04-5105 (DSF)I . I
u�l'�1,i6v
F O�
U
BUILDING & SAFETY DEPARTMENT
�c d►wP�O�. Box 1504 } 3 (760).777-7012
FTt�9 78��4Q5 CALLS TAMPICO "° ' FAX (760) 777-7011
LAI CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
�UIV 2 5 20� QUINTA,
CITY ®� �,QUIr�TA BUILDING PERMIT
FIN
Application Number b . . . . . 1'04-00005105 1 Date'< 6/23/04
Property Address. . . . . . . 46425 JEFFERSON ST
APN: 649-071-019-29 -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
(62 6) 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/LONG <=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
Permit Fee Total 45.00
Plan Check Total .00
Grand Total 45.00
• r
Paid Credited Due
-----
-------.00------�;..,tOOt 45.00
.00 .00 .00
.00 .00 45.00
P.O. Box 1504 • /i •
w VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0q- .5-105 Date: 62 04i
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 rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
C e, and my Li nse ')S i�1f y�I forc and fect. / —7 _
icense Class' —G /S 1 `, License No. L7 5 C/ G1
Date r) —Z 5 1�Contractor.
' OWNE", UILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractofs 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.).
(_.) I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' compens tion insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issueworkers' cpppensatio urance carrier andolic number a
arcie
CrS�� QOIrL�yj�Z cq,� Policy Number / �i 30 _ O
certify that, in tKd 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 Califo ' agree that, if I should beco subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with t e provision
/bate ['ZS-04&--,oZicant
WARNING: FAILURE TO SECURE WORKS' COMPENSATI N COVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La 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 abo rrrr n is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, ca—nd hereby authorize representatives of this unty to enter Pon the above property for inspection purposes.
ate (� 2�7 '�'� ' at�S ure (Applicant or Agent):
A 1 •'r
SCOTTMORRISON & 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#1233
Client: Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253-1504
Project: 46425 Jefferson Avenue
La Quinta, CA
(single family home with attached garage)
On , 2004 an asbestos inspection and bulk sampling was conducted at the above project address. Bulk
samples were taken of all suspect asbestos containing building materials (ACBM) at the request of the
client named above. A total of (12) bulk samples were submitted to Carolina Environmental, Inc. located
at: 107 New Edition Court in Cary, NC (NVLAP Code 101768-0 and Cal. Environ. Lab. Cert. #2483) to
estimate the percentage of asbestos by volume and determine the type(s) present.
Carolina Environmental, Inc. determines percentages and type of asbestos by using EPA approved
method 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Samples. Bulk
samples are analyzed by PLM (Polarized Light Microscopy). Asbestos is quantified by using the visual
arena estimation technique and can only determine the approximate percentage of asbestos present.
After a thorough search is conducted and no asbestos is detected "none detected" will be noted in the
report. The essence of polarized light microscopy is not to emphatically determine that no asbestos is
present, merely that none was detected or, if it was, it was likely to be less than 1.0% of the sample.
When findings reveal less than or close to 1.0% asbestos contained in a sample, further analysis may be
called for on additional samples to confirm or denounce the initial findings. The California Code of
Regulations (CCR 1529) requires bulk sampling be conducted according to the A.H.E.R.A. protocol
provisions of 40 CFR Part 763.86. The A.H.E.R.A. protocol recommends three (3) or more friable
surfacing samples from a homogeneous area be collected and analyzed before any building material is
determined to be non -asbestos containing. Scott Morrison & Associates conducts asbestos inspection
surveys following the A.H.E.R.A. inspection protocol.
ASBESTOS INSPECTION BY: Timothy Morrison, DOSH #02-3142
BULK SAMPLES ANALYZED BY: Carolina Environmental, Inc., NVLAP #101768-0
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
The results on the following page(s) indicate that asbestos was detected in 01 of the 12 samples
analyzed.
PLM0519#1233
Sample #QT -133
Type of material: acoustic ceiling- white
Location: interior ceiling of southwest diningroom
Area: approx. 275 total sq. ft.
Friable:yes
Results: none detected
Sample #QT -134
Type of material: acoustic ceiling- white
Location: interior ceiling of southwest diningroom
Area: approx. 275 total sq. ft.
Friable:yes
Results: none detected
Sample #QT -135
Type of material: acoustic ceiling- white
Location: interior ceiling of southwest diningroom
Area: approx. 275 total sq. ft.
Friable:yes
Results: none detected
Sample #QT -136
Type of material: rolled flooring- grey (1rst layer)
Location: floor of southeast bathroom
Area: approx. 20 sq. ft.
Friable:no
Results: 60% Chrysotile asbestos
Sample #QT -137
Type of material: floor mastic- yellow (2nd layer)
Location: under sample #QT -136
Area: approx. 20 sq. ft.
Friable:no
Results: none detected
Sample #QT -138
Type of material: floor mastic- black (3rd layer)
Location: under sample #QT -137
Area: approx. 20 sq. ft.
