The URL can be used to link to this page

Home My WebLink About3955; Pajama Drive Demolition Project; Pajama Drive Demolition Project; 2008-04-25ASBESTOS ABATEMENT & >H)JwM4rtwJ N Z Ms 0) LU LU •z 0 z LU 0 2 H- -J Z) (0 z o LEAD REMOVAL/STABILIZATION CLOSEOUT REPORT Project Site: PAJAMA DRIVE DEMOLITION PROJECT EndofPajama Drive Oceanside, California Prepared For: Ms. Sherri Howard City of Carlsbad 405 Oak Avenue 1 Carlsbad, California 92008 I I Prepared By: WINZLER & KELLY CONSULTING ENGINEE1 4180 Ruffin Road, Suite 115 San nicon. California 92123 ENGSNEERSWG DEPARTMENT (858) 244-0440 W&K Project Number: 1038207007.77010 April 25, 2008 CONSULTING ENGINEERS TABLE OF CONTENTS SECTION 1 SECTION 2 SECTION 3 SECTION 4 SECTION 5 SECTION 6 SECTION 7 SECTION 8 SECTION 9 MAIN BODY I Introduction II Scope of Work III Methodology IV Standards V Discussion and Results VI Conclusions CONSULTANT CERTIFICATES WINZLER & KELLY DAILY FIELD LOGS WINZLER & KELLY CLEARANCE SPEED MEMOS WINZLER & KELLY DAILY SHIFT REVIEWS WINZLER & KELLY DAILY FIELD FORMS WINZLER & KELLY SAMPLE LOCATION MAPS LABORATORY REPORTS/SAMPLE LOGS CONTRACTOR DOCUMENTATION • Agency Notifications • Supervisor/Worker Certificates • Worker Documentation Summary SECTION 1 MAIN BODY CONSULTING ENGINEERS MAIN BODY I - Introduction Winzler & Kelly Consulting Engineers (Winzler & Kelly) was retained by the City of Carlsbad to provide professional environmental consulting services for the asbestos abatement and lead removal/stabilization activities as part of the Pajama Drive demolition project at the end of Pajama Drive located in Oceanside, California. • II - Scope of Work As part of the Pajama Drive demolition project, the scope of the work consisted of abatement and removal of asbestos-containing materials (ACMs), asbestos containing construction material (ACCMs), and stabilization of lead-based paints (LBPs) in poor condition prior to demolition activities at the end of Pajama Drive located in San Diego, California. The following ACMs/ACCMs were removed at the subject site: ASBESTOS ABATEMENT PAJAMA DRIVE MATERIAL/COMPONENT DESCRIPTION Asbestos-containing (<1%) Concrete Seals Asbestos-containing Window Putty Asbestos-containing Joint Compound Asbestos-containing Roof penetration mastic Asbestos-containing Gaskets Lead-based Paints (Color/Substrate): Green/Wood Green/Wood Green/Wood Green/Metal Green/Metal Green/Metal LOCATION Inlet, Outlet and Overflow Pipes Exterior Windows Interior Walls, Ceilings and Floors Roof at Penetrations Piping at Flanges Doors Door Jambs Door Frames Tank Exterior Doors of Chlorine Meter Overflow pipe APPROX. QUANTITY REMOVED (SF/LF/EA) 15 SF 100SF 500 EA 4SF 15 LF SEA 3EA SEA 1.600SF 6SF 25 LF Closeout Report - Main Body Pajama Drive Demolition Project April 25, 2008 Page 1 CONSULTING ENGINEERS ASBESTOS ABATEMENT PAJAMA DRIVE MATERIAL/COMPONENT DESCRIPTION LOCATION APPROX. QUANTITY REMOVED (SF/LF/EA) Notes: SF = square feet LF = linear feet EA = each N/A = not applicable Asbestos-containing = 1% or greater of asbestos by Polarized Light Microscopy (PLM), as defined by USEPA Asbestos-containing (<\%) = 0.1% or greater but less than 1% of asbestos by Polarized Light Microscopy (PLM), as defined by Cal/OSHA Lead-Based Paint = 1.00 milligrams per square centimeter (mg/cm2) of lead or greater is present, as defined by 17 California Code of Regulations (CCR) 35001-36100 Lead-Bearing Substance = 1.00 mg/cm2 of lead or greater III - Methodology The work was performed by Casper Contracting Inc, a State of California registered asbestos and lead removal contractor, from February 7 to 11, 2008. Winzler & Kelly was on site during abatement and removal/stabilization activities. The contractor oversight, air monitoring and analysis, and clearance sampling activities were conducted and overseen by the following State of California Certified Asbestos Consultants (CACs) and Department of Health Services (DHS) Lead-Related Certified Project Monitors/Inspector- Assessors, respectively. Jerry R. Sherman Stephen S. Reese CAC #97-2324, DHS I/A#5809 CAC #05-3853, DHS PM-I/A#13938 Copies of proj ect-related documents are attached, including the Consultant Certificates (Section 2); Daily Field Logs (Section 3); Clearance Speed Memos (Section 4); Daily Shift Reviews (Section 5); Daily Field Forms (Section 6); Sample Location Maps (Section 7); Laboratory Reports and Sample Logs (Section 8); and Contractor Documentation consisting of Agency Notifications, Supervisor/Worker Certificates, Worker Documentation Summary, Sign-In Sheets and Personnel Logs (Section 9). Additional worker certificates, waste manifests, and personal air-sampling results can be found with Casper Contracting. Asbestos Abatement Activities The interior building work areas were isolated by installing critical barriers constructed with two layers of six millimeter (mil) polyethylene sheeting across, depending on the type of work area, on walls, ceilings and work place openings, such as doorways, windows, diffusers, exhaust vents, and light fixtures. One (1) or more localized negative-pressure differential exhaust devices, equipped with a high-efficiency particulate air (HEPA) filter, were on-site and installed to service the work area as necessary and exhausted to the exterior of the building. Upon obtaining a minimum of four air exchanges per hour, successful inspection and testing of the work place barriers by a Winzler & Kelly representative, authorization was given to commence removal activities. Proper warning signs, in Spanish and English, and applicable barrier tape were placed at entrances to the work area in accordance with the requirements of 8 California Code of Regulations (CCR) 1529. Closeout Report - Main Body Pajama Drive Demolition Project April 25, 2008 Page 2 CONSULTING ENGINEERS The exterior building work areas were isolated by installing six mil polyethylene sheeting draped over horizontal surfaces adjacent to the work areas prior to removal of the components with ACMs/ACCMs. Proper warning signs, in Spanish and English, and applicable barrier tape were placed at entrances to the work area in accordance with the requirements of 8 CCR 1529. Depending on the type of work area, a one-stage, two-stage, and/or three-stage decontamination unit with a shower was attached to the work area. The decontamination unit was separated from the entrance through the use of a triple flap system and utilized by the workers upon ingress/egress from the work area. Prior to entering the work area, workers donned one disposable coverall with attached head and foot coverings, appropriate eye protection, and a half-face air purifying respirator equipped with P-100 (HEPA) filter cartridges. Worker decontamination was accomplished upon exiting the work area or on completion of each work shift through the use of the attached one-stage, two-stage, and/or three-stage decontamination unit. The three-stage decontamination consisted of a dirty room, clean room, and a shower room in accordance of the requirements of 8 CCR 1527 and CCR 1529. The ACMs/ACCMs removed from the subject site were saturated with amended water and then maintained in a continuous wet state during the abatement and removal process. A HEPA filtered vacuum cleaner and wet wiping techniques were utilized to clean up any dust or debris that was generated during these operations. The waste material was promptly placed into properly labeled six mil polyethylene waste bags, loaded into a properly lined disposal bin, and then transported off-site for disposal. LBP Paint Film Stabilization (PFSVComponent Removal; One layer of six mil polyethylene sheeting was also utilized as a "drop cloth" to collect debris generated during the PFS. Proper warning signs, in Spanish and English, and applicable barrier tape were placed at all entrances to the work area in accordance with the requirements 8 CCR 1532.1 for lead. Prior to entering the work area, all workers donned one disposable coverall with attached head and foot coverings, appropriate eye protection, and a half-face air purifying respirator equipped with P-100 (HEPA) filter cartridges. Worker decontamination was accomplished upon exiting the work area or on