED 7. POLLY CONTAINNIENT ENCLOSURE INSTILLED. 8. DECONTAMINATION SYSTEM INSTALLED AND FUNCTIONING - 9. WATER FILTRATION SYSTEM- INSTALLED ). NEGATIVE PRESSURE ESTABLISHED . ... ..... . agent+ ABFIE AT...' E MENT: C ZSq I. -RESPIRATORS & SUITS WORN BY ALL PERSONNEL 1N CONTAINMENT WET REMOVAL / PROPERLY BAGGED ACM / MCM NO SMOKING. EATING, DRINKING IN CONTAINMENT HEPA VACUUM USED -7Z CONTINMENT BARRIER WORKING PROPERLY NEGATIVE AIR PRESSURE OPERATIONAL PERSONAL UTILIZING DECONTAMINATION SYSTEM PROPERLY !=ORMS: SUPERVISOR DAILY LOG SHEET POSTARATEAH. / ��a� •- .. .. .:. .. ... ...... .. .. Y,..'A.�.'1. nT:".'t:: ... ..+. r..v _:.:>i ',,:�'. •ufi'•i.ti ): r.:t i. ES 11A NO: •`: ACM / 1VICM DEFINED IN SCOPE OF WORK REMOVED I . ALL ACM / MCMI WASTE PROPERLY PACKAGED, LABELED & MANIFESTED ?. INSPECTED FOR RESIDUAL DEBRIS A. HORIZONTAL SURFACES - I.E. - FLOORS, PIPES, HVAC .DUCTING, ETC B. VERTICAL SURFACES - I.E. - WALL REGISTERS, WINDOWS, LIGHTS, ETC_ 3. WORK AREA ACHIEVES VISUAL CLEARANCE 4. ENCAPSULATION OF WORD AREA - 5. CLEARANCE AIR SAMPLES COLLECTED ARRIVAL TIME: 1Zlin DEPARTURE TIME: SCOPE OF WORK /FIELD NOTES: •'L vim- � ?"�..� dl. / . , >U.PERVISORS SIGNATURE FORMS: SUPERVISOR DAILY LOG SHEET BRICKLEY ENVIRONMENTAL SUPERVISOR DAILY LOG SHEET SUPERVISOR NAME: OB NUMBER: bCK1 71 JOB NAME 'RE JOB SAFETY MEETING NOTES & ATTENDAN See Entry / Exit Log For Attendance ATEII�IE W.I.N. 1 f•y'' .4J .. F. 'lid• N . I . ENTRY/EXIT LOGS, DECONTAMINATION PROCEEDURES, EMERGENCY PLAN POSTED _ c� 2. JOB/EMPLOYEE FILES; EMERGENCY KIT, FIRE EXTINGUISHER ON SITE -� 3. RESPIRATOR BOARD UP, PROPER RESPIRATOR SELECTED/ USED 4. WARNING SIGNS/.CRITICAL BARRIERS POSTED �. AIR MONITOR ON SITE & READY 6.. WORK AREA PRE -CLEANED ?. POLLY CONTAINMENT ENCLOSURE INSTILLED ' k 3. DECONTAMINATION SYSTEM INSTALLED AND FUNCTIONING_ 9. WATER FILTRATION SYSTEM INSTALLED 6. NEGATIVE PRESSURE ESTABLISHED _ r::::::.> :..........:.... 1. RESPIRATORS & SUITS WORN BY ALL PERSONNEL 1N CONTAINMENT WET REMOVAL / PROPERLY BAGGED ACM / MCM_ 3. NO SMOKING. EATING, DRINKING IN CONTAINMENT 4. HEPA VACUUM USED 5. CONTINMENT BARRIER WORKING PROPERLY_ 6. NEGATIVE AIR PRESSURE OPERATIONAL n ". PERSONAL UTILIZING DECONTAMINATION SYSTEM PROPERLY �C FORMS: SUPERVISOR DAILY LOG SHEET r P :a O. ARATUME ,..... ,. iol YES N ACM / MCM DEFINED IN SCOPE OF WORK REMOVED I . ALL ACM / yICM WASTE PROPERLY PACKAGED, LABELED & MANIFESTED X ?. INSPECTED FOR RESIDUAL DEBRIS A. HORIZONTAL SURFACES - I.E. - FLOORS, PIPES, HVAC DUCTING, ETC B. VERTICAL SURFACES - I.E. - WALL REGISTERS, WINDOWS, LIGHTS, ETC -_ 3. WORK AREA ACHIEVES VISUAL CLEARANCE 4. ENCAPSULATION OF WORK AREA - 5. CLEARANCE AIR SAMPLES COLLECTED ARRIVAL TIME 1 D DEPARTURE TIME: iu3p 'SCOPE OF WORK / FIELD NOTES: SUPERVISORS SIGNATURE : FORMS: SUPERVISOR DAILY LOG SHEET FROM :BRICKLEY ENUIRONMENTAL CLIENT: ATTN. FAX NO. :909 381 3433 May. 25 2004 01:52PM P4 BRICKLEY ENVIRONMENTAL, Environmental Remediation Contractor PROPOSAL & CONTRACT 0 CITY. OF LA QUINTA TOMHA TUNG ADDRESS: P. O. BOX 154 .CITY: LA QUINTA, CA ZIP: 92253 PHONE: 760-777-7013 FAX: 760-777-7011 May 25, 2004 PROPOSAL NUMBER: 10936 'JOB NAME: VACANT SFR SITE ADDRES8:48145 JEF__,FERSON=AVENUE=:I CITY: LA QUINTA, CA ZIP. 92253 PROPERTY OVVNER: CONTRACT AAIOU NT: $44;610:00 REMOVE AND DISPOSE OF ASBESTO CONTAINING MATERIALE., (ACM) PER SITE INSPECTION ON 5/24104, IN QUANTITIES AND LOCATIONS OUTLINED BELOW: • APPROX. 1,400 SQ. FT. OF ACOU IC CEILING SPRAY- THROUGHOUT. • APPROX. 185 SQ. FT. OF 9" X 9" FLOO TILE UNDER MASTIC, APPROX. 5,600 SQ. FT. OF PLASTER WALL AND CEILING. COST $14,385.00 SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJEC COST $225.00 CLIENT/OWNER TO PAY ALL RE-NOTIFICATICN FEES (MINIMUM $25.00 EACH) AND TO BE RESPONSIBLE FOR ALL FEES IF THE PROJECT IS CANCELLED. THIS PROPOSAL IS BASED ON PREVAILING WAGE DETERMINATIC-N C-102-882-1-2003-1, ISSUE DATE FEBRUARY 22, 2003 AT THE RATE OF $29.90 PER HOUR. BRICKLEY ENVIRONMENTAL WILL PROVIDE ALL OSHA REQUIRED PERS L AIR MONITORING AND HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIED LABORATO. AT THE COMPLETION OF THIS PROJECT, OR AS REQUIRED, BRICKLEY ENONMENTAL WILL PROVIDE, COMPLETE DOCUMENTATION i.e. -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 D SPOSAL 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 Bernardino, CA 92411; Lic. No. 61 (11.14 CAL/OSHA No. 49 r2iyn 1 ort 909.888.2010 800-530-3386 FAX 909.381.3433 FROM :BRICKLEY ENUIRONMENTAL FAX NO. :909 381 3433 May. 25 2004 01:52PM P5 WORK SHALL BE PERFORMED IN ACCORDANCE WITHIN OSHA, EP 4, AND STATE REGULATIONS. THE ABOVE WORK TO BE COMPLETED IN A SUBSTANTIAL AND WO'2KMANLIKE MANNER ACCORDING TO STANDARD PRACTICES FOR THE SUM OF: FOURTEEN THOUSAND SIX HUNDRED TEN**********************"'* '.