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HomeMy WebLinkAboutX2019-2071 - Misc30a Aaa. e Ave xZ01R-X071 CITY OF NEWPORT BEACH Amount: MUNICIPAL OPERATIONS DEPARTMENT 592 SUPERIOR AVENUE I / �A NEWPORT BEACH CA 92663 $ {� l (949)644-3055 Demolition Hauler Certification and Deposit Form Owner Name: Property Address: 101 AkXt-}i .Mi Permittee Name:Phone: Z/o-7- 6sV- 6-Sv-S Permit Number: Franchised Hauler: �` 7 / E , -T-, OA_,l Permittee I hereby certify that I have contracted with the above-mentioned City Franchised Solid must initial Waste or Demolition Contractor. I also certify that I understand I must contact the Municipal Operations Department at (949) 644-3064 no less than 24 hours or more than 72 hours prior to my intent to commence demolition activities. Municipal Operations staff will inspect demolition site and verify usage of franchised hauler. City of Newport Beach Municipal Code indicates: A demolition permit deposit, as determined by the Municipal Operations Director, shall be paid at the time of submitting the demolition permit. Said deposit shall be returned to the permittee, at the conclusion of the demolition project assuming permittee follows applicable laws. REFUND TO:,, 4( Name: -' bAi jok^E 4 E S Address:170 A14Evt�btcT O e City, State, I, Permittee hereby certify that I understand that a Ci Franchised Hauler must For Finance Use Only Permittee ( ) y fY t1/ must sign be used to transport all construction and demolition debris generated as a result of and date the demolition referenced above. I agree that the deposit will be forfeited if 1) a City franchised haAlpr is not used to haul construction and demolition debris from this project or 2) 4 fail tQ(y???otify the Municipal Operations Department at (949) 644- 3064 no less` tha/i IZ4 hours or more than 72 hours in advance of my intent to 1commenceAm itio activities. Date For slag ( � ib start use Issued Brr t'''.�---t,? C.. ;'�' Date Y For MOD Notification Date: Staff Use Hauler: Demo Date: Distribution: White: Municipal Operations Yellow: Refund Goldenrod: Finance Pink: Applicant Revised March 2018 X90 q 4071 309 AnaJe Ave COMPREHENSIVE ASBESTOS SURVEY REPORT FOR 309 Anade, Newport Beach, CA Prepared for Sailhouse DATE 6/27/2019 Report # 1906-273-771407 CONDUCTED BY Jackson Environmental 120 Tustin Ave C-1121 Newport Beach, CA 92663 949-230-9779 TABLE OF CONTENTS INTRODUCTION SECTION I ASBESTOS SURVEY SUMMARY Executive Summary Facility Description Survey Findings SECTION 11 BUILDING INSPECTION FOR ASBESTOS Bulk Sampling Bulk Sample Analysis Quality Assurance Limitation of Sampling Suspect Asbestos Containing Materials SECTION III LABORATORY REPORTS Asbestos Laboratory Reports INTRODUCTION Jackson Environmental was retained by Sailhouse to conduct a COMPREHENSIVE Asbestos Survey for the property, on 309 Anade, Newport Beach, CA on June 20th, 2019. The purpose of this survey was to identify Asbestos Containing Material (ACBM) in all areas of the building. Work consisted of collecting bulk samples of all materials suspect of containing asbestos. THE REPORT The survey report is divided into three major sections, which provide identification of all suspected ACBM. Section I presents a summary of the Asbestos Survey and a general description of the area inspected. Survey findings are also provided in this section. Section II describes the methodology used to perform the survey and includes Jackson Environmental, and our Analytical quality control procedures. Section III of this report summarizes the locations and materials which were identified as containing asbestos. Results of the bulk samples are included in this section. SECTION I ASBESTOS SURVEY SUMMARY EXECUTIVE SUMMARY Jackson Environmental was retained by, Sailhouse to conduct a COMPREHENSIVE Asbestos Survey for the property located, 309 Anade, Newport Beach, CA. The sampling was conducted by Michael Jackson an Osha certified asbestos consultant # 04-3635 FACILITY DESCRIPTION The subject property is a single family, 2 story, wood frame building, set on a foundation. While on-site