completion of each work shift through the use of the attached one-stage decontamination unit. LBP components were either removed intact or loose and flaking LBP paint was then removed and "feathered" from the areas manually through the use of hand tools for the impending renovation of the structure. All debris was collected in disposal bags. A HEPA filtered vacuum cleaner and wet wiping techniques were utilized to clean up any dust or debris that was generated during these operations. All waste material was placed in clear six mil polyethylene waste bags for disposal. IV - Standards Abatement, removal, and enclosure operations of ACMs/ACCMs were conducted by a California Occupational Safety and Health Administration (Cal/OSHA)-registered and State of California-licensed asbestos removal contractor. Abatement, removal, and enclosure operations of ACMs/ACCMs were performed under the oversight and direction of a California Certified Asbestos Consultant. Asbestos abatement activities performed at the subject site were performed as per the requirements set forth in 40 Code of Federal Regulations (CFR) 61 Subpart M (National Emission Standard for Hazardous Air Pollutants [NESHAP] for asbestos). Closeout Report - Main Body April 25, 2008 Pajama Drive Demolition Project Page 3 CONSULTING ENGINEERS Activities involving identified LBPs were conducted in accordance with Title 17, CCR, Division 1, Chapter 8, Sections 35001 through 36100, which proscribes the use of DHS-certified workers, work practices, and other requirements. V - Discussion and Results Asbestos Abatement and Oversight Activities Winzler & Kelly personnel, using the National Institute for Occupational Safety and Health (NIOSH) 7400 methodology for phase contrast microscopy (PCM), analyzed daily progress air samples collected prior to and during abatement activities of ACMs. Winzler & Kelly personnel are NIOSH 582-certified for Sampling and Evaluating Airborne Asbestos Dust by the State of California. Progress air samples for asbestos were collected from within and outside each representative work area and analyzed through the use of PCM. Progress air samples revealed the airborne fiber concentrations within work areas to be below the permissible exposure limit (PEL) of 0.1 fibers per cubic centimeter (f/cc) of air. Progress air samples revealed the airborne fiber concentrations outside work areas to be at or below the United States Environmental Protection Agency (USEPA)'s recommended occupancy criteria, following asbestos removal activities, of 0.01 f/cc of air. Upon the completion of asbestos abatement activities, the work areas were detail cleaned by Casper Company. After the cleaning activities had been completed, the work areas were inspected by a Winzler & Kelly representative for signs of any visible debris in accordance with the requirements of 8 CCR 1529. Upon acceptance, Casper Company was authorized to encapsulate each of the work areas. Air samples were collected by a Winzler & Kelly representative. PCM air samples were analyzed by Winzler & Kelly personnel who are NIOSH 5 82-certified for Sampling and Evaluating Airborne Asbestos Dust by the State of California. The PCM sampling was below the USEPA's recommended occupancy criteria, following asbestos removal activities, of 0.01 f/cc of air. Once clearance air samples were collected from within each representative work area, analysis had been completed, and acceptable clearance criteria had been achieved, Casper Company was authorized by a Winzler & Kelly representative to remove polyethylene sheeting and the critical barriers, and conduct final tear down activities within each of the cleared work areas. Asbestos-containing/contaminated waste was transported to Casper Copmpany's properly labeled polyethylene lined dumpster for proper manifesting and disposal. Waste manifests were signed prior to off-site removal for disposal. Work overseen by Winzler & Kelly was performed in compliance with applicable Federal, State, and local regulations governing the environmental aspects of asbestos abatement and disposal. LBP Removal/Stabilization and Oversight Activities Upon the completion of LBP removal/stabilization activities, the work areas were detail cleaned by Casper Company. After the cleaning activities had been completed, the work areas were inspected by a Winzler & Kelly representative for signs of any visible debris. Closeout Report - Main Body April 25, 2008 Pajama Drive Demolition Project Page 4 CONSULTING ENGINEERS VI - Conclusions Work was completed in accordance with the regulatory and contract requirements applicable to this project. At this time, known ACMs/ACCMs and LBPs have been removed that were in work areas to be impacted by the demolition activities at Pajama Drive in Oceanside, California. Report prepared for the City of Carlsbad by: Jerry Kr Sfaennan Hazardous ^Material Division Manager Certified Asbestos Consultant #97-2324, DHS Lead Inspector-Assessor #5809 Closeout Report - Main Body Pajama Drive Demolition Project April 25, 2008 Page 5 SECTION 2 CONSULTANT CERTIFICATES STATE OF CALIFORNIA Arnold Schwarzenegger, Governor DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH ASBESTOS CONSULTANT and TRAINER APPROVAL UNIT 2211 Park Towne Circle, Suite 1 Sacramento, CA 95825 Tel: (916)574-2993 Fax:(916)483-0572 508173853C Stephen S Reese 4123 Twilight Ridge San Diego 282 July 19,2007 CA 92130 Dear Certified Asbestos Consultant or Technician: Enclosed is your certification card. To maintain your certification, please abide by the rules printed on the back of the certification card. Your certification is valid for a period of one year. If you wish to renew your certification, you must apply for renewal at least 60 days before the expiration date shown on your card. [8 CCR 341.15(h)(1)]. Please hold and do not send copies of your required AHERA refresher renewal certificates to our office until you apply for renewal of your certification. Certificates must be kept current if you are actively working as a CAC or CSST. The grace period is only for those who are not actively working as a CAC or CSST. Please inform our office at the above address, fax number or actu(S)dir.ca.qov of any changes in your contact/mailing information within 15 days of the change. Sincerely, State of California of Occupational Sa?e?y and Hea,th Certified Asbestos Consultant Jeff Ferrell Senior Industrial Hygienist JF/ms Attachment: Certification Card cc: File (Renewal - Card Attached Revised 8/29/06) Certification Expires 01 Professions Code Mr. Stephen S. Reese Winzler & Kelly Consulting Engineers 4180RuffmRoad,#115 San Diego, California 92123 State of California Department of Public Health Lead-Related Construction Certificate Certificate Type Expiration Date Inspector/Assessor 11/25/2008 Reject Monitor 11/25/2008 State of California Division of Occupational Safety and Health Certified Asbestos Consultant Jerry Robert Sherman Name ' Certification Mn 97-2324 Expires on n7/nfi/no This certification was issued by the Division of Occupational Safety and Health as authorized by Sections 7180 et seq. of the Business and Professions Code. Mr. Jerry R. Sherman Winzler & Kelly Consulting Engineers 4180RuffmRoad,#115 San Diego, California 92123 ,?^f£*W<Wi!a Department of Public HealthLead-Related Construction Certificate Das I^pectoi/Assewsor 01^)7/2009 *^i \\ j, ••_,.vv/7**.-,' 'v. SECTION 3 WINZLER & KELLY DAILY FIELD LOGS Daily Field Log 3531 E.Miraloma Avenue 4180 Ruffin Road, Suite 115 Anaheim, CA 92806 _ ' _ ' _ San Diego, CA 92123 Client: /i ftr.ftt __ Date/Shift: Work Location: \ d i ft m c, p r . Kg, 5c A/fri r Project Number: / 0 .5 9 *?£ re ,/vt To yg^.A o5l^STpJ *Vc-ll**i~l v\ jfri^T Cr-rtA f) ?**,,! \ AW r^Wtin / 'V^j Jt^t r.-CV^IfelHt^vf^f rA COvT.r-/J B/<jf y _j- _— ^ - / -,3C/^ rcSfe^r- ggCi/tj rc-il^i flfrw 4g T lock /> . -c-^'J Q cC<y fc _fT<u-/ fwvtvi T , nt<j>^ a^ mp*M ToytVh T tAJi^xr l^e^. ^tfq t& ^uf'o Cf-o//.T»^J> cT dr£^ t**Sn$. • 3(7 ^'Cfi-^y^y- ('tl t/ot'fM'^/r? ^ ^MiA^y'i^pr ) C^'/Uvg. • OXJfet.