04-5106 (DSF)o � o
V
BUILDING & SAFETY DEPARTMENT
:its J P'®�Box 1504 (760).777-7012
OFi78-495 CALLS TAMPICO '
'- FAX (760) 777-7011
5 2004LAlQJN INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
CITY OF LA QUINTA
FINANCE DEPT. BUILDING PERMIT
Application Number . . . 04-00'005106 -Date, 6/23/04
Property Address . . . . . �_4'6170 JEFFERSON ST
APN: 649-090-001-39 -2190 -
Application description . DEMO - SINGLE FAMILY
Property Zoning . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 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
Qty Unit Charge
Per
Extension
------------------------------------------.----------------------------------
BASE FEE
45:00
Special Notes and Comments
COMPLETE DEMOLITION OF
EXISTING HOUSE
AND ALL IMPROVEMENTS
Fee summary Charged
Paid Credited
Due
-------------------------.--
Permit Fee Total
------------------------------
45.00 00 "`001,
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 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 04— 5_10& Date:
Applicant: I Architect or Engineer:
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 under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
caciL.and my ense in full force and effect. G 4
icense Clas16cense No.
ate 6-25 61-/ f"Contractor
OWNE UILDER 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 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 1, 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 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 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' com ensation in��nce carrier and ollioy number are:
/Carrier P it5`cy Number / .30?
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, 1 shall
forthwith comply with those ions.
Z 5 — dL/ applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE NLAWFUL, 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 ft Ir
Lender's Address ti LA
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 cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this c o e r upon the abo - on d property for inspection purposes.
/11ate St �natureApplicantorAgent):
Project/Casejn�
and VACANCY WALKTHROUGH
Any and all personal property left on the project premises located atg% • 1 too,.) jt
is to be considered abandoned as of S •
AS EVIDENCE BY SIGNATURE AND DELIVERY OF KEYS I HEREBY AGREE THAT OCCUPANCY OF THE LISTED
ADDRESS HAS BEEN ABANDONED AND THAT NO FURTHER ENTRANCE TO THE ABOVE ADDRES S WILL BE MADE.
X X X o
Cla' ants) Nahe Claimant(s) Signature Date
REPLACEMENT ADDRESS:,� pJy -
NEW ?HONE
ON THIS DATE I PERSONALLY INSPECTED THE DISPLACEMENT AT THE ABOVE ADDRESS AFTER
THE OCCUPANT HAD MOVED AND FOUND THE PRENUSES-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
elocation Representative Date 1
❑ There are tenants remaining on this property. ❑ This property is now vacant ❑ Abandoned property remains
on site
PROPERTY MANAGEMENT
Keys given to:
Date:
Received by :X }� • .
OverlanQuific , ,
6
4 o a
c•
� tip
,.i•
3 '
It T t A L A -n 11
P A C I F I C &
C UTLIER, INC.
41-555 Cook Street, Suite 250
Palm Desert, California 92260
Tel: (760) 776-1238 Fax: (760) 776-1636
I
LETTER OF TRANSMITTAL
TO: Tim Jonasson
FROM: Bob Stoddard I
SUBJECT: Jefferson St. - Keys
DATE: May 4, 2004
SENT VIA: MESSENGER MAIL FedEx x Hand Delivered ]Fax:
Comments:
Tim:
Delivering keys for the following properties:
2. �Ilsgoner
3. Henderson
Bob
The above is transmitted: DO NOT MAIL; Call for Pickup- 776-1238
tMas requested ( ) For Review and comment )For info
For Review and comment (><For signature
By: Date:
P.O. Box 55329 SCOTT MORRISON& ASSOCIATES
Riverside, CA 92517 31855 Date Palm Drive, Ste.. #3-567
909) 624-1665 Cathedral City, CA 92234
------ (760)323-7743
INVOICE
Client: Tom. Hartung?s ,
offib
City of La Quinta Redevelopment
'
P.O. BOX 1504
La Quinta, CA 92253
Project:. 46425 Jefferson Ave.