the Certified Personnel noted the condition of the materials. This is noted in the survey findings below. SURVEY FINDINGS The following building materials were identified and or assumed as containing asbestos: Building Material Location Friable(NonFriabie/ Condition SQ' Approximate e t. None Detected "Please note square footages are approximate estimates only and should not be used as a basis for bidding purposes" RECOMMENDATIONS: All Significantly Damaged and Damaged areas should be repaired or removed as soon as possible to avoid any potential hazards that may result from further disturbance of ACM. SCAQMD's Rule 1403 requires a Procedure 5 Work Plan for any unscheduled asbestos fiber release episode involving ACM or Class 11 non -friable ACM. SECTION II COMPREHENSIVE ASBESTOS INSPECTION BULK SAMPLING Bulk samples of areas containing suspect ACBM were collected. A homogeneous area is defined as surfacing material, thermal insulation, or miscellaneous material that is uniform in color, texture, or date of application. Samples were collected using wet methods; where they are deemed appropriate, to minimize fiber release. Prior to sampling, the location is misted with water from a spray bottle. A sample of the suspect material is then collected using a chisel, core borer, knife, or other appropriate tool. After the sample was collected, the bulk material was placed in a sample bag which was sealed to prevent fiber release or contamination by outside sources. Samples are documented by entering the sample data on a bulk log, including a description of the material, a unique sample number is assigned to each sample and the sample bag was labeled with that number. During the survey, the technician also notes the condition of the material being sampled, its location, condition. and friability. Note: The amended National Emission Standard for Hazardous Air Pollutants (NESHAP), November 20, 1990, included a requirement that when the asbestos content of a bulk sample material is determined using procedures outlined in the Interim Method and the asbestos content is estimated to be less than 10% by method other than Point Counting, the parties legally responsible for a building (owner/operator) may elect to assume the amount to be greater than 1 % and treat the material as a regulated asbestos containing material. If the owner or operator does not want to assume the material is asbestos containing, verification of the amount of asbestos by the Point Counting method may be required. The purpose of this procedure is to minimize false negative analysis, and false positive. Point Counting was included in NESHAP in response to an HEPA study that found unacceptable amounts of false positive and false negative analyses by methods outlined in the Interim Method. Unless otherwise directed, American Analytical will assume that PLM analysis is acceptable for this survey. CLASSIFICATION OF BULK BUILDING MATERIALS "S" Significantly Damaged Material with one or more of the following characteristics: The surface is crumbling or blistered over at least one tenth of the surface if the damage is evenly distributed :( one quarter or more if the damage is localized). One tenth (one quarter or more, if localized) of material hanging from the surface, deteriorated, or showing adhesive failure. Water stains, gouges, or mars over at least one tenth of the surface if the damaged is evenly distributed (one quarter or more if the damage is localized). Accumulation of powder, dust, or debris similar in appearance to the suspect material on surfaces beneath the material can be used as confirmatory evidence. We recommend immediate removal of Significantly Damaged material and clean up of the area by a Licensed Asbestos Abatement Contractor. "D" Damaoed Material with the following characteristics: The surface is crumbling, blistered, water -stained, gouged, marred or otherwise abraded over less than one tenth of the surface if the damage is evenly distributed (less than one quarter if the damage is localized). Accumulation of powder, dust, or debris