$/c-S iPttlto***,'. _^ ^ t»Jv/A^ f,o^T'ct IKX^VI . vt^^w"J 1/1 Ai /- ir^Cvu'TtY >r< dur <«- ci<>$3±if/S C*atJ~t <***'• qo W&K Representative: 7'|fr\/<- /.j^. _ Page I of FieldntJIU WINZLER&KELLY CONSULTING ENGINEERS 353 J E. Miralo ma Avenue • Anaheim, CA 92806 Client: C < Work Location: 6^'f) 1/1 J P d Gu-UkJ "^ 'N A r-^v^ft U/. JvtS-e-^UcJ 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Date/Shift: (?/ 7 /O1 -•if Project Number: S Oa,i j £3^<77cc 7.7 7tf/ I 3-'\AXty k <xrfA r rrlUc4 fxA L^' ff&^Vrfd ^ Lxter 'ko W&K Representative^V^Page of rv«iiw c.-^i^ I ~«Daily Field Log WINZLER&KELLYCO...UIT... 353 IRMiraloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Client: (/lit, PT Date/Shift; Work Location: pw. -tyJ _ -«;.fe. 1/f. TZ>i' \,~- ( h~,. Atv</t>t<r ' Proj ect Number: ) 0 3 BP? # 7Ct>7t 770 10'I - - -<: ef '6«^}&y (S-.fr ?* Tr^flfti /) ^a^7 -fa vva /7 T cM.Ll- v^/^A cr i'c-'iyt > . T yaw/ Tp /" .^q a A I/!' OT fOut.J JJA /O ivitt^ •Tg-tT.Tycno5')-T T -o \\N*S*O faff,it 3(!c.<>p, cT as re . oJ cvnMtTt .e, r/l 7 OT l <a. A! ^JtucJ . £* "t<. I 5 CokTre/ W&K Representative:ive: J^Page I oO WTNZLER&KELLY CONSULTING 3531 E.Mir aloma Avenue Anaheim, CA 92806 4180 Ruffm Road, Suite 115 San Diego, CA 92123 Client: C lfu ct -CfcrUW Date/Shift: Work Location:* .f .-Project Number: T a. c^t^/3. Tc, -i cn jo T < • .nifl^J "ft* ir ew^v «vT fl I rvrfT Wsshf C /*j~ P)lr.U . Cgr w«v"'/.5 . <vue ,; f .^ . y/vg ' ^r A' Cc,<^~Tt*^S 'C/ "C "fywt5.tfy , , C&sfaf Kt ^ .V r?t^H v mt-sf>cJ<\( <*S' -T/CT /?,/?/S ,MTt,n- ~ •- . - nttiK.iQ •flt-r' /J/</rVirT.. 5 ifTcv~ K~r ji>-f. **,itis .^K. W/ r^.mJrc-S AVi*7l*r4+*.T 0T- |A>,J~ ft/r __ __ ^ «rv '._! f)^fift '/ W&K Representative:ive: " ^Page g7 off 7 Daily Field Log WTNZLER&KELLY CONSULTING ENGINEERS 3531 E. Miraloma Avenue Anaheim, CA 92806 4180 Ruffln Road, Suite 115 San Diego, CA 92123 ient: Q*'\Client Work Locationion: V TL 6v~fr Date/Shift:.M Project Number: T >rv . T /y sue. £..<f <ft,vtiiJ ft ft. I M: 3(7 y y-TXTn^ft icr )^ c^ (4f,f*ri of r^Fc ' 6 A •" " l 7 ( <^s/i/y .ti(A .../i -H^ fw (ytyx..; W&K Representative:,Page.of Dailv Field LoaLJdlly ritMU L.UIJ WENZLER&KELLY CONSULTING E N C I H E E R S 353 J E. Miraloma Avenue Anaheim, CA 92806 4180 Ruffm Road, Suite 115 San Diego, CA 92123 Client:n T Work Location: Y^\&M<\ df- \li^t,YVc\Y Date/Shift: ^/l(/ C'& P^ f//. / 7 Project Number: > ^3 $3.0700 1. 7 J G\ 0 ' C.oiKfl c//g r M ft Wc-rii /g d&l J/iS, ~L Mi . "71 S lau -i»j." /jft /? fil^flLt M^ iff >' .T^rt Cj 1 t'C/,u /A t***S 5 iff 4 ,ni . 714- . ^, ' &b Str-jt, r,;: 0 iy r rfinc rT I 6 JitM w.ll rT tf fl W&K Representative;ive: O"/Ryg r\Page J n -K, ,- lrj , __Daily Field Log WINZLER&KELLYCONSULT.^ 3531 E.Mir aloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Client: C, Uu j^T .r^U Work Location: (|^ ft^<l Pr. Date/Shift : **/ f Project Number: Ccl/Ccf' r.^-Af s /A x V.Xy I// W&K Representative:,Page of SECTION 4 WINZLER & KELLY CLEARANCE SPEED MEMOS Clearance Speed Memo CONSULTING ENGINEER 3557 E. Miraloma Avenue Anaheim, CA 92806 4180Ruffm Road, Suite Hi. San Diego, CA 92123 Client: Facility: <T>4 *f> Date: '"••' ' 1 ~~~~-' - "T Project Number: )b5?-:J07o07»'7 On ' (Date) Select One Winzler & Kelly Consulting Engineers performed a visual inspection and collected:' Background Air Samples Process Air Samples Clearance Air Samples Background Wipe Samples Process Wipe Samples Clearance Wipe Samples From: (Location) The results of the aforementioned air monitoring indicate that airborne fiber concentrations were: Select One i (Fail) Below (Pass) •SelectAll That Apply I I 70 Structures per square millimeter (S/mm2) per the AHERA Protocol Method outlined in 40 ~FRPart763SubpartE. . EPA's recommended clearance criteria of 0.01 fibers per cubic centimeter of air (f/cc). Measured background concentrations of fibers per cubic centimeter of air (f/cc). The results of the aforementioned wipe sampling results indicate that settled lead Select One D Above (Fail) D Below (Pass) Select All That Ay, ions were: fit A . )'s recommended clearance criteria of 40 ug/ft2. Measured-background concentrations of ug/ft2 Other (specify):_ Based on the results of the inspection and analysis the following further actions are required: Select O/ne None, containment may be removed. Re-clean the Work Area. Re-testing is required. Other: ' D None. Comments :'-5 To t ^ -f*_T__i£jJ4_/_ \J Analytical Method: D AHERA Protocol l~l Other (specify): i-I Print Name Signature NIOSH 7400 - PCM D EPA SW-846 & 3050/7420 DH^CACSSTff ^*^—e ' Date CSM 1/04 Pagel of 1 Clearance Speed Memo CONSULTING ENGINEER 3531 E. Miraloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 'tUo f»tClient: Facility: \ cv\flt»\f> Date: Mr. 1/08 Project Number: i 0 J 9^O 70&7. 77016 On °y^|/f)6 Winzler & Kelly Consulting Engineers performed a visual inspection and collected: (Date) J (Ccwhf^VUY 5e/ecf One M fl^ruyia^il Background Air Samples Process Air Samples Clearance Air Samples From: t ti. ffr. '3e-*Vc"/" 5 i Background Wipe Samples Process Wipe Samples Clearance Wipe Samples (Location) f~i Below (Pass) •Select All That Apply j I 70 Structures per square millimeter CFR Part 763 SubpartE. The reSiiJts of the aforementioned air monitoring indicate that airborne fiber concentrations were: Select ~ per the AHERA Protocol Method outlined in fj EPA's recommendetrclearance criteria of 0.01 fibers per cubicTteHiimeter of air (t7cc). I I Me^suTe3"Eackground concentrations of fibers per cubic centim^tej of air (f/cc). The results of the aforementioned wipe sampling results indicate that settled lead concentrations-were: Select One. Select All That Apply "ove (Fail) Q HUD's recommended clearance criteria of 40 ug/ir. Below (Pass) I I/Measured background concentration^ of 0^ Other (specify): CQfti S. r,4tri Based on the results of the inspection and analysis the following further actions are required: Select One I j None, containment may be removed. LJ Re-clean the Work Area. Re-testing is required. rl Other: ' 1 0None. Comments:P fit* '*•* T Analytical Method: Q AHERA Protocol \3NWSH7400-rCM D Other (specify): . SW-846 & 3050/7420 1. Print Name (DHSyCAC/CSST#'Dale CSM J/04 Page 1 of 1 SECTION 5 WINZLER & KELLY DAILY SHIFT REVIEWS CONSULTING ENGINEER Daily Shift Review WINZLER&KELLY CONSULTING ENGINEERS 3537 £ Miraloma Avenue Anaheim, CA 92806 Client Name: L/)"Ki Site Address: ] p, \& t*c* Time In: / r 0' Time Out: 1 0 " J . - 41 80 Ruffm Road, Suite 115 San Diego, CA 92 123 Jr C \ \ 1a~T ^o^lSRftA o 0J/r, K/'Sfrru^i^ Date/Shift: & / 7/ C?Y) OcjvJ CI] '' "ft • Proiect Number: ['Q3 8<2o7'&0'i Crt* r >Contractor/Foreman: L v-^Q&C t{/,/ f No. of Workers + Foreman: (>(, L,) 'Xui- ft '+F.M. Air Samples Collected During Shift Background Inside Work Area (IWA) Outside Work Area (O WA) HEPA Exhaust (HEX) Clearance (CLR) Personals (PER) Other (OTH) Field Blanks (FLB) Total Samples Collected Activities Conducted During Shift: Co.tf PCM Lea/Air t Oilier: Comments Related (o Shift Activities/Performance /MrX™ ^r"-^:'f^ku fc^M-ri^oa *V . >-/ c^ 4 ^cTe^-v/ Cf V/&K Representative^n<r&3p.Page ) of Daily Shift Review WINZLER&KELLY CONSULTING ENGINEERS 3 531 E Miraloma Avenue Anaheim, CA 92806 Client Name: O i T-j CT (_ for] 6 1) ft ** '/?'• 'y n n ' < Site Address: l(X%C'iv^(A yf- \\L&f\/v>SJ ' " — ? /•*/-•»Time In: / • C/C7 Time Out: ( b ' 30 Air Samples Collected During Shift Background Inside Work Area (IWA) Outside Work Area (OWA) HEPA Exhaust (HEX) Clearance (CLR) Personals (PER) Other (OTH) . Field Blanks (FLB) Total Samples Collected Activities Conducted During Shift: ' r r '•'-£/ L -/ b -i \ *li &, • / J -x^ikfAt/w fli*\ri\i*y rooT p\afr.oi ^/ Comments Related to Shift Activities/Performance: RyfkjyTti.^ ^bcil^t^ki of If ;!<>.T~ c<w\P&** J 'wtArtMi PvJ ^5"fe*3 ^yeCitiubJ~ 01 flifli ^?c 4180RuffmRoad,Suitell5 San Diego, CA 92 123 Date/Shift: ^/ V/^0 Project Number: [ 0 .3 <? °^^ ' ^ ' ^ / /^' u ' ' /" r /•"? tt-Contractor/Foreman: ( x<\&l«r 6t>- /vxU«M (/• No. of Workers + Foreman: oC -t-F.M. PCM LeadAir Other/ / ^_ 1 / nl 3 5-i ^ ^ -/ /- y/Atf5i P -^ .)