46170 Jefferson Ave.
46390 Jeffetson Ave.
Inspection dates:. May l 9 and May 24, 2004
Date: May 28, 2604
Project/ P.O#
File name: PLM0519 #1233
PLM0519#1 132.
PLM0524#1234
asbestos inspection/ bu'lksampling: 3 single-family homes.@ $125.00 ea..=
$375.00
35 total. -bulk samples for analysis (PLM) @ $20.00 each $700.00
# hours of travel time @ $
Pach "Jincluded
Total amount due = $1,075.00
Please send _payment to:. '31455 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
Terms: Net 15 days
Thank you'.'
APP VE FOR PAYMENT
13y;m
By
ACCOUNT NO. /40Z -171,6. Syb 3o
DESCRIPTIO
AMTOP,
T� . C)
f l�S�e of aliFofnir��En�ifonine tfo a�P1.1ion Agency ✓�/\ I / t✓ � f� f �(/'v �VL' -, �/!j' ((►/r�"7,,
{ Form Approved OMB No. 205070039 (Expires 9-30-99) See Instructio s n back of page 6. Department of Toxic Substances Control
�.t Please print or type. Form designed for use on elite 112 -pitch) typewriter. Sacramento_ C.liferoia
v 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 law.
WASTE MANIFEST
of
rlalnl U 9 r,f3 19
11
3. Generator's Name and Mailing Address
A. State Manifest Document Number
CITY OF LA QUINTA
23535751
P.O. BOX 1504
B. State Generator's ID
I�QU aNTAone CA 92253
AG
760 777-7013
5. Transporter 1 Company Name 6. US EPA ID Number
C. State Transporter's ID [Reserved.]
D. Transporter's Phone
(909)888-2010
7. Transporter 2 Company Name 8. US EPA ID Number
E. State Transporter's ID [Reserved.)
E C T I ICIAIRIOIOIO101419101614
F. Transporter's Phone (9091884-7424
9. Designated Facility Name and Site Address 10. US EPA ID Number
G. State Facility's ID -t
L C
AZUSA LAND RECLAMA ON
C O t
1.211 W. GLADSTONEN
H. Facility's Phone
`;AZUSA CA 91702 c n n
(626 334-0719
'12.
1.1'w US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
- 17
Containers
13. Total
Quantity
14. Unit
Wt/Vol
I. Waste Number
No.
Type
a" R. Q. ASBESTOS, 9, NA2212, PG III (ERG#17V
State
GG)
1
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CITY PRAQUIN—A '
EPA/Other
-• ) FIN CMCE DEPT.
J. Additional Descriptions for Materials listed Abgve''¢"-
K. Handling Codes for Wastes Listed Above
.a)., AS$E,STOSy C8NTATII'NG CONSTRUCTION MATtPIALS ^`-."._._
a:
C.
d.
15. Special Handling Instructions and Additional Information
EMERGENCY CONTACT PHONE 9 (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 are fully and accurately described above by proper shipping name and are classified, packed,
marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and 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 quantity generator, 1 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 J
Month Day Year
T
R
17. Trans orter 1 Acknowledgement of Receipt of Materials
A
Printed/Typed Name
Signature i
Month Day Year
8
18. Transporter 2 Acknowledgement of Receipt of Materials
T
Printed/Typed NameSignature
Month Day Year
E
Cl
19. Discrepancy Indication Space
F
A
C
I
L
20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item
T
Printed/Typed Name
Signature
Day Year
-19.1
�1-;��'y Jv
�M}onth
v 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.)
Vii: - Ar. '.
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
Completed On
May 27th, 2004
PLM0519#1132
Client: Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253-1504
Project: 46170 Jefferson Avenue
La Quinta, CA
(single famly home with attached garage)
On May 19th, 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
SCOTT MOR SOIN & 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
The results on the following page(s) indicate that asbestos was detected in 01 of the 11 samples
analyzed.
PLM0519#1132
Sample #QT -122
Type of material: acoustic ceiling- white
Location: interior ceiling of southeast livingroom
Area: approx. 1465 total sq. ft.