similar in appearance to the suspect material on surfaces beneath the material can be used as confirmatory evidence. We recommended removal of damaged material and clean up of the area by a Licensed Asbestos Abatement Contractor. "G" GOOD Material with no visible damage or deterioration, or showing only very damage or deterioration. We recommended materials identified as in good condition be placed on an Operations and Maintenance Program (O & M). BULK SAMPLE ANALYSIS All bulk samples were analyzed by Patriot Laboratory an NVLAP accredited laboratory. The laboratory accreditations are as follows: NVLAP #200642-0 National Voluntary Laboratory Accreditation Program (Federal) Approximately 10% of the bulk samples were split for quality control purpose. All bulk samples were analyzed by Polarized Light Microscopy (PLM) with dispersion staining in accordance with the EPA Method #600/R-93/116. 40 CFR 783.87. The reliable limit of detection for PLM is 1.0%. Where "None Detected" or ND appears in the report, it should be interpreted as meaning that no asbestos was actually observed in the sample. Samples containing, "Trace" level of asbestos indicates a possible contamination and is considered ACBM. NOTE: If a sample contains greater than 1.0% asbestos, it is considered to be a regulated material by Federal Government Standards. Under the California State Education Code, materials containing greater than 0.1 % in asbestos content are considered regulated. QUALITY ASSURANCE Statement of Quality Assurance At Jackson Environmental Quality Assurance is priceless! Jackson Environmental is committed to providing analytical services and data to its clients that are of the highest quality and legally defensible. Quality Assurance (QA) procedures were employed to ensure reliable results for analysis of bulk samples as follows: The laboratory is currently participating in the NVLAP Quality Assurance Program. Quality control is processed on at least 10% of all bulk samples on a daily basis. Laboratory results of samples submitted to the laboratory were within 3% of the original side by side sample. LIMITATION OF SAMPLING OF SUSPECT ASBESTOS CONTAINING MATERIAL Reasonable effort is made by Jackson Environmental `s staff to locate and sample suspect materials. However, for any facility the existence of unique or concealed asbestos containing material and debris is a possibility. In addition, sampling and laboratory analysis constraints typically hinder the investigation. American Analytical does not warrant, guarantee or profess to have the ability to locate or identify all asbestos containing materials in any given facility. This report is intended to be used in planning for construction or demolition. This report is not intended to be a construction document. Jackson Environmental is not, and has no responsibility as, a generator, operator, treater, storer, transporter or disposer of hazardous materials or waste found or identified as a result of Jackson Environmenntal's work. STATE REQUIREMENTS In accordance with State of California Regulation, all surveys are conducted by personnel holding a minimum of a Site Surveillance Technician certificate. This certificate is awarded to individuals who have fulfilled specific educational and experience requirements, as well as having completed extensive training in asbestos specific courses. Additionally, the State also mandates these individuals pass a rigorous examination. This examination is prepared, proctored, and graded by State officials. The Certified Asbestos Consultant must fulfill all the education and experience requirements as the Site Surveillance Technician, but must have additional and more extensive asbestos related training. Candidates for Certified Asbestos Consultant must also pass a more rigorous examination before being approved by the State of California. In compliance with State of California Requirements surveys and reports prepared by a Certified Site Surveillance Technician are reviewed, approved and signed by a Certified Asbestos Consultant. Certified Asbestos