> /. - /' lirhnS.rL. f)<M. ••• 'J • . //x ' /" VL / R/// ^ jt » \ A;* ^r-f^ ,;r M!;^* ^/ iif^,T5) l^jV^CV /)\f/ru frtfu iv&Snf' i/hiiflSt V/&K Representative: '•AJ?, Aeg.Page t ofi of I Daily Shift Review WINZLER&.KELLY CONSULTING ENGINEERS 3537 E Miraloma Avenue Anaheim, CA 92806 4180 Ruffm Road, Suite 115 San Diego, CA 92123 Client Name: Site Address: rct.flYx.fr 1/f • Time In: 7 Time Out:; 30 Air Samples Collected During Shift Background Inside Work Area (IWA) Outside Work Area (OWA) HEPA Exhaust (HEX) Clearance (CLR) Personals (PER) Other (OTH) Field Blanks (FLB) Total Samples Collected Activities Conducted During Shift: Date/Shift: Project Number: 1 1 0 3 E Contractor/Foreman:Cc- /TiAAt* H No. of Workers + Foreman:+F.M. Lead Air Other: f w,vttt Comments Related to Shift Activities/Performance: f-Hf^ /V V/&K Representative.^Page of SECTION 6 WINZLER & KELLY DAILY FIELD FORMS CONSULTING ENGINEERS Daily Field Form WINZLER&KELLY CONSULTING ENGINEERS 3557 EMiraloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Client Name: Site Address: J :_L^lIU 0- J ; TCVI Q\ Cc.Date/Shift:TiT Project Number: \0 "b $3 REMEDIATION METHODOLOGY UTILIZED Removal I/Containment _ Enclosure Glove Bag Encapsulation Other Materials Remediated From: ^/Floors C PeW^ i] _ Piping Systems j/^Valls _ Ducting Systems ^/Ceilings _ Structural Systems _ Tanks Boilers Identify Specific Materials, Quantities and Locations Remediated (Estimate quantities for each day/shift): MATERIAL TYPE .LOCATION QUANTITY.REMEpIATED Co*\rct\9- ^ eA PERSONAL PROTECTIVE EQUIPMENT: RESPIRATOR TYPE Y 1/2 Face _ Full Face _ PAPR Supplied Air RESPIRATOR MANUFACTURER J/ North _ Survivair _ Racal _ 3M MSA Other CARTRIDGE TYPE j/HEPA jL/P-100 _ P-95 _ P-90 Organic Vapor Acid Vapor Other DISPOSABLE COVERALLS Number of Suits, { Boots Attached I Hoods Attached Stacked Cartridges: 1 Note: Cartridges must be the same manufacturer as respifator OTHER PERSONAL PROTECTIVE EQUIPMENT _v/Hard Hats _ Imbber Boots JARubber Gloves j/ Safety Glasses Splash Goggles Harness & Line Other • PERSONAL AIR MONITORING Personal Air Monitoring is the Responsibility of: Contractor: ^/ W&K: Other: Number of Workers Monitored:Results Current & Posted:Y/N/d W&K Representative:Page 1 of2 Daily Field Form WINZLER&KELLY CONSULTING ENGINEERS 5557 E Miraloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Client Name: ^ Date/Shift: Site Address: f p.P * 1): f P. jftHft J/r,Project Number: I (?3 B 3 0 / DQ Z DECONTAMINATION UNIT (E=Excellent, A=Acceptable, F=FaiI) Number of Chambers Clean Room Shower Room Equipment Room Cleanliness Debris Airflow Direction Condition of Polyethylene Excessive Water Breaches ._ Hot dfcpld Water) Soap Towels WORK PRACTICES & PROCEDURES (E=Excellent, A=Acceptable, F=Fail) INSIDE WORK AREA Adequate Water Use Prompt Bagging of Debris Proper Decontamination Procedures Work Area Cleanliness OUTSIDE WORK AREA Visible Emissions Dumpster On-Site Dumpster is Poly Lined Dumpster is Lockable Dumpster is Labeled • ENGINEERING CONTROLS ., Manometer On-Site and Operational Y /($/ NA HEPA Filtered Vacuum On-Site & Utilized (j? / N / NA Hudson Sprayer On-Site & Utilized Y Xjf / NA Airless Sprayer On-Site & Utilized I®/ N / NA Fire Hose/Water Hose fS^/ NA ' Amending Agent On-Site & Utilized (W N / NA Encapsulant On-Site & Utilized <Y j N / NA • BAG OUT Adequate Water Utilized for Bag Out Bag Out - Housekeeping Procedures Bag Out Polyethylene Condition Breaches During Bag Out Procedures Generator Labels on Bags/Drums CORRECTICTIVE ACTION TAKEN Y /(] Specify Corrective Actions Taken: "Zero Calibration" Checked MANOMETER READINGS: Time _ Reading Y / N / Time Reading_ _/N/NA E/ft/F E/@/F /NA • COMMENTS: W&K Representative:,Page 2 of2 Daily Field Form WINZLER&.KELLY CONSULTING ENGINEERS 5537 EMiraloma Avenue Anaheim, CA 92806 4180Ruffin Road, Suite 115 San Diego, CA 92123 Client Name: (, '.-f \A til C <t< \ f t? Site Address: ]£M(Avnci Vr, Date/Shift:ft/00 .P*t * Project Number: ) O3930 7CO 7> 7 • REMEDIATION METHODOLOGY UTILIZED l/ Removal Containment __ Enclosure /Glove Encapsulation ^ Other. Materials Remediated From: _ Floors _ Walls /Ceilings _ Piping Systems Ducting Systems Structural Systems _ Tanks Boilers Identify Specific Materials, Quantities and Locations Remediated (Estimate quantities for each day/shift): MATERIAL TYPE -r LOCATION QUANTITY REMEDIATED ,r , WiJrw N /^ CCcfKT PERSONAL PROTECTIVE EQUIPMENT: RESPIRATOR TYPE ^ 1/2 Face _ Full Face _ PAPR Supplied Air RESPIRATOR MANUFACTURER J/North _ Survivair _ Racal _ 3M MSA Other GE TYPE _ P-100 _ P-95 _ P-90 __ Organic Vapor _ Acid Vapor Other DISPOSABLE COVERALLS Number of Suits __ ( Boots Attached Hoods Attached (Y/N Stacked Cartridges: Note: Cartridges must be the same manufacturer as respirator OTHER PERSONAL PROTECTIVE EQUIPMENT j/H/rdHats _J&jbber Boots j/Juibber Gloves j/ Safety Glasses Splash Goggles Harness & Line Other • PERSONAL AIR MONITORING Personal Air Mormoring is the Responsibility of: Contractor: v _ W&K:_ Other: Number of Workers Monitored:Results Current & Posted:Y/N/NA W&K Representative:Page 1 of2 Daily Field Form WINZLER&.KELLY CONSULTING ENGINEERS 3531 E Miraloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Client Name:0^3 p"H Date/Shift Site Address: lfc>£.v^ V*~- :: 1/&/V& Project Number: | O 3 EUfl 7g'(? 7g /7£ ^ • DECONTAMINATION UNIT (E=ExceIlent, A=Acceptable, F=FaiI) Number of Chambers I Clean Room Shower Room Cleanliness Debris Airflow Direction Condition of Polyethylene Excessive Water Breaches #oT& Cold Water Soap Towels WORK PRACTICES & PROCEDURES (E=ExceIIent, A=AcceptabIe, F=Fail) iquipment Room INSIDE WORK AREA Adequate Water Use Prompt Bagging of Debris Proper Decontamination Procedures Work Area Cleanliness • ENGINEERING CONTROLS Manometer On-Site and Operational HEPA Filtered Vacuum On-Site & Utilized Hudson Sprayer On-Site & Utilized Airless Sprayer On-Site & Utilized Fire Hose/Water Hose Amending Agent On-Site & Utilized Encapsulant On-Site & Utilized • BAG OUT Adequate Water Utilized for Bag Out Bag Out - Housekeeping Procedures Bag Out Polyethylene Condition Breaches During Bag Out Procedures Generator Labels on Bags/Drums CORRECTICTIVE ACTION TAKEN Specify Corrective Actions Taken: OUTSIDE WORK AREA Visible Emissions •Bornpster On-Site Dumpster is Poly Lined Dumpster is Lockable Dumpster is Labeled )/N/NA i/N/NA Y/N "Zero Calibration" Checked MANOMETER READINGS: Time Reading Y/N/NA Time Reading_ • COMMENTS: W&KRepresentative:Page 2 of2 Daily Field Form WLNZLER&KELLY CONSULTING ENGINEERS 3537 EMraloma Avenue Anaheim.CA 92806 4180Ruffm Road, Suite 115 San Diego, CA 92123 Client Name; L ITU Cl (.. c Site Address: YcT ft*,a j/f. • JREMEDIATION METHODOLOGY UTILIZED ^/Removal _ Enclosure Encapsulation ' Containment __Criove Bag j/Dther Date/Shift:fCf Project Number: I 0 3 (?<& 700 7« 770 I ^ Materials Remediated From: Floors _ Walls Ceilings _ Piping Systems _ Dating Systems Structural Systems j/Tanks Boilers Identify Specific Materials, Quantities and Locations Remediated (Estimate quantities for each day/shift): MATERIAL TYPE'LOCATION QUANTITY REMEDIATED P\fld 2s Lf -H" PERSONAL PROTECTIVE EQUIPMENT: RESPIRATOR TYPE 3/1/2 Face _ Full Face _ PAPR Supplied Air RESPIRATOR MANUFACTURER \/ North Survivair _ Racal ... _ 3M MSA Other CARTRIDGE TYPE PA P-100 _ P-95 _ P-90 Organic Vapor Acid Vapor Other DISPOSABLE COVERALLS Number of Suits Boots Attached! Hoods Attached | Stacked Cartridges: Note: Cartridges must be the same manufacturer as respirator OTHER PERSONAL PROTECTIVE EQUIPMENT j/Hard Hats _ Rubber Boots . _ jfcobber Gloves _«/Safety Glasses _ Splash Goggles Harness & Line Other • PERSONAL AIR MONITORING Personal Air Monitoring is the Responsibility of: Contractor: V W&K: Other:_ Number of Workers Monitored:i Results Current & Posted:Y(N)NA W&K Representative:,R Page 1 of2 Daily Field Form WINZLER&KELLY CONSULTING ENGINEERS 3531 EMiraloma Avenue Anaheim, CA 92806 4180 Ruffin Road, Suite 115 San Diego, CA 92123 Client Name; ( '.. (Tu pf Lc-,i Date/Shift:A/ (l/frff Project Number: \0 3ft?/770O 7. • DECONTAMINATION UNIT (E=ExceIlent, A=Acceptable, F=Fail) Number of Chambers I Clean Room ^lowerRoom Equipment Room Cleanliness Debris Airflow Direction Condition of Polyethylene Excessive Water Breaches Stetnfe Cold Water Soap Towels • WORK PRACTICES & PROCEDURES (E=ExceIlent, A=AcceptabIe, F=Fail) INSIDE WORK AREA Adequate Water Use Prompt Bagging of Debris Proper Decontamination Procedures Work Area Cleanliness • ENGINEERING CONTROLS Manometer On-Site and Operational HEPA Filtered Vacuum On-Site & Utilized Hudson Sprayer On-Site & Utilized Airless Sprayer On-Site & Utilized Fire Hose/Water Hose Amending Agent On-Site & Utilized Encapsulant On-Site & Utilized • BAG OUT Adequate Water Utilized for Bag Out Bag Out - Housekeeping Procedures Bag Out Polyethylene Condition Breaches During Bag Out Procedures Generator Labels on Bags/Drums CORRECTICTIVE ACTION TAKEN Specify Corrective Actions Taken: Y/N/ Y/N Q?