Friableyes
Results: none detected
Sample #QT -123
Type of material: acoustic ceiling- white
Location: interior ceiling of southwest diningroom
Area: approx. 1465 total sq. ft.
Friable:yes
Results: none detected
Sample #QT -124
Type of material: acoustic ceiling- white
Location: interior ceiling of northwest bedroom
Area: approx. 1465 total sq. ft.
Friable:yes
Results: none detected
Sample #QT -125
Type of material: drywall
Location: interior west wall of southwest diningroom
Area: throughout interior walls
Friable:no
Results: none detected
Sample #QT -126
Type of material: sprayed on fireproofing
Location: interior walls & ceilings of central HVAC room
Area: approx. 60 sq. ft.
Friable:yes
Results: none detected
Sample #QT -127
Type of material: rolled linoleum floor- green (1 rst layer)
Location: floor of central hallway bathroom
Area: approx. 25 sq. ft.
Friable:no
Results: 25% Chrysotile asbestos
Sample #QT -128
Type of material: floor mastic- brown (2nd layer)
Location: under sample #QT -127
Area: approx. 25 sq. ft.
Friable:no
Results: none detected
Sample #QT -129
Type of material: rolled linoleum floor- grey
Location: floor of northeast bedroom bathroom
Area: approx. 35 sq. ft.
Friable:no
Results: none detected
(2)
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
PLM0519#1132
Sample #QT -130
Type of material: stucco- cream color (1rst layer)
Location: exterior east wall
Area: throughout exterior walls
Friable:no
Results: none detected
Sample #QT -131
Type of material: plaster- grey (2nd layer)
Location: behind sample #QT -130
• Area: throughout exterior walls
Friable:no
Results: none detected
Sample #QT -132
Type of material: roof felt
Location: exterior roof under wood shingles
Area: throughout exterior roof
Friable:no
Results: none detected
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 e- W11 —
Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
(3)
May-24-04 02:22pm From-CAROLINA ENVIRONMENTAL
CAROUNAENdI t0WEWAL,=
107 New Edition Court, Cary, NC 27511
Phone: (919) ,481-1413 F= (819) 4814442
Client: Scott Morrison & Associates
31855 Date Palm Dr, Suite 3-507
Cathedral City, CA 92234
Project: PLM0519#1132
+4811442 T-586 P. 02/05 F-128
LABORATORY REPORT
ASBESTOS BULK ANALYSIS
CEI Lab Code: A04-3764
Received: 05-24-04
Analyzed: 05-24-04
Reported: 05-24-04
Analyst: Gary A. Swanson
CLIENT ID LAB 1b HOMOGENEIT'YDESCRIPTION ASBE3YO3
QT -122 A264621 ACOUSTIC CEILING 'ND
Homogeneous, White, Non-fibrous, Loosely Bound
BIND 100%
QT -123 A264622 ACOUSTIC CEILING . • ND
Homogeneous, White, Non-fibrous, Loosely Bound
BIND 100%
QT -124 A264623 ACOUSTIC CEILING ND.
Homogeneous, White, Non-fibrous, Loosely Bound
BIND 100%
QT -125 A264624 DRYWALL ND
Homogeneous, White Fibrous, Bound
BIND 95% CELL .5%
QT -126 A264625 FIREPROOFING ND
Homogeneous, White, Fibrous, Bound
BIND 98% CELL 2%
QT -127 � A264626 LINOLEUM CHRY 25%
Heterogeneous, Green, Grey, Fibrous, Bound
CHRY 25% VINYL 50% CELL 5%
BIND 20%
Page 1
May -24-04 02:22Fm From -CAROLINA ENVIRONMENTAL +4811442 T-586 P-03/05 F-128
CAROUNAENVIRONMENUL, IMC.