Consultant Michael Jackson Project Manager CAC # 04-3635 949-230-9779 Report # 1906-273-771407 SECTION III BULK SAMPLE ANALYSIS Certificate of Analysis PLM Asbestos Identification Jackson Environmental 120 Tustin Ave C-1121 Newport Beach, CA 92663 tel - 714.899.8968 free - 888-743-4998 fax - 714-899-1188 Patrlodab.conr 1841 S. Placentia Avenue, Fullerton, fA 92831 Report Number: Project Number: Project Name: Project Location: Date Collected: Collected By: Date Received: 6/20/2019 Claim Number: Date Analyzed: 6/22/2019 PO Number: Date Reported: 6/22/2019 Number of Samples: 771407 309 Anade 309 Anade Newport Beach, CA 14 Lab/Client ID/Layer Location Material Description - Color Composition (%) 771407-001 Upstairs Closet Drywall White 90% Sulfate 1 10% Cellulose Total Asbestos None Detected - 771407-002 Upstairs Bedroom Drywall White 90% Sulfate 2 10% Cellulose Total Asbestos None Detected 771407-003 Upstairs Closet Tape and Mud JC White 96%q Carbonate 3 4% Paint - Total Asbestos None Detected 771407-004 Upstairs Bedroom Tape and Mud JC White 96% Carbonate 4 4% Paint Total Asbestos None Detected , 771407-005 Kitchen Drywall White 90%Sulfate 5 10% Cellulose Total Asbestos None Detected 771407-006 Kitchen Tape and Mud JC White 96% Carbonate 6 4% Paint Total Asbestos None Detected Page 1 of 3 Certificate of Analysis PLM Asbestos Identification Jackson Environmental Report Number: 120 Tustin Ave C-1121 Project Number: Newport Beach, CA 92663 Project Name: Project Location: Date Collected: Collected By: Date Received: 6/20/2019 Claim Number: Date Analyzed: 6/22/2019 PO Number: Date Reported: 6/22/2019 Number of Samples: tel - 714.899-8908 free -88&-743.0998 fax - 714.899.1188 Patrioltab.com 1041 S. Placentia Avenue, Fullerton, (A 92831 771407 309 Anade 309 Anade Newport Beach, CA 14 Lab/Client ID/Layer Location Material Description Color Composition (%) 771407-007 Downstairs Bed Interior Plaster White 75% Minerals 7 20% Carbonate 5% Paint Total Asbestos None Detected 771407-008 Downstairs Bed Interior Plaster White 75% Minerals 8 20% Carbonate 5% Paint Total Asbestos None Detected 771407-009 Upstairs Bed Flooring Brown 100%Non- 9 Fibrous Material Total Asbestos None Detected 771407-010 Upstairs Bed Flooring Brown 100% Non - 10 Fibrous Material Total Asbestos None Detected' 771407-011 Upstairs Bed Flooring Brown 100% Non - 11 Fibrous Material Total Asbestos None Detected 771407-012 Roof Roofing Black 65% Tar 12 15% Glass Fibers 20% Minerals Total Asbestos None Detected Page 2 of 3 Certificate of Analysis PLM Asbestos Identification Jackson Environmental 120 Tustin Ave C-1121 Newport Beach, CA 92663 Report Number: Project Number: Project Name: Project Location: tel - 714-899-8900 free - 888-743.0998 fax - 714-899-1188 Patdot all.taar 1041 S. Placentia Avenue, Fullerton, (A92851 VUE111YI 309 Anade 309 Anade Newport Beach, CA Date Collected: Collected By: Date Received: 6/20/2019 Claim Number: Date Analyzed: 6/22/2019 PO Number: Date Reported: 6/22/2019 Number of Samples: 14 Lab/Client ID/Layer Location Material Description 771407-013 Roof Roofing Black 65% Tar 13 15% Glass Fibers 20% Minerals Total Asbestos None Detected 771407-014 Roof Roofing Black 65% Tar lq 15% Glass Fibers 20% Minerals Total Asbestos None Detected Lyn Terry - Analyst Kwin Legaspi - Approved By Bulls sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US. Federal Register 40 CFR 763, Subpart F; Appendix A; EPA -600/R-93/116 (Method for Determination of Asbestos in Building Materials), and EPA.600/M4-82-020 (US EPA Interim Method for the Determination of Asbestos in Bulk Insulation Samples).Samples were analyzed using Calibrated Visual Estimations (CVES); thereforeresults may not be reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individual layers. This reportapplies only to the items tested. Results are representative of the samples submitted and may not represent the entire material from which the samples were collected. "None Detected" means that no asbestos was observed in the sample. "<1%" (less than one percent) means that asbestos was