********DOLLARS ($14,610,00) 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 $1,000,0[0.00 OR AS REQUIRED BY SPECIFICATIONS. 0, CONDITIONS: THE TERMS AND CONDITIONS AS FOLLOW ARE EXPRESSI.Y INCORPORATED INTO THIS CONTRACT. IAN GO PROJECT MANAGER I ESTIMATOR KEH MII I � I 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 #110936 DATE AUTHORIZED SIGNI%TURE TITLE ADDITIONAL TERMS & CONDITIONS OF CONTRACT TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED. INTEREST AT THE RATE OF 1%2% PER MONTH WILL BE CHARGED ON ALL PAST DUE ACCOUNTS, IN TI -IE EVENT OF FAILURE TO PAY ANY OF THE AMOUNTS DUE ON THIS INVOICE, ALL COLLECTION COSTS, AND/OR ATTORNEY'S FEES IN TIE 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 PROJECT, THIS BID OFFER IS BASED ON REMOVAL OF CERTAIN TYPES AND QUANTITIES OF HAZARDOUS AND NOW HAZARDOUS MATERIALS AS LISTED IN THE PROPOSAL. IF ADDITIONAL OR CONCEALED HAZARDOUS MATERIALS ARE FOUND AND THE OWNER CHOOSES ABATEMENT, A CHANGE OR[ ER 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 GENE 2ATOR 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 RESPONSIBILITY OF THE OWNER 1 GENERATOR, FEES ARE BILLED DIRECTLY FROM DTSC AND ARE NOT INCLUDED IN THE CON-RAC:T 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. Le. DAMAGES STEMMING FROM PLACEMENT CR 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 PERFOF.MED ONLY UNDER SEPARATE WRITTEN AGREEMENT OR CHANGE ORDFR BETWEEN BRICKLEY ENVIRONMENTAL AND OWNER. THE OWNER, BY ACCEPTANCE OF BRICKLEY ENVIRONMENTAL BID )FFER, HEREBY AGREES TO ABSOLVE BRICKLEY ENVIRONMENTAL OF ANY AND ALL RESPONSIBILITY FOP 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 I:i 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 REFERRtO 1"0 TI IE REGISTRAR, CONTRACTORS' STATE LICENSE BOARD, P,O, BOX 26000, SACRAMENTO, CALIFORNIA 95826. Pape 2 of 2 Juji:il,-2004 I'larLangs ;pity Of J,,a Qui po'x'.1.504 TRES.IERRASCONST Tie'sierras Cons General tollp 2235 North Lake Avenue, 5 Tel: (626). 794-M33 - Fax: (626) F Ave, 809.20.Vista'Grande,46-145.1 .�.ons"ction Inc is p E.QF WQWRk: -no v4l a)iQ).Js0osal Of asbestos materials designs 4 PIN 0510#16: : P roj e xpje�,( A 2. Provide MI. three stage.Accon system, Negative air 5 'fleation �p all regul4t d ao i�cies, Cal -OSHA, S1 iii- L.3 N�;h e atLicens -41 Liability -ance and Workman, 5. :Provide Ge4i ylnsul 6: This project !,perforn)ldunder �revailingwiges se _4 .l k7i0100ctor*V provide water ano power to project I PSI )riceJeRnot i10ud'eTh4 Industrial Hygiet ---------- 1 46c390 5 " iq� sqri G Q')Q Vista Grande Ave r-:3. 46- 4 s Jeffqwn.Ave ---------------------- di this propose ,Sriljdyoullav Mptis regarding any Que� 26.-6 ffi�e 626-794-3-333, -001, .257�W, 0 ;Tits propo! ;aIfiema6"open foi thirty (30) days fr, a4i� Void Withqpl,any furdiet noti W, Cee - Y'. - S b)m ifted, rr'�'sierras Con tnicholl _3Z _ �;. ,.4- --. [. .lir. i •+)� f' :�� J�`J��_\ _ C a I'd � • r-�ISS='�/ *, "kTr: ic . rra �4 M 626 289 2085 P.02 ±Udlon, Inc. tractors "R ? 107, Altade-ia, CA 91001 Vu 4 4-3339 • Ste to Ucens4! 725996 A Person Ave 01: w bid .3 - to submit for -/our review a ltunp.�uni i pr 144 TV.! ed in you sure ey provided ()n June 2, 2604 4 1, project # PLM 050#1.130 istern to remain running'until final aif 616aT4ne is ..:_7 Ks 'AQMD and City Penni ling. :d Land fill A2 usa Land Reclamation. ,ompensation --ertificad0n.: ieduled for Re leveloptnint'Agenry, }cation. J I ist Services. r --------- — $13,634.44 8,499.0 please do not hesitate t4 call me at following lisi tj ai the first written, at wqiclitiTnc'lt'sbi'll bi66ir4"4611 J 06/01/2004 13:32 P.O. Box 55329 Riverside, CA 92517 (909)524-1665 7603237743 SCOTT MORRISON & ASS SCOTT MORMON & ASSOCIATES ASBESTOS SURVEY REPORT (Addendum) Completed On June 01, 2004 PLM0510#1130add Client: Tom Hartung's Office City of Le Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 46-10 Jefferson Ave. La Quinta, CA (interior wall plaster only) PAGE 04 31855 Date Palm. Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 On May 24, 2004 an asbestos reinspection and bulk sampling was conducted at the above project address. Bulk samples were taken of the interior wall plaster c my 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 101768-0 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 wimpling 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 colincted 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) 06/01/2004 13:32 P.O. Box 55329 Riverside, CA 92517 (909) 624-1665 7603237743 PLM0510#1130add SCOTT MORRISON & ASS SCOTT M.ORRISON & AS:30CIATES PAGE 05 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 Sample #QT -99a Type of material: interior wall plaster/ grey Location: interior N, wall, NW bedroom Area:throughout interior walls Friable:no Results: none dl?tested Sample #QT -99b Type of material: interior wall plaster/ grey Location: interior W_ wall, NE bedroom Arewthroughout interior walls Friable:no Results: 0.70% Chrysotile asbestos (7 pts./1000) Sample NOT -99c Type of material: interior wail plaster/ grey Location: interior E. wall, SL living room Area:throughout interior walls Friable:no Results: 0.10% I;hrysotille asbestos (1 pt./1000) Inspector (A�� Scott C. Morrison Certified Asbestos Consulta -it DOSH#92-0248 (2) 06/01/2004 13:32 7603237743 W!01-04 04:04pm From -CAROLINA ENVIROMENTAL CAft JW8iW0#MffAL, W- 1074Aw&NmCWACWXNC2M1 sft 0*.4014413 Fmnr. (9 t)4ej4442 Client: Scott Morrison & Associates 31655 Date Palm Dr, Suite 3-507 Cathedrel City, CA 92234 ProJeat: PLM0510#1130add SCOTT MORRISON & ASS N PAGE 06 +4811442 T-788 P.02/04 F-331 LABORATORY REPORT Aga9ST0S SULK ANALY313 CEI Lob Code: A04-3907 ROCOIVOd: 05-27.04 Analyzed: 06-01.04 Reported: 06.01.04 Analyst, Gary A, Swanson CLIENT Id 1 HOMOGENEITY DESCRIPTION � !~ABD ID nae�gTpS QT -99A A266298 PLASTER (POT CQUNTI NO Homogeneous, Grey, Non-fibrous, Swrld BIND 100% No esbestoS detected in sample, 0 CHRY points In 1000 TOTAL points. QT -99B A266299 ELASTER - (POINT COUNT) Homogeneous, Grey, Non-fibrous, Bound CHRY 0.70% BIND ' 69.30 % 0.70 CHRY ■ (7 CHRY points f 1000 TOTAL points) x 100 QT -99C A266300 Homogeneous, 0.10 CHRY = (1 CHRY point/ 1000 TOTAL pointe) x 100 PLASTER (POINT COWNT) Grey, Non.fibrVus, Bound CHRY 0.10% BIND 99.20% CHRY 0Jb % CHRY 0.10% Pop t ProjecMase and VACANCY WALKTHROUGH Any and all personal property left on the project premises located at 4(o" M S - J e -61P /J env S6, /n6-VC�'t J'1� . V1 ��V 7 is to be considered abandoned as ofu o , AS EVIDENCE BY SIGNATURE AND DELIVERY OF KEYS I HEREBY AGREE THAT OCCUPANCY OF THE LISTED ADDRESS HAS BEEN ABANDONED AND THATNOF FURTHER ENTRANCE TO THE ABOVE ADDRESS WILL BE MADE. X Aw. /v, A9Z.-a � Claimants) e REPLACEMENT ADDRESS: XX 51,310 Claimant(s) Signature at 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: X Relocation Representative bate ❑ There are tenants remaining on this property. AThis property is now vacant ❑ Abandoned property remains on site PROPERTY MANAGEMENT Keys given to: Date: Received by :X ' Overland,Paci6c & Cutler, Inc. 07/03 notes: P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORRISON & ASSOCIATES ASBESTOS SURVEY REPORT Completed On May 17th, 2004 PLM0510#1130 Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 46145 Jefferson Avenue La Quinta, CA (3 bedroom single family home with attached garage) 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 On May 10th, 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 (11) 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. ASBESTOS INSPECTION BY: Timothy Morrison, DOSH #02-3142 BULK SAMPLES' ANALYZED BY: Carolina Environmental, Inc., NVLAP #101768-0 (1) U } The results on the following page(s) indicate that asbestos was detected in 06 of the 11 samples analyzed. PLM0510#1130 Sample #QT -95 Type of material: acoustical ceiling- white Location: interior ceiling of west -central livingroom Area: approx. 1395 total sq. ft. Friable:yes Results: 10% Chrysotile asbestos Sample #QT -96 Type of material: acoustical ceiling- white Location: interior ceiling of southeast diningroom Area: approx. 