/N/NA )/NA ?/N7NA OUTSIDE WORK AREA Visible Emissions Dumpster On-Site Dumpster is Poly Lined Dumpster is Lockable Dumpster is Labeled "Zero Calibration" Checked MANOMETER READINGS: Time Reading Y/N| Time Reading_ (Y?/N/NA E/GS/F COMMENTS: W&KRepresentative:Page 2 of 2 SECTION 7 WINZLER & KELLY SAMPLE LOCATION MAPS <*"O^«A yy- f4 SECTION 8 LABORATORY REPORTS/SAMPLE LOGS CONSULTING ENGINEERS Environmental Wipe Sampling Log WINZLER a KELLY CONSULTING ENGINEERS 3531 E. Miraloma Avenue, Anaheim, CA 92806 Client: C/h\ o\ f.arbW " J Facility: fcAfivaa i/fe \{&5&rVc>, f £1 DTaken By: Jl^tf K^^ Project Number: ( D J Functional Space: £^-> Date Sampled: «*/ 7/ 4180 Ruffin Road, Suite 115 San Diego, CA 921 23 ofefW '08 Sample No. •Jw-c/l •y^0^ vh3 Sample Description a * i ^ ^^4- W\<.W«U«\ ConCrt^t ^0^ * ^rcw r,^l flWH J A/c/f.fc/ \f / ^*v-T«r.|< La\? ty}**k Sample Container G> TA*- ^V Sample Area l*F 1 Laboratory Analysis Required Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Chain of Possession: CHAIN OF CUSTODY: 1. 2. Signature Signature Signature Turnaround Time: same Day 5 day rVt Title Inclusive Dates Title Inclusive Dates Title Inclusive Dates Page. J AMERlSd Please Reply To:AmeriSci Los Angeles 24416 South Main Street, Suite 308 Carson, CA 90745 Phone 310-834-4868 / Fax 310-834^772 FACSIMILE TELECOPY TRANSMISSION* To: Mr. Steve Reese Winzler & Kelly San Diego Fax# 858-244-0441 AmeriSci Job# 0802-00016 Subject: city Of Carlsbad Date: Wednesday, February 13, 2008 Time: 6:10:43AM Comments: This report consists of pages, including: Cover Page (Facsimile Telecopy Transmission) Laboratory Report Chain of Custody Record_ Air Bill_ Sample Receiving Form Miscellaneous J2{- pages _pages pages pages pages pages CONFIDENTIALITY NOTICE: Unless otherwise indicated, the information contained in this facsimile communication is cohfidential information intended for the use of the individual named above. If the reader of this communication is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is prohibited. If you have received this communication in error, please immediately notify the sender by telephone and return the original message to the above address via US Postal Service at our expense. Preliminary data reported here will be verified before final report is issued. Samples are disposed of in 60 days unless otherwise instructed by the protocol or special instructions in writing. Thank you. Certified Analysis Service 24 Hours a Day - 7 Days a Week www.ameriscl.com Boston - Los Angeles - New York - Richmond Competitive Prices AMERlSd AmeriSci Los Angeles 24416 South Main Street, Suite 308 Carson, CA 90745 Phone 310-834-4868 / Fax 310-834-4772 Laboratory Report Report Date: 2/13/2008 Workorder No.: 0802-00016 Customer: Winzler & Kelly San Diego 4180RuffinRoad San Diego CA 92123 Suite 115 Attention: Mr. Steve Reese Subject: City Of Carlsbad Sample: 001 Description: Collection Date: 02/11/2008 Matrix: Air Cassette Parameter Lead, Air Sample: 002 Description: Collection Date: 02/11/2008 Matrix: Air Cassette Parameter '.ead. Air Sample: 003 Description: Collection Date: 02/11/2008 Matrix: Air Cassette Parameter Lead. Air Sample: 004 Description: Collection Date: 02/11/2008 Matrix: Air Cassette Parameter Lead. Air Air-01 Method ICP. EPA6010B Air-02 Method ICP. EPA 601 OB Air-03 Method ICP. EPA 601 OB Air-04 Method ICP. EPA 601 OB In Projress, NW Exterior Received Date: 02/12/2008 Time: 10:00:OOAM Results Units <0.52 ug/m3 In Projress, NE Received Date: Results Units <0.52 ug/m3 In Projress, SE Received Date: Results Units <0.51 ug/m3 Lab Blank Received Date: Results Units <0.50 ug/air filter PQL 0.52 Exterior Tech Analysis Date TN 02/13/2008 Qual 02/12/2008 Time: 10:00:OOAM PQL 0.52 Exterior Tech Analysis Date TN 02/13/2008 Qua! 02/12/2008 Time: 10:00:OOAM PQL 0.51 Tech Analysis Date TN 02/13/2008 Qual 02/12/2008 Time: 10:00:OOAM PQL 0.50 Tech Analysis Date TN 02/13/2008 Qual Unless otherwise specified, the samples were received in an acceptable condition and met all holding time and preservation-handling requirements. The laboratory does not correct for field or matrix blanks. To the best of my knowledge this report is true and accurate. Authorized By/Title: \- --- -I „/)/ C#e.Date: Certifications: CA ELAP: 2322 PQL= Practical Quantitation Limit MO L = Method Detectio n Limit Page 1 of 2 % Customer: Winzler & Kelly San Diego S Workorder No.: 0802-00016AMER/SCI The analytical results within this report relate only to tne specific compounds and samples investigated and may not necessarily reflect other apparently similar material from the same or similar localbn. This report shall not be reproduced, except in full, wilhoul the written approval of AmeriSd Los Angeles. No use d this report for promotional or advertising is permitted without the written approval of AmeriSci Los Angeles. » NOTE: All solid results are repotted on a dry weight basis unless otherwise noted. Certifications: CA ELAP: 2322<m POL- Practical QuantitaGon Unit MDL= Method Detection Limit Page 2 of 2 Lead Air Sample Log WINZLER& KELLY cc 5557 E Miraloma Avenue Anaheim. CA 92806 4I80Ruffin Road, Suite 115 San Diego, CA 92123 pT (7ftrUb» Location:Of, J?flifr*Wir Date..: l/M/Ofl Project Number: Analytical Method: ICP - NIOSH 7300 • Signature Turnaround Time: ' Same Day [ 24hr / 5 day Title hclusive Dates Title Inclusive Dates Title Inclusive Dates Page > of „_.„._-_- Please Reply To:^>*>-*:..„ AmeriSci Los Angeles f _ 24416 S. Main Street, Ste 308 /\ A ,f ITD/ ^\/~V Carson, California 90745/—\Wldr\l \J\-sl TEL. {31Q) 834^868 . FAX: (310) 834-4772 FACSIMILE TELECOPY TRANSMISSION To: Steve Reese From: Winzler & Kelly Consulting Engineers / San Di AmeriSci Job #: 408021140 Fax #: Subject: Lead (soil) 24 hour Results Client Project: 103 8207007.77010; City Of Carlsbad; Pajama Dr. ReservoirEmail: stevereese@w-and-k.com Date: Wednesday, February 13,2008 Number of Pages: Time: 08:44:20 (including cover sheet) Comments: CONFIDENTIALITY NOTICE: Unless otherwise indicated, the information contained in this communication is confidential information intended for use of the individual named above. If the reader of this communication is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is prohibited. If you have received this communication in error, please immediately notify the sender by telephone and return the original message to the above address via the US Postal Service at our expense. Preliminary data reported here will be verified before final report is issued. Samples are disposed of in 60 days or unless otherwise instructed by the protocol or special instructions in writing. Thank you. Certified Analysis Service 24 Hours A Day • 7 Days A Week Competitive Prices visit our web site - www.ameriscf.com Boston • Los Angeles • New York • Richmond AmeriSci Los Angeles 24416 S. Main Street. Ste 308 Carson, California 90745 TEL: (310) 834-4868 • FAX: (310) 834-4772 AmeriSci Job #: 408021140 Date Received: 02/12/08 Lead Analysis Results Date Aftalyzed: 02/13/08 Solid/Soil EPA Method 3050/7420 Winzler & Kelly Consulting Engineers / San Di San Diego, CA Job Site: 1038207007.77010; City Of Carlsbad; Pajama Dr. Reservoir AmeriSci # Client Sample Lead 408021140 Number Location % (mg/kg = ppm) 01 Soil-01 (Background) West Ext. From Tank 0.0013 <20 02 Soil-02 (Confirmation) Central Portion Of Site 0.0015 <20 03 Soil-03 (Confirmation) Central Portion Of Site 0.01 100 AmeriSci Reporting limit is 20 mg/kg prior to any dilutions due to high analyte concentrations or matrix interferences. AmeriSci does not correct sample results by the Reviewed by: blank value. All analytical batch data met quality control criteria unless otherwise noted. CA ELAP No. 2322. AIHA Lab No. 100530. 