Friable:no
Results: none detected
Sample #QT -139
Type of material: final coat- white (1 rst layer)
Location: interior west wall of west -central livingroom
Area: throughout interior walls
Friable:no
Results: none detected
Sample #QT -140
Type of material: plaster- grey (2nd layer)
Location: behind ssample #QT -139
Area: throughout interior walls
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#1233
Sample #QT -141
Type of material: smooth coat- white
Location: interior walls of central HVAC closet
Area: approx. 60 sq. ft.
Friable:no
Results: none detected
Sample #QT -142
Type of material: roof felt
Location: exterior roof under wood shingles
Area: throughout exterior roof
Friable:no
Results: none detected
Sample #QT -143
Type of material: plaster- white (1rst layer)
Location: interior east wall of southeast garage
Area: throughout interior walls of garage
Friable:no
Results: none detected
Sample#QT-144
Type of material: plaster- grey (2nd layer)
Location: behind sample #QT -143
Area: throughout interior walls of garage
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.
Inspector6&10140011—
Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
(3).
May -24-04 03:12pm From -CAROLINA ENVIRONMENTAL
CMOLMEIWIRONMENrAL. INC.
10'r New EdW Cowl, Cary, NC2751i
F'I10ne: X19),481.1413 Fax: (B'19)484-0442
}
Client: Scott Morrison & Associates
31855 Date Palm Dr. Suite 3-507
Cathedral City, CA 92234
Project: PLM0519#1233
+4811442 T-590 P.02/05 F-134
LABORATORY REPORT
ASBESTOS SULK ANALYSIS
CEI Lab Code:
A04-3768
Received:
05-24-04
Analyzed:
05-24-04
Reported:
05-24-04
Analyst:
Gary A. Swanson
CLIENT ID CEI
LAB ID HOMOGENEITY DESCRIPTION %
ASBESTOS
QT -133 A264632 ACOUSTIC CEILING ND
Homogeneous, White, Non-fibrous, sound
BIND 100%
QT -134
QT -135
QT -136
QT -137
QT -138
A264633 ACQUSTIC CEILING
Homogeneous, White, Non-fibrous, Bound
BIND 100%
A264634 ACOUSTIC (LING
Homogeneous, White, Non-fibrous, Bound
BIND 100%
A264635 ROLLED FLOORING
Homogeneous, ' Grey, Fibrous, Bound
CHRY 60% l31ND ' 25% CELL
4
A264636 MASTIC
Homogeneous, Yellow, Non-fibrous, Bound
BIND 100%
A264637 MASTIC
Homogeneous, Black, Fibrous, Bound
BIND,
99% Cri i
15%
10".
ND
ND
CHRY 60%
ND
ND
Page 1
` May -24-04 03:12pm Frcm-CAROLINA ENVIRONMENTAL
+4811442 T-590 P.03/05 F-134
CAROUNAENVRONMENTA.IW_ Project: PLM0519#1233
107 New Edt4w Cour; Cary, NC 27511
Phone. 919481-1413 Fax : 919-081-1442 Lab Code: A04-3768
CLIENT ID CEI HOMOGENEITY DESCRIPTION ASB'ES'TOS
LAB ID
QT -139 A264638 FINAL COAT ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QT -140 A264639 WALL PLASTER NO
Homogeneous, Grey, Non-fibrous, Bound
BIND 100%
QT -141 A264640 SMOOTH COAT ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QT -142 A264641 ROOF FELT No
Homogeneous, Black, Fibrous, Bound
BIND 35% CELL 65%
QT -143 A264642 -PLASTER ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QT -144 A264643 PLASTER ND
Homogeneous, Grey, Non-fibrous, Bound
BIND 100%
Page 2
May -24-04 03:12pm From -CAROLINA ENVIRONMENTAL +4811442
T-590 P.04/05 F-134
The following definitions apply to the abbreviations
used in the ASBESTOS
ANALYSIS REPORT:
BULK
CHRY - c Chrysotile CELL =Cellulose
DEER =Debris
AMOS = Amosite FBGL = Fibrous Glass
BIND =Binder
CROC = Crocidolite ORGN = Organics
SILL
TREM = Tremolite SYNT = Synthetics
=Silicates
GRAY =Gravel
ANTH = Anthophyllite WOLL = Wollastonite
MAST =Mastic
ACTN = Actinolite CERWL = Ceramic Wool
PLAS =Plaster
N D = None Detected NTREM = Non-Asbestiform
PERL
NANTH = Non-Asbestiform Tremolite
= Perlite
Anthophyllite
RUBR =Rubber
CLIENT: Scott Morrison & Associates
PROJECT: PLM0519#1233
CEI LM CODE: A04-3768
Stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical technique used
for sample identification. The percentage of each component is visually estimated by volume. These results pertain only
to the samples analyzed. The samples. were analyzed as submitted by the client and may not be representative of the larger
material in question. Unless notified in writing to return samples, Carolina Environmental, Inc. will discard all bulk samples
after 30 days.