1395 total sq. ft. Friable:no Results: 10% Chrysotile asbestos Sample #QT -97 Type of material: acoustical ceiling- white Location: interior ceiling northwest bdrm & HVAC closet Area: approx. 1395 total sq. ft. Friable:yes Results: 10% Chrysotile asbestos Sample #QT -98 Type of material: final coat- tan (1 rst layer) Location: interior north wall of northwest bedroom Area: throughout interior walls of home Friable:yes Results: none detected Sample #QT -99 v�. ?•p Type of material: plaster- light grey (2nd layer) Location: behind sample #QT -98 in northwest bedroom Area: throughout interior walls of home Friable:no Results: 2% Chrysotile asbestos Sample #QT=100 Type of material: rolled vinyl floor- white/tan Location: floor of kitchen Area: approx. 150 sq. ft. Friable:no Results: none detected Sample #QT -101 Type of material: 9" floor tile- grey (1 rst layer) Location: floor of southwest diningroom under carpet Area: approx. 135 sq. ft. Friable:no Results: 5% Chrysotile asbestos Sample #QT -102 Type of material: floor tile mastic- black (2nd layer) Location: under sample #QT -101 Area: approx. 135 sq. ft. Friable:no Results: 5% Chrysotile asbestos (2) 1 P.O. Box 55329 Riverside, CA 92.517 (909)624-1665 PLM0510#1130 SCOTT MORRISON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 Sample #QT -103 Friable:no 1 Type of material: stucco- salmon color (1rst layer) . Location: exterior west wall Area: throughout exterior walls Results: none detected Sample #QT -104 Type of material: plaster- grey (2nd layer) Location: behind sample #QT -103 Area: throughout exterior walls Friable:no Results: none detected Sample #QT -105 Type of material: roof felt- black Location: exterior roof under wood shingles Area: throughout exterior roof . 1=riable:no Results: none detected Note: The one (1) transite pipe located above the south-central roof is presumed asbestos containing material (ACM). 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 Gy' G • ar-�--- 'Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 (3) May -14-04 li:31am From -CAROLINA ENVIRONMENTAL CAROUNP EMARONMENTAI, INC, 10TNewEdNtonC 4Cary,NC21511 Phone: (919). 4811413 Fax: ('9119) 4811442 Client: Scott Morrison & Associates 31855 Date Palm Dr. Suite 3-507 Cathedral City, CA 92234 Project: PLM0510#1130 +4811442 T-364 P.02/05 F-056 LABORATORY REPORT ASBESTOS BULK ANALYSIS CEI Lab Code: A04-3495 Received; 05-13-04 Analyzed: 05-14-04 Reported: 05-14-04 Analyst; Scott Minyard CLIENT ID LAB ID HOMOGENEITY DESCRIPTION ASBESTOS QT -95 A261404 ACOUSTICAL CEILING CHRY 10% Heterogeneous, Beige, Fibrous, Loosely Bound CHRY 10% BIND j 40% CELL <1 PAINT 15% MICA 35% QT -96 A261405 ACOUSTICAL CEILING CHRY 10% Heterogeneous, Beige, Fibrous, Loosely Bound ' CHRY 10% BIND 40% CELL <1 r PAINT 15% MICA 35% QT -97 A261406 ACOUSTICAL CEILING CHRY 10% Heterogeneous, . Beige, Fibrous, Loosely Bound CHRY 10% BIND 40% CELL <1% PAINT 15% MICA 35% QT -98 A261407A PLA&EJR FINAL COAT ND Heterogeneous, Beige, Fibrous, Bound PLAS 90% CELL <1 % PAINT 10% A261407B PLASTER BASE COAT Heterogeneous, Grey, Fibrous, Bound CHRY 2% PLAS 98% CELL <1 % QT -100 A261409 VINYL FLOORING Heterogeneous, Beige, Tan, Fibrous, Bound VINYL 50% CELL 115% B1NO 30% F8GL 5% .CHRY 2% ND Page 1 May -14-04 11::31am� From -CAROLINA ENVIRONMENTAL +4811442 T-364 P. 03/05 F-856 CARflL19VARWRDNM&4TAL,INC. Project: PLM0510#1130 107 New WWn CWt% Cary, NC 27511 Phxw 9184$1.1413 Fax: 919-081-1442 Lab Code: A04-3495 y CLIENT 10 L HOMOGENEITY DESCRIPTION AS9ESTOS QT -101 A261410 FLOOR TILE CHRY 5% Heterogeneous, Beige, Gold, Fibrous, Tightly Bound CHRY 5% VINYL 92% CELL <1 MICA 3% QT -102 A261411 A4ASTIC CHRY 5% Heterogeneous, Black, Fibrous, Bound CHRY 5% MAST., 95% CELL <1 % QT -103 A261412 STUCCO NO Heterogeneous, Pink, Non-fibrous, Bound PLAS 80% CELL PAINT 20% ; QT -104 A261413 PLASTER ND Heterogeneous, Grey, Non-fibrous, Bound PLAS: 100% CELL <1 % QT -105 A261414 FELT NO Heterogeneous, Black, Brown, Fibrous, Bound TAR . 