400 mg/kg for high-contact play areas, 1,000 mg/kg for low-contact areas. Analyzed by: Soheir Galess, Inorganics Supv ELAP No: CA2322 Page 1 of 1 Boston • Los Angeles • New York • Richmond EnviYonmental^yfpg Sampling Log WINZLER a KELLY CONSULTING ENGINEERS 3531 E. Miraloma Avenue, Anaheim, CA 92806 Client 4180Ruffin Road, Suite 115 San Diego, a 92123 ient: C/<Ty Facilityility: Tdvatvi^ l/r. Taken By: Project Number: Functional Space: Tank c(f. Date Sampled: ^/\\ JC% Caninfa • No. SOIL'* 1 |-o^ vr*5 •i ' • " Sample? - --: ..." Description =.,' C^ftcK^ftHrX j w^4£x-f. WT*«K CCpvi-f'K-i-u^) C^^wl f Lf^c^;^i : A ;:- ^AITinl^- - .Container 6'e^-h T-be/ W - ^iarrtnlf*- Area - J"uff*te 5-; 1 J ^ I aHnratorv . . Analysis . Required Rame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Flame AA for Lead Chain of Possession: CHAIN OF CUSTODY: S'i|na1ture Signature Turnaround Time: same Day /24hr) 5 day Title Title Indus v6 Dates 'Inclusive Dates Title Inclusive Dates Page SECTION 9 CONTRACTOR DOCUMENTATION CONSULTING ENGINEERS P05 O H H U O O tfo "v. __t o N CD o£ W O« c vr aN O Q- H-o « \Xi 0000SQ j s*au **^3J 5 ^5 t: .Ja tS M bf^ -2.S r ^ -4*J ' •**• -f->•*^ c« O cflSJ C3 O w - WJ .as « -a "0> « IOU •3ot/3 S« (HO * O •-€ ac n K r K I n, -> oo CO OO SAN DIEGO AIR POLLUTION-CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 PHONE (858) 586-2,660 FAX (858) 586-2651 FOR APCO USE ONLY Postmark Notification # Received Entered Fee/ Receipt Sector Inspector Assigned/Date /\ NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION 0 $ Original D Cancellation J$t{ Other (sped NOTIFICATION ^Revision D Change in asbestos amount (indicate type of revision) (greater than 20%) DniprT TVDP ^Demolition D Ordered Demolition CH Emergency Removal D Emergency Demolition FACILITY INFORMATION Facility Name: fA CT Address: £/u r^> & f. City: O&-G- *&"?\ £>£ Afofl P£l\/£ g£<<>£&\/0)(i. rt 3~A /vi A 122.1 v£ Cross fy): /9lAA/^/2 lA/'/T?v^X^V/\\ "Exchange in start/end date \\^_J) ^Bytenovatlon (rernovai) D Planned Renovation (annual) Street: (\fl£$A ftp. &^A Zip Code: ^L^SM Facility Owner: ClTY Of- C A Ai-** fc>A O Address: \"^-(yO City: C.fte-*-^f>*r. Contact: ^/4£ g. & \ Building Size (sq. ft): uilding prior/present use: C,A.@- ^ fcfl-C? \t\Li- A&£ P/Z-iV£ 1 State: £_/^ Mt> tA^/)/£./^ Title: ^^^p^.. £yt/C, , Building Age (years): ,» Number of Floors: Zip Code: ^ t-OO Phone No: 7&d> •" b& & Z - Z7S-& t Number of Units: 1 JUCommercial Q Hospital D Industrial Q Office D.K-12 School M Public Bldq D House/Condo D Ship D Unlv/College D Other PROJECT INFORMATION Asbestos Survey Is Asbestos Present? Will Performed?* . ./ ,. 13, Yes DNo f^Yes D No J3Y Friable Gate 'ipes: • Pines:Asbestos Amount to be Surfaceremoved (sq/ln ft): ;acmty C Area: £&<* 0 Surfac romportefif- Facilit)MU- JC/XTT Revised Amounts <~° '" <** v*j r*> flf a revision) Asbestos Removal Start Date: / ~ *9 - Z-OP 2 Asbestos Removal End Date: /-/<*' ^0^8 For revisions only Revised Start Date:Z " 7- Zx5P^v Revised End Date: ^-"" o " 'Z-C&o Removal Contractor: ^Jame: Casper ttnpany Address: 3825 ^roDft Drive Cit>'/5 Demolition Contractor: Address: jo5"MO Y&& Name: T"<i. C<?fiJ<3X s^d-rvW City/£ the asbestos be removed? Is ss D No 5? the building to be demolished? Yes D No gory I Category IX £ Area: . Surface Area: /• Component: Facility Comoonent: Total &*o t$ ' Demolition Operation Start Date: / '" fO - %&& & 1 Demolition Operation End Date: /-/6>" 2-OO& For revisions only Revised Start Date: Revised End Date: Z-£- 'LOO'Z 2 - /S- 7~o&<ii Phone No^Tgrng /r State/Zip: Snrim vlly ^ gi SJ.^l7&s?hone No: *«rf W •tate/Zip: 4^^|^^ 001 ICSLB License*: 478g60 j-^te Supervisor: f-.^ ^ r ^ St. C CSLB License#: t/(?2 4 ^ Site Supervisor: ^cyjy (^4T6.i? ;tos Surveys are required prior to Renovation and Demolition, however Ifie actual survey is not required (o ba submitted with the notification. 3DAPCD-SUBPARTM- Rule 361.145 Page 1 of 2 '9/04 ' I NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Waste Transporter*!: Name: 0**?**. C**^ ?<**+* Address: aftVS fe^/u^^ff j?^,* City/State/Zip- 7 r7/^ /t/c. V/l tcJ^Y Contact Person: 74 A*, bfl g.f.1 A Waste Disposal Site (Landfill): <ZA <3r<7?7 Phone b(*jrS.t£> s-^ ucx Waste Transporter#2: Name: Address: City/State/Zip: ^Contact Person: Phone: Name: '1211 HjpKt- dflrfermp Contact Person: VC1 TT_J_' iMIKE rfcrnnrk: Asbestos Detection Procedures: City/State/Zip: . „. n,7no/\9l TR'} ( XV ^ i /( is Phonfi* Check the appropriate procedures and analytical methods used to detect the presence of fX Survey @9 Inspection Q TEM |& Bulk Sampling $ PLM D Othe D PCM r: Describe work practices and engineering controls to be used. Check applicable methods below: JS Water C3 Amended Water D Roofing Cutting Saws D . High Pressure Water Blast D Infrared Machines CD Cranes (wrecking ball, clamshell, bucket) D Zambonl D Demolition w/roofing materials in place O Skid Loaders/bobcats/Top Loaders using sledge hammers. ;p Terminator™ D Axes ' D Shovels Q Irnp|osion D Demolition w/Cat I Floor tiles in place rj Explosion D IceChlppers fj Pry Bars r^ Negative Air Machines D Bulldozer rg Full Containment D Intentional Burning r£ 3 stage Decon D Backhoes _ n Glove Baan o. Bead Blast Floor Buffer 0 Other:Critical Barriers For Ordered Demolition provide a copy of the order and complete the information, below: Agency Name:.Authorizing Person:Title: Date of Order:Date Ordered to Begin:Phone: Contingency Pian Describe actions to be followed if unexpected asbestos is found during demolition or removal or asbestos material becomes disturbed, crumbled, pulverized or reduced to powder. Encapsulate will JhnBrfetely be sprayed en the suspected materials. A oart±6ed asbestos warter will suit up, PL± half fece respirator en aid bepa vactun any loose debris. B=£os will be doile begged and properly disposed of. Training Certification I certify that an Individual trained In the provisions of this regulation (CFR Part 61, SubpartM) will be on site during the removal and evidence that the required training has beea-accomplished by this person will be available for inspection during normal business hours. Signature: (Owner/Operator) Information Certification:I certify that the above information Is correct. Date: r Signature: (Owner/OperatorJ Original notifications are to be submitted to the District at least 10 working days prior to removal or demolition. Revised notices are (o ba/submitted as soon as possible but no later than the original start date. Original notifications cannot be accepted without the required fee(s) (Rule <lO(f/(2)}, however ** -evfsed notifications will be accepted wifhoul the required fee provided the fee is paid prior to the start date of the original notification. SDAPCD-SUBPART M - Rule 361.145 Page 2 of 2 State of California—Health and Human Services Agency California Department of Public Health ABATEMENT OF LEAD HAZARDS NOTIFICATION POST AT ALL ENTRANCES TO WORK AREA AND STRUCTURE Work is being conducted to abate lead-based paint or lead hazards in or on this structure. For more information, please contact the individuals or agencies listed below. Section 1 — Structure Where Abatement of Lead-Based Paint or Lead Hazards is Scheduled Address [numbertfreet, apartment (if applicable)] £//9 Of Y& ZftfrA f?*2iV£ City OCJ&M$\Q£ County f* £4 A v \fr6x? Zip Code °CloS^ Type of structure (check one box only) | I Single family dwelling | | Multi-family building Q Other fanedM M>TE£ TA^ K | | School, daycare, or other child-occupied facility Section 2 — Summary of Specific Work and Location(s) Where Lead-Based Paint or Lead Hazards Will Be Abated Description of work to be performed: Type of Abatement (check all that apply): Do any children reside on the premises? Interior f^ Exterior | | Both interior and exterior Permanent (> 20 years) [~] Temporary (< 20 years) Yes 1X1 No Don't know Section 3 ;. Projected starting date /• 7- £oo<& Projected ending date /- <$-lo<?