107 New Ediffon Court, Cary, NC 27511
Rule: 919,01-1413 Fac; 919.481-1442
Project: PLM0519#1132
Lab Code; A04-3764
CLIENT ID CEI HOMOGENEITY DESCRIPTION %
-LASID ASBESTOS
QT -128 A264627 MASTIC ND
Heterogeneous, Brown, Fibrous, Bound
BIND 95% CELL 5%
QT -129 A264628 LINOLEUM ND
Heterogeneous, Grey, Fibrous, Bound
VINYL 50% CELL 25%
BIND 22% FBGL 3%
QT -130 A264629 STUCCO NO
Homogeneous, White_, Non-fibrous, Bound
BIND 100%
QT -131 A264630, PLASTER
Homogeneous, Grey, Non-fibrous, Bound
BIND 100%
QT -132 A264631 ROOF FELT
Homogeneous, Black, Fibrous, Bound
BIND 35% CELL
65%
ND
lub
Page 2
May -24-04 02:23pm From -CAROLINA ENVIRONANTAL
+4811442 T-586 P. 04/05 F-128
The following definitions apply to the abbreviations used in the ASBESTOS BULK
ANALYSIS REPORT:
CHRY
= Chrysotile
AMOS
= Amosite
CROC
= Crocidolite
TREM
= Tremolite
ANTH
= Anthophyllite
ACTN
= Actinolite
N D
= None Detected
NANTH
= Non-Asbestiform
PLAS =Plaster
Anthophyllite
CELL
= Cellulose
DEBR = Debris
FBGL
= Fibrous Glass
SIND = Binder
ORGN
= Organics
SILI = Silicates
SYNT
= Synthetics
GRAV = Gravel
WOLL
= Wollastonite
MAST = Mastic
CERWL = Ceramic Wool
PLAS =Plaster
NTREM
= Non-Asbestiform
PERIL = Perlite
Tremolite
RUSR =Rubber
CLIENT: Scott Morrison & Associates
PROJECT: PLM0519#1132
CEI LAB CODE: A04-3764
stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical technique used
Dr sample identification. The percentage of each component is visually estimated by volume. These results pertain only
the samples analyzed. The samples were analyzed as submitted by the client and may not be representative of the larger
iaterial in question. Unless notified in writing to return samples, Carolina Environmental, Inc. will discard all bulk samples
fter 30 days.
lany vinyl floor tiles have been manufactured using greater thin 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 the
oes not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive
xm of analysis for vinyl floor tiles.
is certified by the signature below that Carolina Environmental, Inc, is accredited by the National Voluntary Accreditation
i ogram (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 1116 have been incorporated
ihere applicable. The detection limit for the method is 0.1% (trace amount). Carolina Environmental, Ine.'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
isbestos using PLM are not covered under NVLAP accreditation.
ANALYST
REVIEWED BY
Tianbcio Doi, Ph.D.
Laboratory Director
End of Report
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From: Scott Morrison & Associates
P.O Box 35329
Rb►ee, CA 92317
(760) 323.7743
COV c i"
Job Nab x519 1 l2
Fax is Raab Z
ReiinquilbW By
TIC -DU it
Site
CHAIN OF CUSTUD�'
r` v •1 ✓ , - / `J
AdC9y��r.dl�y�
To: Cams Fmvironmental, �.
107 New Edition Court
Cary, NC 27311
(919) 481-141.3
NvLAP Code 10176" CA SLAP KW
Person TaIdDg SmPJ�Z-
1 -,10 ) 0 ( u t arrA
MsWAI To: Scott Morrison & Asoeiatss, 31835 Date P" Dr., Ste. #3-307, Cathedral City, CA 92234, (760) 323-7743
v
�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 -
DEPT. OF INDUSTRIAL RELATIONS
ADDRESS: SAN BERNARDINO DIST. OFFICE
464 WEST 4TH ST., # 332
SAN BERNARDINO, CA 92401
DATE: 6-4-04
LICENSE NO. 610414
ASBESTOS CERT. A-6005
DOSH REGISTRATION #49
NAME / ADDRESS OF EMPLOYER: CITY OF LA QUINTA
P.O. BOX 1504
LA QUINTA, CA. 92253
JOB # 6882
ADDRESS OF JOB SITE: SFR JOB LOCATION: THROUGHOUT
46170 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 25 SQ. FT. OF LINOLEUM
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