45% CELL 55% Page 2 May -14=04 11:31am From -CAROLINA ENVIRONMENTAL +4811442 T-364 P.04/05 F-856 The following definitions apply to the abbreviations used In the ASBESTOS BULK ANALYSIS REPORT: N D = None Detected NTREM = Non-Asbestiform PERIL = Perlae NANTH = Non-Asbestiform Tremolite RUBR =Rubber. Anthophyllite CLIENT: Scott Morrison & Associates , PROJECT: PLM0510##1130 CEI UW CODE: A04-3495 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 Noor tiles have been manufactured using greater than 1 % 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 / 6001 R-931116 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 NVL.AP 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. ANALYST REVIEWED BY Tiranboo Bai, Ph.D. Laboratory Director End of 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 = Wollastonite MAST = Mastic ACTN = Actinolite CERWL = Ceramic Wool PLAS =Plaster N D = None Detected NTREM = Non-Asbestiform PERIL = Perlae NANTH = Non-Asbestiform Tremolite RUBR =Rubber. Anthophyllite CLIENT: Scott Morrison & Associates , PROJECT: PLM0510##1130 CEI UW CODE: A04-3495 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 Noor tiles have been manufactured using greater than 1 % 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 / 6001 R-931116 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 NVL.AP 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. ANALYST REVIEWED BY Tiranboo Bai, Ph.D. Laboratory Director End of Report n May -14-04 11:32am From -CAROLINA ENVIRONMENTAL CA{ LU Q H Leno � a Q z 0 +4011442 T-364 P.05/05 F-656 III I13 N1 III 0 M a III a 'I 'ZI�� u� 5 I�, c h � CA{ LU Q H Leno � a Q z 0 +4011442 T-364 P.05/05 F-656 III I13 LLI III III I III � 'I 5 I�, 7 !, V � i oo II � c� A pt SCOTT MORRISON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, Ste. #3-507 Riverside, CA 92517 Cathedral City, CA 92234 (909)624-1665 (760)323-7743 ASBESTOS SURVEY REPORT (Addendum) Completed On June 01, 2004 PLM0510##1130add Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 46-1�5 Jefferson Ave. La Quinta, CA (interior wall plaster only) On May $4, 2004 an asbestos reinspection and bulk sampling was conducted at the above project address. Bulk samples were taken of the interior 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 101768-0,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) SCOTT MORMON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, Ste. #3-507 Riverside, CA 92517 Cathedral City, CA 92234 (909)624-1665 (760)323-7743 PLM051 0#1 130add Sample #QT -99a Type of material: interior wall plaster/ grey Location: interior N. wall, NW bedroom Area:throughout interior walls Friable:no Results: none detected Sample #QT -99b Type of material: interior wall plaster/ grey Location: interior W. wall, NE bedroom Area:throughout interior walls Friable:no Results: 0.70% Chrysotile asbestos (7 pts./1000) Sample #QT -99c Type of material: interior wall plaster/ grey Location: interior E. wall, SE living room Area:throughout interior walls Friable:no Results: 0.10% Chrysotile asbestos (1 pt./1000) Inspector Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 0 (2) Jun -01-04 04:04pm From -CAROLINA ENVIRONMENTAL +4811442 T -T68 P.02/04 F-331 00' ENMRONMENTAL, INC. LABORATORY REPORT 107 '6wEdftionCmACwy,NCZ7S11 ASBESTOS BULK ANALYSIS Phone: (919).481.1413 Fax: (918)481.1442 ' Client: Scott Morrison & Associates CEI Lab Code: A04-3907 31855 Date Palm Dr, Suite 3-507 Received: 05-27-04 Cathedral City, CA 92234 - Analyzed: 06-01-04 Reported: 06.01-04 Project: PLM0510#1130add Analyst: Gary A, Swanson CLIENT 10 CEI HOMOGENEITY DESCRIPTION % LABID ASBESTOS QT -99A A266298 PLASTER (POINT COUNT), NO Homogeneous, Grey, Non-fibrous, Bound BIND ' 100% No asbestos detected in sample. 0 CHRY, points in 1000 TOTAL points. QT -99B A266299 Homogeneous,. 0.70 CHRY = (7 CHRY points 1000 TOTAL points) x 100 QT -99C A266300 Homogeneous, 0.10 CHRY = (1 CHRY point/ 1000 TOTAL points) x 100 PLASTER (POINT COUNT) Grey, Non-fibrous, Bound CHRY 0.70% • BIND 99,30% PLASTER (POINT COUNT) Grey, Non-fibrous, Bound CHRY 0.10% BIND , 99.90 % CHRY 0.70% CHRY 0.10% Page t Jun -01-04 04:06pm From -CAROLINA ENVIRONMENTAL +4811442 T-768 P.03/04 F-331 `v The following definitions apply to the abbreviations used In the ASBESTOS BULK ANALYSIS REPORT: CHRY = Chrysotile CELL = Cellulose DEBR = Debris AMOS = Autosite FBGL = Fibrous Glass BIND = Binder CROC = Crocidolite ORGN = Organics SILI = Silicates TREM = Tremolite SYNT = Synthetics GRAV = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTN = Actinolite CERWL = Ceramic Wool PLAS = Plaster. N D = None Detected NTREM = Non-Asbestiform PERL = Perlite NANTH = Non-Asbestiform Tremolite ARUBR ;Rubber nthophyllit® CLIENT: Scott Morrison & Associates PROJECT: PLM051 0#1 130add CEI LAB CODE: A04-3907 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 naterial in question. Unless notified in writing to return samples, Carolina Environmental, Inc. will discard all bulk samples ifter 30 days. tlany 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 arm of analysis for vinyl floor tiles. : is certified by the signature below that Carolina Environmental, Inc. is accredited by the National Voluntary Accreditation 'rogram (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA / 600 / M4-82 / 020 for ,e analysis of asbestos in building materials. Procedures described in EPA / 600 / R-93 / 116 have been incorporated there applicable, The detection limit for the method Is 0.1 % (trace amount). Carolina Environmental, Inc.'s NVLAP ccreditation 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. Dust and soil analyses for asbestos using PLM are not covered under NVLAP accreditation, i REVIEWED BY e Tianbao Bai. P . Laboratory Director End of Report Fina: SeW Morriron & Amoeialu P.O. Bos 55329 gives CA 92517 (760)323.-7743 CHA[N OF CUS�'ODY y- yd - Eaviron e+alina ne X-26&-22 p To: Ca _ A.2CoG�o ental, Inc. o 187 New Edition Coon Cary, NC 27511 0 (919) 481-1413 0 NVLAP Coda 181768-0 CA RLAP #2465 3 CZiest: LlIt, d Ca Urit-4f Pen= Taking Sampiea: 711W Morl10A Job No, PLU+�OSl41130aWWAddrew. q� -qqS )44-foh Aw • 0 `A Sample # Semple Dm MaterW & Deaciption PLM 1 AA -ft Odw lArns ion �- Q -f(4 1 �,�1rr`cr walk l� ftp Pl Lfit 7o o�,[��sC Quiif T- i C i l4frj'dy LVA Q ✓ r % �g Ay. �WMOrt Uk ' - I /iw bit_ T Fax in lwuits ? r✓ Ya No T w r Re iragei*M By: `� Dst*mme: OSI L S �G Iteeeived Dy:± -Y, A PADatdrime: �% - lYlsit/Fta To: Soott Moniena & AsociatM 31855 Date Palm Dr., See. 0-597, Catbedral City, CA 92234,(760) 32.3.7743 "PROPOSAL" EMERY LANDCLEARING AND GRADING, INC. P.O. BOX 1009 THERMAL, CA 92274-1009 760/391-5840 FAX: 7601391-5839 LIC. #600283 JUNE 11, 2004 CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA, CA 92253 ATTN: MR. TOM HARTUNG 760x777-7013 FAX: 760777-7011 SUBJ: DEMOLISH REMOVAL OF HOUSE 46-145 JEFFERSON STREET LA QUINTA, CA EMERY LANDCLEARING AND GRADING, INC., PROPOSES TO DEMOLISH REMOVE AND DISPOSE OF ONE HOUSE AND DEBRIS, WORK TO BE PROVIDED AS SPECIFIED BELOW: UPON ASBESTOS REMOVAL (BY OTHERS) 1. TO DEMOLISH REMOVE AND DISPOSE OF ONE HOUSE STRUCTURE. .2. TO REMOVE AND DISPOSE OF MISC. TRASH AND DEBRIS LEFT FROM PREVIOUS OWNER. 3. TO REMOVE AND DISPOSE OF CONCRETE FOUNDATION. 4. TO PUMP AND REMOVE SEPTIC SYSTEM IF APPLICABLE TO CAP OFF SEWER 5. SITE TO BE LEFT AT GRADE UPON COMPLETION. 6. FENCING ALONG GOLF COURSE TO BE LEFT INTACT. NOTES: I. OWNER TO SUPPLY WATER FOR PM -10 DUST CONTROL (EMERY TO SUPPLY HOSE). 2. OWNER TO SUPPLY ANY ADDITIONAL REQUIREMENTS FROM CITY, STATE OR COUNTY. 3. THIS IS A PREVAILING WAGE JOB. 4. IF ANY BEES, WASPS OR RODENTS LOCATED, OWNER TO HAVE PROFESSIONALLY REMOVED. 5. IF ANY BASEMENTS OR BURIED DEBRIS LOCATED, ADDITIONAL COSTS TO BE DETERMINED ON-SITE. TOTAL PROPOSAL: $15,000.00 DOLLARS PAYMENT TO BE MADE AS INVOICED. ACCEPTED BY: /1 EMERY BY: Nal" a a a a.as. v 1t.t, t rt r.J1LJ1:1V 1 V DATED: JUNE 11.2004 BID GOOD FOR 30 DAYS. CITY A BY: L �j" t-rC G TITLE: DATED: 11 FROM :BRICKLEY ENVIRONMENTAL FAX NO. :909 381 3433 Jun. 03 2004 03:23PM P2 Environmental Remediation Contractor PROPOSAL & CONTRACT June 3, 2004 CLIENT_ CITY OF LA QUINTA PROPOSAL NUMBER: 108368 ATTN: TOM HARTUNG JOB NAME; VACANT SFR'S ADDRESS: P. O. BOX 1504 SITE ADDRESS: JEFFERSON AVENUE (SEE BELOW) CITY: LA QUINTA, CA ZIP: 92253 CITY: LA QUINTA, CA ZIP: 92253 PHONE: 760-777-7013 PROPERTY OWNER: FAX; 760.777.7011 CONTRACTAMOUNT: $3,363.00 REMOVE AND DISPOSE OF ASBESTOS CONTAINING MATERIAL3 (ACM) PER SITE INSPECTION ON 5/24/04, IN QUANTITIES AND LOCATIONS AS OUTLINED BELOW: 46145 JEFFERSON AVENUE • APPROX. 1,400 SQ, FT, OF ACOUSTIC CEILING SPRAY : THROUGHOUT. • APPROX. 185.SQ. FT. OF 9"X 9" FLOOR. TILE AND MAS" IC. COST $3,265.00 SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJECT: COST $100.00 CLIENT/OWNER TO PAY ALL RE -NOTIFICATION FEES (MINIMUM $25,00 EACH) AND TO BE RESPONSIBLE FOR ALL FEES IF THE PROJECT IS CANCELLED, 46170,JEFFERSON AVENUE • APPROX. 