Many vinyl floor tiles have been manufactured using greater than 1 % asbestos. Often the asbestos was milled to a fiber
size below the detection limit of polarized light microscopy_ Therefore, a "None Detected" (NO) reading on vinyl floor the
Joes not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive
'orm of analysis for vinyl floor tiles.
t is certified by the signature below that Carolina Environmental, Inc. is accredited by the National Voluntary Accreditation
grogram (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA / 600 / M4-82 / 020 for
he analysis of asbestos in building materials. Procedures described in EPA / 600 / R-93 / 116 have been incorporated
Where applicable. The detection limit for the method is 0.1% (trace amount). Carolina Environmental, Inc.'s NVLAP
a::creditation number is #101768-0. This report Is not to be used to claim product endorsement by NVLAP or any agency
r-' The U. S. Government. This report and its contents are only valid when reproduced in full. Dust and soil analyses for
esbestos using PLM are not covered under NVLAP accreditation.
ANALYST
REVIEWED BY
Tianb2o Bai, Ph,p,
Laboratory Director
End of Report
7
HAM OF !CUSIQDx
From: Scott Monson & Amoeiato To: Caroli" Efevimmentai, mc.
P.O. Boz 53329 107 Nene Edition Court
Rivasside, CA 92517 Cary, NC 27511
(760) 323•'7743 (919) 481-1413
NVLAP c* 1017U4 CA KLAP MV
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s-rt P.�oaT7F�
saropks0 2 — 3l�f ZD- i 9 �.Site Addneas4 4.52? S `)S �vl^tiyu� , A
Sample # Some Date
MaNsW & DescriptionP /AA -ft
Other ][anformat4ion
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MiaWaz ?a: Scott Morrison & Asotbm% 31855 Date Palm Dr., Ste. #3-S , Cathedral City, CA 92234, (760) 323-7743
Or
lSt to dF/Cali ria—E'nvironm n al'Proteciion Agency
Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of page 6. Department of Toxic Substances Control
Please print or type. Form designed for use on elite (12 -pitch) typewriter. Sacramento, California
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.)
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
19°f
3. Generator's Name and Mailing Address
A. State Manifest Document Number
CITY OF LA QUINTA
23535750
P.O. BOX 1504
B. State Generator's ID
LA QUINTA, CA 9?�253
4. Generator's Phone
( 760 777-7013
5. Transporter 1 Company Name 6. US EPA ID Number
C. State Transporter's ID [Reserved.]
r 1
D. Transporter', Phone
BRICKLEY ENVIRONMENTAL r(909)888-2010
7. Transporter 2 Company Name 8. US EPA ID Number
E. State Transporter's ID [Reserved.]
C T I ICIAIP,1010101014191016ld
F. Transporter's Phone (909)884-7424
9. Designated Facility Name and Site Address 10. US EPA ID Number
AZUSA LAND RECLAMAFN
G. State Facility's ID
c C; C� (p
H. Facility's Phone
1211. W. GLADSTONE �J
AZUSA CA 91702 0 41 0 6
(626)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#1716)
State
w
EPA/Other
E
'�"�+�
Y
N
b.
State
E
EPA/Other
R
A
c j?VV
State
O
LL __
D —�
EPA/Other
R
d. U JUIV UU-1
State
EPA/Other
CITY OF LA QUINTA
dlik .•,rc�nr-PT
^*'=-
J. Additional Descriptions. for Materials Listed Above "�
K. Handling Codes for Wastes Listed Above
a)`ASBESTOS CONTAINING%CONSTRUCTION MATERIALS ""
a.03"- -'' b.
C.
d.
15. Special Handling Instructions and Additional Information
EMERGENCY -CONTACT PHONE 0 (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, I have made a good faith effort to minimize my waste generation and select the best waste management method that is
available to me and that I can afford.
Printed/Typed Name j
Signature
Month Day Year
T
R
17. Trans orter 1 Acknowledgement of Receipt of Materials /
I
Printed/Typed Name
i
Signature r �� f
Month Day Year
S
..
0
18. Transporter 2 Acknowledgement of Receipt of Materials
R
T
Printed/T ed Name
YP
Signature
9
Month Day Year
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 It 19.
T
Printed/Typed Name
Signature
Month Day Year
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.)
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
X6425 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 1N
SECTIONS AND DISPOSE OF 20 SQ. FT. OF FLOORING
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
P.O. Box 5529.
Riverside, CA 92517
(909)624-1665
INVOICE
r
SCOTT MORRISON & ASSOCIATES
Client: Tom Hartung's .Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
Project 46425 Jefferson Ave.
46170 Jefferson Ave.
46390 Jefferson Ave.
Inspection dates: May 19 and May 24, 2004 .
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(760)323-7743
Date: May 28, 2004
Project/ P.O#
File name: PLM0519#1233
PLM0519#1132
PLM0524#1234
asbestos inspection/ bulk sampling: 3 single-family homes @ $125.00 ea. = $375.00
35 total bulk samples for analysis (PLM) @ $20.00 each =.$70'0.00
# hours of travel time @ $ each = included
Total amount due = $1,075.00
Please send _payment to: '31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
Terms: Net 15 days APPVE FOR PAYMENT
BY
BY
Thank you. ACCOUNT NO. �/ -
DESCRIPTION_ I t�
AMT.