observed in the sample but the concentration is below the quantifiable level of 1%. This report wasissued by a NIST/NVLAP (Lab .Code 200358-0) and CADOHS- FLAP (Cert. No. 2540) accredited laboratory and may not be reproduced, exceptin full without the expressed written consent of Patriot Environmental Laboratory Services, Inc. This report may not be used to claim product certification, approval or endorsement by NIST, NVLAP, FLAP or any government agency. Page 3 of 3 Lab Use Only Report Number: lel - 714-899-8900 free - 880.743-0998 fax - 714-099-7090 WmI.patriotiab.mm 1041 S. Placentia Avenue, Fullerton, (A 92031 MAIN AF r11CTr%nV PAM? , x Environmental Laboratory Services, Inc. Client:. Innv' me Pro'ect No.: Contact Person: Michael Jackson Project Name: .. 120 Tustin Ave, C-1121, Newport Beach, CA 92663 Project Location: 3Aa7NAG Contact Phone: 949-230.9779 Samples Collected B Contact Fax: Authorized bill: Claim #: PO #: How d0 you want your report? (Circle) Mail Fax Web E-mail: lacrepod0(illgman.com Special Instructions: Test to first positive Analysis Requested Turnaround Timebusiness hours/days) RUSH (4 hours) ❑ , RUSH (8 hours) ❑ ' 24 Hr ❑ 72 Hr ❑ I Other (specify)❑ . Notes: 4HR TATavallahleunW .viable sam /as uhe l•7 de srumaMwWmlNmum, Bacterial colhuae m ulte minimum 30hrTAT. BTL CAL•WerandTCLPmrMmum TA Tam Tlhrs. Asbestos PCM (nber.count) NIOSH 7400A ❑ PointCount400 CARB 435 O Pofnt Count 1000 ED Gravimetric Reduction (Gravimetric Reduction Requires Minimum 40hr TAT) Microbiolou Ewa! Non -Viable Air Spore Trap, SOP IV.4,lm/2m ❑ Viable (Colony ID & Enumeration) Air ❑ Swab/Bulk ❑ Non Viable Surface Tape Lifl/Swab/Bulk, SOP IVA.3m/4m [❑ Bacteria (Samples must be received bythe laboratory within 24hrs of collection or results maybe invalid) liform and E. coil - Surfaces, Swabs, and Bulk Solids, Liquids (non -potable, non -wastewater) — Presence / Absence ❑ TFRotome-terCallbration stry Flame AA - EPA 3050B/7420mod, NIOSH 7082mod: Paint ❑ Air ❑ Dust Wipe ❑ Water (non -potable) ❑ Sollsl3ollds]E1stePraflle(byFlameAA) Threshold ❑ otal by EPA 3050B mod 2: STLC/CAL WET Title 22 CCR Chi 1 Article 5 App 2 ❑ 3: TCLP EPA 1311❑se prov/de at approx. 200 grams (approx. Y rib ) of sample for complete profile. Check here to perform all test necessary rtu disposal on ❑ pH testing (soils, mist. solids, & lfqu/ds) EPA 9045 ❑ Client gample Sample Type - ID Date Total vol Sampled Location Sampled Description of Sample start stop Avg. Total Flowx (Material type, dimensions, etc) Time rime (LPM) Min. Tot. Min) y� 2 h ,^sem•• �. l ) 14 Relin uished By" (Print Michael Jackson Sign: Date: Time: Received B : (Print) ./ Sl9rr Date:Time: Relinquished 13y. (Print) Sign: Date: Tirne: lov Received By: (Print) Sign: Date: Time: Method of Shipment / Preservation During Shipment: Condition of SampleS: Acceptable: YES / NO. Neta-PatrW. FnlAinn ...-.__ ivr mau in air aver analytical results are reported. Unless customer provides written Instructions to extend holding time, samples will be disposed of In accordance with local, state and federal laws. Pagel of v.8.76.2014 L-Drive/Patriot CoC W I 10 Lab Use Only Report Number: lel-714-A9 "Oil free - 888-743-0998 fax - 714-099-7098 www.patdotla6.mm 1041 S. Placentia Avenue, Fn0edon, CA 92831 `:sig PAIR t Environmental Laboratory 5ervtees, Inc. Client Sample ID Sample Type Date Sampled Location Sampled Description of Sample (Material type, dimensions, etc) start Tima stop Time Avg. (LPM) Total Mln. Total Val Tolt Mln) h arr -do/ �af' C /,y l Z �oof .....- b.. o'd , Relinquished By: (Print) Michael Jackson Sign: Date: Time: Received By: (Pont) Sign: Date: Time: b: Relinquished B Print Sign: Date: Time: Received By: (Print) Sign: Date: Time: Note: Patriots holding time far all samples submitted Is 30 days for solid samples, 7 days for digests, and immediate for lead In air after analytical results ere reported. Unless customer provides written instructions to extend holding time, samples will be disposed of In accordance with local, state and federal laws. Page of - E � v.8.18.2014 L-Drive/Patrlot CoC