25 SQ. FT, OF ROLLED GREEN LINOLEUM FLJORING (18T LAYER). COST NO CHARGE 46425 JEFFERSON AVENUE • APPROX, 20 SQ. FT. OF ROLLED GREY FLOORING (1sT LAYER). COST NO CHARGE 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 REQUIRED PERSONAL AIR MONITORING AND HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIED LABORATORY, AT THE COMPLETION OF THIS ' PROJECT, OR AS REQUIRED: BRICKLEY ENVIRONMENTAL WILL PROVIDE, COMPLETE DOCUMENTATION i.e. 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 Bernardino, CA 92411, Lic.. No. 61(414 CAUOSHA No. 49 rage 1 ur2 909-888-260 800-530-3366 FAX 909.381-3433 FROM :BRICtZLEY ENVIRONMENTAL FAX NO. :909 381 3.433 Jun. 02 2004 02:55PM P3 WORK SHALL BE PERFORMED IN ACCORDANCE WITHIN OSHA, TEPA, AND STATE REGULATIONS. THE ABOVE WORK TO BE COMPLETED IN A SUBSTANTIAL AND'WORKMANLIKE MANNER ACCORDING TO STANDARD PRACTICES FOR THE SUM OF: THREE THOUSAND THREE HUNDRED SIXTY-FIVE *****•""""* •***•*••««*****aa DOLLARS ($3,365 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 $1,000,000.00 OR AS REQUIRI_D BY SPECIFICATIONS, D. CONDITIONS: THE TERMS AND CONDITIONS AS FOLLOW ARE EXPRESSLY INCORPORATED INTO THIS CONTRACT, l r IAN GORDblq-7'PROJECT MANAGER / ESTIMATOR Rr� 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 ABO CLIENT ' 6�'dkl� T CS tt°illb(P-esr CITY OF LAQfUINTA 1t10936A AUTHORIZED SIGNATURE DATE ( l 3o 1 . TITLE ADDITIONAL TERMS & CONDITIONS OF CONTRACT TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED. INTERES'r AT THE RATE OF H WILL i'fi% PER MONT BE CHARGED ON ALL PAST DUE ACCOUNTS. IN THE EVENT OF FAILURE? 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 PRO -ADE, AT THEIR COST, -ALL ADDITIONAL TESTING AND ALL FINAL CLEARANCE TESTING OR RETESTING ON THIS P70JECT. 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 GENERATOR 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 RESPONSIBILITY 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 RES.'ONSIBLE FOR ANY SUCH REASONABLE COSMETIC DAMAGES NOR SHALL PAYMENTS TO BRICKLEY ENVIRONMENTAL BE REDUCED OR WITHHELD AS A RESULT THEREOF, 1.0. DAMAGES STEMMING FROM PLACEMENT Oil 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 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 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 REGUu4TEO BY THE CONTRACTORS' STATE LICENSE BOARD. ANY QUESTIONS CONCERNING A CONTRACTOR WY BE REFERRED TO THE REGISTRAR, CONTRACTORS' STATE LICENSE BOARD, P.O, BOX 26000, SACRAMENTO, CALIFORNIA 95826. P -go 2 of 2 06/01/2004 13:32 P-0. Box 55329 'PumAde, CA 92517 (909) 624-1665 INVOICE. 7603237743 SCOTT MOFRISON & ASS PAGE 07 SCOTT MORI ISON & ,ASSOCIATES 31655 bite pRIM Drina Ste. #3-507 CathedrA1'Qty, CA 92234 (760)323-7743 Client. Tom Hartung's Offices 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'.O# Bile name: PLM0427#1226add 'PLM0510#1130add PLM0510#1631add asbestos reinspection/ bulk sampling: 2 days @ $90,00 ea. _ $ 180.00 09 total bulk samples for 1,000 point -count analysis @ 8.125.00 each'.= $1,125,00 # hours of travel time @ $.'each = included Total amount due @ $1,305.0.0 '`Includes lab. reports Please send payment to: 31855 Date Palm Drive, Stia, 83407 Cathedral City, CA 92234 APPROVED FOR PAYM-ENT- Terms: Net 15 days. aY 8Y ACCOUNT No Thank you. DESCMPT e e (.0-C AMr roPY►r..�.r...l.._._3 0.� SCOTT MORRISON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, Ste. #3-507 Riverside, CA 92517 Cathedral City, CA 92234 (909)624-1665 (760)323-7743 CM! F! ()7egad SAY 1 RECD INVOICE RIIILka s Date:: May 14, 2004 Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. BOX 1504 La Quinta, CA 92253 Project:` 46-145 Jefferson Ave. 80-020 Vista Grande Inspection date: May 10 , 2004 Project/ P.O# File name: PLM0510#1130 PLM0510#1631 asbestos inspection/ bulk sampling: 2 single-family homes @ $125.00.ea. = $250.00- 27 total bulk samples for analysis (PLM) @ $20.00 each = $540.00 # hours of travel time @ $ each =. included Total amount due = $790.00 Please send payment to: 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 Terms: Net 15 days ; APPBJDV50 FOR PAYMENT BY ` Thank you. BY -7 ACCOUNT No. -/-/ / IO -SS �� 3o/6 DESCRIPTIO �_ i �0�0" AMT TO PAY 1719 9 O C4__J_1e.:�61 s f�I4 GENERATOR'S COPY EG+ONTRACT1aR8 P.O. Box all