& Section 4 — Restrictions on Entering Work Area List specific times and/or dates residents are not allowed to enter work areas, if applicable.IA*A TO yv Q If you would like more information, please contact the following: Section 5 — Property Owner or Manager Name ftv.Telephone number Address [number, street, apartment (if applicable)] A<Cityx> C A State Zip Code Section 6 — Individual Conducting Abatement (Supervisor or Company and Supervisor) Name and company (if aDDlicable)aDDl C Telephone number CDPH certification number (if applicable) Address {number, street, apartment (if applicable)]State Zip Code Section 7 — Local Environmental Health Agency Telephone number TWs form shall be mailed or faxed to: California Department of Public Health Childhood Lead Poisoning Prevention Branch Reports 850 Marina Bay Parkway, Building P, 3rd Floor Richmond, CA 94804-6403 Fax: (510)680-5656 DPH 8551 (6/07) , EOF CALIFORNIA /ISION OF SAFETY AND HEALTH ,375 METROPOLITAN DRIVE SUITE 207 SAN DIEGO, CA. 92108 FAXED ON: FAXED TO:619-767-2299 619-767-2058 TEMPORARY JOBSITE NOTIFICATION ASBESTOS-RELATED WORK COMPANY NAME: CASPER'S CONCRETE CUTTING, INC. CONTRACTOR'S STATE LICENSE BOARD CERTIFICATION NUMBER: 478960 DOSH ASBESTOS REGISTRATION NUMBER: 730 NAME OF EMPLOYER: CASPER'S CONCRETE COMPANY, INC. CONTACT PERSON: Greg Casper ADDRESS: 3825 Bancroft Drive, Spring Valley, Ca. 91977 ADDRESS OF TEMPORARY JOBSITE: Pajama Drive Reservoir End of Pajama Drive Oceanside Ca JOB LOCATION: NAME OF CERTIFIED SUPERVISOR: Dennis Gray NAME OF QUALIFIED PERSON IN CHARGE OF LABORATORY WORK AND AIR MONITORING: PERSON IN CHARGE OF RESPIRATORS: Dennis Gray JOB START DATE: 7-Jan-08 JOB COMPLETION DATE: 9-Jan-08 DESCRIBE SCOPE OF JOB AND WORK PRACTICES OF JOB: Wet Removal of asbestos, full containment, suits, respirators, gloves and boots will be used. POTENTIAL FOR EXPOSURE: MINIMAL TO NONE ESTIMATED NUMBER OF EMPLOYEES ON THIS JOB: J.M.R. 2+7 DATE OF NOTIFICATION:mititiiiiiii PROJECT NUMBER: 0 Page 1 ritutt-snarp ROBS Staaly 6446632 r-262 P 008/013 P 317 ^A^u. C^V^CASW -u^J;:L/-008/01LJ:;-3IJ.._ (619) 585-4050 ($19J 644-6500 (856)321-2350 MEDICAL ASBESTOS SURVEILLANCE EXAMINATION REPORT EMPLOYER COPY _ _ EMPLOYEE COPY X UktT) ll l^mO^dM— t' _EMPLOYEE NAME UktT) EMPLOYEE ADDRESS gf*f. £• S^v fako B'U. Qpt- ff fLX cL feoU EMPLOYER \msaxs U> - EMPLOYER ADDRESS 38^- &m<>t>Fr- P/&- ^prf/y. .\AilftV- Ox. ^1^1- A licensed physiciaja has examined the above named Individual with the following results: The results of this examination have not detected any medical condition which would place this individual at an increased risk of material health impairment from exposure to asbestos. The results of this examination have detected a medical condition which would place this individual at an increased risk of material health impairment from exposure to asbestos. Employee has no restrictions on use of respirators. [ ] Facial hair may impair good fit of mask to face. _ __ Employee has restrictions on use of respirators. Comments to Employer _ _ _ __________„ _ _ Comments to Employee [ ] Normal Exarn [ J Other The individual named above has been informed of the results of their medical examination and of any medical condition resulting from asbestos. They have also been informed of the increased risk of lung cancer attributable to the combined effects of smoking and asbestos exposure. This report" is based on infonnatiojxpro^jded to us by the employee and employer. '" ~ Physician Signature \- \ Date Name: |C O N C R TFYTi C U T T f'NF G, D It MO L f T I O NT & E NJ V 1 R ON M F. N T A Ij RESPIRATOR TRAINING ACKNOWLEDGMENT Date: (?~7/0 / Social Security Number: Size: Respirator: Mode; A/ fl /g-Trf • Respirator Fit __Oj£_Chin Properly Placed g> |r Fit Across Bridge of nose # K Strap Tension X fJp Tendency to Slip Distance from Chin to nose O i< Negative / Positive Fit-Test Assessment of Comfort OK Position of Mask 0K Room for Eye Protection Room to Speak 0 v\ Position of mask on face and cheeks Test Exercises OK Turn head side to side Breathe Normally jSreathe Deeply Lift Head up and down Jogging in place 0 K Recite the Rainbow Passage Breathe Normal Pass Fail This document certifies that (Jvaf\ \~fof(\QA<ks2- has been made a ware of the Hazards involved in working in an Asbestos Environment and has received training and Understands the care and of the above Fit-Test Respirator(s). Employee Signature; X?U^7 I r~/et^T2^(." / /_ . Competent Person: /fast 6^ Date; O7-Q/-®~7 _Date: O~7-Q/-O "7 3825 BANCROl-T DRIVE SUITE 105 SPRING VAJ.UiY, CA. 91977 (619) 589-6UOI I-AX 589-7158 LICENCE # 478960 DOSI-I # 730 Asbestos Training Program 1 X ."~s / I I ^ This is to certify - " 1 / Miguel Suardz 7967 - Has successfully completed 32 hours of formal training required by section 206 of TSCAII entitled AHERA Asbestos Worker Presented By Environmental Compliance Training PO BOX 16555 San Diego, CA. 92176-6555 (858) 558-7465 Director: Walter T. Amenta,"Approval #CA-029-01 /, iClass Dates: 8-1-4-2007 Exam Date: 8-4-2007 Expirati9n Date: 8-4-2008 Certification Number: 0807ABCA26910 CTJABT) Rees-Stealy OOfltYL Medical CeCenters D 2001 Fourth Ave. IH 8901 Activity Rd. D 4510 Viewridge Ave. San Diego, CA 92101 San Diego, CA 92126 San Diego, CA 92123 (619)446-1524 (858)653-6150 (858)492-3950 D 525 Third Ave. D 5525 Grossmont Ctr. Dr. D 16950 Via Tazon Chula Vista, CA 91910 La Mesa, CA 919142 San Diego, CA 92127 (619)585-4050 (619)644-6600 (858)521-2350 MEDICAL ASBESTOS SURVEILLANCE EXAMINATION REPORT EMPLOYER COPY EMPLOYEE COPY EMPLOYEE NAME /J( raue \ EMPLOYEE ADDRESS gc^/| ^ cDU^ St fc -O ffi ^ <,Q^ (MA IK> \ ^ U M EMPLOYER / EMPLOYER ADDRESS ^32£~ U/>gvm<54- <I> ^ue. -ti ?o^ C^/i^u^Me^fA. WQ 7? A licensed physician has examined the above named individual with the following results: The results of this examination have not detected any medical condition which would place this individual at an increased risk of material health impairment from exposure to asbestos. The results of this examination have detected a medical condition which would place this individual at an increased risk of material health impairment from exposure to asbestos. Employee has no restrictions on use of respirators. [ ] Facial hair may impair good fit of mask to face. Employee has restrictions on use of respirators. Comments to Employer_ Comments to Employee [ ] Normal Exam Other The individual named above has been informed of the results of their medical examination and of any medical condition resulting from asbestos. They have also been informed of the increased risk of lung cancer attributable to the combined effects of smoking and asbestos exposure. This report is based on information provided to us by the employee and employer. _ _ _ Physician Signature Date Name: ' JC O N C R ETfe C U T T 1 N G, D E-: M O L f T 1 O N & E N V 1 R D'N M F. N T ,-\ L| RESPIRATOR TRAINING ACKNOWLEDGMENT Date: \0 Social Security Number: Size: Respirator: Mode: Respirator Fit ' Chin Properly Placed ^^ Fit Across Bridge of nose Strap Tension Tendency to Slip _Distance from Chin to nose Negative / Positive Fit-Test Assessment of Comfort _Position of Mask _JRoom for Eye Protection r ^_Room to Speak Position of mask on face and cheeks Test Exercises Turn head side to side Breathe Normally s Breathe Deeply ^_Lift Head up and down y / Jogging in place l// Recite the Rainbow Passage I/ Breathe Nor Pass Fail This document certifies that &v&-has been made aware of the Hazards involved in working in fhi Asbestos Environment and has received training and Understands the care and of the above Fit-Test Respirator(s), Employee Signature: Competent Person: Date: rt Date: \0" 5 B.'\NCHOI-T URIVH SUITE 105 SI'RJK'C VAl.l.l^', CA. 91977 (619) 589-6OU1 );AK 589-7158 LICliNCE # 47896U DOSM # 730 MAR-05-07 10:48 FROlBharp R99S Stealy 6446632 20D1F(SJrihAVfl. Rees-Stealy •* *- ~i • t x"s •* D 8901Ac5uHyRd.4510 vfe*ridae A»e. SaiOk!go.CA9Zi23 (85S| <92-3950 D . Dr. D Chulavfeta,CA 31910. (619)585-4050 UMesa.CA9l9l42 (Sl9) 544-S60Q (356)521-2550 MEDICAL ASBESTOS SURVEILLANCE EXAMINATION REPORT EMPLOYER COPY. EMPLOYEE NAME EMPLOYEE COPY EMPLOYEE ADDRESS EMPLOYER 3 CJ f~ ^ o EMPLOYER ADDRESS 05 P ./" A licensed physician has examined the above named individual with the following results: /C The results of this examination have not detected any medical condition which would place this individual at an increased risk of material health impairment from exposure to asbestos. The results of this examination have detected a medical condition which would place this individual at an increased risk of material health impairment from exposure to asbestos. Employee has no restrictions on use of respirators. [ ] Facial hair may impair good fit of mask to face. Employee has restrictions on use of respirators. Comments to Employer Comments to Employee [ ] Normal Exam _ _ [ ] Other The individual named above has been informed of the results of their medical examination and of any medical condition resulting from asbestos. They have also been informed of the increased risk of lung cancer attributable to the combined effects of smoking and asbestos exposure. This rrepon is based on inforalStio provided to us by the employee and employer. HAR - 2 2007 ' Physician Signafe Date <D §O 0) <L> .^ CS .•§ « * 6 CO<DO CO COcj W) I ' 'I '43 O u |C O N C R EOTL C U 'fTTTTc, D l.t M O L f I' 1 O N: & E N' V 1 R O'N Nf E N TA RESPIRATOR TRAINING ACKNOWLEDGMENT Date: Social Security Number: Size:Mode Respirator: :J^ Respirator Fit Chin Properly Placed J/__Fit Across Bridge of nose Strap Tension Tendency to Slip Distance from Chin to nose \X Negative / Positive Fit-Test Assessment of Comfort ^Position of Mask, V/ / Room for Eye Protection/ \/Room to Speak v/ Fosition of mask on face and cheeks Test Exercises Turn head side to side Breathe Normally ^/Breathe Deeply \j I Lift Head up and down ogging in place Recite the Rainbow Passage Breathe Nor rat Pass Fail This document certifies that _ has been made aware of the Hazards involved in working in an Asbestos Environment and has received training and Understands the care and of the above Fit-Test Respirator(s). Employee Signature: Competent Person: 38Z5 BANGKOK!" DRIVli SUITE 105 SPRING VAJJJiY, CA. 91977 (619) 589-6(X)l I-'AX 589-7158 LICKNCLC # 478960 POSH ft 731) ease punt or type. (Form designed for useon elite (12-piteh) typewriter.)Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number 2, Page 1 of 1 3- Emergency Response Phone 4, Manifest Tracking NumberOOU19766GBF $ Generator's Name and Mailing AddressCity of Qirliba.l1209 Cdr1sh.il Villas >rtv»- Generator's Site Address (if different than mailing address) P-»jd.:u "rivw c< 'ies-i 'JrLvc- Generator's Phone' 6 Transporter 1 Company Name Caspar Oonp/K ty U.S. EPA ID Number 7. Transporter 2 Company Name MA U.S. £PA ID Number 8 Designated Facility Name and Site AddressAr'ixj !.'in<"< *(***!,•«; *tHn 1211 test *;l ^istX'-w 17 "i : U.S, EPA ID Number Fatality's. Phone, 9b. U S. DOT Description (including Proper SNppmg Name, Hazard Class, ID Number, and Packing Group (if any)) 10. Containers' No,Type 11 Total Quantity ^ Unit 13 Waste Codes ni 14. Special Handling Instructions and Additional Information > " ffii.i' ' _>„,} Hi\ .'M-.-i i.t : )ji 15. G€NERATOR'S/OFFEROR'SCERT1FICATIOK( I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are dsSSed' packaged, marked ami iabeted/placarded, and are in a|l respects in proper condition for transport accoaflng to applicable international and national governmental regulations, if export shipment and I am the Primary Exporter, i certify (Hat Bw contents of this consignment conform to trie^ terms of Ite attached EPA Acknowledgment of Consent. I certify 8iat the waste minimization statement identified m 40 CFR 262^7(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is Irue Generator's/Olferor's Printed/Type!) Name Signature Month Day I" hi Year 16. International Shipments f ILJ Import to U,S. Transporter signature {for exports only): I—lExpoiirtfromlLS,Portofenlry/exit: Daie leaving U.S.: K.17. Transporter Acknowledgment of Receipt of Materials T/aasnort«r 1 PrintBdfiyf«d Mams F<j Month Day Year Transpyifci 2 Printed/Tyiwii Nani«Signature Montn Day Year I II 18. Discrepancy 18a. Discrepancy Indication Space I I Uuantity DType LJ KesMue LJ Partial Rejection LJ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) FacHly's Phone: US. EPAID Number 18c. Signature of Allemate Facility (or Generator)Month Day Year 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 20 Designated Facility Owner or Operator Certfcation of receipt of hazardous materia Is covered by the manifest except as noted in Item 1 $a Pnnied/Tyned Namee ame , /CJi-C'U L Sigiwture f Month I f. -. EPA Forn 8700 22 (Rev 3-05) Previous editions ore obsolete. OESiCMWID FACIUTWO I'M Please print or type. (Form designed for use on elite (12-pitch) typewriter.) UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number CAC002626375 2. Page 1 of 5. Generator's Name and Mailing AddressCity of Carlsbad 1200 Carlsbad Village Drive Carlsbad Ca 92008 Generator's Phone: 3. Emergency Response Phone 619-520-9600 Form Approved. OMB No. 20! 4. Manifest Tracking Number000119766GI Generator's Site Address (if different than mailing address) Pa jama Drive & Mesa Drive Oceanside Ca 92054 760-602-2756 6. Transporter 1 Company Name Casper Company 619-589-6001 7. Transporter 2 Company Name N/A U.S.. EPA ID Number I CAROQQ174QS7 U.S. EPA ID Number 8. Designated Facility Name and Site Address Azusa Land Reclamation 1211 West Gladstone Azusa Ca 91702Facility s Phone: U.S. EPA ID Number 626-334-0719 HM CAD009007626 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, and Packing Group (if any}) Asbestos,9,NA2212, PGIII 10. Containers No. 14. Special Handling Instructions and Additional Information febestos Containing: Type BA 11. Total Quantity 12. Unit Wt./Vol.13. Waste Codes 151 75 Hawthorne Street San Fransisco Ca 94105 Transporter: WD# Casper Company 3825 Bancroft Drive 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by thepftpefallppliig n5m, irntt^re c marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generator's/Offerer's Printed/Typed Name Signature Month Day IZ 111 16. International Shipments I II I Import to U.S. Transporter signature (for exports only): DExport from U.S.Port of entry/exit: Date leaving U.S.: 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Transporter 2 Printed/Typed Name Signature Month Day ^ I II 18. Discrepancy 18a. Discrepancy Indication Space Quanfity nType I I Residue I I Partial Rejection Manifest Reference Number: nFull Rejection LLJ 18b. Alternate Facility (or Generator) :acility's Phone: U.S. EPA ID Number I 18c. Signature of Alternate Facility (or Generator)Month Day 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 2.3. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Tinted/Typed Name Signature Month Day V EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DeSTlNATsow STATP f\e 29266 NON-HAZARDOUS WASTE MANIFEST GENERATOR Generator Name: City of Carlsbad Mailing 1200 Carlsbad Village Drivp Site Address: Address: Carlsbad Ca 92008 TC Construction Pa lama Drive & Mesa Drive Oceanside Ca 9205X4 Description of Waste Materials Roof mastic, window puttyi "ffc^s'.l-e P'^e. Approval Number 530-08- Total Quantity 15" Unit of Measure £wY0 Container Type 3frC»fi<?J[JJ I hereby certify that the above-described materials are not hazardous wastes as defined by 40 CFR Part 261 or any applicable State law, have been fully and accurately described,-classified and packaged, and are in proper condition for transportation according to applicable regulations. Generator Name (Print):HOlO Signature: : .Date: (TV/ Dp TRANSPORTER Transporter Name: Casper Company Address:3825 Bancroft Drive Spring Valley Ca 91Q77 I hereby acknowledge receipt of the above-described materials for transport from the generator site listed above. Driver Name (Print): Driver Signature: Date: BILLING CUSTOMER Customer Name: Casper Account Number: Company Ticket Number: LANDFILL Site Name: Sycamore Address: 8514 Mast Blvd Phone: 619-562-9325 Fax: 619-596-7850 Santee Ca 92071 Certification of receipt of non-hazardous materials covered by this manifest. Name of Authorized Agent (Print)Signature Receipt Date WHITE: LANDFILL CANARY: GENERATOR PINK: TRANSPORTER GOLDENROD: MISCELLANEOUS • An Equal Opportunity Employer M/F/D/V • i i- i i-i K -i i -r 0) $ OO ^ to ttj a** uo oo 3 £ oO c (AC. OO O o CM ^t inCO a o ol o Q)D c CO ro 00 CD i— CN O "rtQ ttfl 02 O CMO) 0 c CO 0)o O Q CO CO 'coD_ enXTin CO O t4oipa a)u 0) CO i oH-t IT* G ^ OKQ O H 2 Pi ^ fcWO ^2 o a O ft ffi ODi .< K HO l i i i ' i i i i i i i ' 11 i i i t i 'i ..i i "i