San Bernardino, CA 92411 ;' 4 TR.4N8PORTA770N, Phone (909) 884-7424 ,NC. Fax (909) 884-3744 NON -HAZARDOUS 1. Generator's US EPA ID No. Manifest Doc. No. 2. Page lC� WASTE MANIFEST f 17365 NOT R F. O U I R E D of I rt 3. Generator's Name and Mailing Address , .r �1 l•? PInY IF LAS{ 4fINTA Q� -q LA CA 92253 14 QUINTA, 4. Generator's Phone ( 760 ) 777-7013 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone ,. BRTCKLEY ENVIRONMEti'PAL IC A R 0 0 0 0 5 3 1 7 3 (`_a0u)88A-2810 Y 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone C 47 T I C A R 0 0 0 0 4 9 0 6 4 (90n)884-7424 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone AZUSA LA14D RECLAMATION 1211 W. GLADSTONE AZUSA, CA 91702 ` C A D 0 0 g U 0 7 6, 2 6(62G)339-bi:19 Description11. Waste Shipping Name and No. Type Quant WtIvol. a.110N FRIABLE ASBESTOS WASTE b. s} C. d.l D. Additional Description for Materials Listed Above E. Handling Codes for Wastes Listed Above 15. Special Handling Instructions and Additional Information EMERGYEt•iCY CONTM7 PII01iE 9 (800) 535-5053 EPA REGION .IX (41.5) 744-1089 75 RAWTHORNE ST., SAtf FPAIICTSCO, CA 94105 SCAQMD (909) 30-6-2335 21.865 E. r'OPLEY .DR., DIAMOND BAP., CA 91765 4 GENERATOR'S16. CERTIFICATION: Printedlfyped Name I Signature Month Day yew 17. Transporter 1 Acknowledgment of Receipt of Printed/Typed Name Materials S pature Month Day rao -I;1,a . �_ , 11 ul 4 U Transporter I Acknowledgment Receipt W U-• t18. .. of of Printed%rryped Name !• Materials Signature ' Month/Day raw ' 19. Discrepancy Indication Space • Facility Owner or •. d by this manifest except as noted Printed/Typed Name Signature \ Mon"' Day roar GENERATOR'S COPY �1 i 7' e�Cft,r �f 7C�/ J ��f.i��': State of 'aliforni EnAgency ironmenlal rofection Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back Of page 6. r pp p" P 9 Department of Toxic Substances Control Please print or type. Form designed for use on elite (12 -pitch) typewriter. Sacramento, California 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 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal low. WASTE MANIFEST of CIAIDI 9113111410101511181 0 1 6 1 R R 1 2 3. Generator's Name and Mailing Address A. State Manifest Document Number CITY OF LA QUINTA 23535738 P.O. BOX 1504 B. State Generator's ID LA QUINTA, CA 92253 ' 4. Generator's Phone ( 760) 777-70.13 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID [Reserved.] D. Transporter's Phone BRICKLEY ENVIRONMENTAL C A -R 0 0 0 0 5 3 1 7-3_ (909)888-2010 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID [Reserved.] F. Transporter's Phone (909) 884-7424 E C T I ICIAIRIOIOIO1014191 01614 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID AZUSA LAND RECLAMA, ION 10 "i C aP CR 1211 W. GLADSTONE H. Facility's Phone AZUSA, CA..91702 CAD 0 0 9 0 0 7 61210 (526)334-0719 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit Wt/Vol I. Waste Number No. Type ° R.Q. ASBESTOS, 9, NA2212, PG III (ERG#171kf State 5 EPA/Other G r 3 o Q � '\ 1 ' 1 Nb. State r E R E D 19 FEE D EPA/Other A ,II T C. JUN 21 2004 State EPA/Other R a_..._ LF LA QUIP A State FINANCE DEf _ ' EPA/Other '1: •Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above ;a.) ,AS.$EST6S CONTAINING CONSTRUCTI02i MATERIALS" a. 03 __ . _. 67 C. d. 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 hereby declare that the contents of this consignment ore fully and accurately described above by propershipping name and are classified, packed, marked, and IabeFed, 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 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 present and future threat to human health and the environment; OR, if I am a small quanti generator, I have mode a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I camafford. C >1 a- 4 i. Printed/Typed Name Signature Month Day Year R17. Trans orter 1 Acknowledgement of Receipt of Materials A N Printed/Typed Name SignalY�� 7,014,1 Month Day Year S P i ljolnH '18. Trans orter 2 Acknow6cl ement of Receipt of Materials R E Printed/Typed Nome de Signature Month Day Year R �"<A ,L) A a C>16 0 19. Discrepancy Indication Space F A C 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 1r9: T Printed/Typed Name Signature DayL� Year /Month j ,[ 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.)